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Cantinotti M, Marchese P, Franchi E, Santoro G, Assanta N, Giordano R. Four-Dimensional Flow Echocardiography: Blood Speckle Tracking in Congenital Heart Disease: How to Apply, How to Interpret, What Is Feasible, and What Is Missing Still. Healthcare (Basel) 2024; 12:263. [PMID: 38275542 PMCID: PMC10815034 DOI: 10.3390/healthcare12020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Blood speckle tracking echocardiography (BSTE) is a new, promising 4D flow ultrafast non-focal plane imaging technique. The aim of the present investigation is to provide a review and update on potentialities and application of BSTE in children with congenital heart disease (CHD) and acquired heart disease. A literature search was performed within the National Library of Medicine using the keywords "echocardiography", "BST", and "children". The search was refined by adding the keywords "ultrafast imaging", "CHD", and "4D flow". Fifteen studies were finally included. Our analysis outlined how BSTE is highly feasible, fast, and easy for visualization of normal/abnormal flow patterns in healthy children and in those with CHD. BSTE allows for visualization and basic 2D measures of normal/abnormal vortices forming the ventricles and in the main vessel. Left ventricular vortex characteristics and aortic flow patterns have been described both in healthy children and in those with CHD. Complex analysis (e.g., energy loss, vorticity, and vector complexity) are also highly feasible with BSTE, but software is currently available only for research. Furthermore, current technology allows for BSTE only in neonates and low-weight children (e.g., <40 kg). In summary, the feasibility and potentialities of BSTE as a complementary diagnostic tool in children have been proved; however, its systemic use is hampered by the lack of (i) accessible tools for complex quantification and for acquisition at all ages/weight, (ii) data on the diagnostic/prognostic significance of BSTE, and (iii) consensus/recommendation papers indicating when and how BSTE should be employed.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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Spaziani G, Bonanni F, Girolami F, Bennati E, Calabri GB, Di Filippo C, Porcedda G, Passantino S, Nistri S, Olivotto I, Favilli S. Aortic Dilatation in Pediatric Patients with Bicuspid Aortic Valve: How the Choice of Nomograms May Change Prevalence. Diagnostics (Basel) 2023; 13:diagnostics13081490. [PMID: 37189592 DOI: 10.3390/diagnostics13081490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Aortic dilation (AoD) is commonly reported in patients with bicuspid aortic valve (BAV) and has been related to flow abnormalities and genetic predisposition. AoD-related complications are reported to be extremely rare in children. Conversely, an overestimate of AoD related to body size may lead to excess diagnoses and negatively impact quality of life and an active lifestyle. In the present study, we compared the diagnosis performance of the newly introduced Q-score (based on a machine-learning algorithm) versus the traditional Z-score in a large consecutive pediatric cohort with BAV. MATERIALS AND METHODS Prevalence and progression of AoD were evaluated in 281 pediatric patients ages > 5 and < 18 years at first observation, 249 of whom had isolated BAV and 32 had BAV associated with aortic coarctation (CoA-BAV). An additional group of 24 pediatric patients with isolated CoA was considered. Measurements were made at the level of the aortic annulus, Valsalva sinuses, sinotubular aorta, and proximal ascending aorta. Both Z-scores using traditional nomograms and the new Q-score were calculated at baseline and at followup (mean 4.5 years). RESULTS A dilation of the proximal ascending aorta was suggested by traditional nomograms (Z-score > 2) in 31.2% of patients with isolated BAV and 18.5% with CoA-BAV at baseline and in 40.7% and 33.3%, respectively, at followup. No significant dilation was found in patients with isolated CoA. Using the new Q-score calculator, ascending aorta dilation was detected in 15.4% of patients with BAV and 18.5% with CoA-BAV at baseline and in 15.8% and 3.7%, respectively, at followup. AoD was significantly related to the presence and degree of aortic stenosis (AS) but not to aortic regurgitation (AR). No AoD-related complications occurred during the followup. CONCLUSIONS Our data confirm the presence of ascending aorta dilation in a consistent subgroup of pediatric patients with isolated BAV, with progression during followup, while AoD was less common when CoA was associated with BAV. A positive correlation was found with the prevalence and degree of AS, but not with AR. Finally, the nomograms used may significantly influence the prevalence of AoD, especially in children, with a possible overestimation by traditional nomograms. This concept requires prospective validation in long-term followup.
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Affiliation(s)
- Gaia Spaziani
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Francesca Bonanni
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Firenze, Italy
| | - Francesca Girolami
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Elena Bennati
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Giovanni Battista Calabri
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Chiara Di Filippo
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Giulio Porcedda
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Silvia Passantino
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
| | - Stefano Nistri
- Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy
| | - Iacopo Olivotto
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Firenze, Italy
| | - Silvia Favilli
- Pediatric and Transition Cardiology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50139 Florence, Italy
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3
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Hanigk M, Burgstaller E, Latus H, Shehu N, Zimmermann J, Martinoff S, Hennemuth A, Ewert P, Stern H, Meierhofer C. Aortic wall shear stress in bicuspid aortic valve disease-10-year follow-up. Cardiovasc Diagn Ther 2023; 13:38-50. [PMID: 36864959 PMCID: PMC9971286 DOI: 10.21037/cdt-22-477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/19/2022] [Indexed: 02/21/2023]
Abstract
Background Bicuspid aortic valve (BAV) disease leads to deviant helical flow patterns especially in the mid-ascending aorta (AAo), potentially causing wall alterations such as aortic dilation and dissection. Among others, wall shear stress (WSS) could contribute to the prediction of long-term outcome of patients with BAV. 4D flow in cardiovascular magnetic resonance (CMR) has been established as a valid method for flow visualization and WSS estimation. The aim of this study is to reevaluate flow patterns and WSS in patients with BAV 10 years after the initial evaluation. Methods Fifteen patients (median age 34.0 years) with BAV were re-evaluated 10 years after the initial study from 2008/2009 using 4D flow by CMR. Our particular patient cohort met the same inclusion criteria as in 2008/2009, all without enlargement of the aorta or valvular impairment at that time. Flow patterns, aortic diameters, WSS and distensibility were calculated in different aortic regions of interest (ROI) with dedicated software tools. Results Indexed aortic diameters in the descending aorta (DAo), but especially in the AAo did not change in the 10-year period. Median difference 0.05 cm/m2 (95% CI: 0.01 to 0.22; P=0.06) for AAo and median difference -0.08 cm/m2 (95% CI: -0.12 to 0.01; P=0.07) for DAo. WSS values were lower in 2018/2019 at all measured levels. Aortic distensibility decreased by median 25.6% in the AAo, while stiffness increased concordantly (median +23.6%). Conclusions After a ten years' follow-up of patients with isolated BAV disease, indexed aortic diameters did not change in this patient cohort. WSS was lower compared to values generated 10 years earlier. Possibly a drop of WSS in BAV could serve as a marker for a benign long-term course and implementation of more conservative treatment strategies.
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Affiliation(s)
- Michael Hanigk
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Elisabeth Burgstaller
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiner Latus
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Judith Zimmermann
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Stefan Martinoff
- Radiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Anja Hennemuth
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany;,Fraunhofer MEVIS Institute for Digital Medicine, Bremen, Germany
| | - Peter Ewert
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiko Stern
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Weiss EK, Jarvis K, Maroun A, Malaisrie SC, Mehta CK, McCarthy PM, Bonow RO, Avery RJ, Allen BD, Carr JC, Rigsby CK, Markl M. Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects. J Cardiovasc Magn Reson 2023; 25:3. [PMID: 36698129 PMCID: PMC9878800 DOI: 10.1186/s12968-022-00906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole. METHODS 510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole. RESULTS BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1). CONCLUSION 4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.
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Affiliation(s)
- Elizabeth K. Weiss
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Anthony Maroun
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Christopher K. Mehta
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Patrick M. McCarthy
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Robert O. Bonow
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Ryan J. Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Cynthia K. Rigsby
- Department of Medical Imaging, Lurie Children’s Hospital, Chicago, IL USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
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5
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Qin JJ, Obeidy P, Gok M, Gholipour A, Grieve SM. 4D-flow MRI derived wall shear stress for the risk stratification of bicuspid aortic valve aortopathy: A systematic review. Front Cardiovasc Med 2023; 9:1075833. [PMID: 36698944 PMCID: PMC9869052 DOI: 10.3389/fcvm.2022.1075833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose Current intervention guidelines for bicuspid aortic valve (BAV) associated ascending aorta (AAo) dilatation are suboptimal predictors of clinical outcome. There is growing interest in identifying better biomarkers such as wall shear stress (WSS) to help risk stratify BAV aortopathy. The aim of the systematic review is to synthesize existing evidence of the relationship between WSS and aortopathy in the BAV population. Methods A comprehensive literature search of available major databases was performed in May 2022 to include studies that used four-dimensional flow cardiac magnetic resonance (4D-flow) MRI to quantify WSS in the AAo in adult BAV populations. Summary results and statistical analysis were provided for key numerical results. A narrative summary was provided to assess similarities between studies. Results A total of 26 studies that satisfied selection criteria and quality assessment were included in the review. The presence of BAV resulted in significantly elevated WSS magnitude and circumferential WSS, but not axial WSS. The presence of aortic stenosis had additional impact on WSS and flow alterations. BAV phenotypes were associated with different WSS distributions and flow profiles. Altered protein expression in the AAo wall associated with WSS supported the contribution of altered hemodynamics to aortopathy in addition to genetic factors. Conclusion WSS has the potential to be a valid biomarker for BAV aortopathy. Future work would benefit from larger study cohorts with longitudinal evaluations to further characterize WSS association with aortopathy, mortality, and morbidities. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337077, identifier CRD42022337077.
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Affiliation(s)
- Jiaxing Jason Qin
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Peyman Obeidy
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mustafa Gok
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Alireza Gholipour
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,*Correspondence: Stuart M. Grieve,
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van Andel MM, van Ooij P, de Waard V, Gottwald LM, van Kimmenade RR, Scholte AJ, Dickinson MG, Zwinderman AH, Mulder BJ, Nederveen AJ, Groenink M. Abnormal aortic hemodynamics are associated with risk factors for aortic complications in patients with marfan syndrome. IJC HEART & VASCULATURE 2022; 43:101128. [PMID: 36268203 PMCID: PMC9576530 DOI: 10.1016/j.ijcha.2022.101128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
Background It is difficult to assess the risk for aortic dissection beyond the aortic root in patients with Marfan syndrome (MFS). To aid risk assessment in these patients, we investigated aortic flow and wall shear stress (WSS) by 4D flow magnetic resonance imaging (MRI) in patients with MFS and compared the results with healthy volunteers. We hypothesized that MFS patients with a high-risk profile for aortic dissection would show abnormal hemodynamics in aortic regions associated with aortic dissection. Methods MFS patients (n = 55) and healthy subjects (n = 25), matched for age and sex, prospectively underwent 4D flow MRI. 4D flow maps were constructed to detect elevated (defined as higher than the three-dimensional 95 % confidence interval) and deviant directed (defined as vector angle differences higher than 120°) WSS in MFS patients as compared to the controls. Univariate and multivariate associations with risk factors for aortic dissection in MFS patients were assessed. Results The maximum incidence for elevated WSS was 20 % (CI 9 %-31 %) and found in the ascending aorta. The maximum for deviant directed WSS was 39 % (CI 26 %-52 %) and found in the inner descending aorta. Significantly more male patients had deviant directed WSS in the inner proximal descending aorta (63 % vs 24 %, p = 0.014). Multivariate analysis showed that deviant directed WSS was associated with male sex (p = 0.019), and a haplo-insufficient FBN1 mutation type (p = 0.040). In 60 % of MFS patients with a previous aortic root replacement surgery, abnormal hemodynamics were found in the ascending aorta. No significant differences between hemodynamics were found in the descending aorta between operated and non-operated patients. Conclusion Deviant directed WSS in the proximal descending aorta is associated with known risk factors for aortic dissection in MFS patients, namely male sex and a haploinsufficient FBN1 mutation type.
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Affiliation(s)
- Mitzi M. van Andel
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Pim van Ooij
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Vivian de Waard
- Department of Medical Biochemistry, Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lukas M. Gottwald
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Arthur J. Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Michael G. Dickinson
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Barbara J.M. Mulder
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Aart J. Nederveen
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Maarten Groenink
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands,Corresponding author at: Amsterdam UMC, University of Amsterdam, Department of Cardiology and Radiology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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7
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Shahid L, Rice J, Berhane H, Rigsby C, Robinson J, Griffin L, Markl M, Roldán-Alzate A. Enhanced 4D Flow MRI-Based CFD with Adaptive Mesh Refinement for Flow Dynamics Assessment in Coarctation of the Aorta. Ann Biomed Eng 2022; 50:1001-1016. [PMID: 35624334 PMCID: PMC11034844 DOI: 10.1007/s10439-022-02980-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/11/2022] [Indexed: 01/28/2023]
Abstract
4D Flow MRI is a diagnostic tool that can visualize and quantify patient-specific hemodynamics and help interventionalists optimize treatment strategies for repairing coarctation of the aorta (COA). Despite recent developments in 4D Flow MRI, shortcomings include phase-offset errors, limited spatiotemporal resolution, aliasing, inaccuracies due to slow aneurysmal flows, and distortion of images due to metallic artifact from vascular stents. To address these limitations, we developed a framework utilizing Computational Fluid Dynamics (CFD) with Adaptive Mesh Refinement (AMR) that enhances 4D Flow MRI visualization/quantification. We applied this framework to five pediatric patients with COA, providing in-vivo and in-silico datasets, pre- and post-intervention. These two data sets were compared and showed that CFD flow rates were within 9.6% of 4D Flow MRI, which is within a clinically acceptable range. CFD simulated slow aneurysmal flow, which MRI failed to capture due to high relative velocity encoding (Venc). CFD successfully predicted in-stent blood flow, which was not visible in the in-vivo data due to susceptibility artifact. AMR improved spatial resolution by factors of 101 to 103 and temporal resolution four-fold. This computational framework has strong potential to optimize visualization/quantification of aneurysmal and in-stent flows, improve spatiotemporal resolution, and assess hemodynamic efficiency post-COA treatment.
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Affiliation(s)
- Labib Shahid
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Room 2476 WIMR II, Madison, WI, 53705, USA.
| | - James Rice
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Room 2476 WIMR II, Madison, WI, 53705, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Cynthia Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Joshua Robinson
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lindsay Griffin
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Room 2476 WIMR II, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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8
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Desai L, Stefek H, Berhane H, Robinson J, Rigsby C, Markl M. Four-Dimensional flow Magnetic Resonance Imaging for Assessment of Pediatric Coarctation of the Aorta. J Magn Reson Imaging 2022; 55:200-208. [PMID: 34173693 PMCID: PMC9084555 DOI: 10.1002/jmri.27802] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) typically requires repair, but re-interventions and vascular complications occur, particularly with associated defects like bicuspid aortic valve (BAV). Magnetic resonance imaging (MRI) may identify anatomic and hemodynamic factors contributing to clinical complications. PURPOSE To investigate 4D flow MRI characteristics in pediatric CoA to determine parameters for long-term clinical surveillance. STUDY TYPE Retrospective. POPULATION CoA (n = 21), CoA with BAV (n = 24), BAV alone (n = 29), and healthy control (n = 25). FIELD STRENGTH/SEQUENCE A 1.5 T, 3D CE IR FLASH MRA, 4D flow MRI using 3D time resolved PC-MRI with velocity encoding. ASSESSMENT Thoracic aorta diameters were measured from 3D CE-MRA. Peak systolic velocities and wall shear stress were calculated and flow patterns were visualized throughout the thoracic aorta using 4D flow. Repair characteristics, re-interventions, and need for anti-hypertensive medications were recorded. STATISTICS Descriptive statistics, ANOVA with post hoc t-testing and Bonferroni correction, Kruskal-Wallis H, intraclass correlation coefficient, Fleiss' kappa. RESULTS Patients with CoA with or without repair had smaller transverse arch diameters compared to BAV alone and control cohorts (P < 0.05), higher peak systolic flow velocities and wall shear stress compared to controls in the transverse arch and descending aorta (P < 0.05), and flow derangements in the descending aorta. The most common CoA repairs were extended end-to-end anastomosis (n = 22/45, 48.9%, age at repair 1 ± 2 years, seven re-interventions) and stent/interposition graft placement (n = 10/45, 22.2%, age at repair 12 ± 3 years, one re-intervention). Anti-hypertensive medications were prescribed to 33.3% (n = 15/45) of CoA and 34.4% of BAV alone patients (n = 10/29). DATA CONCLUSIONS Despite repair, CoA alters hemodynamics and flow patterns in the transverse arch and descending aorta. These findings may contribute to vascular remodeling and secondary complications. 4D flow MRI may be valuable in risk stratification, treatment selection and postintervention assessment. Long-term, prospective studies are warranted to correlate patient and MRI factors with clinical outcomes. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lajja Desai
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA,Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | | | - Haben Berhane
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | - Joshua Robinson
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA,Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | - Cynthia Rigsby
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
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9
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Franco P, Sotelo J, Guala A, Dux-Santoy L, Evangelista A, Rodríguez-Palomares J, Mery D, Salas R, Uribe S. Identification of hemodynamic biomarkers for bicuspid aortic valve induced aortic dilation using machine learning. Comput Biol Med 2021; 141:105147. [PMID: 34929463 DOI: 10.1016/j.compbiomed.2021.105147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 01/06/2023]
Abstract
Recent advances in medical imaging have confirmed the presence of altered hemodynamics in bicuspid aortic valve (BAV) patients. Therefore, there is a need for new hemodynamic biomarkers to refine disease monitoring and improve patient risk stratification. This research aims to analyze and extract multiple correlation patterns of hemodynamic parameters from 4D Flow MRI data and find which parameters allow an accurate classification between healthy volunteers (HV) and BAV patients with dilated and non-dilated ascending aorta using machine learning. Sixteen hemodynamic parameters were calculated in the ascending aorta (AAo) and aortic arch (AArch) at peak systole from 4D Flow MRI. We used sequential forward selection (SFS) and principal component analysis (PCA) as feature selection algorithms. Then, eleven machine-learning classifiers were implemented to separate HV and BAV patients (non- and dilated ascending aorta). Multiple correlation patterns from hemodynamic parameters were extracted using hierarchical clustering. The linear discriminant analysis and random forest are the best performing classifiers, using five hemodynamic parameters selected with SFS (velocity angle, forward velocity, vorticity, and backward velocity in AAo; and helicity density in AArch) a 96.31 ± 1.76% and 96.00 ± 0.83% accuracy, respectively. Hierarchical clustering revealed three groups of correlated features. According to this analysis, we observed that features selected by SFS have a better performance than those selected by PCA because the five selected parameters were distributed according to 3 different clusters. Based on the proposed method, we concluded that the feature selection method found five potentially hemodynamic biomarkers related to this disease.
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Affiliation(s)
- Pamela Franco
- Biomedical Imaging Center, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile; Electrical Engineering Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Cardio, MR, Chile
| | - Julio Sotelo
- Biomedical Imaging Center, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Cardio, MR, Chile; School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Domingo Mery
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile; Instituto Milenio Intelligent Healthcare Engineering, Chile
| | - Rodrigo Salas
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile; Instituto Milenio Intelligent Healthcare Engineering, Chile
| | - Sergio Uribe
- Biomedical Imaging Center, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Cardio, MR, Chile; Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Instituto Milenio Intelligent Healthcare Engineering, Chile.
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10
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Doyle CM, Orr J, Greenwood JP, Plein S, Tsoumpas C, Bissell MM. Four-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review. J Magn Reson Imaging 2021; 55:1301-1321. [PMID: 34416048 DOI: 10.1002/jmri.27874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Four-dimensional (4D) flow magnetic resonance imaging (MRI) allows multidirectional quantification of blood flow in the heart and great vessels. Comparability of the technique to the current reference standards of flow assessment-two-dimensional (2D) flow MRI and Doppler echocardiography-varies in the literature. Image acquisition parameters likely impact upon the accuracy and reproducibility of 4D flow MRI. We therefore sought to review the current literature on 4D flow MRI in the heart and great vessels, in comparison to 2D flow MRI, Doppler echocardiography, and invasive catheterization. Using a predefined search strategy and inclusion and exclusion criteria, the databases EMBASE and Medline were searched in January 2021 for peer-reviewed research articles comparing cardiac 4D flow MRI to 2D flow MRI, Doppler echocardiography and/or invasive catheterization. The data from all relevant articles were assimilated and analyzed using Mann-Whitney U and chi χ2 test. Forty-four manuscripts met the eligibility criteria and were included in the review. The review showed agreement of 4D flow MRI to the reference standard methods of flow assessment, particular in the measurement of peak velocity and stroke volume in 55% of manuscripts. The use of valve tracking significantly improves agreement between 4D flow MRI and the reference modalities (79% matching with the use of valve tracking vs. 50% without, P = 0.04). This review highlights that the impact of acquisition parameters on 4D flow MRI accuracy is multifactorial. It is therefore important that each center conducts its own quality assurance prior to using 4D flow MRI for clinical decision-making. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ciara M Doyle
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Jenny Orr
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - John P Greenwood
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Charalampos Tsoumpas
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK.,Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
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11
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Xu K, Wang XD, Yang ZG, Xu HY, Xu R, Xie LJ, Wen LY, Fu H, Yan WF, Guo YK. Quantification of peak blood flow velocity at the cardiac valve and great thoracic vessels by four-dimensional flow and two-dimensional phase-contrast MRI compared with echocardiography: a systematic review and meta-analysis. Clin Radiol 2021; 76:863.e1-863.e10. [PMID: 34404516 DOI: 10.1016/j.crad.2021.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/15/2021] [Indexed: 02/08/2023]
Abstract
AIM To objectively examine the agreement and correlation between four-dimensional (4D) flow magnetic resonance imaging (MRI) and traditional two-dimensional (2D) phase-contrast (PC) MRI with the reference standard of Doppler echocardiography for measuring peak blood velocity at the cardiac valve and great arteries, and to assess if 4D flow MRI offers an advantage over the traditional 2D method. MATERIALS AND METHODS The literature was searched systematically for studies that evaluate the degree of correlation and agreement between 4D flow MRI or 2D PC MRI and Doppler retrieved from PubMed, EMBASE, and the Cochrane Library. A meta-analysis was conducted to determine the peak velocity pooled bias with 95% limits of agreement (LoA) and correlation coefficient (r) for 4D flow MRI and 2D PC MRI compared with Doppler. RESULTS Ten studies that compared 4D flow MRI with Doppler and 12 studies that compared 2D PC MRI with Doppler were included. 4D flow MRI showed an underestimation with bias and 95% LoA of -0.09 (-0.41, 0.24) m/s (p=0.079) while 2D PC MRI showed a poorer agreement with a bias and 95% LoA of -0.25 (-0.53, 0.03), p=0.596. 4D flow MRI and 2D PC MRI showed a strong correlation with R=0.80 (95% CI 0.75, 0.84; p<0.001) and R=0.83 (95% CI 0.79, 0.87; p<0.001), respectively. CONCLUSION In this meta-analysis, 4D flow MRI provides improved assessment of peak velocity when compared with traditional 2D PC MRI. 4D flow MRI can be considered an important complement or substitute to Doppler echocardiography for peak velocity assessment.
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Affiliation(s)
- K Xu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - X D Wang
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Z G Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - H Y Xu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - R Xu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - L J Xie
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - L Y Wen
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - H Fu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - W F Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Y K Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
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12
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Schäfer M, Barker AJ, Jaggers J, Morgan GJ, Stone ML, Truong U, Browne LP, Malone L, Ivy DD, Mitchell MB. Abnormal aortic flow conduction is associated with increased viscous energy loss in patients with repaired tetralogy of Fallot. Eur J Cardiothorac Surg 2021; 57:588-595. [PMID: 31535124 DOI: 10.1093/ejcts/ezz246] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/29/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Aortopathy in tetralogy of Fallot (TOF) is characterized by increased aortic stiffness, dilation and reduced left ventricular (LV) function. Repair in infancy normalizes aortic dimensions in early childhood. Our prior work demonstrated that early TOF repair does not normalize aortic compliance and that abnormal ascending aortic flow patterns are prevalent. The objectives of this study were to: (i) determine whether proximal aortic flow-mediated viscous energy loss (EL') is elevated in patients with early TOF repair compared with healthy controls, and (ii) determine whether the degree of EL' is associated with LV function. METHODS Forty-one patients post TOF repair with normalized aortic size and 15 healthy controls underwent 4-dimenisonal-flow magnetic resonance imaging flow analysis and EL' assessment. Correlations between EL', aortic size, and LV function were assessed. RESULTS The TOF group had increased peak systolic thoracic aorta EL' (3.8 vs 1.5 mW, P = 0.004) and increased averaged EL' throughout the cardiac cycle (1.2 vs 0.5 mW, P = 0.003). Peak and mean systolic EL' in the ascending aorta was increased 2-fold in the TOF group compared with control (peak: 2.0 vs 0.9 mW, P = 0.007). Peak EL' measured along the entire thoracic aortic length correlated with LV ejection fraction (R = -0.45, P = 0.009), indexed LV end-systolic volume (R = -0.40, P = 0.010), and right ventricular end-systolic volume (R = -0.37, P = 0.034). CONCLUSIONS Patients with repaired TOF exhibit abnormal aortic flow associated with increased EL' in the thoracic aorta. The magnitude of EL' is associated with LV function and volumes. Increased aortic EL' in TOF is likely due to inherently abnormal LV outflow geometry and or right ventricular interaction. Reduced aortic flow efficiency in TOF increases cardiac work and may be an important factor in long-term cardiac performance.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.,Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - James Jaggers
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Gareth J Morgan
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew L Stone
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Uyen Truong
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Lorna P Browne
- Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Ladonna Malone
- Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - D Dunbar Ivy
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Max B Mitchell
- Department of Surgery, Section of Congenital Heart Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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13
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Gunn AJ, Kalva SP, Majdalany BS, Craft J, Eldrup-Jorgensen J, Ferencik M, Ganguli S, Kendi AT, Khaja MS, Obara P, Russell RR, Sutphin PD, Vijay K, Wang DS, Dill KE. ACR Appropriateness Criteria® Nontraumatic Aortic Disease. J Am Coll Radiol 2021; 18:S106-S118. [PMID: 33958105 DOI: 10.1016/j.jacr.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/16/2023]
Abstract
Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatment planning, and assessment of therapeutic response. Depending upon the clinical scenario, each of these modalities has strengths and weaknesses. Whenever possible, the selection of a diagnostic imaging examination should be based upon the best available evidence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. The purpose of this document is to assist physicians select the most appropriate diagnostic imaging examination for nontraumatic aortic diseases.
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Affiliation(s)
- Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama, Director, Interventional Oncology, Director, Ambulatory Clinic, Assistant Program Director, Diagnostic Radiology Residency, Assistant Program Director, Interventional Radiology Residency, University of Alabama at Birmingham, Member, American College of Radiology-Radiologic Society of North America Patient Information Committee.
| | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts, Chief, Division of Interventional Radiology, Massachusetts General Hospital
| | | | - Jason Craft
- St. Francis Hospital, Catholic Health Services of Long Island, Roslyn, New York, Society for Cardiovascular Magnetic Resonance
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts, Society for Vascular Surgery
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, Society of Cardiovascular Computed Tomography
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapies at Mayo Clinic Rochester
| | - Minhajuddin S Khaja
- University of Virginia, Charlottesville, Virginia, Vice-Chair ACR Vascular Imaging Panel 2, Program Director, Independent IR Residency, UVA Health
| | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | - Raymond R Russell
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, Nuclear cardiology expert, Program Director, Cardiology Fellowship, Director, Nuclear Cardiology, Director, Cardio-Oncology Program, Rhode Island Hospital
| | | | | | - David S Wang
- Stanford University Medical Center, Stanford, California
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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14
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Geiger J, Callaghan FM, Burkhardt BEU, Valsangiacomo Buechel ER, Kellenberger CJ. Additional value and new insights by four-dimensional flow magnetic resonance imaging in congenital heart disease: application in neonates and young children. Pediatr Radiol 2021; 51:1503-1517. [PMID: 33313980 PMCID: PMC8266722 DOI: 10.1007/s00247-020-04885-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/08/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Cardiovascular MRI has become an essential imaging modality in children with congenital heart disease (CHD) in the last 15-20 years. With use of appropriate sequences, it provides important information on cardiovascular anatomy, blood flow and function for initial diagnosis and post-surgical or -interventional monitoring in children. Although considered as more sophisticated and challenging than CT, in particular in neonates and infants, MRI is able to provide information on intra- and extracardiac haemodynamics, in contrast to CT. In recent years, four-dimensional (4-D) flow MRI has emerged as an additional MR technique for retrospective assessment and visualisation of blood flow within the heart and any vessel of interest within the acquired three-dimensional (3-D) volume. Its application in young children requires special adaptations for the smaller vessel size and faster heart rate compared to adolescents or adults. In this article, we provide an overview of 4-D flow MRI in various types of complex CHD in neonates and infants to demonstrate its potential indications and beneficial application for optimised individual cardiovascular assessment. We focus on its application in clinical routine cardiovascular workup and, in addition, show some examples with pathologies other than CHD to highlight that 4-D flow MRI yields new insights in disease understanding and therapy planning. We shortly review the essentials of 4-D flow data acquisition, pre- and post-processing techniques in neonates, infants and young children. Finally, we conclude with some details on accuracy, limitations and pitfalls of the technique.
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Affiliation(s)
- Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Steinwiesstr 75, 8032, Zürich, Switzerland. .,Children's Research Centre, University Children's Hospital Zürich, Zürich, Switzerland.
| | - Fraser M. Callaghan
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Center for MR research, University Children’s Hospital Zürich, Zürich, Switzerland
| | - Barbara E. U. Burkhardt
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Department of Pediatric Cardiology, University Hospital Zürich, Zürich, Switzerland
| | - Emanuela R. Valsangiacomo Buechel
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Department of Pediatric Cardiology, University Hospital Zürich, Zürich, Switzerland
| | - Christian J. Kellenberger
- Department of Diagnostic Imaging, University Children’s Hospital Zürich, Steinwiesstr 75, 8032 Zürich, Switzerland ,Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland
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15
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Rizk J. 4D flow MRI applications in congenital heart disease. Eur Radiol 2020; 31:1160-1174. [PMID: 32870392 DOI: 10.1007/s00330-020-07210-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
Advances in the diagnosis and management of congenital heart disease (CHD) have resulted in a growing population of patients surviving well into adulthood and requiring lifelong follow-up. Flow quantification is a central component in the assessment of patients with CHD. 4D flow magnetic resonance imaging (MRI) has emerged as a tool that enables comprehensive study of flow. It involves the acquisition of a three-dimensional time-resolved volume with velocity encoding in all three spatial directions along the cardiac cycle. This allows flow quantification and visualization of blood flow patterns as well as the study of advanced hemodynamic parameters as kinetic energy and wall shear stress. 4D flow MRI-based study of flow has given insight into the altered hemodynamics in CHD particularly in bicuspid aortic valve disease and Fontan circulation. The aim of this review is to discuss the expanding clinical and research applications of 4D flow MRI in CHD as well its limitations.Key Points• Three-dimensional velocity encoding allows not only flow quantification but also the visualization of multidirectional flow patterns and the study of advanced hemodynamic parameters.• 4D flow MRI has added insight into the abnormal hemodynamics involved in congenital heart disease in particular in bicuspid aortic valve and Fontan circulation.• The main limitation of 4D flow MRI in congenital heart disease is the relatively long scan duration required for the complete coverage of the heart and great vessels with adequate spatiotemporal resolution.
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Affiliation(s)
- Judy Rizk
- Department of Cardiology, Faculty of Medicine, Alexandria University, El-Khartoum Square, Alexandria, 21521, Egypt.
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16
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Validation of four-dimensional flow cardiovascular magnetic resonance for aortic stenosis assessment. Sci Rep 2020; 10:10569. [PMID: 32601326 PMCID: PMC7324609 DOI: 10.1038/s41598-020-66659-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
The management of patients with aortic stenosis (AS) crucially depends on accurate diagnosis. The main aim of this study were to validate the four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) methods for AS assessment. Eighteen patients with clinically severe AS were recruited. All patients had pre-valve intervention 6MWT, echocardiography and CMR with 4D flow. Of these, ten patients had a surgical valve replacement, and eight patients had successful transcatheter aortic valve implantation (TAVI). TAVI patients had invasive pressure gradient assessments. A repeat assessment was performed at 3–4 months to assess the remodelling response. The peak pressure gradient by 4D flow was comparable to an invasive pressure gradient (54 ± 26 mmHG vs 50 ± 34 mmHg, P = 0.67). However, Doppler yielded significantly higher pressure gradient compared to invasive assessment (61 ± 32 mmHG vs 50 ± 34 mmHg, P = 0.0002). 6MWT was associated with 4D flow CMR derived pressure gradient (r = −0.45, P = 0.01) and EOA (r = 0.54, P < 0.01) but only with Doppler EOA (r = 0.45, P = 0.01). Left ventricular mass regression was better associated with 4D flow derived pressure gradient change (r = 0.64, P = 0.04). 4D flow CMR offers an alternative method for non-invasive assessment of AS. In addition, 4D flow derived valve metrics have a superior association to prognostically relevant 6MWT and LV mass regression than echocardiography.
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17
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Abstract
Magnetic resonance imaging (MRI) has become an important tool for the clinical evaluation of patients with cardiac and vascular diseases. Since its introduction in the late 1980s, quantitative flow imaging with MRI has become a routine part of standard-of-care cardiothoracic and vascular MRI for the assessment of pathological changes in blood flow in patients with cardiovascular disease. More recently, time-resolved flow imaging with velocity encoding along all three flow directions and three-dimensional (3D) anatomic coverage (4D flow MRI) has been developed and applied to enable comprehensive 3D visualization and quantification of hemodynamics throughout the human circulatory system. This article provides an overview of the use of 4D flow applications in different cardiac and vascular regions in the human circulatory system, with a focus on using 4D flow MRI in cardiothoracic and cerebrovascular diseases.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois 60208, USA
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18
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Grattan M, Prince A, Rumman RK, Morgan C, Petrovic M, Hauck A, Young L, Franco-Cereceda A, Loeys B, Mohamed SA, Dietz H, Mital S, Fan CPS, Manlhiot C, Andelfinger G, Mertens L. Predictors of Bicuspid Aortic Valve–Associated Aortopathy in Childhood. Circ Cardiovasc Imaging 2020; 13:e009717. [DOI: 10.1161/circimaging.119.009717] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Bicuspid aortic valve (BAV) is the most prevalent congenital heart defect affecting 1% to 2% of the population. It is associated with ascending aorta dilatation. Valve morphology, aortic stenosis (AS), and aortic insufficiency (AI) have been proposed as potential risk factors; however, evaluating their role is difficult, as these factors are inherently related. The aim of this study was to determine whether BAV morphology and dysfunction are independent determinants for ascending aorta dilatation in pediatric patients.
Methods:
A multicenter, retrospective, cross-sectional study of pediatric BAV patients followed since 2004 was performed. Imaging data were assessed for BAV morphology, severity of AS and AI, history of coarctation, and aortic dimensions. Associations were determined using multivariable regression analysis. A subset of patients undergoing aortic interventions (balloon dilation or Ross) were assessed longitudinally.
Results:
Data were obtained from 2122 patients (68% male; median age 10.2 years). Fifty percent of patients had ascending aorta dilatation. Right and noncoronary cusp fusion, increasing AS and AI, and older age were independently associated with ascending aorta dilatation. A history of coarctation was associated with less ascending aorta dilatation. In patients with neither AS nor AI, 37% had ascending aorta dilatation (4% severe). No complications related to aortic dilatation occurred in this cohort. Aortic
Z
scores were determined, and a
Z
-score calculator was created for this population.
Conclusions:
In this large pediatric cohort of patients with BAV, valve morphology, AS, and AI are independently associated with ascending aorta dilatation, suggesting that hemodynamic factors influence aortopathy. However, even in BAVs with no AS or AI, there is significant ascending aorta dilatation independent of valve morphology. Interventions that led to changes in degree of AI and AS did not seem to influence change in aortic dimensions. The current BAV cohort can be used as a reference group for expected changes in aortic dimensions during childhood.
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Affiliation(s)
- Michael Grattan
- Department of Paediatrics, LHSC Children’s Hospital, University of Western Ontario, London, Canada (M.G.)
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Andrea Prince
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Canada (A.P., G.A.)
| | - Rawan K. Rumman
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Conall Morgan
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Michele Petrovic
- Division of Cardiology, The Hospital for Sick Children, Toronto, Canada (M.P.)
| | - Amanda Hauck
- Division of Cardiology, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL (A.H., L.Y.)
| | - Luciana Young
- Division of Cardiology, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL (A.H., L.Y.)
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (A.F.-C.)
| | - Bart Loeys
- Center for Medical Genetics, University of Antwerp/Antwerp University Hospital, Belgium (B.L.)
| | - Salah A. Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Germany (S.A.M.)
| | - Harry Dietz
- Medicine, Pediatrics, and Molecular Biology and Genetics, Johns Hopkins University School of Medicine/HHMI, Baltimore, MD (H.D.)
| | - Seema Mital
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Chun-Po Steve Fan
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Cedric Manlhiot
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Gregor Andelfinger
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Canada (A.P., G.A.)
| | - Luc Mertens
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
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Altered 4-D magnetic resonance imaging flow characteristics in complex congenital aortic arch repair. Pediatr Radiol 2020; 50:17-27. [PMID: 31473788 PMCID: PMC6943192 DOI: 10.1007/s00247-019-04507-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/08/2019] [Accepted: 08/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Interrupted aortic arch (IAA) is a rare but severe congenital abnormality often associated with bicuspid aortic valve (BAV). Complex re-interventions are often needed despite surgical advances, but the impact of aortic hemodynamics in repaired patients is unknown. OBJECTIVE Investigate effect of IAA repairs on aortic hemodynamics, wall shear stress and flow derangements via 4-D flow MRI. MATERIALS AND METHODS We retrospectively analyzed age- and gender-matched cohorts (IAA [n=6], BAV alone [n=6], controls [n=6]) undergoing cardiac MRI including 4-D flow. Aortic dimensions were measured from standard MR angiography. We quantified peak systolic velocities, regurgitant fractions and wall shear stress in the ascending aorta (AAo), transverse arch and descending aorta (DAo) from 4-D flow, and we graded helix/vortex flow patterns from 3-D blood flow visualization. RESULTS Children and young adults with IAA had a wide range of arch dimensions, peak systolic velocities, regurgitant fractions and flow grades. Peak transverse arch systolic velocities were higher in patients with IAA versus controls (P=0.02). Flow derangements in the AAo were found in patients with IAA (median grade=2, 5/6 patients, P=0.04) and BAV (median grade=3, 5/6 patients, P=0.03) versus controls. Flow derangements in the DAo were only seen in patients with IAA (median grade=1, 5/6 patients, P=0.04), and 5/6 people with IAA had helical flow in head and neck vessels. Wall shear stress was increased in people with IAA along the superior transverse arch and proximal DAo versus controls (P=0.02). CONCLUSION Complex congenital aortic arch repairs can change aortic hemodynamics. Associated cardiac defects can further alter findings. Studies are warranted to investigate clinical implications in larger cohorts.
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Palen RL, Deurvorst QS, Kroft LJ, Boogaard PJ, Hazekamp MG, Blom NA, Lamb HJ, Westenberg JJ, Roest AA. Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries. J Magn Reson Imaging 2019; 51:1105-1116. [DOI: 10.1002/jmri.26934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Roel L.F. Palen
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical Center Leiden The Netherlands
| | - Quirine S. Deurvorst
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical Center Leiden The Netherlands
| | - Lucia J.M. Kroft
- Department of RadiologyLeiden University Medical Center Leiden The Netherlands
| | - Pieter J. Boogaard
- Department of RadiologyLeiden University Medical Center Leiden The Netherlands
| | - Mark G. Hazekamp
- Department of Cardiothoracic SurgeryLeiden University Medical Center Leiden The Netherlands
| | - Nico A. Blom
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical Center Leiden The Netherlands
| | - Hildo J. Lamb
- Department of RadiologyLeiden University Medical Center Leiden The Netherlands
| | - Jos J.M. Westenberg
- Department of RadiologyLeiden University Medical Center Leiden The Netherlands
| | - Arno A.W. Roest
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical Center Leiden The Netherlands
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Comprehensive MR Analysis of Cardiac Function, Aortic Hemodynamics and Left Ventricular Strain in Pediatric Cohort with Isolated Bicuspid Aortic Valve. Pediatr Cardiol 2019; 40:1450-1459. [PMID: 31342116 PMCID: PMC6786923 DOI: 10.1007/s00246-019-02157-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/13/2019] [Indexed: 02/08/2023]
Abstract
Bicuspid aortic valve (BAV) disease demonstrates a range of clinical presentations and complications. We aim to use cardiac MRI (CMR) to evaluate left ventricular (LV) parameters, myocardial strain and aortic hemodynamics in pediatric BAV patients with and without aortic stenosis (AS) or regurgitation (AR) compared to tricuspid aortic valve (TAV) controls. We identified 58 pediatric BAV patients without additional cardiovascular pathology and 25 healthy TAV controls (15.3 ± 2.2 years) who underwent CMR with 4D flow. BAV cohort included subgroups with no valvulopathy (n = 13, 14.3 ± 4.7 years), isolated AS (n = 19, 14.5 ± 4.0 years), mixed valve disease (AS + AR) (n = 13, 17.1 ± 3.2 years), and prior valvotomy/valvuloplasty (n = 13, 13.9 ± 3.2 years). CMR data included LV volumetric and mass indices, myocardial strain and aortic hemodynamics. BAV patients with no valvulopathy or isolated AS had similar LV parameters to controls excepting cardiac output (p < 0.05). AS + AR and post-surgical patients had abnormal LV volumetric and mass indices (p < 0.01). Post-surgical patients had decreased global longitudinal strain (p = 0.02); other subgroups had comparable strain to controls. Patients with valvulopathy demonstrated elevated velocity and wall shear stress (WSS) in the ascending aorta (AAo) and arch (p < 0.01), while those without valve dysfunction had only elevated AAo velocity (p = 0.03). Across the cohort, elevated AAo velocity and WSS correlated to higher LV mass (p < 0.01), and abnormal hemodynamics correlated to decreased strain rates (p < 0.045). Pediatric BAV patients demonstrate abnormalities in LV parameters as a function of valvular dysfunction, most significantly in children with AS + AR or prior valvotomy/valvuloplasty. Correlations between aortic hemodynamics, LV mass and strain suggest valvular dysfunction could drive LV remodeling. Multiparametric CMR assessment in pediatric BAV may help stratify risk for cardiac remodeling and dysfunction.
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Della Corte A, Michelena HI, Citarella A, Votta E, Piatti F, Lo Presti F, Ashurov R, Cipollaro M, Forte A. Risk Stratification in Bicuspid Aortic Valve Aortopathy: Emerging Evidence and Future Perspectives. Curr Probl Cardiol 2019; 46:100428. [PMID: 31296418 DOI: 10.1016/j.cpcardiol.2019.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/06/2019] [Indexed: 12/21/2022]
Abstract
The current management of aortic dilatation associated with congenital bicuspid aortic valve (bicuspid aortic valve aortopathy) is based on dimensional parameters (diameter of the aneurysm, growth of the diameter over time) and few other criteria. The disease is however heterogeneous in terms of natural and clinical history and risk of acute complications, ie aortic dissection. Dimensional criteria are now admitted to have limited value as predictors of such complications. Thus, novel principles for risk stratification have been recently investigated, including phenotypic criteria, flow-related metrics, and circulating biomarkers. A systematization of the typical anatomoclinical forms that the aortopathy can assume has led to the identification of the more severe root phenotype, associated with higher risk of progression of the aneurysm and possible higher aortic dissection risk. Four-dimensional-flow magnetic resonance imaging studies are searching for potentially clinically significant metrics of flow derangement, based on the recognized association of local abnormal shear stress with wall pathology. Other research initiatives are addressing the question whether circulating molecules could predict the presence or, more importantly, the future development of aortopathy. The present review summarizes the latest progresses in the knowledge on risk stratification of bicuspid aortic valve aortopathy, focusing on critical aspects and debated points.
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Starker A, Goot B, Gerardin J, Ginde S, Earing MG. Increased aortic wall stiffness is predictive of aortic dilation in adult patients following coarctation of the aorta repair. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Liu T, Xie M, Lv Q, Li Y, Fang L, Zhang L, Deng W, Wang J. Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment. Front Physiol 2019; 9:1921. [PMID: 30761020 PMCID: PMC6363677 DOI: 10.3389/fphys.2018.01921] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022] Open
Abstract
The bicuspid aortic valve, a kind of heart disease that comes from parents, has been paid attention around the world. Although most bicuspid aortic valve (BAV) patients will suffer from some complications including aortic stenosis, aortic regurgitation, endocarditis, and heart dysfunction in the late stage of the disease, there is none symptom in the childhood, which restrains us to diagnose and treatment in the onset phase of BAV. Hemodynamic abnormalities induced by the malformations of the valves in BAV patients for a long time will cause BAV-associated aortopathy: including progress aortic dilation, aneurysm, dissection and rupture, cardiac cyst and even sudden death. At present, preventive surgical intervention is the only effective method used in this situation and the diameter of the aorta is the primary reference criterion for surgery. And the treatment effects are always not satisfactory for patients and clinicians. Therefore, we need more methods to evaluate the progression of BAV and the surgery value and the appropriate intervention time by combining basic research with clinical treatment. In this review, advances in morphology, genetic, biomarkers, diagnosis and treatments are summarized, which expects to provide an update about BAV. It is our supreme expectations to provide some evidences for BAV early screening and diagnosis, and in our opinion, personalized surgical strategy is the trend of future BAV treatment.
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Affiliation(s)
- Tianshu Liu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lingyun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenhui Deng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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4-D flow MRI aortic 3-D hemodynamics and wall shear stress remain stable over short-term follow-up in pediatric and young adult patients with bicuspid aortic valve. Pediatr Radiol 2019; 49:57-67. [PMID: 30203126 PMCID: PMC6430639 DOI: 10.1007/s00247-018-4257-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/13/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Children with bicuspid aortic valve (BAV) are at risk for serious complications including aortic valve stenosis and aortic rupture. Most studies investigating biomarkers predictive of BAV complications are focused on adults. OBJECTIVE To investigate whether hemodynamic parameters change over time in children and young adults with BAV by comparing baseline and follow-up four-dimensional (4-D) flow MRI examinations. MATERIALS AND METHODS We retrospectively included 19 children and young adults with BAV who had serial 4-D flow MRI exams (mean difference in scan dates 1.8±1.0 [range, 0.6-3.4 years]). We compared aortic peak blood flow velocity, three-dimensional (3-D) wall shear stress, aortic root and ascending aortic (AAo) z-scores between baseline and follow-up exams. We generated systolic streamlines for all patients and visually compared their baseline and follow-up exams. RESULTS The only significant difference between baseline and follow-up exams occurred in AAo z-scores (3.12±2.62 vs. 3.59±2.76, P<0.05) indicating growth of the AAo out of proportion to somatic growth. There were no significant changes in either peak velocity or 3-D wall shear stress between baseline and follow-up exams. Ascending aortic peak velocity at baseline correlated with annual change in AAo z-score (r=0.58, P=0.009). Visual assessment revealed abnormal blood flow patterns, which were unique to each patient and remained stable between baseline and follow-up exams. CONCLUSION In our pediatric and young adult BAV cohort, hemodynamic markers and systolic blood flow patterns remained stable over short-term follow-up despite significant AAo growth, suggesting minimal acute disease progression. Baseline AAo peak velocity was a predictor of AAo dilation and might help in determining pediatric patients with BAV who are at risk of increased AAo growth.
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Hemodynamics in diabetic human aorta using computational fluid dynamics. PLoS One 2018; 13:e0202671. [PMID: 30138473 PMCID: PMC6107202 DOI: 10.1371/journal.pone.0202671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/07/2018] [Indexed: 02/04/2023] Open
Abstract
Three-dimensional (3D) computational aortic models have been established to reproduce aortic diseases such as aortic aneurysm and dissection; however, no such models have been developed to study diabetes mellitus (DM). To characterize biomechanical properties of the human aorta with DM, reconstructed aortic CT images were converted into DICOM format, and imported into the 3D segmentation using Mimics software. This resulted in a 3D reconstruction of the complete aorta, including three branches. We applied a pulsatile blood pressure waveform for the ascending aorta to provide a biomimetic environment using COMSOL Multiphysics software. Hemodynamics were compared between the control and DM models. We observed that mean blood flow velocity, aortic pressure, and von Mises stress values were lower in the DM model than in the control model. Furthermore, the range of aortic movement was lower in the DM model than in the control model, suggesting that the DM aortic wall is more susceptible to rupture. When comparing biomechanical properties in discrete regions of the aorta, all values were higher in the ascending aorta for both control and DM models, corresponding to the location of most aortic lesions. We have developed a compute based that integrates advanced image processing strategies and computational techniques based on finite element method to perform hemodynamics analysis based on CT images. Our study of image-based CFD analysis hopes to provide a better understanding of the relationship between aortic hemodynamic and developing pathophysiology of aortic diseases.
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Impact of different coarctation therapies on aortic stiffness: phase-contrast MRI study. Int J Cardiovasc Imaging 2018; 34:1459-1469. [DOI: 10.1007/s10554-018-1357-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/13/2018] [Indexed: 11/25/2022]
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Zimmermann J, Demedts D, Mirzaee H, Ewert P, Stern H, Meierhofer C, Menze B, Hennemuth A. Wall shear stress estimation in the aorta: Impact of wall motion, spatiotemporal resolution, and phase noise. J Magn Reson Imaging 2018; 48:718-728. [PMID: 29607574 DOI: 10.1002/jmri.26007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wall shear stress (WSS) presents an important parameter for assessing blood flow characteristics and evaluating flow-mediated lesions in the aorta. PURPOSE To investigate the robustness of WSS and oscillatory shear index (OSI) estimation based on 4D flow MRI against vessel wall motion, spatiotemporal resolution, and velocity encoding (VENC). STUDY TYPE Simulated and prospective. POPULATION Synthetic 4D flow MRI data of the aorta, simulated using the Lattice-Boltzmann method; in vivo 4D flow MRI data of the aorta from healthy volunteers (n = 11) and patients with congenital heart defects (n = 17). FIELD STRENGTH/SEQUENCE 1.5T; 4D flow MRI with PEAK-GRAPPA acceleration and prospective electrocardiogram triggering. ASSESSMENT Predicated upon 3D cubic B-splines interpolation of the image velocity field, WSS was estimated in mid-systole, early-diastole, and late-diastole and OSI was derived. We assessed the impact of spatiotemporal resolution and phase noise, and compared results based on tracked-using deformable registration-and static vessel wall location. STATISTICAL TESTS Bland-Altman analysis to assess WSS/OSI differences; Hausdorff distance (HD) to assess wall motion; and Pearson's correlation coefficient (PCC) to assess correlation of HD with WSS. RESULTS Synthetic data results show systematic over-/underestimation of WSS when different spatial resolution (mean ± 1.96 SD up to -0.24 ± 0.40 N/m2 and 0.5 ± 1.38 N/m2 for 8-fold and 27-fold voxel size, respectively) and VENC-depending phase noise (mean ± 1.96 SD up to 0.31 ± 0.12 N/m2 and 0.94 ± 0.28 N/m2 for 2-fold and 4-fold VENC increase, respectively) are given. Neglecting wall motion when defining the vessel wall perturbs WSS estimates to a considerable extent (1.96 SD up to 1.21 N/m2 ) without systematic over-/underestimation (Bland-Altman mean range -0.06 to 0.05). DATA CONCLUSION In addition to sufficient spatial resolution and velocity to noise ratio, accurate tracking of the vessel wall is essential for reliable image-based WSS estimation and should not be neglected if wall motion is present. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Judith Zimmermann
- Department of Computer Science, Technical University of Munich, Munich, Germany
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center at Technical University of Munich, Munich, Germany
| | - Daniel Demedts
- Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
| | - Hanieh Mirzaee
- Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center at Technical University of Munich, Munich, Germany
| | - Heiko Stern
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center at Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center at Technical University of Munich, Munich, Germany
| | - Bjoern Menze
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Anja Hennemuth
- Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany
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Sotelo J, Dux‐Santoy L, Guala A, Rodríguez‐Palomares J, Evangelista A, Sing‐Long C, Urbina J, Mura J, Hurtado DE, Uribe S. 3D axial and circumferential wall shear stress from 4D flow MRI data using a finite element method and a laplacian approach. Magn Reson Med 2017; 79:2816-2823. [DOI: 10.1002/mrm.26927] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Julio Sotelo
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of Electrical Engineering, Schools of EngineeringPontificia Universidad Católica de ChileSantiago Chile
| | - Lydia Dux‐Santoy
- Department of CardiologyHospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de BarcelonaBarcelona Spain
| | - Andrea Guala
- Department of CardiologyHospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de BarcelonaBarcelona Spain
| | - José Rodríguez‐Palomares
- Department of CardiologyHospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de BarcelonaBarcelona Spain
| | - Arturo Evangelista
- Department of CardiologyHospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de BarcelonaBarcelona Spain
| | - Carlos Sing‐Long
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Mathematical and Computational Engineering, School of EngineeringPontificia Universidad Católica de ChileSantiago Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine, and Biological SciencesPontificia Universidad Católica de ChileSantiago Chile
| | - Jesús Urbina
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of Radiology, School of MedicinePontificia Universidad Catolica de ChileSantiago Chile
| | - Joaquín Mura
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
| | - Daniel E. Hurtado
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine, and Biological SciencesPontificia Universidad Católica de ChileSantiago Chile
- Department of Structural and Geotechnical Engineering, Schools of EngineeringPontificia Universidad Católica de ChileSantiago Chile
| | - Sergio Uribe
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine, and Biological SciencesPontificia Universidad Católica de ChileSantiago Chile
- Department of Radiology, School of MedicinePontificia Universidad Catolica de ChileSantiago Chile
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Magnetic resonance imaging 4-D flow-based analysis of aortic hemodynamics in Turner syndrome. Pediatr Radiol 2017; 47:382-390. [PMID: 28184962 DOI: 10.1007/s00247-016-3767-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/25/2016] [Accepted: 12/07/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cardiovascular surveillance is important in Turner syndrome because of the increased risk of aortic dilation and dissection with consecutively increased mortality. OBJECTIVE To compare 4-D flow MRI for the characterization of aortic 3-D flow patterns, dimensions and vessel wall parameters in pediatric patients with Turner syndrome and age-matched controls. MATERIALS AND METHODS We performed 4-D flow MRI measuring in vivo 3-D blood flow with coverage of the thoracic aorta in 25 patients with Turner syndrome and in 16 female healthy controls (age mean ± standard deviation were 16 ± 5 years and 17 ± 4 years, respectively). Blood flow was visualized by time-resolved 3-D path lines. Visual grading of aortic flow in terms of helices and vortices was performed by two independent observers. Quantitative analysis included measurement of aortic diameters, quantification of peak systolic wall shear stress, pulsatility index and oscillatory shear index at eight defined sites. RESULTS Patients with Turner syndrome had significantly larger aortic diameters normalized to BSA, increased vortices in the ascending aorta and elevated helix flow in the ascending and descending aorta compared to controls (all P<0.03). Patients with abnormal helical or vortical flow in the ascending aorta had significantly larger diameters of the ascending aorta (P<0.03). Peak systolic wall shear stress, pulsatility index and oscillatory shear index were significantly lower in Turner patients compared to controls (p=0.02, p=0.002 and p=0.01 respectively). CONCLUSION Four-dimensional flow MRI provides new insights into the altered aortic hemodynamics and wall shear stress that could have an impact on the development of aortic dissections.
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31
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Geiger J, Hirtler D, Gottfried K, Rahman O, Bollache E, Barker AJ, Markl M, Stiller B. Longitudinal Evaluation of Aortic Hemodynamics in Marfan Syndrome: New Insights from a 4D Flow Cardiovascular Magnetic Resonance Multi-Year Follow-Up Study. J Cardiovasc Magn Reson 2017; 19:33. [PMID: 28327193 PMCID: PMC5361800 DOI: 10.1186/s12968-017-0347-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this 4D flow cardiovascular magnetic resonance (CMR) follow-up study was to investigate longitudinal changes in aortic hemodynamics in adolescent patients with Marfan syndrome (MFS). METHODS 4D flow CMR for the assessment of in-vivo 3D blood flow with full coverage of the thoracic aorta was performed twice (baseline scan t1/follow-up scan t2) in 19 adolescent MFS patients (age at t1: 12.7 ± 3.6 years, t2: 16.2 ± 4.3 years) with a mean follow-up duration of 3.5 ± 1.2 years. Ten healthy volunteers (24 ± 3.8 years) served as a control group. Data analysis included aortic blood flow visualization by color-coded 3D pathlines, and grading of flow patterns (helices/vortices) on a 3-point scale (none, moderate, severe; blinded reading, 2 observers). Regional aortic peak systolic velocities and systolic 3D wall shear stress (WSS) along the entire aortic wall were quantified. Z-Scores of the aortic root and proximal descending aorta (DAo) were assessed. RESULTS Regional systolic WSS was stable over the follow-up duration, except for a significant decrease in the proximal inner DAo segment (p = 0.02) between t1 and t2. MFS patients revealed significant lower mean systolic WSS in the proximal inner DAo compared with volunteers (0.78 ± 0.15 N/m2) at baseline t1 (0.60 ± 0.18 N/m2; p = 0.01) and follow-up t2 (0.55 ± 0.16 N/m2; p = 0.001). There were significant relationships (p < 0.01) between the segmental WSS in the proximal inner DAo, DAo Z-scores (r = -0.64) and helix/vortex pattern grading (r = -0.55) at both t1 and t2. The interobserver agreement for secondary flow patterns assessment was excellent (Cohen's k = 0.71). CONCLUSIONS MFS patients have lower segmental WSS in the inner proximal DAo segment which correlates with increased localized aberrant vortex/helix flow patterns and an enlarged diameter at one of the most critical sites for aortic dissection. General aortic hemodynamics are stable but these subtle localized DAo changes are already present at young age and tend to be more pronounced in the course of time.
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Affiliation(s)
- Julia Geiger
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Daniel Hirtler
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Kristina Gottfried
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
- Department of Anesthesiology, University Hospital Mainz, Mainz, Germany
| | - Ozair Rahman
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
| | - Emilie Bollache
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
| | - Alex J. Barker
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, USA
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
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van der Palen RLF, Barker AJ, Bollache E, Garcia J, Rose MJ, van Ooij P, Young LT, Roest AAW, Markl M, Robinson JD, Rigsby CK. Altered aortic 3D hemodynamics and geometry in pediatric Marfan syndrome patients. J Cardiovasc Magn Reson 2017; 19:30. [PMID: 28302143 PMCID: PMC5356404 DOI: 10.1186/s12968-017-0345-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/16/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Blood flow dynamics make it possible to better understand the development of aortopathy and cardiovascular events in patients with Marfan syndrome (MFS). Aortic 3D blood flow characteristics were investigated in relation to aortic geometry in children and adolescents with MFS. METHODS Twenty-five MFS patients (age 15.6 ± 4.0 years; 11 females) and 21 healthy controls (age 16.0 ± 2.6 years; 12 females) underwent magnetic resonance angiography and 4D flow CMR for assessment of thoracic aortic size and 3D blood flow velocities. Data analysis included calculation of aortic diameter and BSA-indexed aortic dimensions (Z-score) along the thoracic aorta, 3D mean systolic wall shear stress (WSSmean) in ten aortic segments and assessment of aortic blood flow patterns. RESULTS Aortic root (root), ascending (AAo) and descending (DAo) aortic size was significantly larger in MFS patients than healthy controls (Root Z-score: 3.56 ± 1.45 vs 0.49 ± 0.78, p < 0.001; AAo Z-score 0.21 ± 0.95 vs -0.54 ± 0.64, p = 0.004; proximal DAo Z-score 2.02 ± 1.60 vs 0.56 ± 0.66, p < 0.001). A regional variation in prevalence and severity of flow patterns (vortex and helix flow patterns) was observed, with the aortic root and the proximal DAo (pDAo) being more frequently affected in MFS. MFS patients had significantly reduced WSSmean in the proximal AAo (pAAo) outer segment (0.65 ± 0.12 vs. 0.73 ± 0.14 Pa, p = 0.029) and pDAo inner segment (0.74 ± 0.17 vs. 0.87 ± 0.21 Pa, p = 0.021), as well as higher WSSmean in the inner segment of the distal AAo (0.94 ± 0.14 vs. 0.84 ± 0.15 Pa, p = 0.036) compared to healthy subjects. An inverse relationship existed between pDAo WSSmean and both pDAo diameter (R = -0.53, p < 0.001) and % diameter change along the pDAo segment (R = -0.64, p < 0.001). CONCLUSIONS MFS children and young adults have altered aortic flow patterns and differences in aortic WSS that were most pronounced in the pAAo and pDAo, segments where aortic dissection or rupture often originate. The presence of vortex flow patterns and abnormal WSS correlated with regional size of the pDAo and are potentially valuable additional markers of disease severity.
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Affiliation(s)
- Roel L. F. van der Palen
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL USA
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Alex J. Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL USA
| | - Emilie Bollache
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL USA
| | - Julio Garcia
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL USA
- Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary - Cumming School of Medicine, Calgary, AB Canada
| | - Michael J. Rose
- Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Pim van Ooij
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL USA
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Luciana T. Young
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Arno A. W. Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL USA
- Department of Biomedical Engineering, McCormick School; of Engineering, Northwestern University, Chicago, IL USA
| | - Joshua D. Robinson
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL USA
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Cynthia K. Rigsby
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL USA
- Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
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Burchill LJ, Huang J, Tretter JT, Khan AM, Crean AM, Veldtman GR, Kaul S, Broberg CS. Noninvasive Imaging in Adult Congenital Heart Disease. Circ Res 2017; 120:995-1014. [DOI: 10.1161/circresaha.116.308983] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
Multimodality cardiovascular imaging plays a central role in caring for patients with congenital heart disease (CHD). CHD clinicians and scientists are interested not only in cardiac morphology but also in the maladaptive ventricular responses and extracellular changes predisposing to adverse outcomes in this population. Expertise in the applications, strengths, and pitfalls of these cardiovascular imaging techniques as they relate to CHD is essential. The purpose of this article is to provide an overview of cardiovascular imaging in CHD. We focus on the role of 3 widely used noninvasive imaging techniques in CHD—echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography. Consideration is given to the common goals of cardiac imaging in CHD, including assessment of structural and residual heart disease before and after surgery, quantification of ventricular volume and function, stress imaging, shunt quantification, and tissue characterization. Extracardiac imaging is highlighted as an increasingly important aspect of CHD care.
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Affiliation(s)
- Luke J. Burchill
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Jennifer Huang
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Justin T. Tretter
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Abigail M. Khan
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Andrew M. Crean
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Gruschen R. Veldtman
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Sanjiv Kaul
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Craig S. Broberg
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
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Kimura N, Nakamura M, Komiya K, Nishi S, Yamaguchi A, Tanaka O, Misawa Y, Adachi H, Kawahito K. Patient-specific assessment of hemodynamics by computational fluid dynamics in patients with bicuspid aortopathy. J Thorac Cardiovasc Surg 2017; 153:S52-S62.e3. [PMID: 28190607 DOI: 10.1016/j.jtcvs.2016.12.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/25/2016] [Accepted: 12/18/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Hemodynamics related to eccentric blood flow may factor into the development of bicuspid aortic valve aortopathy. We investigated wall shear stress distribution by means of magnetic resonance imaging-based computational fluid dynamics in patients with a bicuspid aortic valve. METHODS Included were 12 patients with a bicuspid aortic valve (aortic stenosis, n = 11; root enlargement, n = 1). Three patients with a normal tricuspid aortic valve (arch aneurysm, n = 1; descending aortic aneurysm, n = 2) were included for comparison. The thoracic aorta geometry was reconstructed by means of 3-dimensional computed tomography angiography, and the bicuspid aortic valve orifice was modeled. Flow rates at the sinotubular junction and 3 aortic branches were measured at various time points by cine phase-contrast magnetic resonance imaging to define boundary conditions for computational fluid dynamics, and the flow was simulated. RESULTS Bicuspid aortic valve cusp configurations were type 0 lateral (n = 4), type 0 anterior-posterior (n = 2), type 1 L-R (n = 4), and type 1 R-N (n = 2). Abnormal aortic helical flow was seen in the ascending aorta and transverse arch in all patients with bicuspid aortic valves and was right handed in 11 patients (91%). No such flow was seen in the patients with tricuspid aortic valves. The patients with bicuspid aortic valves were likely to have jet flow/wall impingement against the greater curvature of the proximal ascending aorta, resulting in remarkably increased wall shear stress around the impingement area. CONCLUSIONS Computational fluid dynamics simulation is useful for precise evaluation of hemodynamics related to bicuspid aortic valve aortopathy. Such evaluation will advance our understanding of the disease pathophysiology and may facilitate molecular biological investigation.
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Affiliation(s)
- Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Masanori Nakamura
- Department of Mechanical Engineering, Biomechanics Laboratory, Saitama University, Saitama, Japan.
| | - Kenji Komiya
- Department of Mechanical Engineering, Biomechanics Laboratory, Saitama University, Saitama, Japan
| | - Satoshi Nishi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Osamu Tanaka
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshio Misawa
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koji Kawahito
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Saitama, Japan
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Moreno R, Sewonu A, Meyrignac O, Krid O, Rousseau H. Prospects of numerical modeling in the monitoring of aortic diseases. Phys Med 2015. [DOI: 10.1016/j.ejmp.2015.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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