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Yaman MM, Chetrit M, Bullen J, Bolen MA, Flamm SD, Kwon D. Novel contouring method for optimizing MRI flow quantification in patients with aortic valve disease. Int J Cardiovasc Imaging 2024; 40:665-673. [PMID: 38286950 PMCID: PMC10950979 DOI: 10.1007/s10554-023-03036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/13/2023] [Indexed: 01/31/2024]
Abstract
Optimizing MRI aortic flow quantification is crucial for accurate assessment of valvular disease severity. In this study, we sought to evaluate the accuracy of a novel method of contouring systolic aortic forward flow in comparison to standard contouring methods at various aortic levels. The study included a cohort of patients with native aortic valve (AoV) disease and a small control group referred to cardiac MRI over a 1-year period. Inclusion criteria included aortic flow quantification at aortic valve and one additional level, and no or trace mitral regurgitation (MR) documented both by the MRI AND an echocardiogram done within a year. In addition to flow quantification with standard contouring (SC), a novel Selective Systolic Contouring (SSC) method was performed at aortic valve level, contouring the area demarcated by the AoV leaflets in systole. The bias in each technique's estimate of aortic forward flow was calculated as the mean difference between aortic forward flow and left ventricular stroke volume (LV SV). 98 patients (mean age 56, 71% male) were included: 33 with tricuspid and 65 with congenitally abnormal (bicuspid or unicuspid) AoV. All methods tended to underestimate aortic forward flow, but the bias was smallest with the SSC method (p < 0.001). Therefore, SSC yielded the lowest estimates of mitral regurgitant volume (4.8 ml) and regurgitant fraction (3.9%) (p < 0.05). SSC at AoV level better approximates LV SV in our cohort, and may provide more accurate quantitative assessment of both aortic and mitral valve function.
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Affiliation(s)
- Malek M Yaman
- Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
| | - Michael Chetrit
- Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Jennifer Bullen
- Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Michael A Bolen
- Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Scott D Flamm
- Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Deborah Kwon
- Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA
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Leo I, Sabatino J, Avesani M, Moscatelli S, Bianco F, Borrelli N, De Sarro R, Leonardi B, Calcaterra G, Surkova E, Di Salvo G. Non-Invasive Imaging Assessment in Patients with Aortic Coarctation: A Contemporary Review. J Clin Med 2023; 13:28. [PMID: 38202035 PMCID: PMC10779918 DOI: 10.3390/jcm13010028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
Coarctation of the aorta (CoA) is a congenital abnormality characterized by a narrowing of the aortic lumen, which can lead to significant morbidity and mortality if left untreated. Even after repair and despite significant advances in therapeutic management, these patients have overall reduced long-term survival due to the consequences of chronic afterload increase. Cardiovascular imaging is key from the first diagnosis to serial follow-up. In recent years, novel imaging techniques have emerged, increasing accessibility to advanced imaging modalities and enabling early and non-invasive identification of complications after repair. The aim of this paper is to provide a comprehensive review of the role of different imaging techniques in the evaluation and management of patients with native or repaired CoA, highlighting their unique strengths and limitations.
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Affiliation(s)
- Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (I.L.)
- CMR Unit, Royal Brompton and Harefield Hospitals, London SW3 5NP, UK;
| | - Jolanda Sabatino
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (I.L.)
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
| | - Martina Avesani
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
| | - Sara Moscatelli
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital, London WC1N 3JH, UK;
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Rosalba De Sarro
- Department of Experimental and Clinical Medicine, University of Messina, 98166 Messina, Italy;
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | | | - Elena Surkova
- CMR Unit, Royal Brompton and Harefield Hospitals, London SW3 5NP, UK;
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
- Paediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy
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de la Torre Hernandez JM, Veiga Fernandez G, Ben-Assa E, Iribarren J, Sainz Laso F, Lee DH, Ruisanchez Villar C, Lerena P, Garcia Camarero T, Iribarren Sarrias JL, Cuesta Cosgaya JM, Maza Fernandez ME, Garilleti C, Fradejas-Sastre V, Benito M, Barrera S, Gil Ongay A, Vazquez de Prada JA, Zueco J. First description and validation of a new method for estimating aortic stenosis burden and predicting the functional response to TAVI. Front Cardiovasc Med 2023; 10:1215826. [PMID: 38034386 PMCID: PMC10682652 DOI: 10.3389/fcvm.2023.1215826] [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: 05/02/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Up to one-fifth of patients continue to have poor quality of life after transcatheter aortic valve implantation (TAVI), with an additional similar proportion not surviving 1 year after the procedure. We aimed to assess the value of a new method based on an integrated analysis of left ventricular outflow tract flow velocity and aortic pressure to predict objective functional improvement and prognosis after TAVI. Methods In a cohort of consecutive patients undergoing TAVI, flow velocity-pressure integrated analysis was obtained from simultaneous pressure recordings in the ascending aorta and flow velocity recordings in the left ventricular outflow tract by echocardiography. Objective functional improvement 6 months after TAVI was assessed through changes in a 6-min walk test and NT-proBNP levels. A clinical follow-up was conducted at 2 years. Results Of the 102 patients studied, 82 (80.4%) showed objective functional improvement. The 2-year mortality of these patients was significantly lower (9% vs. 44%, p = 0.001). In multivariate analysis, parameter "(Pressure at Vmax - Pressure at Vo)/Vmax" was found to be an independent predictor for objective improvement. The C-statistic was 0.70 in the overall population and 0.78 in the low-gradient subgroup. All echocardiographic parameters and the valvuloarterial impedance showed a C-statistic of <0.6 for the overall and low-gradient patients. In a validation cohort of 119 patients, the C-statistic was 0.67 for the total cohort and 0.76 for the low-gradient subgroup. Conclusion This new method allows predicting objective functional improvement after TAVI more precisely than the conventional parameters used to assess the severity of aortic stenosis, particularly in low-gradient patients.
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Affiliation(s)
- Jose M. de la Torre Hernandez
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
- Department of Cardiology, Medical School, University of Cantabria, Santander, Spain
| | | | - Eyal Ben-Assa
- Cardiology Division, Assuta Ashdod University Hospital, Ben Gurion University, Ashdod, Israel
| | - Julia Iribarren
- School of Mathematics, Universidad de la Laguna, San Cristobal de la Laguna, Spain
| | - Fermin Sainz Laso
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Dae-Hyun Lee
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Piedad Lerena
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Tamara Garcia Camarero
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Jose M. Cuesta Cosgaya
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Maria E. Maza Fernandez
- Hydrodynamics and Coastal Infrastructures Group of IH Cantabria, Instituto de Hidraulica Ambiental, Universidad de Cantabria, Santander, Spain
| | - Celia Garilleti
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Victor Fradejas-Sastre
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Mercedes Benito
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Sergio Barrera
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Aritz Gil Ongay
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Jose A. Vazquez de Prada
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
- Department of Cardiology, Medical School, University of Cantabria, Santander, Spain
| | - Javier Zueco
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
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Alkassar M, Engelhardt S, Abu-Tair T, Ojeda E, Treffer PC, Weyand M, Rompel O. Comparative Study of 2D-Cine and 3D-wh Volumetry: Revealing Systemic Error of 2D-Cine Volumetry. Diagnostics (Basel) 2023; 13:3162. [PMID: 37891983 PMCID: PMC10605840 DOI: 10.3390/diagnostics13203162] [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: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
This study investigates the crucial factors influencing the end-systolic and end-diastolic volumes in MRI volumetry and their direct effects on the derived functional parameters. Through the simultaneous acquisition of 2D-cine and 3D whole-heart slices in end-diastole and end-systole, we present a novel direct comparison of the volumetric measurements from both methods. A prospective study was conducted with 18 healthy participants. Both 2D-cine and 3D whole-heart sequences were obtained. Despite the differences in the creation of 3D volumes and trigger points, the impact on the LV volume was minimal (134.9 mL ± 16.9 mL vs. 136.6 mL ± 16.6 mL, p < 0.01 for end-diastole; 50.6 mL ± 11.0 mL vs. 51.6 mL ± 11.2 mL, p = 0.03 for end-systole). In our healthy patient cohort, a systematic underestimation of the end-systolic volume resulted in a significant overestimation of the SV (5.6 mL ± 2.6 mL, p < 0.01). The functional calculations from the 3D whole-heart method proved to be highly accurate and correlated well with function measurements from the phase-contrast sequences. Our study is the first to demonstrate the superiority of 3D whole-heart volumetry over 2D-cine volumetry and sheds light on the systematic error inherent in 2D-cine measurements.
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Affiliation(s)
- Muhnnad Alkassar
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
- Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, 90419 Nuremberg, Germany
| | - Sophia Engelhardt
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Tariq Abu-Tair
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany;
| | - Efren Ojeda
- Siemens Healtineers, 91052 Erlangen, Germany; (E.O.); (P.C.T.)
| | | | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
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Schwaiger JP, Reinstadler SJ, Holzknecht M, Tiller C, Reindl M, Begle J, Lechner I, Lamina C, Mayr A, Graziadei I, Bauer A, Metzler B, Klug G. Prognostic value of depressed cardiac index after STEMI: a phase-contrast magnetic resonance study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 11:53-61. [PMID: 34750623 DOI: 10.1093/ehjacc/zuab098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/14/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022]
Abstract
AIMS An invasively measured cardiac index (CI) of ≤2.2 L/min/m2 is one of the strongest prognostic indicators after ST-elevation myocardial infarction (STEMI), however, knowledge is mainly based on invasive evaluations performed in the pre-stent era. Velocity-encoded phase-contrast cardiac magnetic resonance (PC-CMR) allows non-invasive determination of CI. METHODS AND RESULTS In this prospective study, CMR was performed in 406 stable and contemporarily revascularized patients a median of 3 days after STEMI. Forward stroke volume was assessed at the level of the ascending aorta by PC-CMR. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were determined by cine CMR. Major adverse cardiac events (MACE) were defined as the composite of death, myocardial infarction, or hospitalization for heart failure. Median CI was 2.52 L/min/m2 and 27% of patients had ≤2.2 L/min/m2. Median LVEF was 53% and median GLS was -12.2%. During a median follow-up of 14.2 [95% confidence interval (95% CI) 13.6-14.7] months, 41 patients (10.1%) experienced a MACE. A depressed CI was significantly associated with MACE after adjustment for LVEF, GLS, Thrombolysis in Myocardial Infarction (TIMI) risk score, and infarct size [hazard ratio = 3.15 (95% CI 1.53-6.47); P = 0.002] and led to significant discrimination improvement [net reclassification improvement 0.61 (95% CI 0.25-0.97); P < 0.001]. CONCLUSIONS A CI of 2.2 L/min/m2 or less as measured by PC-CMR was present in 27% of clinically stable patients after STEMI and strongly and independently predicted medium-term MACE. The prognostic value of a depressed CI was superior and incremental to LVEF, GLS, TIMI risk score, and infarct size.
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Affiliation(s)
- Johannes P Schwaiger
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Milser Strasse 10, 6060 Hall in Tirol, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Jana Begle
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Claudia Lamina
- Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ivo Graziadei
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Milser Strasse 10, 6060 Hall in Tirol, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Guzzetti E, Racine HP, Tastet L, Shen M, Larose E, Clavel MA, Pibarot P, Beaudoin J. Accuracy of stroke volume measurement with phase-contrast cardiovascular magnetic resonance in patients with aortic stenosis. J Cardiovasc Magn Reson 2021; 23:124. [PMID: 34732204 PMCID: PMC8567621 DOI: 10.1186/s12968-021-00814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Phase contrast (PC) cardiovascular magnetic resonance (CMR) in the ascending aorta (AAo) is widely used to calculate left ventricular (LV) stroke volume (SV). The accuracy of PC CMR may be altered by turbulent flow. Measurement of SV at another site is suggested in the presence of aortic stenosis, but very few data validates the accuracy or inaccuracy of PC in that setting. Our objective is to compare flow measurements obtained in the AAo and LV outflow tract (LVOT) in patients with aortic stenosis. METHODS Retrospective analysis of patients with aortic stenosis who had CMR and echocardiography. Patients with mitral regurgitation were excluded. PC in the AAo and LVOT were acquired to derive SV. LV SV from end-systolic and end-diastolic tracings was used as the reference measure. A difference ≥ 10% between the volumetric method and PC derived SVs was considered discordant. Metrics of turbulence and jet eccentricity were assessed to explore the predictors of discordant measurements. RESULTS We included 88 patients, 41% with bicuspid aortic valve. LVOT SV was concordant with the volumetric method in 79 (90%) patients vs 52 (59%) patients for AAo SV (p = 0.015). In multivariate analysis, aortic stenosis flow jet angle was a strong predictor of discordant measurement in the AAo (p = 0.003). Mathematical correction for the jet angle improved the concordance from 59 to 91%. Concordance was comparable in patients with bicuspid and trileaflet valves (57% and 62% concordance respectively; p = 0.11). Accuracy of SV measured in the LVOT was not influenced by jet eccentricity. For aortic regurgitation quantification, PC in the AAo had better correlation to volumetric assessments than LVOT PC. CONCLUSION LVOT PC SV in patients with aortic stenosis and eccentric jet might be more accurate compared to the AAo SV. Mathematical correction for the jet angle in the AAo might be another alternative to improve accuracy.
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Affiliation(s)
- Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V-4G5, Canada
| | - Hugo-Pierre Racine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V-4G5, Canada
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V-4G5, Canada
| | - Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V-4G5, Canada
| | - Eric Larose
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V-4G5, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V-4G5, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V-4G5, Canada
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V-4G5, Canada.
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Hungerford SL, Adji AI, Hayward CS, Muller DWM. Ageing, Hypertension and Aortic Valve Stenosis: A Conscious Uncoupling. Heart Lung Circ 2021; 30:1627-1636. [PMID: 34274230 DOI: 10.1016/j.hlc.2021.05.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/17/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
Aortic valve stenosis (AS) is no longer considered to be a disease of fixed left ventricular (LV) afterload (due to an obstructive valve), but rather, functions as a series circuit with important contributions from both the valve and ageing vasculature. Patients with AS are frequently elderly, with hypertension and a markedly remodelled aorta. The arterial component is sizable, and yet, the contribution of ventricular afterload has been difficult to determine. Arterial stiffening increases the speed of propagation of the blood pressure wave along the central arteries (estimated as the pulse wave velocity), which results in an earlier return of reflected waves. The effect is to augment blood pressure in the proximal aorta during systole, increasing the central pulse pressure and, in turn, placing even greater afterload on the heart. Elevated global LV afterload is known to have adverse consequences on LV remodelling, function and survival in patients with AS. Consequently, there is renewed focus on methods to estimate the relative contributions of local versus global changes in arterial mechanics and valvular haemodynamics in patients with AS. We present a review on existing and upcoming methods to quantify valvulo-arterial impedance and thereby global LV load in patients with AS.
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Affiliation(s)
- Sara L Hungerford
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
| | - Audrey I Adji
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Christopher S Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - David W M Muller
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Bertelsen L, Vejlstrup N, Andreasen L, Olesen MS, Svendsen JH. Cardiac magnetic resonance systematically overestimates mitral regurgitations by the indirect method. Open Heart 2020; 7:openhrt-2020-001323. [PMID: 32675299 PMCID: PMC7368492 DOI: 10.1136/openhrt-2020-001323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Cardiac MRI is quickly emerging as the gold standard for assessment of mitral regurgitation, most commonly with the indirect method subtracting forward flow in aorta from volumetric segmentation of the left ventricle. We aimed to investigate how aortic flow measurements with increasing distance from the aortic valve affect calculated mitral regurgitations and whether measurements were influenced by breath-hold regimen. Methods Free-breathing and breath-hold phase contrast flows were measured in aorta at valve level, sinotubular (ST) junction, mid-ascending aorta and in the pulmonary trunk. Flow measurements were pairwise compared, and subsequently, after exclusion of patients with visible mitral and tricuspid regurgitations for left-sided and right-sided comparisons, respectively, flow-measured stroke volumes were compared with ventricular volumetric segmentations. Results Thirty-nine participants without arrhythmias or structural abnormalities of the large vessels were included. Stroke volumes measured with free-breathing and breath-hold flow decreased equally with increasing distance to the aortic valves (breath-hold flow: aortic valve 105.6±20.8 mL, ST junction 101.5±20.7 mL, mid-ascending aorta 98.1±21.5 mL). After exclusion of atrioventricular regurgitations, stroke volumes determined by volumetric measurements were higher compared with values determined by flow measurements, corresponding to ‘false’ atrioventricular regurgitations of 8.0%±5.8% with flow measured at valve level, 11.6%±5.2% at the ST junction and 15.3%±5.0% at the mid-ascending aorta. Conclusions Stroke volumes determined by flow decrease throughout the proximal aorta and are systematically lower than volumetrically measured stroke volumes. The indirect method systematically overestimates mitral regurgitations, especially with increasing distance from the aortic valves.
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Affiliation(s)
- Litten Bertelsen
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Andreasen
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Salling Olesen
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P, Hahn R, Han Y, Hung J, Lang R, Little S, Shah D, Shernan S, Thavendiranathan P, Thomas J, Weissman N. Recommendations for noninvasive evaluation of native valvular regurgitation
A report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/2543-1463.282191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Assuncao-Jr AN, Dantas-Jr RN, do Val RM, Gianotto P, Marin ADS, Golden M, Gutierrez MA, Parga JR, Nomura CH. Clinical evaluation of left ventricular function and morphology using an accelerated k-t sensitivity encoding method in cardiovascular magnetic resonance. Insights Imaging 2019; 10:62. [PMID: 31197500 PMCID: PMC6565778 DOI: 10.1186/s13244-019-0750-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives To provide clinical validation of a recent 2D SENSE-based accelerated cardiovascular magnetic resonance (CMR) sequence (accelerated k-t SENSE), investigating whether this technique accurately quantifies left ventricle (LV) volumes, function, and mass as compared to 2D cine steady-state free precession (2D-SSFP). Methods Healthy volunteers (n = 16) and consecutive heart failure patients (n = 26) were scanned using a 1.5 T MRI system. Two LV short axis (SA) stacks were acquired: (1) accelerated k-t SENSE (5–6 breath-holds; temporal/spatial resolution: 37 ms/1.82 × 1.87 mm; acceleration factor = 4) and (2) standard 2D-SSFP (10–12 breath-holds; temporal/spatial resolution: 49 ms/1.67 × 1.87 mm, parallel imaging). Ascending aorta phase-contrast was performed on all volunteers as a reference to compare LV stroke volumes (LVSV) and validate the sequences. An image quality score for SA images was used, with lower scores indicating better quality (from 0 to 18). Results There was a high agreement between accelerated k-t SENSE and 2D-SSFP for LV measurements: bias (limits of agreement) of 2.4% (− 5.4% to 10.1%), 6.9 mL/m2 (− 4.7 to 18.6 mL/m2), − 1.5 (− 8.3 to 5.2 mL/m2), and − 0.2 g/m2 (− 11.9 to 12.3 g/m2) for LV ejection fraction, end-diastolic volume index, end-systolic volume index, and mass index, respectively. LVSV by accelerated k-t SENSE presented good agreement with aortic flow. Interobserver and intraobserver variabilities for all LV parameters were also high. Conclusion The accelerated k-t SENSE CMR sequence is clinically feasible and accurately quantifies LV volumes, function, and mass, with short acquisition time and good image quality.
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Kammerlander AA, Mascherbauer J. The Authors Reply:. JACC Cardiovasc Imaging 2019; 12:2284. [DOI: 10.1016/j.jcmg.2019.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
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Venneri L, Khattar RS, Senior R. Assessment of Complex Multi-Valve Disease and Prosthetic Valves. Heart Lung Circ 2019; 28:1436-1446. [DOI: 10.1016/j.hlc.2019.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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Azarine A, Garçon P, Stansal A, Canepa N, Angelopoulos G, Silvera S, Sidi D, Marteau V, Zins M. Four-dimensional Flow MRI: Principles and Cardiovascular Applications. Radiographics 2019; 39:632-648. [PMID: 30901284 DOI: 10.1148/rg.2019180091] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In-plane phase-contrast (PC) imaging is now a routine component of MRI of regional blood flow in the heart and great vessels. In-plane PC MRI provides a volumetric, isotropic, time-resolved cine sequence that enables three-directional velocity encoding, a technique known as four-dimensional (4D) flow MRI. Recent advances in 4D flow MRI have shortened imaging times, while progress in big-data processing has improved dataset pre- and postprocessing, thereby increasing the feasibility of 4D flow MRI in clinical practice. Important technical issues include selection of the optimal velocity-encoding sensitivity before acquisition and preprocessing of the raw data for phase-offset corrections. Four-dimensional flow MRI provides unprecedented capabilities for comprehensive analysis of complex blood flow patterns using new visualization tools such as streamlines and velocity vectors. Retrospective multiplanar navigation enables flexible retrospective flow quantification through any plane across the volume with good accuracy. Current flow parameters include forward flow, reverse flow, regurgitation fraction, and peak velocity. Four-dimensional flow MRI also supplies advanced flow parameters of use for research, such as wall shear stress. The vigorous burgeoning of new applications indicates that 4D flow MRI is becoming an important imaging modality for cardiovascular disorders. This article reviews the main technical issues of 4D flow MRI and the different parameters provided by it and describes the main applications in cardiovascular diseases, including congenital heart disease, cardiac valvular disease, aortic disease, and pulmonary hypertension. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by Ordovas .
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Affiliation(s)
- Arshid Azarine
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Philippe Garçon
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Audrey Stansal
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Nadia Canepa
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Giorgios Angelopoulos
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Stephane Silvera
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Daniel Sidi
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Véronique Marteau
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Marc Zins
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
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Phase-Contrast Magnetic Resonance Quantification of Aortic Regurgitation in Patients With Turbulent Aortic Flow. J Comput Assist Tomogr 2018; 43:317-322. [PMID: 30407246 DOI: 10.1097/rct.0000000000000819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess variability in measurements and accurately quantify aortic regurgitation in patients with coexisting turbulent aortic flow using phase-contrast magnetic resonance. METHODS All patients (n = 21) underwent phase-contrast magnetic resonance at 2 or more sites: ascending aorta, sinuses of Valsalva, and left ventricular outflow tract. The net flow/minute (NF), forward flow/minute (FF), regurgitant flow/minute (RF), and regurgitant fraction (RF%) were compared with the sum of superior vena cava and descending aortic flow/minute, left ventricular cardiac output, difference between the 2, and percentage difference, respectively. RESULTS The NF, FF, and RF were significantly different between each site. The combination of FF in the left ventricular outflow tract and NF from the superior vena cava + descending aorta provided the best reliability of RF and regurgitant fraction (intraclass correlation coefficients, 0.881 [95% confidence interval, 0.882-0.878] and 0.838 [95% confidence interval, 0.837-0.838]). CONCLUSION Combining flow measurements from more than 1 site provides the most accurate quantification of aortic regurgitation in patients with turbulent aortic flow.
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Four-dimensional flow cardiovascular magnetic resonance in aortic dissection: Assessment in an ex vivo model and preliminary clinical experience. J Thorac Cardiovasc Surg 2018; 157:467-476.e1. [PMID: 30121136 DOI: 10.1016/j.jtcvs.2018.06.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/24/2018] [Accepted: 06/03/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Four-dimensional flow cardiovascular magnetic resonance may improve assessment of hemodynamics in patients with aortic dissection. The purpose of this study was to evaluate the feasibility and accuracy of 4-dimensional flow cardiovascular magnetic resonance assessment of true and false lumens flow. METHODS Thirteen ex vivo porcine aortic dissection models were mounted to a flow loop. Four-dimensional flow cardiovascular magnetic resonance and 2-dimensional phase-contrast cardiovascular magnetic resonance measurements were performed, assessed for intraobserver and interobserver variability, and compared with a reference standard of sonotransducer flow volume measurements. Intraobserver and interobserver variability of 4-dimensional flow cardiovascular magnetic resonance were also assessed in 14 patients with aortic dissection and compared with 2-dimensional phase-contrast cardiovascular magnetic resonance. RESULTS In the ex vivo model, the intraobserver and interobserver measurements had Lin's correlation coefficients of 0.98 and 0.96 and mean differences of 0.17 (±3.65) mL/beat and -0.59 (±5.33) mL/beat, respectively; 4-dimensional and sonotransducer measurements had a Lin's concordance correlation coefficient of 0.95 with a mean difference of 0.35 (±4.92) mL/beat, respectively. In patients with aortic dissection, the intraobserver and interobserver measurements had Lin's concordance correlation coefficients of 0.98 and 0.97 and mean differences of -0.95 (±8.24) mL/beat and 0.62 (±10.05) mL/beat, respectively; 4-dimensional and 2-dimensional flow had a Lin's concordance correlation coefficient of 0.91 with a mean difference of -9.27 (±17.79) mL/beat because of consistently higher flow measured with 4-dimensional flow cardiovascular magnetic resonance in the ascending aorta. CONCLUSIONS Four-dimensional flow cardiovascular magnetic resonance is feasible in patients with aortic dissection and can reliably assess flow in the true and false lumens of the aorta. This promotes potential future work on functional assessment of aortic dissection hemodynamics.
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Grading of aortic stenosis severity: a head-to-head comparison between cardiac magnetic resonance imaging and echocardiography. Radiol Med 2018; 123:643-654. [PMID: 29730841 DOI: 10.1007/s11547-018-0895-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/20/2018] [Indexed: 12/26/2022]
Abstract
AIM To prospectively evaluate the accuracy of cardiac magnetic resonance (cMR) imaging for the assessment of aortic valve effective orifice area (EOA) by continuity equation and anatomical aortic valve area (AVA) by direct planimetry, as compared with transthoracic (TTE) and transesophageal (TEE) two-dimensional (2D) echocardiography, respectively. METHODS AND RESULTS A total of 31 patients (21 men, 10 women, mean age 69 ± 10 years) with moderate-to-severe aortic stenosis (AS) diagnosed by TTE and scheduled for elective aortic valve replacement, underwent both cMR and TEE. AVA by cMR was obtained from balanced steady-state free-precession cine-images. EOA was computed from phase-contrast MR flow analysis. AVA at cMR (0.93 ± 0.42 cm2) was highly correlated with TEE-derived planimetry (0.92 ± 0.32 cm2) (concordance correlation coefficient, CCC = 0.85). By excluding 11 patients with extensively thickened and heavily calcified cusps, the CCC increased to 0.93. EOA at cMR (0.86 ± 0.30 cm2) showed a strong correlation with TTE-derived EOA (0.78 ± 0.25 cm2) (CCC = 0.82). CONCLUSIONS cMR imaging is an accurate alternative for the grading of AS severity. Its use may be recommended especially in patients with poor transthoracic acoustic windows and/or in case of discordance between 2D echocardiographic parameters.
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Bech-Hanssen O, Polte CL, Svensson F, Johnsson ÅA, Lagerstrand KM, Cederbom U, Gao SA. Pulsed-Wave Doppler Recordings in the Proximal Descending Aorta in Patients with Chronic Aortic Regurgitation: Insights from Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2018; 31:304-313.e3. [PMID: 29290484 DOI: 10.1016/j.echo.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The pulsed-wave Doppler recording in the descending aorta (PWDDAO) is one of the parameters used in grading aortic regurgitation (AR) severity. The aim of the present study was to investigate the assessment of chronic AR by PWDDAO with insights from cardiovascular magnetic resonance (CMR). METHODS This prospective study comprised 40 patients investigated with echocardiography and CMR within 4 hours either prior to valve surgery (n = 23) or as part of their follow-up (n = 17) due to moderate or severe AR. End-diastolic flow velocity (EDFV) and the diastolic velocity time integral (dVTI) were measured. The appearance of diastolic forward flow (DFF) was noted. Phase-contrast flow rate curves were obtained in the DAO. RESULTS Twenty-five patients had severe and eight had moderate AR by echocardiography (seven were indeterminate). The EDFV was below the recommended threshold (>20 cm/sec) in 13 patients (52%) with severe AR. Lowering the EDFV threshold (>13 cm/sec) and with a dVTI threshold >13 cm showed negative likelihood ratios of 0.27 and 0.09, respectively. Detection of DFF with PWDDAO identified a nonuniform velocity profile by CMR with positive and negative likelihood ratios of 7.0 and 0.19, respectively. The relation between EDFV and DAO regurgitant volume (DAO-RVolCMR) was strong in patients without (R = 0.88) and weak in patients with DFF (R = 0.49). The DAO-RVolCMR as a percent of the total RVolCMR decreased with increasing ascending aorta (AAO) size and increased with increasing AR severity. CONCLUSIONS Our findings suggest that PWDDAO provides semiquantitative parameters useful to assess chronic AR severity. The limitations are related to nonuniform velocity contour and variable degree of lower body contribution, which depends on AR severity but also on the AAO size.
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Affiliation(s)
- Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christian L Polte
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frida Svensson
- the Department of Diagnostic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- the Department of Diagnostic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulf Cederbom
- Department of Clinical Physiology, Northern Älvsborg County Hospital, Trollhättan, Sweden
| | - Sinsia A Gao
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Śpiewak M, Kłopotowski M, Gawor M, Kubik A, Kowalik E, Miłosz-Wieczorek B, Dąbrowski M, Werys K, Mazurkiewicz Ł, Kożuch K, Polańska-Skrzypczyk M, Petryka-Mazurkiewicz J, Klisiewicz A, Bilińska ZT, Grzybowski J, Witkowski A, Marczak M. Quantification of mitral regurgitation in patients with hypertrophic cardiomyopathy using aortic and pulmonary flow data: impacts of left ventricular outflow tract obstruction and different left ventricular segmentation methods. J Cardiovasc Magn Reson 2017; 19:105. [PMID: 29268761 PMCID: PMC5740710 DOI: 10.1186/s12968-017-0417-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/23/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging in patients with hypertrophic cardiomyopathy (HCM) enables the assessment of not only left ventricular (LV) hypertrophy and scarring but also the severity of mitral regurgitation. CMR assessment of mitral regurgitation is primarily based on the difference between LV stroke volume (LVSV) and aortic forward flow (Ao) measured using the phase-contrast (PC) technique. However, LV outflow tract (LVOT) obstruction causing turbulent, non-laminar flow in the ascending aorta may impact the accuracy of aortic flow quantification, leading to false conclusions regarding mitral regurgitation severity. Thus, we decided to quantify mitral regurgitation in patients with HCM using Ao or, alternatively, main pulmonary artery forward flow (MPA) for mitral regurgitation volume (MRvol) calculations. METHODS The analysis included 143 prospectively recruited subjects with HCM and 15 controls. MRvol was calculated as the difference between LVSV computed with either the inclusion (LVSVincl) or exclusion (LVSVexcl) of papillary muscles and trabeculations from the blood pool and either Ao (MRvolAoi or MRvolAoe) or MPA (MRvolMPAi or MRvolMPAe). The presence or absence of LVOT obstruction was determined based on Doppler echocardiography findings. RESULTS MRvolAoi was higher than MRvolMPAi in HCM patients with LVOT obstruction [47.0 ml, interquartile range (IQR) = 31.5-60.0 vs. 35.5 ml, IQR = 26.0-51.0; p < 0.0001] but not in non-obstructive HCM patients (23.0 ml, IQR = 16.0-32.0 vs. 24.0 ml, IQR = 15.3-32.0; p = 0.26) or controls (18.0 ml, IQR = 14.3-21.8 vs. 20.0 ml, IQR = 14.3-22.0; p = 0.89). In contrast to controls and HCM patients without LVOT obstruction, in HCM patients with LVOT obstruction, aortic flow-based MRvol (MRvolAoi) was higher than pulmonary-based findings (MRvolMPAi) (bias = 9.5 ml; limits of agreement: -11.7-30.7 with a difference of 47 ml in the extreme case). The differences between aortic-based and pulmonary-based MRvol values calculated using LVSVexcl mirrored those derived using LVSVincl. However, MRvol values calculated using LVSVexcl were lower in all the groups analyzed (HCM with LVOT obstruction, HCM without LVOT obstruction, and controls) and with all methods of MRvol quantification used (p ≤ 0.0001 for all comparisons). CONCLUSIONS In HCM patients, LVOT obstruction significantly affects the estimation of aortic flow, leading to its underestimation and, consequently, to higher MRvol values than those obtained with MPA-based MRvol calculations.
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Affiliation(s)
- Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kłopotowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Headington, Oxford, UK
| | | | - Katarzyna Kożuch
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - Joanna Petryka-Mazurkiewicz
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Anna Klisiewicz
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Zofia T. Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
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Bech-Hanssen O, Svensson F, Polte CL, Johnsson ÅA, Gao SA, Lagerstrand KM. Characterization of complex flow patterns in the ascending aorta in patients with aortic regurgitation using conventional phase-contrast velocity MRI. Int J Cardiovasc Imaging 2017; 34:419-429. [PMID: 28871348 PMCID: PMC5847208 DOI: 10.1007/s10554-017-1239-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/31/2017] [Indexed: 01/15/2023]
Abstract
Ascending aorta (AA) flow displacement (FD) is a surrogate for increased wall shear stress. We prospectively studied the flow profile in the AA in patients with aortic regurgitation (AR), to identify predictors of FD and investigate whether magnetic resonance imaging (MRI) phase-contrast flow rate curves (PC-FRC) contain quantitative information related to FD. Forty patients with chronic moderate (n = 14) or severe (n = 26) AR (21 (53%) with bicuspid aortic valve) and 22 controls were investigated. FD was determined from phase-contrast velocity profiles and defined as the distance between the center of the lumen and the "center of velocity" of the peak systolic forward flow or the peak diastolic negative flow, normalized to the lumen radius. Forward and backward volume flow was determined separately for systole and diastole. Seventy percent had systolic backward flow and 45% had diastolic forward flow in large areas of the vessel. AA dimension was an independent predictor of systolic FD while AA dimension and regurgitant volume were independent predictors of diastolic FD. Valve phenotype was not an independent predictor of systolic or diastolic FD. The linear relationships between systolic backward flow and systolic FD and diastolic forward flow and diastolic FD were strong (R = 0.77 and R = 0.76 respectively). Systolic backward flow and diastolic forward flow identified marked systolic and diastolic FD (≥0.35) with a positive likelihood ratio of 6.0 and 10.8, respectively. In conclusion, conventional PC-FRC data can detect and quantify FD in patients with AR suggesting the curves as a research and screening tool in larger patient populations.
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Affiliation(s)
- Odd Bech-Hanssen
- Departments of Clinical Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. .,Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Frida Svensson
- Departments of Diagnostic Radiation Physics, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christian L Polte
- Departments of Cardiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åse A Johnsson
- Departments of Radiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Departments of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sinsia A Gao
- Departments of Clinical Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- Departments of Diagnostic Radiation Physics, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Utility of Cardiac Magnetic Resonance Imaging in the Management of Adult Congenital Heart Disease. J Thorac Imaging 2017. [DOI: 10.1097/rti.0000000000000280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Polte CL, Gao SA, Johnsson ÅA, Lagerstrand KM, Bech-Hanssen O. Characterization of Chronic Aortic and Mitral Regurgitation Undergoing Valve Surgery Using Cardiovascular Magnetic Resonance. Am J Cardiol 2017; 119:2061-2068. [PMID: 28450039 DOI: 10.1016/j.amjcard.2017.03.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Abstract
Grading of chronic aortic regurgitation (AR) and mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR) is currently based on thresholds, which are neither modality nor quantification method specific. Accordingly, this study sought to identify CMR-specific and quantification method-specific thresholds for regurgitant volumes (RVols), RVol indexes, and regurgitant fractions (RFs), which denote severe chronic AR or MR with an indication for surgery. The study comprised patients with moderate and severe chronic AR (n = 38) and MR (n = 40). Echocardiography and CMR was performed at baseline and in all operated AR/MR patients (n = 23/25) 10 ± 1 months after surgery. CMR quantification of AR: direct (aortic flow) and indirect method (left ventricular stroke volume [LVSV] - pulmonary stroke volume [PuSV]); MR: 2 indirect methods (LVSV - aortic forward flow [AoFF]; mitral inflow [MiIF] - AoFF). All operated patients had severe regurgitation and benefited from surgery, indicated by a significant postsurgical reduction in end-diastolic volume index and improvement or relief of symptoms. The discriminatory ability between moderate and severe AR was strong for RVol >40 ml, RVol index >20 ml/m2, and RF >30% (direct method) and RVol >62 ml, RVol index >31 ml/m2, and RF >36% (LVSV-PuSV) with a negative likelihood ratio ≤ 0.2. In MR, the discriminatory ability was very strong for RVol >64 ml, RVol index >32 ml/m2, and RF >41% (LVSV-AoFF) and RVol >40 ml, RVol index >20 ml/m2, and RF >30% (MiIF-AoFF) with a negative likelihood ratio < 0.1. In conclusion, CMR grading of chronic AR and MR should be based on modality-specific and quantification method-specific thresholds, as they differ largely from recognized guideline criteria, to assure appropriate clinical decision-making and timing of surgery.
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Rutz T, Meierhofer C, Naumann S, Martinoff S, Ewert P, Stern HC, Fratz S. Comparison of MR flow quantification in peripheral and main pulmonary arteries in patients after right ventricular outflow tract surgery: A retrospective study. J Magn Reson Imaging 2017; 46:1839-1845. [PMID: 28301100 DOI: 10.1002/jmri.25701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/24/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare the quantification of pulmonary stroke volume (SV) by phase contrast magnetic resonance (PC-MR) in the main pulmonary artery (MPA) to the sum of SVs in both peripheral pulmonary arteries (PPA) in different right ventricular (RV) outflow pathologies. MATERIALS AND METHODS Pulmonary SV was determined by PC-MR in the MPA and the PPA in healthy individuals (H, n = 54), patients after correction for tetralogy of Fallot with significant pulmonary regurgitation and without pulmonary or RV outflow tract stenosis (PR, n = 50), and in patients with RV outflow tract or pulmonary valve stenosis (PS, n = 50). Resulting SVs were compared to aortic SV in the ascending aorta. RESULTS Mean age was similar between the groups: H 28 ± 17 vs. PR 24 ± 11 vs. PS 22 ± 10 years. Bland-Altman analyses revealed in all groups a relatively small systemic (bias) but large random error (limits of agreement) for pulmonary SV determined in the MPA as compared to summed SVs in the PPA. The largest limits of agreement were present in PS patients: H: MPA 3.9% (-11, + 19) vs. PPA 0.4% (-15, + 15); PR: MPA 5.2% (-25, + 36) vs. PPA 0.6% (-24, + 26); PS: MPA 5% (-36; + 46), PPA -0.03% (-34, + 35). CONCLUSION The accuracy of PC-MR in the MPA is reasonable; however, a large random error (precision) is observed that is most pronounced in PS patients. This potential error should be taken into consideration when interpreting MPA flow measurements. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1839-1845.
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Affiliation(s)
- Tobias Rutz
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany.,Service of Cardiology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - Christian Meierhofer
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Susanne Naumann
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Stefan Martinoff
- Department of Radiology, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Peter Ewert
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Heiko C Stern
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Sohrab Fratz
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
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Abstract
Although echocardiography remains the mainstay imaging technique for the evaluation of patients with valvular heart disease (VHD), innovations in noninvasive imaging in the past few years have provided new insights into the pathophysiology and quantification of VHD, early detection of left ventricular (LV) dysfunction, and advanced prognostic assessment. The severity grading of valve dysfunction has been refined with the use of Doppler echocardiography, cardiac magnetic resonance (CMR), and CT imaging. LV ejection fraction remains an important criterion when deciding whether patients should be referred for surgery. However, echocardiographic strain imaging can now detect impaired LV systolic function before LV ejection fraction reduces, thus provoking the debate on whether patients with severe VHD should be referred for surgery at an earlier stage (before symptom onset). Impaired LV strain correlates with the amount of myocardial fibrosis detected with CMR techniques. Furthermore, accumulating data show that the extent of fibrosis associated with severe VHD has important prognostic implications. The present Review focuses on using these novel imaging modalities to assess pathophysiology, early LV dysfunction, and prognosis of major VHDs, including aortic stenosis, mitral regurgitation, and aortic regurgitation.
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Skårdal K, Espe EKS, Zhang L, Aronsen JM, Sjaastad I. Three-Directional Evaluation of Mitral Flow in the Rat Heart by Phase-Contrast Cardiovascular Magnetic Resonance. PLoS One 2016; 11:e0150536. [PMID: 26930073 PMCID: PMC4773091 DOI: 10.1371/journal.pone.0150536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose Determination of mitral flow is an important aspect in assessment of cardiac function. Traditionally, mitral flow is measured by Doppler echocardiography which suffers from several challenges, particularly related to the direction and the spatial inhomogeneity of flow. These challenges are especially prominent in rodents. The purpose of this study was to establish a cardiovascular magnetic resonance (CMR) protocol for evaluation of three-directional mitral flow in a rodent model of cardiac disease. Materials and Methods Three-directional mitral flow were evaluated by phase contrast CMR (PC-CMR) in rats with aortic banding (AB) (N = 7) and sham-operated controls (N = 7). Peak mitral flow and deceleration rate from PC-CMR was compared to conventional Doppler echocardiography. The accuracy of PC-CMR was investigated by comparison of spatiotemporally integrated mitral flow with left ventricular stroke volume assessed by cine CMR. Results PC-CMR portrayed the spatial distribution of mitral flow and flow direction in the atrioventricular plane throughout diastole. Both PC-CMR and echocardiography demonstrated increased peak mitral flow velocity and higher deceleration rate in AB compared to sham. Comparison with cine CMR revealed that PC-CMR measured mitral flow with excellent accuracy. Echocardiography presented significantly lower values of flow compared to PC-CMR. Conclusions For the first time, we show that PC-CMR offers accurate evaluation of three-directional mitral blood flow in rodents. The method successfully detects alterations in the mitral flow pattern in response to cardiac disease and provides novel insight into the characteristics of mitral flow.
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Affiliation(s)
- Kristine Skårdal
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
- * E-mail:
| | - Emil KS Espe
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Lili Zhang
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Jan Magnus Aronsen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- Bjørknes College, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
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Burris NS, Hope MD. Bicuspid valve-related aortic disease: flow assessment with conventional phase-contrast MRI. Acad Radiol 2015; 22:690-6. [PMID: 25769698 DOI: 10.1016/j.acra.2015.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES Abnormal blood flow with bicuspid aortic valve (BAV) has been characterized with four-dimensional flow magnetic resonance imaging (MRI), but this approach is time consuming and requires technical expertise. We assess the relationship between different leaflets fusion patterns with BAV, eccentric systolic flow, and dilation patterns of the ascending aorta using two-dimensional (2D) phase-contrast (PC) MRI. MATERIALS AND METHODS Fifty-nine patients with BAV who underwent cardiac MRI were identified; 47 had right-left (RL) aortic leaflet fusion and 12 had right-noncoronary (RN) fusion. Flow displacement was calculated, and patients with abnormal displacement (>0.1) were classified as either rightward or leftward. Patterns of aortopathy were determined (0-3), and correlation between leaflet fusion, flow direction, aortopathy type, and other clinical parameters was performed with Pearson correlation, the Fisher exact test and chi-square analysis. RESULTS Normal systolic flow was seen in 24% of cases and was significantly correlated with normal aortas (P = .011). Abnormal flow displacement with RL fusion was strongly associated with rightward deviation (36 of 37 cases), whereas RN fusion skewed leftward (seven of eight cases; P < .01). In patients with aortopathy, RL fusion was strongly associated with type 2 aortopathy and RN with type 3 aortopathy (P < .01). CONCLUSIONS Conventional PC MRI can identify abnormal systolic flow and differences in jet orientation with BAV. RL leaflet fusion is associated with rightward flow deviation and type 2 aortopathy, whereas RN fusion is linked to leftward deviation and type 3 aortopathy. The presence and direction of eccentric flow jets may help risk stratify these patients for valve-related aortic disease.
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Vincenti G, Monney P, Chaptinel J, Rutz T, Coppo S, Zenge MO, Schmidt M, Nadar MS, Piccini D, Chèvre P, Stuber M, Schwitter J. Compressed Sensing Single–Breath-Hold CMR for Fast Quantification of LV Function, Volumes, and Mass. JACC Cardiovasc Imaging 2014; 7:882-92. [DOI: 10.1016/j.jcmg.2014.04.016] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 11/28/2022]
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