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In de Braekt T, Aben JP, Maussen M, van den Bosch HCM, Houthuizen P, Roest AAW, van den Boogaard PJ, Lamb HJ, Westenberg JJM. Fully Automated Valve Segmentation for Blood Flow Assessment From 4D Flow MRI Including Automated Cardiac Valve Tracking and Transvalvular Velocity Mapping. J Magn Reson Imaging 2024. [PMID: 38558490 DOI: 10.1002/jmri.29370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Automated 4D flow MRI valvular flow quantification without time-consuming manual segmentation might improve workflow. PURPOSE Compare automated valve segmentation (AS) to manual (MS), and manually corrected automated segmentation (AMS), in corrected atrioventricular septum defect (c-AVSD) patients and healthy volunteers, for assessing net forward volume (NFV) and regurgitation fraction (RF). STUDY TYPE Retrospective. POPULATION 27 c-AVSD patients (median, 23 years; interquartile range, 16-31 years) and 24 healthy volunteers (25 years; 12.5-36.5 years). FIELD STRENGTH/SEQUENCE Whole-heart 4D flow MRI and cine steady-state free precession at 3T. ASSESSMENT After automatic valve tracking, valve annuli were segmented on time-resolved reformatted trans-valvular velocity images by AS, MS, and AMS. NFV was calculated for all valves, and RF for right and left atrioventricular valves (RAVV and LAVV). NFV variation (standard deviation divided by mean NFV) and NFV differences (NFV difference of a valve vs. mean NFV of other valves) expressed internal NFV consistency. STATISTICAL TESTS Comparisons between methods were assessed by Wilcoxon signed-rank tests, and intra/interobserver variability by intraclass correlation coefficients (ICCs). P < 0.05 was considered statistically significant, with multiple testing correction. RESULTS AMS mean analysis time was significantly shorter compared with MS (5.3 ± 1.6 minutes vs. 9.1 ± 2.5 minutes). MS NFV variation (6.0%) was significantly smaller compared with AMS (6.3%), and AS (8.2%). Median NFV difference of RAVV, LAVV, PV, and AoV between segmentation methods ranged from -0.7-1.0 mL, -0.5-2.8 mL, -1.1-3.6 mL, and - 3.1--2.1 mL, respectively. Median RAVV and LAVV RF, between 7.1%-7.5% and 3.8%-4.3%, respectively, were not significantly different between methods. Intraobserver/interobserver agreement for AMS and MS was strong-to-excellent for NFV and RF (ICC ≥0.88). DATA CONCLUSION MS demonstrates strongest internal consistency, followed closely by AMS, and AS. Automated segmentation, with or without manual correction, can be considered for 4D flow MRI valvular flow quantification. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Thomas In de Braekt
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Marc Maussen
- Pie Medical Imaging BV, Maastricht, the Netherlands
| | | | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Ramaekers MJFG, van der Vlugt IB, Westenberg JJM, Perinajová R, Lamb HJ, Wildberger JE, Kenjereš S, Schalla S. Flow patterns in ascending aortic aneurysms: Determining the role of hypertension using phase contrast magnetic resonance and computational fluid dynamics. Comput Biol Med 2024; 172:108310. [PMID: 38508054 DOI: 10.1016/j.compbiomed.2024.108310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Thoracic aortic aneurysm (TAA) is a local dilation of the thoracic aorta. Although universally used, aneurysm diameter alone is a poor predictor of major complications such as rupture. There is a need for better biomarkers for risk assessment that also reflect the aberrant flow patterns found in TAAs. Furthermore, hypertension is often present in TAA patients and may play a role in progression of aneurysm. The exact relation between TAAs and hypertension is poorly understood. This study aims to create a numerical model of hypertension in the aorta by using computational fluid dynamics. First, a normotensive state was simulated in which flow and resistance were kept unaltered. Second, a hypertensive state was modeled in which blood inflow was increased by 30%. Third, a hypertensive state was modeled in which the proximal and peripheral resistances and capacitance parameters from the three-element Windkessel boundary condition were adjusted to mimic an increase in resistance of the rest of the cardiovascular system. One patient with degenerative TAA and one healthy control were successfully simulated at hypertensive states and were extensively analyzed. Furthermore, three additional TAA patients and controls were simulated to validate our method. Hemodynamic variables such as wall shear stress, oscillatory shear index, endothelial cell activation potential (ECAP), vorticity and helicity were studied to gain more insight on the effects of hypertension on flow patterns in TAAs. By comparing a TAA patient and a control at normotensive state at peak-systole, helicity and vorticity were found to be lower in the TAA patient throughout the entire domain. No major changes in flow and flow derived quantities were observed for the TAA patient and control when resistance was increased. When flow rate was increased, regions with high ECAP values were found to reduce in TAA patients in the aneurysm region which could reduce the risk of thrombogenesis. Thus, it may be important to assess cardiac output in patients with TAA.
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Affiliation(s)
- M J F G Ramaekers
- Departments of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - I B van der Vlugt
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - J J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Perinajová
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands; J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands
| | - H J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - S Kenjereš
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands; J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands.
| | - S Schalla
- Departments of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Ramaekers MJFG, Westenberg JJM, Venner MFGHM, Juffermans JF, van Assen HC, Te Kiefte BJC, Adriaans BP, Lamb HJ, Wildberger JE, Schalla S. Evaluating a Phase-Specific Approach to Aortic Flow: A 4D Flow MRI Study. J Magn Reson Imaging 2024; 59:1056-1067. [PMID: 37309838 DOI: 10.1002/jmri.28852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Aortic flow parameters can be quantified using 4D flow MRI. However, data are sparse on how different methods of analysis influence these parameters and how these parameters evolve during systole. PURPOSE To assess multiphase segmentations and multiphase quantification of flow-related parameters in aortic 4D flow MRI. STUDY TYPE Prospective. POPULATION 40 healthy volunteers (50% male, 28.9 ± 5.0 years) and 10 patients with thoracic aortic aneurysm (80% male, 54 ± 8 years). FIELD STRENGTH/SEQUENCE 4D flow MRI with a velocity encoded turbo field echo sequence at 3 T. ASSESSMENT Phase-specific segmentations were obtained for the aortic root and the ascending aorta. The whole aorta was segmented in peak systole. In all aortic segments, time to peak (TTP; for flow velocity, vorticity, helicity, kinetic energy, and viscous energy loss) and peak and time-averaged values (for velocity and vorticity) were calculated. STATISTICAL TESTS Static vs. phase-specific models were assessed using Bland-Altman plots. Other analyses were performed using phase-specific segmentations for aortic root and ascending aorta. TTP for all parameters was compared to TTP of flow rate using paired t-tests. Time-averaged and peak values were assessed using Pearson correlation coefficient. P < 0.05 was considered statistically significant. RESULTS In the combined group, velocity in static vs. phase-specific segmentations differed by 0.8 cm/sec for the aortic root, and 0.1 cm/sec (P = 0.214) for the ascending aorta. Vorticity differed by 167 sec-1 mL-1 (P = 0.468) for the aortic root, and by 59 sec-1 mL-1 (P = 0.481) for the ascending aorta. Vorticity, helicity, and energy loss in the ascending aorta, aortic arch, and descending aorta peaked significantly later than flow rate. Time-averaged velocity and vorticity values correlated significantly in all segments. DATA CONCLUSION Static 4D flow MRI segmentation yields comparable results as multiphase segmentation for flow-related parameters, eliminating the need for time-consuming multiple segmentations. However, multiphase quantification is necessary for assessing peak values of aortic flow-related parameters. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Mitch J F G Ramaekers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Max F G H M Venner
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Simon Schalla
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Van den Eynde J, Westenberg JJM, Hazekamp MG, Lamb HJ, Jongbloed MRM, Wentzel JJ, Kenjeres S, Dekkers IA, Van De Bruaene A, Rijnberg FM, Roest AAW. Noninvasive Advanced Cardiovascular Magnetic Resonance-Derived Fontan Hemodynamics Are Associated With Reduced Kidney Function But Not Albuminuria. J Am Heart Assoc 2024; 13:e033122. [PMID: 38293946 PMCID: PMC11056124 DOI: 10.1161/jaha.123.033122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/01/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Kidney disease is the most important predictor of death in patients with a Fontan circulation, yet its clinical and hemodynamic correlates have not been well established. METHODS AND RESULTS A total of 53 ambulatory patients with a Fontan circulation (median age, 16.2 years, 52.8% male patients) underwent advanced cardiovascular magnetic resonance assessment, including 4-dimensional flow imaging and computational fluid dynamics. Estimated glomerular filtration rate (eGFR) <90 mL/min per 1.73 m2 was observed in 20.8% and albumin-to-creatinine ratio >3 mg/mmol in 39.6%. The average eGFR decline rate was -1.83 mL/min per 1.73 m2 per year (95% CI, -2.67 to -0.99; P<0.001). Lower eGFR was associated with older age, larger body surface area at examination, longer time since Fontan procedure, and lower systemic ventricular ejection fraction. Higher albumin-to-creatinine ratio was associated with absence of fenestration at the Fontan operation, and older age and lower systemic ventricular ejection fraction at the assessment. Lower cross-sectional area of the Fontan conduit indexed to flow (r=0.32, P=0.038), higher inferior vena cava-conduit velocity mismatch factor (r=-0.35, P=0.022), higher kinetic energy indexed to flow in the total cavopulmonary connection (r=-0.59, P=0.005), and higher total cavopulmonary connection resistance (r=-0.42, P=0.005 at rest; r=-0.43, P=0.004 during exercise) were all associated with lower eGFR but not with albuminuria. CONCLUSIONS Kidney dysfunction and albuminuria are common among clinically well adolescents and young adults with a Fontan circulation. Advanced cardiovascular magnetic resonance-derived metrics indicative of declining Fontan hemodynamics are associated with eGFR and might serve as targets to improve kidney health. Albuminuria might be driven by other factors that need further investigation.
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Affiliation(s)
- Jef Van den Eynde
- Department of Pediatrics, Division of Pediatric CardiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Cardiothoracic SurgeryLeiden University Medical CenterLeidenThe Netherlands
- Congenital and Structural CardiologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of Cardiovascular SciencesCatholic University LeuvenLeuvenBelgium
| | - Jos J. M. Westenberg
- CardioVascular Imaging Group, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Mark G. Hazekamp
- Department of Cardiothoracic SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Hildo J. Lamb
- CardioVascular Imaging Group, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Monique R. M. Jongbloed
- Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Anatomy & EmbryologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jolanda J. Wentzel
- Department of CardiologyBiomechanical Engineering, Erasmus MCRotterdamThe Netherlands
| | - Sasa Kenjeres
- Department of Chemical Engineering, Faculty of Applied SciencesDelft University of TechnologyDelftThe Netherlands
- J.M. Burgers Centrum Research School for Fluid MechanicsDelftThe Netherlands
| | - Ilona A. Dekkers
- CardioVascular Imaging Group, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Alexander Van De Bruaene
- Congenital and Structural CardiologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of Cardiovascular SciencesCatholic University LeuvenLeuvenBelgium
| | - Friso M. Rijnberg
- Department of Cardiothoracic SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Arno A. W. Roest
- Department of Pediatrics, Division of Pediatric CardiologyLeiden University Medical CenterLeidenThe Netherlands
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Wu X, Saaid H, Voorneveld J, Claessens T, Westenberg JJM, de Jong N, Bosch JG, Kenjereš S. 4D Flow Patterns and Relative Pressure Distribution in a Left Ventricle Model by Shake-the-Box and Proper Orthogonal Decomposition Analysis. Cardiovasc Eng Technol 2023; 14:743-754. [PMID: 37783950 PMCID: PMC10739257 DOI: 10.1007/s13239-023-00684-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/05/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Intraventricular blood flow dynamics are associated with cardiac function. Accurate, noninvasive, and easy assessments of hemodynamic quantities (such as velocity, vortex, and pressure) could be an important addition to the clinical diagnosis and treatment of heart diseases. However, the complex time-varying flow brings many challenges to the existing noninvasive image-based hemodynamic assessments. The development of reliable techniques and analysis tools is essential for the application of hemodynamic biomarkers in clinical practice. METHODS In this study, a time-resolved particle tracking method, Shake-the-Box, was applied to reconstruct the flow in a realistic left ventricle (LV) silicone model with biological valves. Based on the obtained velocity, 4D pressure field was calculated using a Poisson equation-based pressure solver. Furthermore, flow analysis by proper orthogonal decomposition (POD) of the 4D velocity field has been performed. RESULTS As a result of the Shake-the-Box algorithm, we have extracted: (i) particle positions, (ii) particle tracks, and finally, (iii) 4D velocity fields. From the latter, the temporal evolution of the 3D pressure field during the full cardiac cycle was obtained. The obtained maximal pressure difference extracted along the base-to-apex was about 2.7 mmHg, which is in good agreement with those reported in vivo. The POD analysis results showed a clear picture of different scale of vortices in the pulsatile LV flow, together with their time-varying information and corresponding kinetic energy content. To reconstruct 95% of the kinetic energy of the LV flow, only the first six POD modes would be required, leading to significant data reduction. CONCLUSIONS This work demonstrated Shake-the-Box is a promising technique to accurately reconstruct the left ventricle flow field in vitro. The good spatial and temporal resolutions of the velocity measurements enabled a 4D reconstruction of the pressure field in the left ventricle. The application of POD analysis showed its potential in reducing the complexity of the high-resolution left ventricle flow measurements. For future work, image analysis, multi-modality flow assessments, and the development of new flow-derived biomarkers can benefit from fast and data-reducing POD analysis.
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Affiliation(s)
- Xiaolin Wu
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands.
- J. M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands.
| | - Hicham Saaid
- Institute Biomedical Technology, Ghent University, Ghent, Belgium
| | - Jason Voorneveld
- Department of Biomedical Engineering, Thorax Center, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Tom Claessens
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
| | - Jos J M Westenberg
- CardioVascular Imaging Group, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico de Jong
- Department of Biomedical Engineering, Thorax Center, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Johan G Bosch
- Department of Biomedical Engineering, Thorax Center, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Saša Kenjereš
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
- J. M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands
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Zhao X, Tan RS, Garg P, Chai P, Leng S, Bryant JA, Teo LLS, Yeo TJ, Fortier MV, Low TT, Ong CC, Zhang S, Van der Geest RJ, Allen JC, Tan TH, Yip JW, Tan JL, Hughes M, Plein S, Westenberg JJM, Zhong L. Age- and sex-specific reference values of biventricular flow components and kinetic energy by 4D flow cardiovascular magnetic resonance in healthy subjects. J Cardiovasc Magn Reson 2023; 25:50. [PMID: 37718441 PMCID: PMC10506211 DOI: 10.1186/s12968-023-00960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Advances in four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) have allowed quantification of left ventricular (LV) and right ventricular (RV) blood flow. We aimed to (1) investigate age and sex differences of 4D flow CMR-derived LV and RV relative flow components and kinetic energy (KE) parameters indexed to end-diastolic volume (KEiEDV) in healthy subjects; and (2) assess the effects of age and sex on these parameters. METHODS We performed 4D flow analysis in 163 healthy participants (42% female; mean age 43 ± 13 years) of a prospective registry study (NCT03217240) who were free of cardiovascular diseases. Relative flow components (direct flow, retained inflow, delayed ejection flow, residual volume) and multiple phasic KEiEDV (global, peak systolic, average systolic, average diastolic, peak E-wave, peak A-wave) for both LV and RV were analysed. RESULTS Compared with men, women had lower median LV and RV residual volume, and LV peak and average systolic KEiEDV, and higher median values of RV direct flow, RV global KEiEDV, RV average diastolic KEiEDV, and RV peak E-wave KEiEDV. ANOVA analysis found there were no differences in flow components, peak and average systolic, average diastolic and global KEiEDV for both LV and RV across age groups. Peak A-wave KEiEDV increased significantly (r = 0.458 for LV and 0.341 for RV), whereas peak E-wave KEiEDV (r = - 0.355 for LV and - 0.318 for RV), and KEiEDV E/A ratio (r = - 0.475 for LV and - 0.504 for RV) decreased significantly, with age. CONCLUSION These data using state-of-the-art 4D flow CMR show that biventricular flow components and kinetic energy parameters vary significantly by age and sex. Age and sex trends should be considered in the interpretation of quantitative measures of biventricular flow. Clinical trial registration https://www. CLINICALTRIALS gov . Unique identifier: NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Pankaj Garg
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Ping Chai
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tee Joo Yeo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Ting Ting Low
- National University Hospital Singapore, Singapore, Singapore
| | - Ching Ching Ong
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuo Zhang
- Philips Healthcare Germany, Hamburg, Germany
| | - Rob J Van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - James W Yip
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Marina Hughes
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Nabeta T, Meucci MC, Westenberg JJM, Reiber JH, Knuuti J, van der Bijl P, Marsan NA, Bax JJ. Prognostic implications of left ventricular inward displacement assessed by cardiac magnetic resonance imaging in patients with myocardial infarction. Int J Cardiovasc Imaging 2023; 39:1525-1533. [PMID: 37249652 PMCID: PMC10427538 DOI: 10.1007/s10554-023-02861-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/23/2023] [Indexed: 05/31/2023]
Abstract
Risk stratification of patients with ischemic heart disease (IHD) still depends mainly on the left ventricular ejection fraction (LVEF). LV inward displacement (InD) is a novel parameter of LV systolic function, derived from feature tracking cardiac magnetic resonance (CMR) imaging. We aimed to investigate the prognostic impact of InD in patients with IHD and prior myocardial infarction. A total of 111 patients (mean age 57 ± 10, 86% male) with a history of myocardial infarction who underwent CMR were included. LV InD was quantified by measuring the displacement of endocardially tracked points towards the centreline of the LV during systole with feature tracking CMR. The endpoint was a composite of all-cause mortality, heart failure hospitalization and arrhythmic events. During a median follow-up of 142 (IQR 107-159) months, 31 (27.9%) combined events occurred. Kaplan-Meier analysis demonstrated that patients with LV InD below the study population median value (23.0%) had a significantly lower event-free survival (P < 0.001). LV InD remained independently associated with outcomes (HR 0.90, 95% CI 0.84-0.98, P = 0.010) on multivariate Cox regression analysis. InD also provided incremental prognostic value to LVEF, LV global radial strain and CMR scar burden. LV InD, measured with feature tracking CMR, was independently associated with outcomes in patients with IHD and prior myocardial infarction. LV InD also provided incremental prognostic value, in addition to LVEF and LV global radial strain. LV InD holds promise as a pragmatic imaging biomarker for post-infarct risk stratification.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands.
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Johan Hc Reiber
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Medis Medical Imaging Systems, Schuttersveld 9, Leiden, 2316 XG, The Netherlands
| | - Juhani Knuuti
- Heart Centre, University of Turku, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Heart Centre, University of Turku, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
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Warmerdam EG, Westenberg JJM, Voskuil M, Rijnberg FM, Roest AAW, Lamb HJ, van Wijk B, Sieswerda GT, Doevendans PA, Ter Heide H, Krings GJ, Leiner T, Grotenhuis HB. Comparison of Four-Dimensional Flow MRI, Two-Dimensional Phase-Contrast MRI and Echocardiography in Transposition of the Great Arteries. Pediatr Cardiol 2023:10.1007/s00246-023-03238-2. [PMID: 37488239 DOI: 10.1007/s00246-023-03238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023]
Abstract
Pulmonary artery (PA) stenosis is a common complication after the arterial switch operation (ASO) for transposition of the great arteries (TGA). Four-dimensional flow (4D flow) CMR provides the ability to quantify flow within an entire volume instead of a single plane. The aim of this study was to compare PA maximum velocities and stroke volumes between 4D flow CMR, two-dimensional phase-contrast (2D PCMR) and echocardiography. A prospective study including TGA patients after ASO was performed between December 2018 and October 2020. All patients underwent echocardiography and CMR, including 2D PCMR and 4D flow CMR. Maximum velocities and stroke volumes were measured in the main, right, and left PA (MPA, LPA, and RPA, respectively). A total of 39 patients aged 20 ± 8 years were included. Maximum velocities in the MPA, LPA, and RPA measured by 4D flow CMR were significantly higher compared to 2D PCMR (p < 0.001 for all). PA assessment by echocardiography was not possible in the majority of patients. 4D flow CMR maximum velocity measurements were consistently higher than those by 2D PCMR with a mean difference of 65 cm/s for the MPA, and 77 cm/s for both the RPA and LPA. Stroke volumes showed good agreement between 4D flow CMR and 2D PCMR. Maximum velocities in the PAs after ASO for TGA are consistently lower by 2D PCMR, while echocardiography only allows for PA assessment in a minority of cases. Stroke volumes showed good agreement between 4D flow CMR and 2D PCMR.
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Affiliation(s)
- Evangeline G Warmerdam
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno A W Roest
- Department of Paedidatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bram van Wijk
- Department of Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Gertjan T Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Henriette Ter Heide
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Gregor J Krings
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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9
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Ramaekers MJFG, Westenberg JJM, Adriaans BP, Nijssen EC, Wildberger JE, Lamb HJ, Schalla S. A clinician's guide to understanding aortic 4D flow MRI. Insights Imaging 2023; 14:114. [PMID: 37395817 DOI: 10.1186/s13244-023-01458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/03/2023] [Indexed: 07/04/2023] Open
Abstract
Four-dimensional flow magnetic resonance imaging is an emerging technique which may play a role in diagnosis and risk-stratification of aortic disease. Some knowledge of flow dynamics and related parameters is necessary to understand and apply this technique in clinical workflows. The purpose of the current review is to provide a guide for clinicians to the basics of flow imaging, frequently used flow-related parameters, and their relevance in the context of aortic disease.Clinical relevance statement Understanding normal and abnormal aortic flow could improve clinical care in patients with aortic disease.
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Affiliation(s)
- Mitch J F G Ramaekers
- Department of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bouke P Adriaans
- Department of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Estelle C Nijssen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Simon Schalla
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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10
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Juffermans JF, Westenberg JJM, van den Boogaard PJ, Lamb HJ. Effects of ageing on aortic hemodynamics measured by 4D-flow MRI: a case series. Eur Heart J Case Rep 2023; 7:ytad130. [PMID: 37090762 PMCID: PMC10113929 DOI: 10.1093/ehjcr/ytad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/06/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
Background It has been demonstrated that the rate of aortic dilatation is influenced by alteration of aortic hemodynamics, such as normalized flow displacement (FDN) and wall shear stress (WSS). However, the effects of ageing on aortic hemodynamics have not yet been described. Case summary 4D-Flow MRI derived aorta hemodynamics were derived in the ascending aorta of a patient with ascending aortic aneurysm (mean ± standard deviation: 46 ± 1 mm) and a healthy volunteer (aortic diameter 30 ± 1 mm) with long-term follow-up of ten and eight years, respectively. At all timepoints, compared to the healthy volunteer, the patient demonstrated higher magnitudes of FDN (7% ± 1% vs. 3% ± 1%) and WSS angle (36° ± 3° vs. 24° ± 6°), and lower WSS magnitude (565 ± 100 mPa vs. 910 ± 115 mPa), axial WSS (426 ± 71 mPa vs. 800 ± 108 mPa) and circumferential WSS (297 ± 64 mPa vs. 340 ± 85 mPa). The patient and healthy volunteer demonstrated different aortic dilatation rates (regression slope ± standard error: 0.2 ± 0.1 vs. 0.1 ± 0.2 mm per year) and trends in FDN (0.1% ± 0.1% vs. 0.1% ± 0.2% per year), WSS magnitude (22 ± 9 vs. 35 ± 13 mPa per year), axial WSS (19 ± 4 vs. 37 ± 7 mPa per year), circumferential WSS (9 ± 8 vs. 5 ± 15 mPa per year), and WSS angle (-0.5° ± 0.4° vs. -0.8° ± 1.0° per year). Discussion Aortic hemodynamic parameters are marginally affected by ageing and the aortic diameter in this case series. Since aortic hemodynamic parameters have been associated with aortic dilation by previous studies, the outcomes of the two subjects suggest that the aortic dilatation rate will remain constant while individuals are ageing and dilating.
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Affiliation(s)
- Joe F Juffermans
- Corresponding author. Tel: +31 71 526 22 33, Fax: +31 71 524 82 56,
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Pieter J van den Boogaard
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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11
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Roos PR, Rijnberg FM, Westenberg JJM, Lamb HJ. Particle Tracing Based on
4D
Flow Magnetic Resonance Imaging: A Systematic Review into Methods, Applications, and Current Developments. J Magn Reson Imaging 2022; 57:1320-1339. [PMID: 36484213 DOI: 10.1002/jmri.28540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Particle tracing based on 4D Flow MRI has been applied as a quantitative and qualitative postprocessing technique to study temporally evolving blood flow patterns. PURPOSE To systematically review the various methods to perform 4D Flow MRI-based particle tracing, as well as the clinical value, clinical applications, and current developments of the technique. STUDY TYPE The study type is systematic review. SUBJECTS Patients with cardiovascular disease (such as Marfan, Fontan, Tetralogy of Fallot), healthy controls, and cardiovascular phantoms that received 4D Flow MRI with particle tracing. FIELD STRENGTH/SEQUENCE Three-dimensional three-directional cine phase-contrast MRI, at 1.5 T and 3 T. ASSESSMENT Two systematic searches were performed on the PubMed database using Boolean operators and the relevant key terms covering 4D Flow MRI and particle tracing. One systematic search was focused on particle tracing methods, whereas the other on applications. Additional articles from other sources were sought out and included after a similar inspection. Particle tracing methods, clinical applications, clinical value, and current developments were extracted. STATISTICAL TESTS The main results of the included studies are summarized, without additional statistical analysis. RESULTS Of 127 unique articles retrieved from the initial search, 56 were included (28 for methods and 54 for applications). Most articles that described particle tracing methods used an adaptive timestep, a fourth order Runge-Kutta integration method, and linear interpolation in the time dimension. Particle tracing was applied in heart chambers, aorta, venae cavae, Fontan circulation, pulmonary arteries, abdominal vasculature, peripheral arteries, carotid arteries, and cerebral vasculature. Applications were grouped as intravascular, intracardiac, flow stasis, and research. DATA CONCLUSIONS Particle tracing based on 4D Flow MRI gives unique insight into blood flow in several cardiovascular diseases, but the quality depends heavily on the MRI data quality. Further studies are required to evaluate the clinical value of the technique for different cardiovascular diseases. EVIDENCE LEVEL 5. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Paul R. Roos
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
| | - Friso M. Rijnberg
- Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands
| | | | - Hildo J. Lamb
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
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12
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Rijnberg FM, van ‘t Hul LC, Hazekamp MG, van den Boogaard PJ, Juffermans JF, Lamb HJ, Terol Espinosa de Los Monteros C, Kroft LJM, Kenjeres S, le Cessie S, Jongbloed MRM, Westenberg JJM, Roest AAW, Wentzel JJ. Haemodynamic performance of 16-20-mm extracardiac Goretex conduits in adolescent Fontan patients at rest and during simulated exercise. Eur J Cardiothorac Surg 2022; 63:6808623. [PMID: 36342204 PMCID: PMC9972516 DOI: 10.1093/ejcts/ezac522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/03/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To date, it is not known if 16-20-mm extracardiac conduits are outgrown during somatic growth from childhood to adolescence. This study aims to determine total cavopulmonary connection (TCPC) haemodynamics in adolescent Fontan patients at rest and during simulated exercise and to assess the relationship between conduit size and haemodynamics. METHODS Patient-specific, magnetic resonance imaging-based computational fluid dynamic models of the TCPC were performed in 51 extracardiac Fontan patients with 16-20-mm conduits. Power loss, pressure gradient and normalized resistance were quantified in rest and during simulated exercise. The cross-sectional area (CSA) (mean and minimum) of the vessels of the TCPC was determined and normalized for flow rate (mm2/l/min). Peak (predicted) oxygen uptake was assessed. RESULTS The median age was 16.2 years (Q1-Q3 14.0-18.2). The normalized mean conduit CSA was 35-73% smaller compared to the inferior and superior vena cava, hepatic veins and left/right pulmonary artery (all P < 0.001). The median TCPC pressure gradient was 0.7 mmHg (Q1-Q3 0.5-0.8) and 2.0 (Q1-Q3 1.4-2.6) during rest and simulated exercise, respectively. A moderate-strong inverse non-linear relationship was present between normalized mean conduit CSA and TCPC haemodynamics in rest and exercise. TCPC pressure gradients of ≥1.0 at rest and ≥3.0 mmHg during simulated exercise were observed in patients with a conduit CSA ≤ 45 mm2/l/min and favourable haemodynamics (<1 mmHg during both rest and exercise) in conduits ≥125 mm2/l/min. Normalized TCPC resistance correlated with (predicted) peak oxygen uptake. CONCLUSIONS Extracardiac conduits of 16-20 mm have become relatively undersized in most adolescent Fontan patients leading to suboptimal haemodynamics.
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Affiliation(s)
- Friso M Rijnberg
- Corresponding author. Department of Cardiothoracic surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands, Telephone number:+31715262348 (F.M. Rijnberg)
| | - Luca C van ‘t Hul
- Department of Cardiology, Biomechanical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Sasa Kenjeres
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology and J.M. Burgers centrum Research School for Fluid Mechanics, Delft, Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology and Anatomy & Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
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13
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Ververs FA, Eikendal ALM, Kofink D, Nuboer R, Westenberg JJM, Hovenkamp GT, Kemps JJ, Coenen ICJ, Daems JJN, Claus LR, Ju Y, Wulffraat NM, van der Ent CK, Monaco C, Boes M, Leiner T, Grotenhuis HB, Schipper HS. Preclinical Aortic Atherosclerosis in Adolescents With Chronic Disease. J Am Heart Assoc 2022; 11:e024675. [PMID: 35861840 PMCID: PMC9707823 DOI: 10.1161/jaha.122.024675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Adolescents with chronic disease are often exposed to inflammatory, metabolic, and hemodynamic risk factors for early atherosclerosis. Since postmortem studies have shown that atherogenesis starts in the aorta, the CDACD (Cardiovascular Disease in Adolescents with Chronic Disease) study investigated preclinical aortic atherosclerosis in these adolescents.
Methods and Results
The cross‐sectional CDACD study enrolled 114 adolescents 12 to 18 years old with chronic disorders including juvenile idiopathic arthritis, cystic fibrosis, obesity, corrected coarctation of the aorta, and healthy controls with a corrected atrial septal defect. Cardiovascular magnetic resonance was used to assess aortic pulse wave velocity and aortic wall thickness, as established aortic measures of preclinical atherosclerosis. Cardiovascular magnetic resonance showed a higher aortic pulse wave velocity, which reflects aortic stiffness, and higher aortic wall thickness in all adolescent chronic disease groups, compared with controls (
P
<0.05). Age (β=0.253), heart rate (β=0.236), systolic blood pressure (β=−0.264), and diastolic blood pressure (β=0.365) were identified as significant predictors for aortic pulse wave velocity, using multivariable linear regression analysis. Aortic wall thickness was predicted by body mass index (β=0.248) and fasting glucose (β=0.242), next to aortic lumen area (β=0.340). Carotid intima‐media thickness was assessed using ultrasonography, and was only higher in adolescents with coarctation of the aorta, compared with controls (
P
<0.001).
Conclusions
Adolescents with chronic disease showed enhanced aortic stiffness and wall thickness compared with controls. The enhanced aortic pulse wave velocity and aortic wall thickness in adolescents with chronic disease could indicate accelerated atherogenesis. Our findings underscore the importance of the aorta for assessment of early atherosclerosis, and the need for tailored cardiovascular follow‐up of children with chronic disease.
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Affiliation(s)
- Francesca A. Ververs
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Anouk L. M. Eikendal
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
| | - Daniel Kofink
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Roos Nuboer
- Department of Pediatrics Meander Medical Center Amersfoort Amersfoort the Netherlands
| | | | - Gijs T. Hovenkamp
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Jitske J.A. Kemps
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Iris C. J. Coenen
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Joëlle J. N. Daems
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Laura R. Claus
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Yillie Ju
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Nico M. Wulffraat
- Department of Pediatric Immunology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
- Rare Immunodeficiency, Autoinflammatory and Autoimmune European Reference Network Utrecht the Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Claudia Monaco
- Kennedy Institute of RheumatologyUniversity of Oxford Oxford UK
| | - Marianne Boes
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
- Department of Pediatric Immunology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Tim Leiner
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
- Department of Radiology Mayo Clinic Rochester MN
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
| | - Henk S. Schipper
- Center for Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
- Department of Pediatric Cardiology Wilhelmina Children’s HospitalUniversity Medical Center Utrecht Utrecht the Netherlands
- Kennedy Institute of RheumatologyUniversity of Oxford Oxford UK
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14
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Rijnberg FM, Westenberg JJM, van Assen HC, Juffermans JF, Kroft LJM, van den Boogaard PJ, Terol Espinosa de Los Monteros C, Warmerdam EG, Leiner T, Grotenhuis HB, Jongbloed MRM, Hazekamp MG, Roest AAW, Lamb HJ. 4D flow cardiovascular magnetic resonance derived energetics in the Fontan circulation correlate with exercise capacity and CMR-derived liver fibrosis/congestion. J Cardiovasc Magn Reson 2022; 24:21. [PMID: 35346249 PMCID: PMC8962091 DOI: 10.1186/s12968-022-00854-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/15/2022] [Indexed: 12/12/2022] Open
Abstract
AIM This study explores the relationship between in vivo 4D flow cardiovascular magnetic resonance (CMR) derived blood flow energetics in the total cavopulmonary connection (TCPC), exercise capacity and CMR-derived liver fibrosis/congestion. BACKGROUND The Fontan circulation, in which both caval veins are directly connected with the pulmonary arteries (i.e. the TCPC) is the palliative approach for single ventricle patients. Blood flow efficiency in the TCPC has been associated with exercise capacity and liver fibrosis using computational fluid dynamic modelling. 4D flow CMR allows for assessment of in vivo blood flow energetics, including kinetic energy (KE) and viscous energy loss rate (EL). METHODS Fontan patients were prospectively evaluated between 2018 and 2021 using a comprehensive cardiovascular and liver CMR protocol, including 4D flow imaging of the TCPC. Peak oxygen consumption (VO2) was determined using cardiopulmonary exercise testing (CPET). Iron-corrected whole liver T1 (cT1) mapping was performed as a marker of liver fibrosis/congestion. KE and EL in the TCPC were computed from 4D flow CMR and normalized for inflow. Furthermore, blood flow energetics were compared between standardized segments of the TCPC. RESULTS Sixty-two Fontan patients were included (53% male, 17.3 ± 5.1 years). Maximal effort CPET was obtained in 50 patients (peak VO2 27.1 ± 6.2 ml/kg/min, 56 ± 12% of predicted). Both KE and EL in the entire TCPC (n = 28) were significantly correlated with cT1 (r = 0.50, p = 0.006 and r = 0.39, p = 0.04, respectively), peak VO2 (r = - 0.61, p = 0.003 and r = - 0.54, p = 0.009, respectively) and % predicted peak VO2 (r = - 0.44, p = 0.04 and r = - 0.46, p = 0.03, respectively). Segmental analysis indicated that the most adverse flow energetics were found in the Fontan tunnel and left pulmonary artery. CONCLUSIONS Adverse 4D flow CMR derived KE and EL in the TCPC correlate with decreased exercise capacity and increased levels of liver fibrosis/congestion. 4D flow CMR is promising as a non-invasive screening tool for identification of patients with adverse TCPC flow efficiency.
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Affiliation(s)
- Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Tim Leiner
- Department of Radiology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology and Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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15
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Zhao Q, Nooren SJL, Zijlstra LE, Westenberg JJM, Kroft LJM, Jukema JW, Berkhout-Byrne NC, Rabelink TJ, van Zonneveld AJ, van Buren M, Mooijaart SP, Bijkerk R. Circulating miRNAs and Vascular Injury Markers Associate with Cardiovascular Function in Older Patients Reaching End-Stage Kidney Disease. Noncoding RNA 2022; 8:ncrna8010002. [PMID: 35076541 PMCID: PMC8788543 DOI: 10.3390/ncrna8010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
The prevalence of end-stage kidney disease (ESKD) is rapidly increasing and mostly occurring in patients aged 65 years or older. The main cause of death in these patients is cardiovascular disease (CVD). Novel markers of vascular integrity may thus be of clinical value for identifying patients at high risk for CVD. Here we associated the levels of selected circulating angiogenic miRNAs, angiopoietin-2 (Ang-2) and asymmetric dimethylarginine (ADMA) with cardiovascular structure and function (as determined by cardiovascular MRI) in 67 older patients reaching ESKD that were included from ‘The Cognitive decline in Older Patients with End stage renal disease’ (COPE) prospective, multicentered cohort study. We first determined the association between the vascular injury markers and specific heart conditions and observed that ESKD patients with coronary heart disease have significantly higher levels of circulating ADMA and miR-27a. Moreover, circulating levels of miR-27a were higher in patients with atrial fibrillation. In addition, the circulating levels of the vascular injury markers were associated with measures of cardiovascular structure and function obtained from cardiovascular MRI: pulse wave velocity (PWV), ejection fraction (EF) and cardiac index (CI). We found Ang-2 and miR-27a to be strongly correlated to the PWV, while Ang-2 also associated with ejection fraction. Finally, we observed that in contrast to miR-27a, Ang-2 was not associated with a vascular cause of the primary kidney disease, suggesting Ang-2 may be an ESKD-specific marker of vascular injury. Taken together, among older patients with ESKD, aberrant levels of vascular injury markers (miR-27a, Ang-2 and ADMA) associated with impaired cardiovascular function. These markers may serve to identify individuals at higher risk of CVD, as well as give insight into the underlying (vascular) pathophysiology.
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Affiliation(s)
- Qiao Zhao
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (Q.Z.); (S.J.L.N.); (N.C.B.-B.); (T.J.R.); (A.J.v.Z.); (M.v.B.)
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Sabine J. L. Nooren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (Q.Z.); (S.J.L.N.); (N.C.B.-B.); (T.J.R.); (A.J.v.Z.); (M.v.B.)
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Laurien E. Zijlstra
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (L.E.Z.); (J.W.J.)
| | - Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (J.J.M.W.); (L.J.M.K.)
| | - Lucia J. M. Kroft
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (J.J.M.W.); (L.J.M.K.)
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (L.E.Z.); (J.W.J.)
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Noeleen C. Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (Q.Z.); (S.J.L.N.); (N.C.B.-B.); (T.J.R.); (A.J.v.Z.); (M.v.B.)
| | - Ton J. Rabelink
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (Q.Z.); (S.J.L.N.); (N.C.B.-B.); (T.J.R.); (A.J.v.Z.); (M.v.B.)
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Anton Jan van Zonneveld
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (Q.Z.); (S.J.L.N.); (N.C.B.-B.); (T.J.R.); (A.J.v.Z.); (M.v.B.)
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (Q.Z.); (S.J.L.N.); (N.C.B.-B.); (T.J.R.); (A.J.v.Z.); (M.v.B.)
- Department of Nephrology, HAGA Hospital, 2545 AA The Hague, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Roel Bijkerk
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (Q.Z.); (S.J.L.N.); (N.C.B.-B.); (T.J.R.); (A.J.v.Z.); (M.v.B.)
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Correspondence: ; Tel.: +31-(0)71-526-8138; Fax: +31-(0)71-526-6868
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Westenberg JJM, van Assen HC, van den Boogaard PJ, Goeman JJ, Saaid H, Voorneveld J, Bosch J, Kenjeres S, Claessens T, Garg P, Kouwenhoven M, Lamb HJ. Echo planar imaging-induced errors in intracardiac 4D flow MRI quantification. Magn Reson Med 2021; 87:2398-2411. [PMID: 34866236 PMCID: PMC9300143 DOI: 10.1002/mrm.29112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 01/09/2023]
Abstract
Purpose To assess errors associated with EPI‐accelerated intracardiac 4D flow MRI (4DEPI) with EPI factor 5, compared with non‐EPI gradient echo (4DGRE). Methods Three 3T MRI experiments were performed comparing 4DEPI to 4DGRE: steady flow through straight tubes, pulsatile flow in a left‐ventricle phantom, and intracardiac flow in 10 healthy volunteers. For each experiment, 4DEPI was repeated with readout and blip phase‐encoding gradient in different orientations, parallel or perpendicular to the flow direction. In vitro flow rates were compared with timed volumetric collection. In the left‐ventricle phantom and in vivo, voxel‐based speed and spatio‐temporal median speed were compared between sequences, as well as mitral and aortic transvalvular net forward volume. Results In steady‐flow phantoms, the flow rate error was largest (12%) for high velocity (>2 m/s) with 4DEPI readout gradient parallel to the flow. Voxel‐based speed and median speed in the left‐ventricle phantom were ≤5.5% different between sequences. In vivo, mean net forward volume inconsistency was largest (6.4 ± 8.5%) for 4DEPI with nonblip phase‐encoding gradient parallel to the main flow. The difference in median speed for 4DEPI versus 4DGRE was largest (9%) when the 4DEPI readout gradient was parallel to the flow. Conclusions Velocity and flow rate are inaccurate for 4DEPI with EPI factor 5 when flow is parallel to the readout or blip phase‐encoding gradient. However, mean differences in flow rate, voxel‐based speed, and spatio‐temporal median speed were acceptable (≤10%) when comparing 4DEPI to 4DGRE for intracardiac flow in healthy volunteers.
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Affiliation(s)
- Jos J M Westenberg
- CardioVascular Imaging Group, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans C van Assen
- CardioVascular Imaging Group, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter J van den Boogaard
- CardioVascular Imaging Group, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Hicham Saaid
- Institute Biomedical Technology, Ghent University, Ghent, Belgium
| | - Jason Voorneveld
- Department of Biomedical Engineering, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johan Bosch
- Department of Biomedical Engineering, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sasa Kenjeres
- Department of Chemical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Tom Claessens
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
| | - Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Marc Kouwenhoven
- Department of MR R&D-Clinical Science, Philips, Best, the Netherlands
| | - Hildo J Lamb
- CardioVascular Imaging Group, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Rijnberg FM, van der Woude SFS, Hazekamp MG, van den Boogaard PJ, Lamb HJ, Terol Espinosa de Los Monteros C, Kroft LJM, Kenjeres S, Karim T, Jongbloed MRM, Westenberg JJM, Wentzel JJ, Roest AAW. Extracardiac conduit adequacy along the respiratory cycle in adolescent Fontan patients. Eur J Cardiothorac Surg 2021; 62:6423130. [PMID: 34747442 PMCID: PMC9257669 DOI: 10.1093/ejcts/ezab478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/12/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Sasa Kenjeres
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology and J.M. Burgers Centrum Research School for Fluid Mechanics, Delft, Netherlands
| | - Tawab Karim
- Department of Cardiology, Biomechanical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology and Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Biomechanical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
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18
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Blanken CPS, Gottwald LM, Westenberg JJM, Peper ES, Coolen BF, Strijkers GJ, Nederveen AJ, Planken RN, van Ooij P. Whole-Heart 4D Flow MRI for Evaluation of Normal and Regurgitant Valvular Flow: A Quantitative Comparison Between Pseudo-Spiral Sampling and EPI Readout. J Magn Reson Imaging 2021; 55:1120-1130. [PMID: 34510612 PMCID: PMC9290924 DOI: 10.1002/jmri.27905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/23/2023] Open
Abstract
Background Pseudo‐spiral Cartesian sampling with compressed sensing reconstruction has facilitated highly accelerated 4D flow magnetic resonance imaging (MRI) in various cardiovascular structures. However, unlike echo planar imaging (EPI)‐accelerated 4D flow MRI, it has not been validated in whole‐heart applications. Hypothesis Pseudo‐spiral 4D flow MRI (PROUD [PROspective Undersampling in multiple Dimensions]) is comparable to EPI in robustness of valvular flow measurements and remains comparable as the undersampling factor is increased and scan time reduced. Study Type Prospective. Population Twelve healthy subjects and eight patients with valvular regurgitation. Field Strength/Sequence 3.0 T; PROUD and EPI 4D flow sequences, 2D flow and balanced steady‐state free precession sequences. Assessment Valvular blood flow was quantified using valve tracking. PROUD‐ and EPI‐based measurements of aortic (AV) and pulmonary (PV) flow volumes and left and right ventricular stroke volumes were tested for agreement with 2D MRI‐based measurements. PROUD reconstructions with undersampling factors (R) of 9, 14, 28, and 56 were tested for intervalve consistency (per valve, compared to the other valves) and preservation of peak velocities and E/A ratios. Statistical Tests We used repeated measures ANOVA, Bland‐Altman, Wilcoxon signed rank, and intraclass correlation coefficients. P < 0.05 was considered statistically significant. Results PROUD and EPI intervalve consistencies were not significantly different both in healthy subjects (valve‐averaged mean difference [limits of agreement width]: 3.2 ± 0.8 [8.7 ± 1.1] mL/beat for PROUD, 5.5 ± 2.9 [13.7 ± 2.3] mL/beat for EPI, P = 0.07) and in patients with valvular regurgitation (2.3 ± 1.2 [15.3 ± 5.9] mL/beat for PROUD, 0.6 ± 0.6 [19.3 ± 2.9] mL/beat for EPI, P = 0.47). Agreement between EPI and PROUD was higher than between 4D flow (EPI or PROUD) and 2D MRI for forward flow, stroke volumes, and regurgitant volumes. Up to R = 28 in healthy subjects and R = 14 in patients with valvular regurgitation, PROUD intervalve consistency remained comparable to that of EPI. Peak velocities and E/A ratios were preserved up to R = 9. Conclusion PROUD is comparable to EPI in terms of intervalve consistency and may be used with higher undersampling factors to shorten scan times further. Level of Evidence 1 Technical Efficacy Stage 2
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Affiliation(s)
- Carmen P S Blanken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Lukas M Gottwald
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - Eva S Peper
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Bram F Coolen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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van der Woude SFS, Rijnberg FM, Hazekamp MG, Jongbloed MRM, Kenjeres S, Lamb HJ, Westenberg JJM, Roest AAW, Wentzel JJ. The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection. Front Cardiovasc Med 2021; 8:683849. [PMID: 34422920 PMCID: PMC8374887 DOI: 10.3389/fcvm.2021.683849] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/05/2021] [Indexed: 12/18/2022] Open
Abstract
Congenital heart disease is the most common birth defect and functionally univentricular heart defects represent the most severe end of this spectrum. The Fontan circulation provides an unique solution for single ventricle patients, by connecting both caval veins directly to the pulmonary arteries. As a result, the pulmonary circulation in Fontan palliated patients is characterized by a passive, low-energy circulation that depends on increased systemic venous pressure to drive blood toward the lungs. The absence of a subpulmonary ventricle led to the widely believed concept that respiration, by sucking blood to the pulmonary circulation during inspiration, is of great importance as a driving force for antegrade blood flow in Fontan patients. However, recent studies show that respiration influences pulsatility, but has a limited effect on net forward flow in the Fontan circulation. Importantly, since MRI examination is recommended every 2 years in Fontan patients, clinicians should be aware that most conventional MRI flow sequences do not capture the pulsatility of the blood flow as a result of the respiration. In this review, the unique flow dynamics influenced by the cardiac and respiratory cycle at multiple locations within the Fontan circulation is discussed. The impact of (not) incorporating respiration in different MRI flow sequences on the interpretation of clinical flow parameters will be covered. Finally, the influence of incorporating respiration in advanced computational fluid dynamic modeling will be outlined.
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Affiliation(s)
- Séline F S van der Woude
- Department of Cardiology, Biomedical Engineering, Biomechanics Laboratory, Rotterdam, Netherlands
| | - Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy, Embryology and Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Sasa Kenjeres
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology and J. M. Burgerscentrum Research School for Fluid Mechanics, Delft, Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Biomechanics Laboratory, Rotterdam, Netherlands
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20
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Perinajová R, Juffermans JF, Mercado JL, Aben JP, Ledoux L, Westenberg JJM, Lamb HJ, Kenjereš S. Assessment of turbulent blood flow and wall shear stress in aortic coarctation using image-based simulations. Biomed Eng Online 2021; 20:84. [PMID: 34419047 PMCID: PMC8379896 DOI: 10.1186/s12938-021-00921-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/07/2021] [Indexed: 01/23/2023] Open
Abstract
In this study, we analyzed turbulent flows through a phantom (a 180[Formula: see text] bend with narrowing) at peak systole and a patient-specific coarctation of the aorta (CoA), with a pulsating flow, using magnetic resonance imaging (MRI) and computational fluid dynamics (CFD). For MRI, a 4D-flow MRI is performed using a 3T scanner. For CFD, the standard [Formula: see text], shear stress transport [Formula: see text], and Reynolds stress (RSM) models are applied. A good agreement between measured and simulated velocity is obtained for the phantom, especially for CFD with RSM. The wall shear stress (WSS) shows significant differences between CFD and MRI in absolute values, due to the limited near-wall resolution of MRI. However, normalized WSS shows qualitatively very similar distributions of the local values between MRI and CFD. Finally, a direct comparison between in vivo 4D-flow MRI and CFD with the RSM turbulence model is performed in the CoA. MRI can properly identify regions with locally elevated or suppressed WSS. If the exact values of the WSS are necessary, CFD is the preferred method. For future applications, we recommend the use of the combined MRI/CFD method for analysis and evaluation of the local flow patterns and WSS in the aorta.
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Affiliation(s)
- Romana Perinajová
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands. .,J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands.
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonhatan Lorenzo Mercado
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | | | - Leon Ledoux
- Pie Medical Imaging BV, Maastricht, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saša Kenjereš
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands.,J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands
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21
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Rijnberg FM, van Assen HC, Hazekamp MG, Roest AAW, Westenberg JJM. Hemodynamic Consequences of an Undersized Extracardiac Conduit in an Adult Fontan Patient Revealed by 4-Dimensional Flow Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2021; 14:e012612. [PMID: 34380326 DOI: 10.1161/circimaging.121.012612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Friso M Rijnberg
- Departments of Cardiothoracic Surgery (F.M.R., M.G.H.), Leiden University Medical Center, the Netherlands
| | - Hans C van Assen
- Radiology (H.C.v.A., J.J.M.W.), Leiden University Medical Center, the Netherlands
| | - Mark G Hazekamp
- Departments of Cardiothoracic Surgery (F.M.R., M.G.H.), Leiden University Medical Center, the Netherlands
| | - Arno A W Roest
- Pediatric Cardiology (A.A.W.R.), Leiden University Medical Center, the Netherlands
| | - Jos J M Westenberg
- Radiology (H.C.v.A., J.J.M.W.), Leiden University Medical Center, the Netherlands
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22
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Rijnberg FM, Juffermans JF, Hazekamp MG, Helbing WA, Lamb HJ, Roest AAW, Westenberg JJM, van Assen HC. Segmental assessment of blood flow efficiency in the total cavopulmonary connection using four-dimensional flow magnetic resonance imaging: vortical flow is associated with increased viscous energy loss rate. European Heart Journal Open 2021; 1:oeab018. [PMID: 35919267 PMCID: PMC9241567 DOI: 10.1093/ehjopen/oeab018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 11/12/2022]
Abstract
Aims To study flow-related energetics in multiple anatomical segments of the total cavopulmonary connection (TCPC) in Fontan patients from four-dimensional (4D) flow magnetic resonance imaging (MRI), and to study the relationship between adverse flow patterns and segment-specific energetics. Methods and results Twenty-six extracardiac Fontan patients underwent 4D flow MRI of the TCPC. A segmentation of the TCPC was automatically divided into five anatomical segments [conduit, superior vena cava (SVC), right/left pulmonary artery (LPA), and the Fontan confluence]. The presence of vortical flow in the pulmonary arteries or Fontan confluence was qualitatively scored. Kinetic energy (KE), viscous energy loss rate, and vorticity were calculated from the 4D flow MRI velocity field and normalized for segment length and/or inflow. Energetics were compared between segments and the relationship between vortical flow and segment cross-sectional area (CSA) with segment-specific energetics was determined. Vortical flow in the LPA (n = 6) and Fontan confluence (n = 12) were associated with significantly higher vorticity (P = 0.001 and P = 0.015, respectively) and viscous energy loss rate (P = 0.046 and P = 0.04, respectively) compared to patients without vortical flow. The LPA and conduit segments showed the highest KE and viscous energy loss rate, while most favourable energetics were observed in the SVC. Conduit CSA inversely correlated with KE (r = −0.614, P = 0.019) and viscous energy loss rate (r = −0.652, P = 0.011). Conclusions Vortical flow in the Fontan confluence and LPA associated with significantly increased viscous energy loss rate. Four-dimensional flow MRI-derived energetics may be used as a screening tool for direct, MRI-based assessment of flow efficiency in the TCPC.
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Affiliation(s)
- Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Willem A Helbing
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
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23
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Ramaekers MJFG, Adriaans BP, Juffermans JF, van Assen HC, Bekkers SCAM, Scholte AJHA, Kenjeres S, Lamb HJ, Wildberger JE, Westenberg JJM, Schalla S. Characterization of Ascending Aortic Flow in Patients With Degenerative Aneurysms: A 4D Flow Magnetic Resonance Study. Invest Radiol 2021; 56:494-500. [PMID: 33653992 DOI: 10.1097/rli.0000000000000768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Degenerative thoracic aortic aneurysm (TAA) patients are known to be at risk of life-threatening acute aortic events. Guidelines recommend preemptive surgery at diameters of greater than 55 mm, although many patients with small aneurysms show only mild growth rates and more than half of complications occur in aneurysms below this threshold. Thus, assessment of hemodynamics using 4-dimensional flow magnetic resonance has been of interest to obtain more insights in aneurysm development. Nonetheless, the role of aberrant flow patterns in TAA patients is not yet fully understood. MATERIALS AND METHODS A total of 25 TAA patients and 22 controls underwent time-resolved 3-dimensional phase contrast magnetic resonance imaging with 3-directional velocity encoding (ie, 4-dimensional flow magnetic resonance imaging). Hemodynamic parameters such as vorticity, helicity, and wall shear stress (WSS) were calculated from velocity data in 3 anatomical segments of the ascending aorta (root, proximal, and distal). Regional WSS distribution was assessed for the full cardiac cycle. RESULTS Flow vorticity and helicity were significantly lower for TAA patients in all segments. The proximal ascending aorta showed a significant increase in peak WSS in the outer curvature in TAA patients, whereas WSS values at the inner curvature were significantly lower as compared with controls. Furthermore, positive WSS gradients from sinotubular junction to midascending aorta were most prominent in the outer curvature, whereas from midascending aorta to brachiocephalic trunk, the outer curvature showed negative WSS gradients in the TAA group. Controls solely showed a positive gradient at the inner curvature for both segments. CONCLUSIONS Degenerative TAA patients show a decrease in flow vorticity and helicity, which is likely to cause perturbations in physiological flow patterns. The subsequent differing distribution of WSS might be a contributor to vessel wall remodeling and aneurysm formation.
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Affiliation(s)
| | | | | | | | | | | | - Sasa Kenjeres
- Department of Chemical Engineering, Transport Phenomena Section, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center
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Grafton-Clarke C, Crandon S, Westenberg JJM, Swoboda PP, Greenwood JP, van der Geest RJ, Swift AJ, Vassiliou VS, Plein S, Garg P. Reproducibility of left ventricular blood flow kinetic energy measured by four-dimensional flow CMR. BMC Res Notes 2021; 14:289. [PMID: 34315510 PMCID: PMC8314539 DOI: 10.1186/s13104-021-05697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Four-dimensional flow CMR allows for a comprehensive assessment of the blood flow kinetic energy of the ventricles of the heart. In comparison to standard two-dimensional image acquisition, 4D flow CMR is felt to offer superior reproducibility, which is important when repeated examinations may be required. The objective was to evaluate the inter-observer and intra-observer reproducibility of blood flow kinetic energy assessment using 4D flow of the left ventricle in 20 healthy volunteers across two centres in the United Kingdom and the Netherlands. DATA DESCRIPTION This dataset contains 4D flow CMR blood flow kinetic energy data for 20 healthy volunteers with no known cardiovascular disease. Presented is kinetic energy data for the entire cardiac cycle (global), the systolic and diastolic components, in addition to blood flow kinetic energy for both early and late diastolic filling. This data is available for reuse and would be valuable in supporting other research, such as allowing for larger sample sizes with more statistical power for further analysis of these variables.
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Affiliation(s)
- Ciaran Grafton-Clarke
- George Davies Centre, School of Medicine, University of Leicester, Lancaster Road, Leicester, LE1 7HA UK
| | - Saul Crandon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter P. Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Rob J. van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J. Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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25
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van der Palen RLF, Juffermans JF, Kroft LJM, Hazekamp MG, Lamb HJ, Blom NA, Roest AAW, Westenberg JJM. Wall shear stress in the thoracic aorta at rest and with dobutamine stress after arterial switch operation. Eur J Cardiothorac Surg 2021; 59:814-822. [PMID: 33382414 PMCID: PMC8083947 DOI: 10.1093/ejcts/ezaa392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Progressive root dilatation is an important complication in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) that may be caused by altered flow dynamics. Aortic wall shear stress (WSS) distribution at rest and under dobutamine stress (DS) conditions using 4D flow magnetic resonance imaging were investigated in relation to thoracic aorta geometry. METHODS 4D flow magnetic resonance imaging was performed in 16 adolescent TGA patients after ASO (rest and DS condition) and in 10 healthy controls (rest). The primary outcome measure was the WSS distribution along the aortic segments and the WSS change with DS in TGA patients. Based on the results, we secondary zoomed in on factors [aortic geometry and left ventricular (LV) function parameters] that might relate to these WSS distribution differences. Aortic diameters, arch angle, LV function parameters (stroke volume, LV ejection fraction, cardiac output) and peak systolic aortic WSS were obtained. RESULTS TGA patients had significantly larger neoaortic root and smaller mid-ascending aorta (AAo) dimensions and aortic arch angle. At rest, patients had significantly higher WSS in the entire thoracic aorta, except for the dilated root. High WSS levels beyond the proximal AAo were associated with the diameter decrease from the root to the mid-AAo (correlation coefficient r = 0.54–0.59, P = 0.022–0.031), not associated with the aortic arch angle. During DS, WSS increased in all aortic segments (P < 0.001), most pronounced in the AAo segments. The increase in LV ejection fraction, stroke volume and cardiac output as a result of DS showed a moderate linear relationship with the WSS increase in the distal AAo (correlation coefficient r = 0.54–0.57, P = 0.002–0.038). CONCLUSIONS Increased aortic WSS was observed in TGA patients after ASO, related to the ASO-specific geometry, which increased with DS. Stress-enhanced elevated WSS may play a role in neoaortic root dilatation and anterior aortic wall thinning of the distal AAo.
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Affiliation(s)
- Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arno A W Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
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26
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van Hout MJP, Dekkers IA, Westenberg JJM, Schalij MJ, Scholte AJHA, Lamb HJ. The impact of visceral and general obesity on vascular and left ventricular function and geometry: a cross-sectional magnetic resonance imaging study of the UK Biobank. Eur Heart J Cardiovasc Imaging 2021; 21:273-281. [PMID: 31722392 PMCID: PMC7031704 DOI: 10.1093/ehjci/jez279] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/05/2019] [Accepted: 10/21/2019] [Indexed: 12/31/2022] Open
Abstract
Aims We aimed to evaluate the associations of body fat distribution with cardiovascular function and geometry in the middle-aged general population. Methods and results Four thousand five hundred and ninety participants of the UK Biobank (54% female, mean age 61.1 ± 7.2 years) underwent cardiac magnetic resonance for assessment of left ventricular (LV) parameters [end-diastolic volume (EDV), ejection fraction (EF), cardiac output (CO), and index (CI)] and magnetic resonance imaging for body composition analysis [subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT)]. Body fat percentage (BF%) was assessed by bioelectrical impedance. Linear regressions were performed to assess the impact of visceral (VAT) and general (SAT and BF%) obesity on cardiac function and geometry. Visceral obesity was associated with a smaller EDV [VAT: β −1.74 (−1.15 to −2.33)], lower EF [VAT: β −0.24 (−0.12 to −0.35), SAT: β 0.02 (−0.04 to 0.08), and BF%: β 0.02 (−0.02 to 0.06)] and the strongest negative association with CI [VAT: β −0.05 (−0.06 to −0.04), SAT: β −0.02 (−0.03 to −0.01), and BF% β −0.01 (−0.013 to −0.007)]. In contrast, general obesity was associated with a larger EDV [SAT: β 1.01 (0.72–1.30), BF%: β 0.37 (0.23–0.51)] and a higher CO [SAT: β 0.06 (0.05–0.07), BF%: β 0.02 (0.01–0.03)]. In the gender-specific analysis, only men had a significant association between VAT and EF [β −0.35 (−0.19 to −0.51)]. Conclusion Visceral obesity was associated with a smaller LV EDV and subclinical lower LV systolic function in men, suggesting that visceral obesity might play a more important role compared to general obesity in LV remodelling.
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Affiliation(s)
- Max J P van Hout
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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27
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Demirkiran A, van Ooij P, Westenberg JJM, Hofman MBM, van Assen HC, Schoonmade LJ, Asim U, Blanken CPS, Nederveen AJ, van Rossum AC, Götte MJW. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Eur Heart J Cardiovasc Imaging 2021; 23:154-165. [PMID: 34143872 PMCID: PMC8787996 DOI: 10.1093/ehjci/jeab112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
Identification of flow patterns within the heart has long been recognized as a potential contribution to the understanding of physiological and pathophysiological processes of cardiovascular diseases. Although the pulsatile flow itself is multi-dimensional and multi-directional, current available non-invasive imaging modalities in clinical practice provide calculation of flow in only 1-direction and lack 3-dimensional volumetric velocity information. Four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) has emerged as a novel tool that enables comprehensive and critical assessment of flow through encoding velocity in all 3 directions in a volume of interest resolved over time. Following technical developments, 4D flow CMR is not only capable of visualization and quantification of conventional flow parameters such as mean/peak velocity and stroke volume but also provides new hemodynamic parameters such as kinetic energy. As a result, 4D flow CMR is being extensively exploited in clinical research aiming to improve understanding of the impact of cardiovascular disease on flow and vice versa. Of note, the analysis of 4D flow data is still complex and accurate analysis tools that deliver comparable quantification of 4D flow values are a necessity for a more widespread adoption in clinic. In this article, the acquisition and analysis processes are summarized and clinical applications of 4D flow CMR on the heart including conventional and novel hemodynamic parameters are discussed. Finally, clinical potential of other emerging intra-cardiac 4D flow imaging modalities is explored and a near-future perspective on 4D flow CMR is provided.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Usman Asim
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Carmen P S Blanken
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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28
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Veger HTC, Pasveer EH, Westenberg JJM, Wever JJ, van Eps RGS. Wall Shear Stress Assessment of the False Lumen in Acute Type B Aortic Dissection Visualized by 4-Dimensional Flow Magnetic Resonance Imaging: An Ex-Vivo Study. Vasc Endovascular Surg 2021; 55:696-701. [PMID: 34078199 DOI: 10.1177/15385744211017117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Four-dimensional flow magnetic resonance imaging (4D flow MRI) can accurately visualize and quantify flow and provide hemodynamic information such as wall shear stress (WSS). This imaging technique can be used to obtain more insight in the hemodynamic changes during cardiac cycle in the true and false lumen of uncomplicated acute Type B Aortic Dissection (TBAD). Gaining more insight of these forces in the false lumen in uncomplicated TBAD during optimal medical treatment, might result in prediction of adverse outcomes. METHODS A porcine aorta dissection model with an artificial dissection was positioned in a validated ex-vivo circulatory system with physiological pulsatile flow. 4D flow MR images with 3 set heartrates (HR; 60 bpm, 80 bpm and 100 bpm) were acquired. False lumen volume per cycle (FLV), mean and peak systolic WSS were determined from 4D flow MRI data. For validation, the experiment was repeated with a second porcine aorta dissection model. RESULTS During both experiments an increase in FLV (initial experiment: ΔFLV = 2.05 ml, p < 0.001, repeated experiment: ΔFLV = 1.08 ml, p = 0.005) and peak WSS (initial experiment: ΔWSS = 1.2 Pa, p = 0.004, repeated experiment: ΔWSS = 1.79 Pa, p = 0.016) was observed when HR increased from 60 to 80 bpm. Raising the HR from 80 to 100 bpm, no significant increase in FLV (p = 0.073, p = 0.139) was seen during both experiments. The false lumen mean WSS increased significant during initial (2.71 to 3.85 Pa; p = 0.013) and non-significant during repeated experiment (3.22 to 4.00 Pa; p = 0.320). CONCLUSION 4D flow MRI provides insight into hemodynamic dimensions including WSS. Our ex-vivo experiments showed that an increase in HR from 60 to 80 bpm resulted in a significant increase of FLV and WSS of the false lumen. We suggest that strict heart rate control is of major importance to reduce the mean and peak WSS in uncomplicated acute TBAD. Because of the limitations of an ex-vivo study, 4D flow MRI will have to be performed in clinical setting to determine whether this imaging model would be of value to predict the course of uncomplicated TBAD.
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Affiliation(s)
- Hugo T C Veger
- Department of Vascular Surgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - Erik H Pasveer
- Department of Vascular Surgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan J Wever
- Department of Vascular Surgery, Haga Teaching Hospital, The Hague, the Netherlands
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29
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Perinajová R, Juffermans JF, Westenberg JJM, van der Palen RLF, van den Boogaard PJ, Lamb HJ, Kenjereš S. Geometrically induced wall shear stress variability in CFD-MRI coupled simulations of blood flow in the thoracic aortas. Comput Biol Med 2021; 133:104385. [PMID: 33894502 DOI: 10.1016/j.compbiomed.2021.104385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 01/16/2023]
Abstract
Aortic aneurysm is associated with aberrant blood flow and wall shear stress (WSS). This can be studied by coupling magnetic resonance imaging (MRI) with computational fluid dynamics (CFD). For patient-specific simulations, extra attention should be given to the variation in segmentation of the MRI data-set and its effect on WSS. We performed CFD simulations of blood flow in the aorta for ten different volunteers and provided corresponding WSS distributions. The aorta of each volunteer was segmented four times. The same inlet and outlet boundary conditions were applied for all segmentation variations of each volunteer. Steady-state CFD simulations were performed with inlet flow based on phase-contrast MRI during peak systole. We show that the commonly used comparison of mean and maximal values of WSS, based on CFD in the different segments of the thoracic aorta, yields good to excellent correlation (0.78-0.95) for rescan and moderate to excellent correlation (0.64-1.00) for intra- and interobserver reproducibility. However, the effect of geometrical variations is higher for the voxel-to-voxel comparison of WSS. With this analysis method, the correlation for different segments of the whole aorta is poor to moderate (0.43-0.66) for rescan and poor to good (0.48-0.73) for intra- and interobserver reproducibility. Therefore, we advise being critical about the CFD results based on the MRI segmentations to avoid possible misinterpretation. While the global values of WSS are similar for different modalities, the variation of results is high when considering the local distributions.
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Affiliation(s)
- Romana Perinajová
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology and J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, the Netherlands.
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Saša Kenjereš
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology and J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, the Netherlands.
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30
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Adriaans BP, Ramaekers MJFG, Heuts S, Crijns HJGM, Bekkers SCAM, Westenberg JJM, Lamb HJ, Wildberger JE, Schalla S. Determining the optimal interval for imaging surveillance of ascending aortic aneurysms. Neth Heart J 2021; 29:623-631. [PMID: 33847905 PMCID: PMC8630294 DOI: 10.1007/s12471-021-01564-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 01/16/2023] Open
Abstract
Background Cardiovascular guidelines recommend (bi-)annual computed tomography (CT) or magnetic resonance imaging (MRI) for surveillance of the diameter of thoracic aortic aneurysms (TAAs). However, no previous study has demonstrated the necessity for this approach. The current study aims to provide patient-specific intervals for imaging follow-up of non-syndromic TAAs. Methods A total of 332 patients with non-syndromic ascending aortic aneurysms were followed over a median period of 6.7 years. Diameters were assessed using all available imaging techniques (echocardiography, CT and MRI). Growth rates were calculated from the differences between the first and last examinations. The diagnostic accuracy of follow-up protocols was calculated as the percentage of subjects requiring pre-emptive surgery in whom timely identification would have occurred. Results The mean growth rate in our population was 0.2 ± 0.4 mm/year. The highest recorded growth rate was 2.0 mm/year, while 40.6% of patients showed no diameter expansion during follow-up. Females exhibited significantly higher growth rates than men (0.3 ± 0.5 vs 0.2 ± 0.4 mm/year, p = 0.007). Conversely, a bicuspid aortic valve was not associated with more rapid aortic growth. The optimal imaging protocol comprises triennial imaging of aneurysms 40–49 mm in diameter and yearly imaging of those measuring 50–54 mm. This strategy is as accurate as annual follow-up, but reduces the number of imaging examinations by 29.9%. Conclusions In our population of patients with non-syndromic TAAs, we found aneurysm growth rates to be lower than those previously reported. Yearly imaging does not lead to changes in the management of small aneurysms. Thus, lower imaging frequencies might be a good alternative approach.
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Affiliation(s)
- B P Adriaans
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. .,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. .,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
| | - M J F G Ramaekers
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Radiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - S Heuts
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - H J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - S C A M Bekkers
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - J J M Westenberg
- Department of Radiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - H J Lamb
- Department of Radiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - J E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - S Schalla
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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31
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Rijnberg FM, van der Woude SFS, van Assen HC, Juffermans JF, Hazekamp MG, Jongbloed MRM, Kenjeres S, Lamb HJ, Westenberg JJM, Wentzel JJ, Roest AAW. Non-uniform mixing of hepatic venous flow and inferior vena cava flow in the Fontan conduit. J R Soc Interface 2021; 18:20201027. [PMID: 33823607 PMCID: PMC8086942 DOI: 10.1098/rsif.2020.1027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Fontan patients require a balanced hepatic blood flow distribution (HFD) to prevent pulmonary arteriovenous malformations. Currently, HFD is quantified by tracking Fontan conduit flow, assuming hepatic venous (HV) flow to be uniformly distributed within the Fontan conduit. However, this assumption may be unvalid leading to inaccuracies in HFD quantification with potential clinical impact. The aim of this study was to (i) assess the mixing of HV flow and inferior vena caval (IVC) flow within the Fontan conduit and (ii) quantify HFD by directly tracking HV flow and quantitatively comparing results with the conventional approach. Patient-specific, time-resolved computational fluid dynamic models of 15 total cavopulmonary connections were generated, including the HV and subhepatic IVC. Mixing of HV and IVC flow, on a scale between 0 (no mixing) and 1 (perfect mixing), was assessed at the caudal and cranial Fontan conduit. HFD was quantified by tracking particles from the caudal (HFDcaudal conduit) and cranial (HFDcranial conduit) conduit and from the hepatic veins (HFDHV). HV flow was non-uniformly distributed at both the caudal (mean mixing 0.66 ± 0.13) and cranial (mean 0.79 ± 0.11) level within the Fontan conduit. On a cohort level, differences in HFD between methods were significant but small; HFDHV (51.0 ± 20.6%) versus HFDcaudal conduit (48.2 ± 21.9%, p = 0.033) or HFDcranial conduit (48.0 ± 21.9%, p = 0.044). However, individual absolute differences of 8.2–14.9% in HFD were observed in 4/15 patients. HV flow is non-uniformly distributed within the Fontan conduit. Substantial individual inaccuracies in HFD quantification were observed in a subset of patients with potential clinical impact.
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Affiliation(s)
- Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology and Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sasa Kenjeres
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology and J. M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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32
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Kamphuis VP, Roest AAW, van den Boogaard PJ, Kroft LJM, Lamb HJ, Helbing WA, Blom NA, Westenberg JJM, Elbaz MSM. Hemodynamic interplay of vorticity, viscous energy loss, and kinetic energy from 4D Flow MRI and link to cardiac function in healthy subjects and Fontan patients. Am J Physiol Heart Circ Physiol 2021; 320:H1687-H1698. [PMID: 33635164 DOI: 10.1152/ajpheart.00806.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to directly assess (patho)physiology of intraventricular hemodynamic interplay between four-dimensional flow cardiovascular magnetic resonance imaging (4D Flow MRI)-derived vorticity with kinetic energy (KE) and viscous energy loss (EL) over the cardiac cycle and their association to ejection fraction (EF) and stroke volume (SV). Fifteen healthy subjects and thirty Fontan patients underwent whole heart 4D Flow MRI. Ventricular vorticity, KE, and EL were computed over systole (vorticity_volavg systole, KEavg systole, and ELavg systole) and diastole (vorticity_volavg diastole, KEavg diastole, and ELavg diastole). The association between vorticity_vol and KE and EL was tested by Spearman correlation. Fontan patients were grouped to normal and impaired EF groups. A significant correlation was found between SV and vorticity in healthy subjects (systolic: ρ = 0.84, P < 0.001; diastolic: ρ = 0.81, P < 0.001) and in Fontan patients (systolic: ρ = 0.61, P < 0.001; diastolic: ρ = 0.54, P = 0.002). Healthy subjects showed positive correlation between vorticity_vol versus KE (systole: ρ = 0.96, P < 0.001; diastole: ρ = 0.90, P < 0.001) and EL (systole: ρ = 0.85, P < 0.001; diastole: ρ = 0.84, P < 0.001). Fontan patients showed significantly elevated vorticity_vol compared with healthy subjects (vorticity_volavg systole: 3.1 [2.3-3.9] vs. 1.7 [1.3-2.4] L/s, P < 0.001; vorticity_volavg diastole: 3.1 [2.0-3.7] vs. 2.1 [1.6-2.8] L/s, P = 0.002). This elevated vorticity in Fontan patients showed strong association with KE (systole: ρ = 0.91, P < 0.001; diastole: ρ = 0.85, P < 0.001) and EL (systole: ρ = 0.82, P < 0.001; diastole: ρ = 0.89, P < 0.001). Fontan patients with normal EF showed significantly higher vorticity_volavg systole and ELavg systole, but significantly decreased KE avg diastole, in the presence of normal SV, compared with healthy subjects. Healthy subjects show strong physiological hemodynamic interplay between vorticity with KE and EL. Fontan patients demonstrate a pathophysiological hemodynamic interplay characterized by correlation of elevated vorticity with KE and EL in the presence of maintained normal stroke volume. Altered vorticity and energetic hemodynamics are found in the presence of normal EF in Fontan patients.NEW & NOTEWORTHY Physiologic intraventricular hemodynamic interplay/coupling is present in the healthy left ventricle between vorticity versus viscous energy loss and kinetic energy from four-dimensional flow cardiovascular magnetic resonance imaging (4D Flow MRI). Conversely, Fontan patients present compensatory pathophysiologic hemodynamic coupling by an increase in intraventricular vorticity that positively correlates to viscous energy loss and kinetic energy levels in the presence of maintained normal stroke volume. Altered vorticity and energetics are found in the presence of normal ejection fraction in Fontan patients.
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Affiliation(s)
- Vivian P Kamphuis
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arno A W Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem A Helbing
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mohammed S M Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Juffermans JF, Minderhoud SCS, Wittgren J, Kilburg A, Ese A, Fidock B, Zheng YC, Zhang JM, Blanken CPS, Lamb HJ, Goeman JJ, Carlsson M, Zhao S, Planken RN, van Ooij P, Zhong L, Chen X, Garg P, Emrich T, Hirsch A, Töger J, Westenberg JJM. Multicenter Consistency Assessment of Valvular Flow Quantification With Automated Valve Tracking in 4D Flow CMR. JACC Cardiovasc Imaging 2021; 14:1354-1366. [PMID: 33582060 DOI: 10.1016/j.jcmg.2020.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study determined: 1) the interobserver agreement; 2) valvular flow variation; and 3) which variables independently predicted the variation of valvular flow quantification from 4-dimensional (4D) flow cardiac magnetic resonance (CMR) with automated retrospective valve tracking at multiple sites. BACKGROUND Automated retrospective valve tracking in 4D flow CMR allows consistent assessment of valvular flow through all intracardiac valves. However, due to the variance of CMR scanners and protocols, it remains uncertain if the published consistency holds for other clinical centers. METHODS Seven sites each retrospectively or prospectively selected 20 subjects who underwent whole heart 4D flow CMR (64 patients and 76 healthy volunteers; aged 32 years [range 24 to 48 years], 47% men, from 2014 to 2020), which was acquired with locally used CMR scanners (scanners from 3 vendors; 2 1.5-T and 5 3-T scanners) and protocols. Automated retrospective valve tracking was locally performed at each site to quantify the valvular flow and repeated by 1 central site. Interobserver agreement was evaluated with intraclass correlation coefficients (ICCs). Net forward volume (NFV) consistency among the valves was evaluated by calculating the intervalvular variation. Multiple regression analysis was performed to assess the predicting effect of local CMR scanners and protocols on the intervalvular inconsistency. RESULTS The interobserver analysis demonstrated strong-to-excellent agreement for NFV (ICC: 0.85 to 0.96) and moderate-to-excellent agreement for regurgitation fraction (ICC: 0.53 to 0.97) for all sites and valves. In addition, all observers established a low intervalvular variation (≤10.5%) in their analysis. The availability of 2 cine images per valve for valve tracking compared with 1 cine image predicted a decreasing variation in NFV among the 4 valves (beta = -1.3; p = 0.01). CONCLUSIONS Independently of locally used CMR scanners and protocols, valvular flow quantification can be performed consistently with automated retrospective valve tracking in 4D flow CMR.
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Affiliation(s)
- Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Savine C S Minderhoud
- Department of Cardiology and Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johan Wittgren
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Anton Kilburg
- Department of Radiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amir Ese
- Department of Radiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Benjamin Fidock
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Yu-Cong Zheng
- Department of MRI, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun-Mei Zhang
- National Heart Centre Singapore; Duke-NUS Medical School Singapore, National University of Singapore, Singapore
| | - Carmen P S Blanken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Shihua Zhao
- Department of MRI, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Liang Zhong
- National Heart Centre Singapore; Duke-NUS Medical School Singapore, National University of Singapore, Singapore
| | - Xiuyu Chen
- Department of MRI, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pankaj Garg
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Tilman Emrich
- Department of Radiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Alexander Hirsch
- Department of Cardiology and Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes Töger
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Juffermans JF, Westenberg JJM, van den Boogaard PJ, Roest AAW, van Assen HC, van der Palen RLF, Lamb HJ. Reproducibility of Aorta Segmentation on 4D Flow MRI in Healthy Volunteers. J Magn Reson Imaging 2020; 53:1268-1279. [PMID: 33179389 PMCID: PMC7984392 DOI: 10.1002/jmri.27431] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background Hemodynamic aorta parameters can be derived from 4D flow MRI, but this requires lumen segmentation. In both commercially available and research 4D flow MRI software tools, lumen segmentation is mostly (semi‐)automatically performed and subsequently manually improved by an observer. Since the segmentation variability, together with 4D flow MRI data and image processing algorithms, will contribute to the reproducibility of patient‐specific flow properties, the observer's lumen segmentation reproducibility and repeatability needs to be assessed. Purpose To determine the interexamination, interobserver reproducibility, and intraobserver repeatability of aortic lumen segmentation on 4D flow MRI. Study Type Prospective and retrospective. Population A healthy volunteer cohort of 10 subjects who underwent 4D flow MRI twice. Also, a clinical cohort of six subjects who underwent 4D flow MRI once. Field Strength/Sequence 3T; time‐resolved three‐directional and 3D velocity‐encoded sequence (4D flow MRI). Assessment The thoracic aorta was segmented on the 4D flow MRI in five systolic phases. By positioning six planes perpendicular to a segmentation's centerline, the aorta was divided into five segments. The volume, surface area, centerline length, maximal diameter, and curvature radius were determined for each segment. Statistical Tests To assess the reproducibility, the coefficient of variation (COV), Pearson correlation coefficient (r), and intraclass correlation coefficient (ICC) were calculated. Results The interexamination and interobserver reproducibility and intraobserver repeatability were comparable for each parameter. For both cohorts there was very good reproducibility and repeatability for volume, surface area, and centerline length (COV = 10–32%, r = 0.54–0.95 and ICC = 0.65–0.99), excellent reproducibility and repeatability for maximal diameter (COV = 3–11%, r = 0.94–0.99, ICC = 0.94–0.99), and good reproducibility and repeatability for curvature radius (COV = 25–62%, r = 0.73–0.95, ICC = 0.84–0.97). Data Conclusion This study demonstrated no major reproducibility and repeatability limitations for 4D flow MRI aortic lumen segmentation. Level of Evidence 3 Technical Efficacy Stage 2
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Affiliation(s)
- Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Arno A W Roest
- Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roel L F van der Palen
- Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Blanken CPS, Westenberg JJM, Aben JP, Bijvoet GP, Chamuleau SAJ, Boekholdt SM, Nederveen AJ, Leiner T, van Ooij P, Planken RN. Quantification of Mitral Valve Regurgitation from 4D Flow MRI Using Semiautomated Flow Tracking. Radiol Cardiothorac Imaging 2020; 2:e200004. [PMID: 33778618 DOI: 10.1148/ryct.2020200004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022]
Abstract
Purpose To compare the accuracy of semiautomated flow tracking with that of semiautomated valve tracking in the quantification of mitral valve (MV) regurgitation from clinical four-dimensional (4D) flow MRI data obtained in patients with mild, moderate, or severe MV regurgitation. Materials and Methods The 4D flow MRI data were retrospectively collected from 30 patients (21 men; mean age, 61 years ± 10 [standard deviation]) who underwent 4D flow MRI from 2006 to 2016. Ten patients had mild MV regurgitation, nine had moderate MV regurgitation, and 11 had severe MV regurgitation, as diagnosed by using semiquantitative echocardiography. The regurgitant volume (Rvol) across the MV was obtained using three methods: indirect quantification of Rvol (RvolINDIRECT), semiautomated quantification of Rvol using valve tracking (RvolVALVE), and semiautomated quantification of Rvol using flow tracking (RvolFLOW). A second observer repeated the measurements. Aortic valve flow was quantified as well to test for intervalve consistency. The Wilcoxon signed rank test, orthogonal regression, Bland-Altman analysis, and coefficients of variation were used to assess agreement among measurements and between observers. Results RvolFLOW was higher (median, 24.8 mL; interquartile range [IQR], 14.3-45.7 mL) than RvolVALVE (median, 9.9 mL; IQR, 6.0-16.9 mL; P < .001). Both RvolFLOW and RvolVALVE differed significantly from RvolINDIRECT (median, 19.1 mL; IQR, 4.1-47.5 mL; P = .03). RvolFLOW agreed more with RvolINDIRECT (ŷ = 0.78x + 12, r = 0.88) than with RvolVALVE (ŷ = 0.16x + 8.1, r = 0.53). Bland-Altman analysis revealed underestimation of RvolVALVE in severe MV regurgitation. Interobserver agreement was excellent for RvolFLOW (r = 0.95, coefficient of variation = 27%) and moderate for RvolVALVE (r = 0.72, coefficient of variation = 57%). Orthogonal regression demonstrated better intervalve consistency for flow tracking (ŷ = 1.2x - 13.4, r = 0.82) than for valve tracking (ŷ = 2.7x - 92.4, r = 0.67). Conclusion Flow tracking enables more accurate 4D flow MRI-derived MV regurgitation quantification than valve tracking in terms of agreement with indirect quantification and intervalve consistency, particularly in severe MV regurgitation.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Carmen P S Blanken
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jos J M Westenberg
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jean-Paul Aben
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geertruida P Bijvoet
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Steven A J Chamuleau
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Matthijs Boekholdt
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aart J Nederveen
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tim Leiner
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pim van Ooij
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Nils Planken
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
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Veger HTC, Pasveer EH, Westenberg JJM, Wever JJ, van Eps RGS. The Influence of Aortic Wall Elasticity on the False Lumen in Aortic Dissection: An In Vitro Study. Vasc Endovascular Surg 2020; 54:592-597. [PMID: 32643584 DOI: 10.1177/1538574420939733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemodynamics, dissection morphology, and aortic wall elasticity have a major influence on the pressure in the false lumen. In contrast to aortic wall elasticity, the influence of hemodynamics and dissection morphology have been investigated often in multiple in vitro and ex vivo studies. The purpose of this study was to evaluate the influence of aortic wall elasticity on the diameter and pressure of the false lumen in aortic dissection. METHODS An artificial dissection was created in 3 ex vivo porcine aortas. The aorta models were consecutively positioned in a validated in vitro circulatory system with physiological pulsatile flow. Each model was imaged with ultrasound on 4 positions along the aorta and the dissection. At these 4 locations, pressure measurement was also performed in the true and false lumen with an arterial catheter. After baseline experiments, the aortic wall elasticity was adjusted with silicon and the experiments were repeated. RESULTS The aortic wall elasticity was decreased in all 3 models after siliconizing. In all 3 siliconized models, the diameters of the true and false lumen increased at proximal, mid, and distal location, while the mean arterial pressure did not significantly change. CONCLUSIONS In this in vitro study, we showed that aortic wall elasticity is an important parameter altering the false lumen. An aortic wall with reduced elasticity results in an increased false lumen diameter in the mid and distal part of the false lumen. These results can only be transferred to corresponding clinical situations to a limited extent.
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Affiliation(s)
- Hugo T C Veger
- Department of Vascular Surgery, 37134Haga Hospital, The Hague, the Netherlands
| | - Erik H Pasveer
- Department of Vascular Surgery, 37134Haga Hospital, The Hague, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Jan J Wever
- Department of Vascular Surgery, 37134Haga Hospital, The Hague, the Netherlands
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Paiman EHM, van Eyk HJ, van Aalst MMA, Bizino MB, van der Geest RJ, Westenberg JJM, Geelhoed-Duijvestijn PH, Kharagjitsingh AV, Rensen PCN, Smit JWA, Jazet IM, Lamb HJ. Effect of Liraglutide on Cardiovascular Function and Myocardial Tissue Characteristics in Type 2 Diabetes Patients of South Asian Descent Living in the Netherlands: A Double-Blind, Randomized, Placebo-Controlled Trial. J Magn Reson Imaging 2019; 51:1679-1688. [PMID: 31799782 PMCID: PMC7318583 DOI: 10.1002/jmri.27009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022] Open
Abstract
Background The glucagon‐like peptide‐1 (GLP‐1) receptor agonist liraglutide may be beneficial in the regression of diabetic cardiomyopathy. South Asian ethnic groups in particular are at risk of developing type 2 diabetes. Purpose To assess the effects of liraglutide on left ventricular (LV) diastolic and systolic function in South Asian type 2 diabetes patients. Study Type Prospective, double‐blind, randomized, placebo‐controlled trial. Population Forty‐seven type 2 diabetes patients of South Asian ancestry living in the Netherlands, with or without ischemic heart disease, who were randomly assigned to 26‐week treatment with liraglutide (1.8 mg/day) or placebo. Field Strength/Sequence 3T (balanced steady‐state free precession cine MRI, 2D and 4D velocity‐encoded MRI, 1H‐MRS, T1 mapping). Assessment Primary endpoints were changes in LV diastolic function (early deceleration peak [Edec], ratio of early and late peak filling rate [E/A], estimated LV filling pressure [E/Ea]) and LV systolic function (ejection fraction). Secondary endpoints were changes in aortic stiffness (aortic pulse wave velocity [PWV]), myocardial steatosis (myocardial triglyceride content), and diffuse fibrosis (extracellular volume [ECV]). Statistical Tests Data were analyzed according to intention‐to‐treat. Between‐group differences were reported as mean (95% confidence interval [CI]) and were assessed using analysis of covariance (ANCOVA). Results Liraglutide (n = 22) compared with placebo (n = 25) did not change Edec (+0.2 mL/s2 × 10‐3 (–0.3;0.6)), E/A (–0.09 (–0.23;0.05)), E/Ea (+0.1 (–1.2;1.3)) and ejection fraction (0% (–3;2)), but decreased stroke volume (–9 mL (–14;–5)) and increased heart rate (+10 bpm (4;15)). Aortic PWV (+0.5 m/s (–0.6;1.6)), myocardial triglyceride content (+0.21% (–0.09;0.51)), and ECV (–0.2% (–1.4;1.0)) were unaltered. Data Conclusion Liraglutide did not affect LV diastolic and systolic function, aortic stiffness, myocardial triglyceride content, or extracellular volume in Dutch South Asian type 2 diabetes patients with or without coronary artery disease. Level of Evidence: 1 Technical Efficacy Stage: 4 J. Magn. Reson. Imaging 2020;51:1679–1688.
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Affiliation(s)
- Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Huub J van Eyk
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - Minke M A van Aalst
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Maurice B Bizino
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Aan V Kharagjitsingh
- Department of Diabetology and Endocrinology, University Hospital Brussels, Brussels, Belgium
| | - Patrick C N Rensen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - Johannes W A Smit
- Department of Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ingrid M Jazet
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
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Bizino MB, Jazet IM, Westenberg JJM, van Eyk HJ, Paiman EHM, Smit JWA, Lamb HJ. Correction to: Effect of liraglutide on cardiac function in patients with type 2 diabetes mellitus: randomized placebo-controlled trial. Cardiovasc Diabetol 2019; 18:101. [PMID: 31399033 PMCID: PMC6688215 DOI: 10.1186/s12933-019-0905-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 11/25/2022] Open
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Ververs FA, Eikendal ALM, Westenberg JJM, Van Der Geest RJ, Nuboer R, Wulffraat NM, Van Der Ent CK, Leiner T, Grotenhuis HB, Schipper HS. P3447Multimodal assessment and phenomapping of early atherosclerosis in children with chronic disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Childhood survival of chronic disease steadily increased over the last decades. However, accumulating evidence suggests that survivors are at risk for early atherosclerosis. The “Cardiovascular Disease in Children with chronic disease” (CDC) study has two aims. First, multimodal assessment of early atherosclerosis was performed in adolescents with chronic inflammatory- and metabolic disorders in order to develop new diagnostic approaches. As fatty streak formation starts in the abdominal aorta, aortic wall thickness (AWT) and pulse wave velocity (PWV) were measured using cardiovascular magnetic resonance imaging (MRI), and compared with traditional carotid intima-media thickness (cIMT) and echocardiography. Second, comprehensive risk profiling was performed, including phenomapping of early risk factors, in order to establish cardiovascular risk profiles in childhood.
Methods
113 adolescents aged 12–19 years old were enrolled*. The study population includes adolescents with juvenile idiopathic arthritis (JIA, n=19), cystic fibrosis (CF, n=24), obesity (n=20), corrected coarctation of the aorta (CoA, n=25), and corrected atrial septal defect as control group (ASD, n=25). The aorta was imaged on a 3.0 Tesla MR system using the 3D-T1-BB-VISTA sequence. Aortic PWV was assessed using velocity-encoded MRI. cIMT was measured in three directions for both the right- and left carotid artery using echography. Unbiased hierarchical clustering was performed on phenotypic data (phenomapping), including anthropomorphic-, metabolic-, and inflammatory parameters.
Results*
Aortic pulse wave velocity on MRI was highest in the obese group compared to controls (p=0.002), yet JIA patients (p=0.015), CoA patients (p=0.029), and CF patients (p=0.044) also showed increased PWV compared to controls. Aortic wall thickness was highest in obese adolescents (p=0.020) and in CF patients (p=0.043). cIMT was only increased in CoA patients (p=0.000). While PWV and AWT showed correlation with inflammatory- and metabolic parameters such as lymphocyte count (PWV, p=0.043), monocyte count (PWV, p=0.002; AWT, p=0.036), CRP (AWT, p=0.032), and QUICKI (PWV, p=0.026), cIMT correlated with systolic blood pressure (p=0.017). Phenomapping of risk factors will further define distinct cardiovascular risk profiles*.
Conclusion
Multimodal assessment of early atherosclerosis in children with chronic disease reveals differential vascular changes. While traditional cIMT is associated with increased systolic blood pressure in young CoA patients, aortic PWV and aortic wall thickness reflect early systemic inflammatory- and metabolic derangement. Phenomapping traditional risk factors alongside inflammatory- and metabolic parameters bears promise to establish early cardiovascular risk profiles in childhood chronic disease*.
*Patient inclusion finishes May 2019, followed by phenomapping of patient characteristics. At the ESC, final data will be presented.
Acknowledgement/Funding
Wilhelmina Children's Hospital Research Fund, Dutch Topsector Life Sciences and Health TKI fund, Nutricia Research fund. HS was supported by VENI-NWO.
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Affiliation(s)
- F A Ververs
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - A L M Eikendal
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | | | | | - R Nuboer
- Meander Medical Center, Amersfoort, Netherlands (The)
| | - N M Wulffraat
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - C K Van Der Ent
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - T Leiner
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - H B Grotenhuis
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - H S Schipper
- University Medical Center Utrecht, Utrecht, Netherlands (The)
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Kamphuis VP, Elbaz MSM, van den Boogaard PJ, Kroft LJM, Lamb HJ, Hazekamp MG, Jongbloed MRM, Blom NA, Helbing WA, Roest AAW, Westenberg JJM. Stress increases intracardiac 4D flow cardiovascular magnetic resonance -derived energetics and vorticity and relates to VO 2max in Fontan patients. J Cardiovasc Magn Reson 2019; 21:43. [PMID: 31340834 PMCID: PMC6657113 DOI: 10.1186/s12968-019-0553-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/14/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. Therefore, the purpose of this study was to assess the effect of pharmacologic stress on intraventricular kinetic energy (KE), viscous energy loss (EL) and vorticity from four-dimensional (4D) Flow cardiovascular magnetic resonance (CMR) imaging in Fontan patients and to study the association between stress response and exercise capacity. METHODS Ten Fontan patients underwent whole-heart 4D flow CMR before and during 7.5 μg/kg/min dobutamine infusion and cardiopulmonary exercise testing (CPET) on the same day. Average ventricular KE, EL and vorticity were computed over systole, diastole and the total cardiac cycle (vorticity_volavg cycle, KEavg cycle, ELavg cycle). The relation to maximum oxygen uptake (VO2 max) from CPET was tested by Pearson's correlation or Spearman's rank correlation in case of non-normality of the data. RESULTS Dobutamine stress caused a significant 88 ± 52% increase in KE (KEavg cycle: 1.8 ± 0.5 vs 3.3 ± 0.9 mJ, P < 0.001), a significant 108 ± 49% increase in EL (ELavg cycle: 0.9 ± 0.4 vs 1.9 ± 0.9 mW, P < 0.001) and a significant 27 ± 19% increase in vorticity (vorticity_volavg cycle: 3441 ± 899 vs 4394 ± 1322 mL/s, P = 0.002). All rest-stress differences (%) were negatively correlated to VO2 max (KEavg cycle: r = - 0.83, P = 0.003; ELavg cycle: r = - 0.80, P = 0.006; vorticity_volavg cycle: r = - 0.64, P = 0.047). CONCLUSIONS 4D flow CMR-derived intraventricular kinetic energy, viscous energy loss and vorticity in Fontan patients increase during pharmacologic stress and show a negative correlation with exercise capacity measured by VO2 max.
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Affiliation(s)
- Vivian P. Kamphuis
- Department of Pediatrics division of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Mohammed S. M. Elbaz
- Department of Radiology Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Lucia J. M. Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J. Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark G. Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Nico A. Blom
- Department of Pediatrics division of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pediatrics division of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Willem A. Helbing
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics division of Pediatric Cardiology, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Arno A. W. Roest
- Department of Pediatrics division of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jos J. M. Westenberg
- Department of Radiology Feinberg School of Medicine, Northwestern University, Chicago, USA
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41
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Zhong L, Schrauben EM, Garcia J, Uribe S, Grieve SM, Elbaz MSM, Barker AJ, Geiger J, Nordmeyer S, Marsden A, Carlsson M, Tan RS, Garg P, Westenberg JJM, Markl M, Ebbers T. Intracardiac 4D Flow MRI in Congenital Heart Disease: Recommendations on Behalf of the ISMRM Flow & Motion Study Group. J Magn Reson Imaging 2019; 50:677-681. [PMID: 31317587 DOI: 10.1002/jmri.26858] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/08/2022] Open
Abstract
LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:677-681.
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Affiliation(s)
- Liang Zhong
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School Singapore, National University of Singapore, Singapore
| | - Eric M Schrauben
- Translational Medicine, Hospital for Sick Children, Toronto, Canada
| | - Julio Garcia
- Departments of Radiology and Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Sergio Uribe
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Radiology Department and Biomedical Imaging Center, School of Medicine, Pontifica Universidad Catolica de Chile, Chile
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Australia; Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Mohammed S M Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology and Bioengineering, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Switzerland
| | - Sarah Nordmeyer
- Department of Pediatric Cardiology and Congenital Heart Diseases German Heart Center Berlin Germany; Institute for Cardiovascular Computer-assisted Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - Alison Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California, USA
| | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School Singapore, National University of Singapore, Singapore
| | | | | | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tino Ebbers
- Department of Medical and Health Sciences and Center for Medical Imaging Sciences and Visualization, Linköping University, Sweden
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Adriaans BP, Wildberger JE, Westenberg JJM, Lamb HJ, Schalla S. Predictive imaging for thoracic aortic dissection and rupture: moving beyond diameters. Eur Radiol 2019; 29:6396-6404. [PMID: 31278573 PMCID: PMC6828629 DOI: 10.1007/s00330-019-06320-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/07/2019] [Accepted: 06/11/2019] [Indexed: 01/09/2023]
Abstract
Abstract Acute aortic syndromes comprise a group of potentially fatal conditions that result from weakening of the aortic vessel wall. Pre-emptive surgical intervention is currently reserved for patients with severe aortic dilatation, although abundant evidence describes the occurrence of dissection and rupture in aortas with diameters below surgical thresholds. Modern imaging techniques (such as hybrid PET-CT and 4D flow MRI) afford the non-invasive assessment of anatomic, hemodynamic, and molecular features of the aorta, and may provide for a more accurate selection of patients who will benefit from preventative surgical intervention. In the current review, we summarize evidence and considerations regarding predictive aortic imaging and highlight evolving imaging modalities that have shown promise to improve risk assessment for the occurrence of dissection and rupture. Key Points • Guidelines for the preventative management of aortic disease depend on maximal vessel diameters, while these have shown to be poor predictors for the occurrence of catastrophic acute aortic events. • Evolving imaging modalities (such as 4D flow MRI and hybrid PET-CT) afford a more comprehensive insight into anatomic, hemodynamic, and molecular features of the aorta and have shown promise to detect vessel wall instability at an early stage.
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Affiliation(s)
- Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. .,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands. .,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Simon Schalla
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
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43
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Adriaans BP, Westenberg JJM, van Cauteren YJM, Gerretsen S, Elbaz MSM, Bekkers SCAM, Veenstra LF, Crijns HJGM, Wildberger JE, Schalla S. Clinical assessment of aortic valve stenosis: Comparison between 4D flow MRI and transthoracic echocardiography. J Magn Reson Imaging 2019; 51:472-480. [PMID: 31257647 PMCID: PMC7004028 DOI: 10.1002/jmri.26847] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/30/2022] Open
Abstract
Background The prevalence of valvular aortic stenosis (AS) increases as the population ages. Echocardiographic measurements of peak jet velocity (Vpeak), mean pressure gradient (Pmean), and aortic valve area (AVA) determine AS severity and play a pivotal role in the stratification towards valvular replacement. A multimodality imaging approach might be needed in cases of uncertainty about the actual severity of the stenosis. Purpose To compare four‐dimensional phase‐contrast magnetic resonance (4D PC‐MR), two‐dimensional (2D) PC‐MR, and transthoracic echocardiography (TTE) for quantification of AS. Study Type Prospective. Population Twenty patients with various degrees of AS (69.3 ± 5.0 years). Field Strength/Sequences 4D PC‐MR and 2D PC‐MR at 3T. Assessment We compared Vpeak, Pmean, and AVA between TTE, 4D PC‐MR, and 2D PC‐MR. Flow eccentricity was quantified by means of normalized flow displacement, and its influence on the accuracy of TTE measurements was investigated. Statistical Tests Pearson's correlation, Bland–Altman analysis, paired t‐test, and intraclass correlation coefficient. Results 4D PC‐MR measured higher Vpeak (r = 0.95, mean difference + 16.4 ± 10.7%, P <0.001), and Pmean (r = 0.92, mean difference + 14.9 ± 16.0%, P = 0.013), but a less critical AVA (r = 0.80, mean difference + 19.9 ± 20.6%, P = 0.002) than TTE. In contrast, unidirectional 2D PC‐MR substantially underestimated AS severity when compared with TTE. Differences in Vpeak between 4D PC‐MR and TTE showed to be strongly correlated with the eccentricity of the flow jet (r = 0.89, P <0.001). Use of 4D PC‐MR improved the concordance between Vpeak and AVA (from 0.68 to 0.87), and between PGmean and AVA (from 0.68 to 0.86). Data Conclusion 4D PC‐MR improves the concordance between the different AS parameters and could serve as an additional imaging technique next to TTE. Future studies should address the potential value of 4D PC‐MR in patients with discordant echocardiographic parameters. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:472–480.
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Affiliation(s)
- Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yvonne J M van Cauteren
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Suzanne Gerretsen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mohammed S M Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sebastiaan C A M Bekkers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Leo F Veenstra
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Simon Schalla
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
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Juffermans JF, Nederend I, van den Boogaard PJ, Ten Harkel ADJ, Hazekamp MG, Lamb HJ, Roest AAW, Westenberg JJM. The effects of age at correction of aortic coarctation and recurrent obstruction on adolescent patients: MRI evaluation of wall shear stress and pulse wave velocity. Eur Radiol Exp 2019; 3:24. [PMID: 31222473 PMCID: PMC6586735 DOI: 10.1186/s41747-019-0102-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/17/2019] [Indexed: 01/17/2023] Open
Abstract
Background Coarctation patients before curative reconstruction are exposed to abnormal flow patterns which potentially could cause wall deterioration. This study evaluated the effect of age at correction on the pulse wave velocity (PWV) and peak wall shear stress (WSS) in adolescent patients with corrected coarctation. Effects of valve morphology and presence of reobstruction were also evaluated. Methods Twenty-one patients aged 13.7 ± 2.6 years (mean ± standard deviation) were included (bicuspid aortic valve, n = 14; reobstruction, n = 9). Mean age at correction was 1.0 ± 1.8 years. PWV was determined from two high-temporal through-plane phase-contrast magnetic resonance imaging (MRI) acquisitions, for two segments: ascending aorta plus aortic arch and descending aorta. WSS was determined from four-dimensional flow MRI. Peak WSS over five systolic phases was determined for ascending aorta, aortic arch, and descending aorta. Results Patients with tricuspid aortic valve showed a significant correlation between the age at correction and descending aorta PWV (rs = 0.80, p = 0.010). Significant differences were found between patients without and with reobstruction for peak WSS in the aortic arch (3.9 ± 1.3 Pa versus 6.5 ± 2.2 Pa, respectively; p = 0.003) and descending aorta (5.0 ± 1.3 Pa versus 6.7 ± 1.1 Pa, respectively; p = 0.005). Conclusions A prolonged period of abnormal haemodynamic exposure may result in increased aortic wall stiffening. The increased peak WSS as results of a reobstruction possibly promotes different disease progression, which endorse longitudinal follow-up examination of corrected coarctation patients.
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Affiliation(s)
- Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | - Ineke Nederend
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Pieter J van den Boogaard
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
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45
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Adriaans B, Westenberg JJM, Van Cauteren YJM, Bekkers SCAM, Wildberger JE, Schalla S. 517Assessment of aortic valve stenosis using 4D flow MR: comparison to 2D PC MR and TTE. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez124.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Adriaans
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - J J M Westenberg
- Leiden University Medical Center, Radiology, Leiden, Netherlands (The)
| | - Y J M Van Cauteren
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - S C A M Bekkers
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - J E Wildberger
- Maastricht University Medical Centre (MUMC), Radiology, Maastricht, Netherlands (The)
| | - S Schalla
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
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46
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Hofman MBM, Rodenburg MJA, Markenroth Bloch K, Werner B, Westenberg JJM, Valsangiacomo Buechel ER, Nijveldt R, Spruijt OA, Kilner PJ, van Rossum AC, Gatehouse PD. In-vivo validation of interpolation-based phase offset correction in cardiovascular magnetic resonance flow quantification: a multi-vendor, multi-center study. J Cardiovasc Magn Reson 2019; 21:30. [PMID: 31104632 PMCID: PMC6526620 DOI: 10.1186/s12968-019-0538-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 04/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A velocity offset error in phase contrast cardiovascular magnetic resonance (CMR) imaging is a known problem in clinical assessment of flow volumes in vessels around the heart. Earlier studies have shown that this offset error is clinically relevant over different systems, and cannot be removed by protocol optimization. Correction methods using phantom measurements are time consuming, and assume reproducibility of the offsets which is not the case for all systems. An alternative previously published solution is to correct the in-vivo data in post-processing, interpolating the velocity offset from stationary tissue within the field-of-view. This study aims to validate this interpolation-based offset correction in-vivo in a multi-vendor, multi-center setup. METHODS Data from six 1.5 T CMR systems were evaluated, with two systems from each of the three main vendors. At each system aortic and main pulmonary artery 2D flow studies were acquired during routine clinical or research examinations, with an additional phantom measurement using identical acquisition parameters. To verify the phantom acquisition, a region-of-interest (ROI) at stationary tissue in the thorax wall was placed and compared between in-vivo and phantom measurements. Interpolation-based offset correction was performed on the in-vivo data, after manually excluding regions of spatial wraparound. Correction performance of different spatial orders of interpolation planes was evaluated. RESULTS A total of 126 flow measurements in 82 subjects were included. At the thorax wall the agreement between in-vivo and phantom was - 0.2 ± 0.6 cm/s. Twenty-eight studies were excluded because of a difference at the thorax wall exceeding 0.6 cm/s from the phantom scan, leaving 98. Before correction, the offset at the vessel as assessed in the phantom was - 0.4 ± 1.5 cm/s, which resulted in a - 5 ± 16% error in cardiac output. The optimal order of the interpolation correction plane was 1st order, except for one system at which a 2nd order plane was required. Application of the interpolation-based correction revealed a remaining offset velocity of 0.1 ± 0.5 cm/s and 0 ± 5% error in cardiac output. CONCLUSIONS This study shows that interpolation-based offset correction reduces the offset with comparable efficacy as phantom measurement phase offset correction, without the time penalty imposed by phantom scans. TRIAL REGISTRATION The study was registered in The Netherlands National Trial Register (NTR) under TC 4865 . Registered 19 September 2014. Retrospectively registered.
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Affiliation(s)
- Mark B. M. Hofman
- Radiology and Nuclear Medicine, ICaR-VU, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Manouk J. A. Rodenburg
- Radiology and Nuclear Medicine, ICaR-VU, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Karin Markenroth Bloch
- Lund University Bioimaging Center, Lund University, SE-221 85 Lund, Sweden
- Philips Healthcare, SE-164 85 Stockholm, Sweden
| | - Beat Werner
- Department Diagnostic Imaging, University Children’s Hospital, Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Jos J. M. Westenberg
- Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | | | - Robin Nijveldt
- Cardiology, ICaR-VU, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Onno A. Spruijt
- Pulmonology, ICaR-VU, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Philip J. Kilner
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
| | - Albert C. van Rossum
- Cardiology, ICaR-VU, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Peter D. Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
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Shahzad R, Shankar A, Amier R, Nijveldt R, Westenberg JJM, de Roos A, Lelieveldt BPF, van der Geest RJ. Quantification of aortic pulse wave velocity from a population based cohort: a fully automatic method. J Cardiovasc Magn Reson 2019; 21:27. [PMID: 31088480 PMCID: PMC6518670 DOI: 10.1186/s12968-019-0530-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 02/14/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Aortic pulse wave velocity (PWV) is an indicator of aortic stiffness and is used as a predictor of adverse cardiovascular events. PWV can be non-invasively assessed using magnetic resonance imaging (MRI). PWV computation requires two components, the length of the aortic arch and the time taken for the systolic pressure wave to travel through the aortic arch. The aortic length is calculated using a multi-slice 3D scan and the transit time is computed using a 2D velocity encoded MRI (VE) scan. In this study we present and evaluate an automatic method to quantify the aortic pulse wave velocity using a large population-based cohort. METHODS For this study 212 subjects were retrospectively selected from a large multi-center heart-brain connection cohort. For each subject a multi-slice 3D scan of the aorta was acquired in an oblique-sagittal plane and a 2D VE scan acquired in a transverse plane cutting through the proximal ascending and descending aorta. PWV was calculated in three stages: (i) a multi-atlas-based segmentation method was developed to segment the aortic arch from the multi-slice 3D scan and subsequently estimate the length of the proximal aorta, (ii) an algorithm that delineates the proximal ascending and descending aorta from the time-resolved 2D VE scan and subsequently obtains the velocity-time flow curves was also developed, and (iii) automatic methods that can compute the transit time from the velocity-time flow curves were implemented and investigated. Finally the PWV was obtained by combining the aortic length and the transit time. RESULTS Quantitative evaluation with respect to the length of the aortic arch as well as the computed PWV were performend by comparing the results of the novel automatic method to those obtained manually. The mean absolute difference in aortic length obtained automatically as compared to those obtained manually was 3.3 ± 2.8 mm (p < 0.05), the manual inter-observer variability on a subset of 45 scans was 3.4 ± 3.4 mm (p = 0.49). Bland-Altman analysis between the automataic method and the manual methods showed a bias of 0.0 (-5.0,5.0) m/s for the foot-to-foot approach, -0.1 (-1.2, 1.1) and -0.2 (-2.6, 2.1) m/s for the half-max and the cross-correlation methods, respectively. CONCLUSION We proposed and evaluated a fully automatic method to calculate the PWV on a large set of multi-center MRI scans. It was observed that the overall results obtained had very good agreement with manual analysis. Our proposed automatic method would be very beneficial for large population based studies, where manual analysis requires a lot of manpower.
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Affiliation(s)
- Rahil Shahzad
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
| | - Arun Shankar
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
| | - Raquel Amier
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV The Netherlands
| | - Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
| | - Boudewijn P. F. Lelieveldt
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
- Intelligent Systems Department, Delft University of Technology, Van Mourik Broekmanweg 6, Delft, 2628 XE The Netherlands
| | - Rob J. van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
| | - on behalf of the Heart Brain Connection study group
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV The Netherlands
- Intelligent Systems Department, Delft University of Technology, Van Mourik Broekmanweg 6, Delft, 2628 XE The Netherlands
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Bizino MB, Jazet IM, Westenberg JJM, van Eyk HJ, Paiman EHM, Smit JWA, Lamb HJ. Effect of liraglutide on cardiac function in patients with type 2 diabetes mellitus: randomized placebo-controlled trial. Cardiovasc Diabetol 2019; 18:55. [PMID: 31039778 PMCID: PMC6492440 DOI: 10.1186/s12933-019-0857-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background Liraglutide is an antidiabetic agent with cardioprotective effect. The purpose of this study is to test efficacy of liraglutide to improve diabetic cardiomyopathy in patients with diabetes mellitus type 2 (DM2) without cardiovascular disease. Methods Patients with DM2 were randomly assigned to receive liraglutide 1.8 mg/day or placebo in this double-blind trial of 26 weeks. Primary outcome measures were LV diastolic function (early (E) and late (A) transmitral peak flow rate, E/A ratio, early deceleration peak (Edec), early peak mitral annular septal tissue velocity (Ea) and estimated LV filling pressure (E/Ea), and systolic function (stroke volume, ejection fraction, cardiac output, cardiac index and peak ejection rate) assessed with CMR. Intention-to-treat analysis of between-group differences was performed using ANCOVA. Mean estimated treatment differences (95% confidence intervals) are reported. Results 23 patients were randomized to liraglutide and 26 to placebo. As compared with placebo, liraglutide significantly reduced E (− 56 mL/s (− 91 to − 21)), E/A ratio (− 0.17 (− 0.27 to − 0.06)), Edec (− 0.9 mL/s2 * 10−3 (− 1.3 to − 0.2)) and E/Ea (− 1.8 (− 3.0 to − 0.6)), without affecting A (3 mL/s (− 35 to 41)) and Ea (0.4 cm/s (− 0.9 to 1.4)). Liraglutide reduced stroke volume (− 9 mL (− 16 to − 2)) and ejection fraction (− 3% (− 6 to − 0.1)), but did not change cardiac output (− 0.4 L/min (− 0.9 to 0.2)), cardiac index (− 0.1 L/min/m2 (− 0.4 to 0.1)) and peak ejection rate (− 46 mL/s (− 95 to 3)). Conclusions Liraglutide reduced early LV diastolic filling and LV filling pressure, thereby unloading the left ventricle. LV systolic function reduced and remained within normal range. Future studies are needed to investigate if liraglutide-induced left ventricular unloading slows progression of diabetic cardiomyopathy into symptomatic stages. Trial registration ClinicalTrials.gov: NCT01761318.
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Affiliation(s)
- Maurice B Bizino
- Department of Radiology, Leiden University Medical Center, LUMC Postzone C2S, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Ingrid M Jazet
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, LUMC Postzone C2S, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Huub J van Eyk
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, LUMC Postzone C2S, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jan W A Smit
- Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hildebrandus J Lamb
- Department of Radiology, Leiden University Medical Center, LUMC Postzone C2S, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Paiman EHM, Louwerens M, Bresters D, Westenberg JJM, Tao Q, van der Geest RJ, Lankester AC, Roest AAW, Lamb HJ. Late effects of pediatric hematopoietic stem cell transplantation on left ventricular function, aortic stiffness and myocardial tissue characteristics. J Cardiovasc Magn Reson 2019; 21:6. [PMID: 30651110 PMCID: PMC6335808 DOI: 10.1186/s12968-018-0513-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 12/04/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pediatric hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of cardiovascular disease later in life. As HSCT survival has significantly improved, with a growing number of HSCT indications, tailored screening strategies for HSCT-related late effects are warranted. Little is known regarding the value of cardiovascular magnetic resonance (CMR) for early identification of high-risk patients after HSCT, before symptomatic cardiovascular disease manifests. This study aimed to assess CMR-derived left ventricular (LV) systolic and diastolic function, aortic stiffness and myocardial tissue characteristics in young adults who received HSCT during childhood. METHODS Sixteen patients (22.1 ± 1.5 years) treated with HSCT during childhood and 16 healthy controls (22.1 ± 1.8 years) underwent 3 T CMR. LV systolic and diastolic function were measured as LV ejection fraction (LVEF), the ratio of transmitral early and late peak filling rate (E/A), the estimated LV filling pressure (E/Ea) and global longitudinal and circumferential systolic strain and diastolic strain rates, using balanced steady-state free precession cine CMR and 2D velocity-encoded CMR over the mitral valve. Aortic stiffness, myocardial fibrosis and steatosis were assessed with 2D velocity-encoded CMR, native T1 mapping and proton CMR spectroscopy (1H-CMRS), respectively. RESULTS In the patient compared to the control group, E/Ea (9.92 ± 3.42 vs. 7.24 ± 2.29, P = 0.004) was higher, LVEF (54 ± 6% vs. 58 ± 5%, P = 0.055) and global longitudinal strain (GLS) ( -20.7 ± 3.5% vs. -22.9 ± 3.0%, P = 0.063) tended to be lower, while aortic pulse wave velocity (4.40 ± 0.26 vs. 4.29 ± 0.29 m/s, P = 0.29), native T1 (1211 ± 36 vs. 1227 ± 28 ms, P = 0.16) and myocardial triglyceride content (0.47 ± 0.18 vs. 0.50 ± 0.13%, P = 0.202) were comparable. There were no differences between patients and controls in E/A (2.76 ± 0.92 vs. 2.97 ± 0.91, P = 0.60) and diastolic strain rates. CONCLUSION In young adults who received HSCT during childhood, LV diastolic function was decreased (higher estimated LV filling pressure) and LV systolic function (LVEF and GLS) tended to be reduced as compared to healthy controls, whereas no concomitant differences were found in aortic stiffness and myocardial tissue characteristics. When using CMR, assessment of LV diastolic function in particular is important for early detection of patients at risk of HSCT-related cardiovascular disease, which may warrant closer surveillance.
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Affiliation(s)
- Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, postal zone C2-S, 2300 RC, Leiden, The Netherlands.
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, P.O. Box 9600, postal zone C7-Q, 2300 RC, Leiden, The Netherlands
| | - Dorine Bresters
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, postal zone C2-S, 2300 RC, Leiden, The Netherlands
| | - Qian Tao
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, postal zone C2-S, 2300 RC, Leiden, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, postal zone C2-S, 2300 RC, Leiden, The Netherlands
| | - Arjan C Lankester
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno A W Roest
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, postal zone C2-S, 2300 RC, Leiden, The Netherlands
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50
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Garg P, van der Geest RJ, Swoboda PP, Crandon S, Fent GJ, Foley JRJ, Dobson LE, Al Musa T, Onciul S, Vijayan S, Chew PG, Brown LAE, Bissell M, Hassell MECJ, Nijveldt R, Elbaz MSM, Westenberg JJM, Dall'Armellina E, Greenwood JP, Plein S. Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood flow energetics. Eur Heart J Cardiovasc Imaging 2019; 20:108-117. [PMID: 30137274 PMCID: PMC6302263 DOI: 10.1093/ehjci/jey121] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/31/2018] [Accepted: 08/02/2018] [Indexed: 01/16/2023] Open
Abstract
Aims The main aim of this study was to characterize changes in the left ventricular (LV) blood flow kinetic energy (KE) using four-dimensional (4D) flow cardiovascular magnetic resonance imaging (CMR) in patients with myocardial infarction (MI) with/without LV thrombus (LVT). Methods and results This is a prospective cohort study of 108 subjects [controls = 40, MI patients without LVT (LVT- = 36), and MI patients with LVT (LVT+ = 32)]. All underwent CMR including whole-heart 4D flow. LV blood flow KE wall calculated using the formula: KE=12 ρblood . Vvoxel . v2, where ρ = density, V = volume, v = velocity, and was indexed to LV end-diastolic volume. Patient with MI had significantly lower LV KE components than controls (P < 0.05). LVT+ and LVT- patients had comparable infarct size and apical regional wall motion score (P > 0.05). The relative drop in A-wave KE from mid-ventricle to apex and the proportion of in-plane KE were higher in patients with LVT+ compared with LVT- (87 ± 9% vs. 78 ± 14%, P = 0.02; 40 ± 5% vs. 36 ± 7%, P = 0.04, respectively). The time difference of peak E-wave KE demonstrated a significant rise between the two groups (LVT-: 38 ± 38 ms vs. LVT+: 62 ± 56 ms, P = 0.04). In logistic-regression, the relative drop in A-wave KE (beta = 11.5, P = 0.002) demonstrated the strongest association with LVT. Conclusion Patients with MI have reduced global LV flow KE. Additionally, MI patients with LVT have significantly reduced and delayed wash-in of the LV. The relative drop of distal intra-ventricular A-wave KE, which represents the distal late-diastolic wash-in of the LV, is most strongly associated with the presence of LVT.
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Affiliation(s)
- Pankaj Garg
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Rob J van der Geest
- The Department of Radiology, Leiden University Medical Center, Postalzone C2-S, RC Leiden, The Netherlands
| | - Peter P Swoboda
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Saul Crandon
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Graham J Fent
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - James R J Foley
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Laura E Dobson
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Tarique Al Musa
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Sebastian Onciul
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | | | - Pei G Chew
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Louise A E Brown
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Malenka Bissell
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Mariëlla E C J Hassell
- Radboudumc, Department of Cardiology, Geert Grooteplein Zuid 10, GA Nijmegen, The Netherlands
| | - Robin Nijveldt
- Radboudumc, Department of Cardiology, Geert Grooteplein Zuid 10, GA Nijmegen, The Netherlands
| | - Mohammed S M Elbaz
- The Department of Radiology, Leiden University Medical Center, Postalzone C2-S, RC Leiden, The Netherlands
| | - Jos J M Westenberg
- The Department of Radiology, Leiden University Medical Center, Postalzone C2-S, RC Leiden, The Netherlands
| | | | - John P Greenwood
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
| | - Sven Plein
- Division of Biomedical Imaging, LICAMM, University of Leeds, Leeds, UK
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