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Fortunato RN, Huckaby LV, Emerel LV, Schlosser V, Yang F, Phillippi JA, Vorp DA, Maiti S, Gleason TG. The predictive capability of aortic stiffness index for aortic dissection among dilated ascending aortas. J Thorac Cardiovasc Surg 2024; 167:2015-2024. [PMID: 36207164 PMCID: PMC10225159 DOI: 10.1016/j.jtcvs.2022.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/19/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE We created a finite element model to predict the probability of dissection based on imaging-derived aortic stiffness and investigated the link between stiffness and wall tensile stress using our model. METHODS Transthoracic echocardiogram measurements were used to calculate aortic diameter change over the cardiac cycle. Aortic stiffness index was subsequently calculated based on diameter change and blood pressure. A series of logistic models were developed to predict the binary outcome of aortic dissection using 1 or more series of predictor parameters such as aortic stiffness index or patient characteristics. Finite element analysis was performed on a subset of diameter-matched patients exhibiting patient-specific material properties. RESULTS Transthoracic echocardiogram scans of patients with type A aortic dissection (n = 22) exhibited elevated baseline aortic stiffness index when compared with aneurysmal patients' scans with tricuspid aortic valve (n = 83, P < .001) and bicuspid aortic valve (n = 80, P < .001). Aortic stiffness index proved an excellent discriminator for a future dissection event (area under the curve, 0.9337, odds ratio, 2.896). From the parametric finite element study, we found a correlation between peak longitudinal wall tensile stress and stiffness index (ρ = .6268, P < .001, n = 28 pooled). CONCLUSIONS Noninvasive transthoracic echocardiogram-derived aortic stiffness measurements may serve as an impactful metric toward predicting aortic dissection or quantifying dissection risk. A correlation between longitudinal stress and stiffness establishes an evidence-based link between a noninvasive stiffness parameter and stress state of the aorta with clinically apparent dissection events.
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Affiliation(s)
- Ronald N Fortunato
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa
| | - Lauren V Huckaby
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Leonid V Emerel
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Virginia Schlosser
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa
| | - Fan Yang
- Department of Statistics, University of Pittsburgh School of Public Health, Pittsburgh, Pa
| | - Julie A Phillippi
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa
| | - David A Vorp
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa; Department of Chemical and Petroleum Engineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Asheville Heart, Asheville, NC
| | - Spandan Maiti
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Department of Chemical and Petroleum Engineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa
| | - Thomas G Gleason
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Asheville Heart, Asheville, NC.
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Lindenberger M, Ziegler M, Bjarnegård N, Ebbers T, Dyverfeldt P. Regional and Global Aortic Pulse Wave Velocity in Patients with Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2024; 67:506-513. [PMID: 37777048 DOI: 10.1016/j.ejvs.2023.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/22/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) is commonly defined as localised aortic dilatation with a diameter > 30 mm. The pathophysiology of AAA includes chronic inflammation and enzymatic degradation of elastin, possibly increasing aortic wall stiffness and pulse wave velocity (PWV). Whether aortic stiffness is more prominent in the abdominal aorta at the aneurysm site is not elucidated. The aim of this study was to evaluate global and regional aortic PWV in patients with AAA. METHODS Experimental study of local PWV in the thoracic descending and abdominal aorta in patients with AAA and matched controls. The study cohort comprised 25 patients with an AAA > 30 mm (range 36 - 70 mm, all male, age range 65 - 76 years) and 27 age and sex matched controls free of AAA. PWV was measured with applanation tonometry (carotid-femoral PWV, cfPWV) as well as a 4D flow MRI technique, assessing regional aortic PWV. Blood pressure and anthropometrics were measured. RESULTS Global aortic PWV was greater in men with an AAA than controls, both by MRI (AAA 8.9 ± 2.4 m/s vs. controls 7.1 ± 1.5 m/s; p = .007) and cfPWV (AAA 11.0 ± 2.1 m/s vs. controls 9.3 ± 2.3 m/s; p = .007). Regionally, PWV was greater in the abdominal aorta in the AAA group (AAA 7.0 ± 1.8 m/s vs. controls 5.8 ± 1.0 m/s; p = .022), but similar in the thoracic descending aorta (AAA 8.7 ± 3.2 m/s vs. controls 8.2 ± 2.4 m/s; p = .59). Furthermore, PWV was positively associated with indices of central adiposity both in men with AAA and controls. CONCLUSION PWV is higher in men with AAA compared with matched controls in the abdominal but not the thoracic descending aorta. Furthermore, aortic stiffness was linked with central fat deposition. It remains to be seen whether there is a causal link between AAA and increased regional aortic stiffness.
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Affiliation(s)
- Marcus Lindenberger
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Magnus Ziegler
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualisation (CMIV), Linköping University, Linköping, Sweden
| | - Niclas Bjarnegård
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualisation (CMIV), Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualisation (CMIV), Linköping University, Linköping, Sweden
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3
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Antequera-González B, Collell-Hernández R, Martínez-Micaelo N, Marimon-Blanch C, Carbonell-Prat B, Escribano J, Alegret JM. miR-130a expression is related to aortic dilation in bicuspid aortic valve children. Pediatr Res 2024:10.1038/s41390-024-03018-5. [PMID: 38273119 DOI: 10.1038/s41390-024-03018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/03/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Bicuspid aortic valve disease (BAV) is present in 0.5-2% of the population and can promote aortic dilation, eventually leading to fatal consequences. Although some biomarkers have been proposed in adults, no studies have tested these candidates in children. We aimed to evaluate four miRNAs previously described to be related to BAV disease and aortic dilation in adults in a paediatric cohort. METHODS Eighty participants ≤17 years old (4-17; mean 12) were included. From the BAV group, 40% had a dilated aorta (z score >2). RT‒qPCR were performed in plasma samples to quantify miR-122, miR-130a, miR-486, and miR-718 using the delta-delta Ct method. Functional and enrichment analyses of miR-130a were also performed. RESULTS miR-130a expression in plasma was found to be significantly lower in BAV patients with a dilated aorta versus nondilated patients (p = 0.008) and healthy TAV controls (p = 0.004). Furthermore, miR-130a expression in plasma was inversely correlated with ascending aorta (r = 0.318, p = 0.004) and aortic root z scores (r = 0.322; p = 0.004). Enrichment analysis showed that miR-130a target genes are related to the TGFβ signalling pathway. CONCLUSIONS miR-130a expression in plasma is decreased in aortic-dilated BAV children compared to nondilated BAV children, helping differentiate low- to high-risk patients. IMPACT miR-130a expression in plasma is related to aortic dilation in bicuspid aortic valve (BAV) children. To our knowledge, this is the first study that analyses miRNA patterns in bicuspid aortic valve children with aortic dilation. miR-130a expression in plasma could be a biomarker in order to help differentiate low-to high-risk BAV children, which is vitally important for advanced care planning.
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Affiliation(s)
- Borja Antequera-González
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Rosa Collell-Hernández
- Pediatric Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Neus Martínez-Micaelo
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Cristina Marimon-Blanch
- Pediatric Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Bàrbara Carbonell-Prat
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204, Reus, Spain
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Joaquín Escribano
- Pediatric Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Josep M Alegret
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204, Reus, Spain.
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain.
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Ruiz-Muñoz A, Guala A, Dux-Santoy L, Teixidó-Turà G, Valente F, Garrido-Oliver J, Galian-Gay L, Gutiérrez L, Fernandez-Galera R, Casas-Masnou G, González-Alujas T, Cuéllar-Calabria H, Carrasco-Poves A, Morales-Galán A, Johnson KM, Wieben O, Ferreira-González I, Evangelista A, Rodriguez-Palomares J. False lumen hemodynamics and partial thrombosis in chronic aortic dissection of the descending aorta. Eur Radiol 2024:10.1007/s00330-023-10513-6. [PMID: 38183450 DOI: 10.1007/s00330-023-10513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVES Partial thrombosis of the false lumen (FL) in patients with chronic aortic dissection (AD) of the descending aorta has been associated with poor outcomes. Meanwhile, the fluid dynamic and biomechanical characteristics associated with partial thrombosis remain to be elucidated. This retrospective, single-center study tested the association between FL fluid dynamics and biomechanics and the presence and extent of FL thrombus. METHODS Patients with chronic non-thrombosed or partially thrombosed FLs in the descending aorta after an aortic dissection underwent computed tomography angiography, cardiovascular magnetic resonance (CMR) angiography, and a 4D flow CMR study. A comprehensive quantitative analysis was performed to test the association between FL thrombus presence and extent (percentage of FL with thrombus) and FL anatomy (diameter, entry tear location and size), fluid dynamics (inflow, rotational flow, wall shear stress, kinetic energy, and flow acceleration and stasis), and biomechanics (pulse wave velocity). RESULTS Sixty-eight patients were included. In multivariate logistic regression FL kinetic energy (p = 0.038) discriminated the 33 patients with partial FL thrombosis from the 35 patients with no thrombosis. Similarly, in separated multivariate linear correlations kinetic energy (p = 0.006) and FL inflow (p = 0.002) were independently related to the extent of the thrombus. FL vortexes, flow acceleration and stasis, wall shear stress, and pulse wave velocity showed limited associations with thrombus presence and extent. CONCLUSION In patients with chronic descending aorta dissection, false lumen kinetic energy is related to the presence and extent of false lumen thrombus. CLINICAL RELEVANCE STATEMENT In patients with chronic aortic dissection of the descending aorta, false lumen hemodynamic parameters are closely linked with the presence and extent of false lumen thrombosis, and these non-invasive measures might be important in patient management. KEY POINTS • Partial false lumen thrombosis has been associated with aortic growth in patients with chronic descending aortic dissection; therefore, the identification of prothrombotic flow conditions is desirable. • The presence of partial false lumen thrombosis as well as its extent was related with false lumen kinetic energy. • The assessment of false lumen hemodynamics may be important in the management of patients with chronic aortic dissection of the descending aorta.
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Affiliation(s)
- Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | | | - Gisela Teixidó-Turà
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Filipa Valente
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | | | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Rubén Fernandez-Galera
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Guillem Casas-Masnou
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Teresa González-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Hug Cuéllar-Calabria
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Kevin M Johnson
- Departments of Medical Physics & Radiology, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Departments of Medical Physics & Radiology, University of Wisconsin, Madison, WI, USA
| | - Ignacio Ferreira-González
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Jose Rodriguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Ma Z, Zhou Y, Li P, He W, Li M. Clinical application of four-dimensional flow cardiovascular magnetic resonance in Marfan syndrome: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102177. [PMID: 37913934 DOI: 10.1016/j.cpcardiol.2023.102177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
This study aims to fill this gap by assessing the application of 4D flow CMR in MFS through a systematic review and meta-analysis. We conducted a comprehensive search of databases from their inception to May 1, 2023. Eligibility criteria were established based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS), with studies scoring above five deemed high quality. Meta-analyses were performed using Stata 15.1 software. Nine studies were analyzed. Findings indicate MFS patients had increased vortex flow in the descending aorta (DAo), larger aortic root diameter (ARD) and Z-scores, lower inner wall shear stress (WSS) in the proximal descending aorta (pDAo), reduced in-plane rotational flow (IRF) in the aortic arch and proximal descending aorta (pDAo), and increased pulse wave velocity (PWV) in the ascending aorta (AAo) and DAo compared to healthy subjects. No significant difference in systolic flow reversal ratio was observed. Sensitivity analysis showed no heterogeneity and Egger's test revealed no publication bias. This meta-analysis underscores the effectiveness of 4D flow CMR in detecting MFS, particularly through indicators such as vortex flow, WSS, IRF, ARD, and PWV. The findings provide insights into diagnosing cardiovascular diseases and predicting cardiovascular events in MFS patients. Further case-control studies are needed to establish measurement standards and explore potential indicators for improved diagnosis and treatment of MFS.
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Affiliation(s)
- Zixuan Ma
- Second Clinical College, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Yuanxin Zhou
- Second Clinical College, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Pengpu Li
- College of Pharmacy, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Wenkai He
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, The Second Affiliated Hospital, Guangzhou Medical University, No. 63 South Asian Games Road, Panyu District, Guangzhou, Guangdong, 510260, China.
| | - Mingyan Li
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, The Second Affiliated Hospital, Guangzhou Medical University, No. 63 South Asian Games Road, Panyu District, Guangzhou, Guangdong, 510260, China.
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Park S, Kwon M, Nam H, Huh H. Interpolation time-optimized aortic pulse wave velocity estimation by 4D flow MRI. Sci Rep 2023; 13:16484. [PMID: 37777620 PMCID: PMC10542805 DOI: 10.1038/s41598-023-43799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/28/2023] [Indexed: 10/02/2023] Open
Abstract
Four-dimensional flow magnetic resonance imaging-based pulse wave velocity (4D flow PWV) estimation is a promising tool for measuring regional aortic stiffness for non-invasive cardiovascular disease screening. However, the effect of variations in the shape of flow waveforms on 4D flow PWV measurements remains unclear. In this study, 4D flow PWV values were compared using cross-correlation algorithm with different interpolation times (iTs) based on flow rate and beat frequency. A critical iT (iTCrit) was proposed from in vitro study using flexible and stiff phantom models to simultaneously achieve a low difference and a low computation time. In vivo 4D flow PWV values from six healthy volunteers were also compared between iTCrit and the conventionally used interpolation time of 1 ms (iT1 ms). The results indicated that iTCrit reduced the mean difference of in vitro 4D flow PWV values by 19%, compared to iT1 ms. In addition, iTCrit measured in vivo 4D flow PWV, showing differences similar to those obtained with iT1 ms. A difference estimation model was proposed to retrospectively estimate potential differences of 4D flow PWV using known values of PWV and the used iT. This study would be helpful for understanding the differences of PWV generated by physiological changes and time step of obtained flow waveforms.
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Affiliation(s)
- Sungho Park
- Daegu-Gyeongbuk Medical Innovation Foundation, Medical Device Development Center, Daegu, 41061, South Korea
- Institute of Medical Devices, Kangwon National University, Chuncheon, South Korea
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Minseong Kwon
- Daegu-Gyeongbuk Medical Innovation Foundation, Medical Device Development Center, Daegu, 41061, South Korea
| | - Hyojin Nam
- Daegu-Gyeongbuk Medical Innovation Foundation, Medical Device Development Center, Daegu, 41061, South Korea
| | - Hyungkyu Huh
- Daegu-Gyeongbuk Medical Innovation Foundation, Medical Device Development Center, Daegu, 41061, South Korea.
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Swahn E, Lekedal H, Engvall J, Nyström FH, Jonasson L. Prevalence and determinants of dilated ascending aorta in a Swedish population: a case-control study. Eur Heart J Open 2023; 3:oead085. [PMID: 37767013 PMCID: PMC10519809 DOI: 10.1093/ehjopen/oead085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/26/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023]
Abstract
Aims Dilation of the ascending aorta (AA) is often asymptomatic until a life-threatening dissection or rupture occurs. An overall increase in the use of thoracic imaging has enabled early and sometimes incidental identification of AA dilation. Still, the prevalence and determinants of AA dilation remain to be clarified. The aim was to identify and characterize persons with AA dilation in a middle-aged Swedish population. Methods and results We used the Swedish CardioPulmonary BioImage Study Linköping (n = 5058, age 50-65 years) to identify cases with AA diameter ≥ 40 mm on coronary computed tomography angiography (CCTA) or chest computed tomography. Age- and gender-matched individuals with AA diameter < 40 mm served as controls. Echocardiography, blood pressure (BP) measurements (office and home), pulse wave velocity (PWV), coronary artery calcification (CAC), CCTA-detected coronary atherosclerosis, and carotid ultrasound were used to characterize these subjects. We identified 70 cases (mean AA diameter 44 mm, 77% men) and matched these to 146 controls (mean AA diameter 34 mm). Bicuspid aortic valve and aortic valve dysfunction were more common in cases than in controls (8% vs. 0% and 39% vs. 11%, respectively). Both office and home BP levels were significantly higher among cases. Also, high PWV (>10 m/s) levels were more common in cases (33% vs. 17%). Neither CAC scores nor prevalence or burden of atherosclerosis in coronary and carotid arteries differed between groups. Conclusion The prevalence of dilated AA was 1.4% and showed positive associations with male gender, aortic valve pathology, and diastolic BP, though not with subclinical atherosclerosis.
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Affiliation(s)
- Eva Swahn
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Hanna Lekedal
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
- Department of Clinical Physiology, Linköping University, Linköping, Sweden
- CMIV, Center for Medical Image Science and Viusalization, Linköping University, Linköping, Sweden
| | - Fredrik H Nyström
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Lena Jonasson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
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8
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Rodríguez-Palomares JF, Dux-Santoy L, Guala A, Galian-Gay L, Evangelista A. Mechanisms of Aortic Dilation in Patients With Bicuspid Aortic Valve: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:448-464. [PMID: 37495282 DOI: 10.1016/j.jacc.2022.10.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 07/28/2023]
Abstract
Bicuspid aortic valve is the most common congenital heart disease and exposes patients to an increased risk of aortic dilation and dissection. Aortic dilation is a slow, silent process, leading to a greater risk of aortic dissection. The prevention of adverse events together with optimization of the frequency of the required lifelong imaging surveillance are important for both clinicians and patients and motivated extensive research to shed light on the physiopathologic processes involved in bicuspid aortic valve aortopathy. Two main research hypotheses have been consolidated in the last decade: one supports a genetic basis for the increased prevalence of dilation, in particular for the aortic root, and the second supports the damaging impact on the aortic wall of altered flow dynamics associated with these structurally abnormal valves, particularly significant in the ascending aorta. Current opinion tends to rule out mutually excluding causative mechanisms, recognizing both as important and potentially clinically relevant.
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Affiliation(s)
- Jose F Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | | | - Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain.
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
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9
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Guala A, Gil-Sala D, Garcia Reyes ME, Azancot MA, Dux-Santoy L, Allegue Allegue N, Teixido-Turà G, Goncalves Martins G, Galian-Gay L, Garrido-Oliver J, Constenla García I, Evangelista A, Tello Díaz C, Carrasco-Poves A, Morales-Galán A, Ferreira-González I, Rodríguez-Palomares J, Bellmunt Montoya S. Impact of thoracic endovascular aortic repair following blunt traumatic thoracic aortic injury on blood pressure. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00623-2. [PMID: 37490995 DOI: 10.1016/j.jtcvs.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/16/2023] [Accepted: 07/02/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Blunt traumatic thoracic aortic injuries (BTAIs) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical, and functional factors involved in HT development. METHODS Twenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body surface area and underwent a comprehensive follow-up study, including cardiovascular magnetic resonance, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated vasodilation. RESULTS The mean patient age was 43.5 ± 12.9 years, and the majority were male (23 of 26; 88.5%). At a mean of 120.2 ± 69.7 months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging. CONCLUSIONS HT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.
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Affiliation(s)
- Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
| | - Daniel Gil-Sala
- Vascular and Endovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marvin E Garcia Reyes
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria A Azancot
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Gisela Teixido-Turà
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Laura Galian-Gay
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ivan Constenla García
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Heart Institute, Quirónsalud-Teknon, Barcelona, Spain
| | - Cristina Tello Díaz
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Ignacio Ferreira-González
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Center for Biomedical Research in Epidemiology and Public Health Network (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jose Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Sergi Bellmunt Montoya
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain; Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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10
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Beroukhim RS, Merlocco A, Gerardin JF, Tham E, Patel JK, Siddiqui S, Goot B, Farooqi K, Soslow J, Grotenhuis H, Hor K, Muthurangu V, Raimondi F. Multicenter research priorities in pediatric CMR: results of a collaborative wiki survey. Sci Rep 2023; 13:9022. [PMID: 37270629 DOI: 10.1038/s41598-023-34720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/06/2023] [Indexed: 06/05/2023] Open
Abstract
Multicenter studies in pediatric cardiovascular magnetic resonance (CMR) improve statistical power and generalizability. However, a structured process for identifying important research topics has not been developed. We aimed to (1) develop a list of high priority knowledge gaps, and (2) pilot the use of a wiki survey to collect a large group of responses. Knowledge gaps were defined as areas that have been either unexplored or under-explored in the research literature. High priority goals were: (1) feasible and answerable from a multicenter research study, and (2) had potential for high impact on the field of pediatric CMR. Seed ideas were contributed by a working group and imported into a pairwise wiki survey format which allows for new ideas to be uploaded and voted upon ( https://allourideas.org ). Knowledge gaps were classified into 2 categories: 'Clinical CMR Practice' (16 ideas) and 'Disease Specific Research' (22 ideas). Over a 2-month period, 3,658 votes were cast by 96 users, and 2 new ideas were introduced. The 3 highest scoring sub-topics were myocardial disorders (9 ideas), translating new technology & techniques into clinical practice (7 ideas), and normal reference values (5 ideas). The highest priority gaps reflected strengths of CMR (e.g., myocardial tissue characterization; implementation of technologic advances into clinical practice), and deficiencies in pediatrics (e.g., data on normal reference values). The wiki survey format was effective and easy to implement, and could be used for future surveys.
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Affiliation(s)
- Rebecca S Beroukhim
- Department of Cardiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Anthony Merlocco
- Department of Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Jennifer F Gerardin
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Edythe Tham
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Jyoti K Patel
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Saira Siddiqui
- Division of Pediatric Cardiology, Atlantic Health System, Morristown, NJ, USA
| | - Benjamin Goot
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Kanwal Farooqi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Heynric Grotenhuis
- Department of Pediatric Cardiology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Kan Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Vivek Muthurangu
- Department of Cardiology, UCL Center for Translational Cardiovascular Imaging, University College London, London, UK
| | - Francesca Raimondi
- Department of Cardiology, Meyer Children's Hospital, University of Florence, Florence, Italy
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11
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Bianchini E, Lønnebakken MT, Wohlfahrt P, Piskin S, Terentes‐Printzios D, Alastruey J, Guala A. Magnetic Resonance Imaging and Computed Tomography for the Noninvasive Assessment of Arterial Aging: A Review by the VascAgeNet COST Action. J Am Heart Assoc 2023; 12:e027414. [PMID: 37183857 PMCID: PMC10227315 DOI: 10.1161/jaha.122.027414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Magnetic resonance imaging and computed tomography allow the characterization of arterial state and function with high confidence and thus play a key role in the understanding of arterial aging and its translation into the clinic. Decades of research into the development of innovative imaging sequences and image analysis techniques have led to the identification of a large number of potential biomarkers, some bringing improvement in basic science, others in clinical practice. Nonetheless, the complexity of some of these biomarkers and the image analysis techniques required for their computation hamper their widespread use. In this narrative review, current biomarkers related to aging of the aorta, their founding principles, the sequence, and postprocessing required, and their predictive values for cardiovascular events are summarized. For each biomarker a summary of reference values and reproducibility studies and limitations is provided. The present review, developed in the COST Action VascAgeNet, aims to guide clinicians and technical researchers in the critical understanding of the possibilities offered by these advanced imaging modalities for studying the state and function of the aorta, and their possible clinically relevant relationships with aging.
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Affiliation(s)
| | - Mai Tone Lønnebakken
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
| | - Peter Wohlfahrt
- Department of Preventive CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
- Centre for Cardiovascular PreventionCharles University Medical School I and Thomayer HospitalPragueCzech Republic
- Department of Medicine IICharles University in Prague, First Faculty of MedicinePragueCzech Republic
| | - Senol Piskin
- Department of Mechanical Engineering, Faculty of Engineering and Natural SciencesIstinye UniversityIstanbulTurkey
- Modeling, Simulation and Extended Reality LaboratoryIstinye UniversityIstanbulTurkey
| | - Dimitrios Terentes‐Printzios
- First Department of Cardiology, Hippokration Hospital, Athens Medical SchoolNational and Kapodistrian University of AthensGreece
| | - Jordi Alastruey
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca (VHIR)BarcelonaSpain
- CIBER‐CV, Instituto de Salud Carlos IIIMadridSpain
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12
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Schafstedde M, Jarmatz L, Brüning J, Hüllebrand M, Nordmeyer S, Harloff A, Hennemuth A. Population-based reference values for 4D flow MRI derived aortic blood flow parameters. Physiol Meas 2023; 44. [PMID: 36735968 DOI: 10.1088/1361-6579/acb8fd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/03/2023] [Indexed: 02/05/2023]
Abstract
Objective. This study assesses age-related differences of thoracic aorta blood flow profiles and provides age- and sex-specific reference values using 4D flow cardiovascular magnetic resonance (CMR) data.Approach. 126 volunteers (age 20-80 years, female 51%) underwent 4D flow CMR and 12 perpendicular analysis planes in the thoracic aorta were specified. For these planes the following parameters were evaluated: body surface area-adjusted aortic area (A'), normalized flow displacement (NFD), the degree of wall parallelism (WPD), the minimal relative cross-sectional area through which 80% of the volume flow passes (A80) and the angle between flow direction and centerline (α).Main results. Age-related differences in blood flow parameters were seen in the ascending aorta with higher values for NFD and angle and lower values for WPD and A80 in older subjects. All parameters describing blood flow patterns correlated with the cross-sectional area in the ascending aorta. No relevant sex-differences regarding blood flow profiles were found.Significance. These age- and sex-specific reference values for quantitative parameters describing blood flow within the aorta might help to study the clinical relevance of flow profiles in the future.
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Affiliation(s)
- Marie Schafstedde
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Lina Jarmatz
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany
| | - Jan Brüning
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Markus Hüllebrand
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Fraunhofer MEVIS, Bremen, Germany
| | - Sarah Nordmeyer
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany
| | - Andreas Harloff
- Department of Neurology, University Medical Center Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Germany
| | - Anja Hennemuth
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,Fraunhofer MEVIS, Bremen, Germany
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13
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Pan Y, Wang Y, Li J, Xu P, Zeng M, Shan Y, Lin J. Prognostic role of aortic distensibility in patients with bicuspid aortic valve: a CMR study. Int J Cardiovasc Imaging 2023; 39:161-168. [PMID: 36598697 DOI: 10.1007/s10554-022-02710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
To evaluate the prognostic value of aortic distensibility measured by cardiovascular magnetic resonance (CMR) as predictors of prophylactic aortic valve or aortic surgery in patients with bicuspid aortic valve (BAV). 110 patients with BAV were included. Distensibility of middle ascending aorta (AscAo) and proximal descending aorta (DescAo) at baseline was determined using CMR. The association between aortic distensibility and primary endpoint of aortic valve and/or aortic surgery was investigated with Cox proportional hazard regression analyses. The receiver operating characteristics curves (ROC) of the area under receiver-operator (AUC) and DeLong test were used to evaluate and compare the performance of different models. During a median follow-up of 66.5 months [IQR 13-75 months], 42 patients experienced surgical treatments. After adjusting for traditional risk factors, aortic distensibility (P = 0.003) and severe valve dysfunction (P < 0.001) were found significantly associated with aortic valve and/or aortic surgery. The model 2 (aortic distensibility and severe valve dysfunction) is slightly better in predicting primary endpoint than the model 1 (aortic diameter and severe valve dysfunction) (AUC: 0.893 vs. 0.842, P = 0.106). In BAV patients, aortic distensibility and severe valve dysfunction are valuable predictors for final aortic valve and/or aortic surgery.
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Affiliation(s)
- Yijun Pan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Pengju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yan Shan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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14
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Johnson EMI, Scott MB, Jarvis K, Allen B, Carr J, Chris Malaisrie S, McCarthy P, Mehta C, Fedak PWM, Barker AJ, Markl M. Global Aortic Pulse Wave Velocity is Unchanged in Bicuspid Aortopathy With Normal Valve Function but Elevated in Patients With Aortic Valve Stenosis: Insights From a 4D Flow MRI Study of 597 Subjects. J Magn Reson Imaging 2023; 57:126-136. [PMID: 35633284 PMCID: PMC9701914 DOI: 10.1002/jmri.28266] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Aortopathy is common with bicuspid aortic valve (BAV), and underlying intrinsic tissue abnormalities are believed causative. Valve-mediated hemodynamics are altered in BAV and may contribute to aortopathy and its progression. The contribution of intrinsic tissue defects versus altered hemodynamics to aortopathy progression is not known. PURPOSE To investigate relative contributions of tissue-innate versus hemodynamics in progression of BAV aortopathy. STUDY TYPE Retrospective. SUBJECTS Four hundred seventy-three patients with aortic dilatation (diameter ≥40 mm; comprised of 281 BAV with varied AS severity, 192 tricuspid aortic valve [TAV] without AS) and 124 healthy controls. Subjects were 19-91 years (141/24% female). FIELD STRENGTH/SEQUENCE 1.5T, 3T; time-resolved gradient-echo 3D phase-contrast (4D flow) MRI. ASSESSMENT A surrogate measure for global aortic wall stiffness, pulse wave velocity (PWV), was quantified from MRI by standardized, automated technique based on through-plane flow cross-correlation maximization. Comparisons were made between BAV patients with aortic dilatation and varying aortic valve stenosis (AS) severity and healthy subjects and aortopathy patients with normal TAV. STATISTICAL TESTS Multivariable regression, analysis of covariance (ANCOVA), Tukey's, student's (t), Mann-Whitney (U) tests, were used with significance levels P < 0.05 or P < 0.01 for post-hoc Bonferroni-corrected t/U tests. Bland-Altman and ICC calculations were performed. RESULTS Multivariable regression showed age with the most significant association for increased PWV in all groups (increase 0.073-0.156 m/sec/year, R2 = 0.30-48). No significant differences in aortic PWV were observed between groups without AS (P = 0.20-0.99), nor were associations between PWV and regurgitation or Sievers type observed (P = 0.60, 0.31 respectively). In contrast, BAV AS patients demonstrated elevated PWV and a significant relationship for AS severity with increased PWV (covariate: age, R2 = 0.48). BAV and TAV patients showed no association between aortic diameter and PWV (P = 0.73). DATA CONCLUSION No significant PWV differences were observed between BAV patients with normal valve function and control groups. However, AS severity and age in BAV patients were directly associated with PWV increases. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
| | - Michael B Scott
- Northwestern University, Radiology,Northwestern University, Bioengineering
| | | | | | | | | | | | | | | | - Alex J Barker
- University of Colorado Anschutz, Radiology, Bioengineering
| | - Michael Markl
- Northwestern University, Radiology,Northwestern University, Bioengineering
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15
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Antequera-González B, Faiges M, Martínez-Micaelo N, Galian-Gay L, Ligero C, Ferré-Vallverdú M, Masana L, Amigó N, Evangelista A, Alegret JM. Glycoprotein and Lipoprotein Profiles Assessed by 1H-NMR and Its Relation to Ascending Aortic Dilatation in Bicuspid Aortic Valve Disease. J Clin Med 2022; 12:jcm12010332. [PMID: 36615132 PMCID: PMC9821550 DOI: 10.3390/jcm12010332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The bicuspid aortic valve (BAV) confers a high risk of ascending aorta dilatation (AAoD), although its progression seems highly variable. Furthermore, the implication of lipoprotein metabolism and inflammation in the mechanisms that underlie AAoD is not fully established. The aim of this study consisted of evaluating the impact of the lipoprotein and glycoprotein profiles in AAOD as well as its progression in BAV aortopathy. METHODS Using 1H-nuclear magnetic resonance (1H-NMR), we analyzed and compared the lipoprotein and glycoprotein profiles of plasma samples from 152 BAV patients with dilated and nondilated ascending aorta. Additionally, these profiles were also compared for 119 of these patients who were prospectively followed-up clinically and by echocardiography in the long-term (5 years). Ascending aorta dilation velocity (mm/year) was calculated for this analysis. RESULTS Several parameters related to the lipoprotein profile including remnant cholesterol, small LDL and IDL-cholesterol were found to be significantly increased in the dilated group compared to those in the nondilated group. The glycoprotein A-nuclear magnetic resonance (NMR) signal, a novel inflammation biomarker, was also observed to be increased in the dilated group. After performing multivariate analysis, remnant cholesterol remained an independent variable related to AAoD. In the long-term follow-up, proatherogenic lipoprotein parameters were related to ascending aorta dilatation velocity ascending. After a lineal regression analysis, non-HDL particles remained as an independent predictor of ascending aorta dilation velocity. CONCLUSIONS Patients with BAV and AAoD presented a more pro-atherogenic profile assessed by 1H-NMR, especially related to triglyceride-rich lipoproteins. This pro-atherogenic profile seems to contribute to the higher growth rate of ascending aorta diameter.
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Affiliation(s)
- Borja Antequera-González
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Marta Faiges
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Neus Martínez-Micaelo
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Laura Galian-Gay
- Cardiology Department, Hospital General Universitari Vall d’Hebron, VHIR, CIBER-CV, 08035 Barcelona, Spain
| | - Carmen Ligero
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - María Ferré-Vallverdú
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Lluís Masana
- Vascular Medicine and Metabolism Unit, IISPV, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Núria Amigó
- Biosfer Teslab SL, DEEEA, Metabolomics Platform, Universitat Rovira i Virgili, IISPV, CIBERDEM, 43007 Tarragona, Spain
| | - Arturo Evangelista
- Cardiology Department, Hospital General Universitari Vall d’Hebron, VHIR, CIBER-CV, 08035 Barcelona, Spain
| | - Josep M. Alegret
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
- Correspondence:
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16
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Richards CE, Parker AE, Alfuhied A, McCann GP, Singh A. The role of 4-dimensional flow in the assessment of bicuspid aortic valve and its valvulo-aortopathies. Br J Radiol 2022; 95:20220123. [PMID: 35852109 PMCID: PMC9793489 DOI: 10.1259/bjr.20220123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Bicuspid aortic valve is the most common congenital cardiac malformation and the leading cause of aortopathy and aortic stenosis in younger patients. Aortic wall remodelling secondary to altered haemodynamic flow patterns, changes in peak velocity, and wall shear stress may be implicated in the development of aortopathy in the presence of bicuspid aortic valve and dysfunction. Assessment of these parameters as potential predictors of disease severity and progression is thus desirable. The anatomic and functional information acquired from 4D flow MRI can allow simultaneous visualisation and quantification of the pathological geometric and haemodynamic changes of the aorta. We review the current clinical utility of haemodynamic quantities including velocity, wall sheer stress and energy losses, as well as visual descriptors such as vorticity and helicity, and flow direction in assessing the aortic valve and associated aortopathies.
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Affiliation(s)
- Caryl Elizabeth Richards
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Alex E Parker
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Aseel Alfuhied
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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17
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Dong H, Raterman B, White RD, Starr J, Vaccaro P, Haurani M, Go M, Eisner M, Brock G, Kolipaka A. MR Elastography of Abdominal Aortic Aneurysms: Relationship to Aneurysm Events. Radiology 2022; 304:721-729. [PMID: 35638926 PMCID: PMC9434816 DOI: 10.1148/radiol.212323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/26/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
Abstract
Background Abdominal aortic aneurysm (AAA) diameter remains the standard clinical parameter to predict growth and rupture. Studies suggest that using solely AAA diameter for risk stratification is insufficient. Purpose To evaluate the use of aortic MR elastography (MRE)-derived AAA stiffness and stiffness ratio at baseline to identify the potential for future aneurysm rupture or need for surgical repair. Materials and Methods Between August 2013 and March 2019, 72 participants with AAA and 56 healthy participants were enrolled in this prospective study. MRE examinations were performed to estimate AAA stiffness and the stiffness ratio between AAA and its adjacent remote normal aorta. Two Cox proportional hazards models were used to assess AAA stiffness and stiffness ratio for predicting aneurysmal events (subsequent repair, rupture, or diameter >5.0 cm). Log-rank tests were performed to determine a critical stiffness ratio suggesting high-risk AAAs. Baseline AAA stiffness and stiffness ratio were studied using Wilcoxon rank-sum tests between participants with and without aneurysmal events. Spearman correlation was used to investigate the relationship between stiffness and other potential imaging markers. Results Seventy-two participants with AAA (mean age, 71 years ± 9 [SD]; 56 men and 16 women) and 56 healthy participants (mean age, 42 years ± 16; 27 men and 29 women) were evaluated. In healthy participants, aortic stiffness positively correlated with age (ρ = 0.44; P < .001). AAA stiffness (event group [n = 21], 50.3 kPa ± 26.5 [SD]; no-event group [n = 21], 86.9 kPa ± 52.6; P = .01) and the stiffness ratio (event group, 0.7 ± 0.4; no-event group, 2.0 ± 1.4; P < .001) were lower in the event group than the no-event group at a mean follow-up of 449 days. AAA stiffness did not correlate with diameter in the event group (ρ = -0.06; P = .68) or the no-event group (ρ = -0.13; P = .32). AAA stiffness was inversely correlated with intraluminal thrombus area (ρ = -0.50; P = .01). Conclusion Lower abdominal aortic aneurysm stiffness and stiffness ratio measured with use of MR elastography was associated with aneurysmal events at a 15-month follow-up. © RSNA, 2022 See also the editorial by Sakuma in this issue.
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Affiliation(s)
- Huiming Dong
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Brian Raterman
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Richard D. White
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Jean Starr
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Patrick Vaccaro
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Mounir Haurani
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Michael Go
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Mariah Eisner
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Guy Brock
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Arunark Kolipaka
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
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18
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Pan Y, Lin J, Wang Y, Li J, Xu P, Zeng M, Shan Y. Association of aortic distensibility and left ventricular function in patients with stenotic bicuspid aortic valve and preserved ejection fraction: a CMR study. Int J Cardiovasc Imaging 2022; 38:2025-2033. [PMID: 35279784 DOI: 10.1007/s10554-022-02581-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
To determine the relationship between aortic distensibility and left ventricular (LV) remodeling, myocardial strain and blood biomarkers in patients with stenotic bicuspid aortic valve (BAV) and preserved ejection fraction (EF) by cardiovascular magnetic resonance (CMR). 43 stenotic BAV patients were prospectively selected for 3.0 T CMR. Patients were divided into LV remodeling group (LV mass/volume ≥ 1.15, n = 21) and non-remodeling group (LV mass/volume < 1.15, n = 22). Clinical characteristics, biochemical data including cardiac troponin T(cTNT), N-terminal pro-B type natriuretic peptide (NT-proBNP) and creatine kinase isoenzyme (CK-MB) were noted. Distensibility of middle ascending aorta (mid-AA) and proximal descending aorta, LV structural and functional parameters, global and regional myocardial strain were measured. Compared to non-remodeling group, LV remodeling group had significantly decreased LV global strain (radial: 26.04 ± 8.70% vs. 32.92 ± 7.81%, P = 0.009; circumferential: - 17.20 ± 3.38% vs. - 19.65 ± 2.34%, P = 0.008; longitudinal: - 9.13 ± 2.34% vs. - 11.63 ± 1.99%, P < 0.001) and decreased mid-AA distensibility (1.22 ± 0.24 10-3 mm/Hg vs 1.60 ± 0.41 10-3 mm/Hg, P = 0.001). In addition, mid-AA distensibility was independently associated with LV remodeling (β = - 0.282, P = 0.003), and it was also significantly correlated with LV global strain (radial: r = 0.392, P = 0.009; circumferential: r = - 0.348, P = 0.022; longitudinal: r = - 0.333, P = 0.029), cTNT (r = - 0.333, P = 0.029) and NT-proBNP (r = - 0.440, P = 0.003). In this cohort with stenotic BAV and preserved EF, mid-AA distensibility is found significantly associated with LV remolding, which encouraging to better understand mechanism of ventricular vascular coupling.
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Affiliation(s)
- Yijun Pan
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jiang Lin
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongshi Wang
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Pengju Xu
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yan Shan
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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19
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Soulat G, Scott MB, Pathrose A, Jarvis K, Berhane H, Allen B, Avery R, Alsate AR, Rigsby CK, Markl M. 4D flow MRI derived aortic hemodynamics multi-year follow-up in repaired coarctation with bicuspid aortic valve. Diagn Interv Imaging 2022; 103:418-426. [PMID: 35523699 PMCID: PMC11041270 DOI: 10.1016/j.diii.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the relationships between hemodynamic parameters and longitudinal changes in aortic dimensions on four-dimensional (4D) flow magnetic resonance imaging (MRI) in patients with bicuspid aortic valve (BAV) and repaired coarctation. MATERIALS AND METHODS The study retrospectively included patients with BAV and childhood coarctation repair who had at least two cardiothoracic MRI examinations including 4D flow MRI at baseline and follow-up. Analysis included the calculation of aortic peak velocities, wall shear stress (WSS), pulse wave velocity (PWV), aortic dimensions and annual growth rates. Differences between examinations were assessed using paired t-test or Wilcoxon signed rank test. Relationships between growth rate and 4D flow metrics were assessed using Pearson or Spearman correlation tests. RESULTS The cohort included 15 patients (mean age 35 ± 8 [SD] years, 9 men) with a median follow-up time of 3.98 years (Q1: 2.10; Q3: 4.96). There were no significant differences in aortic mean WSS, peak velocities, and PWV between baseline and follow-up values. Greater baseline peak velocities at the site of the coarctation were strongly associated with aortic narrowing (follow-up vs. baseline diameter) at coarctation zone (r = -0.64; P = 0.010) and moderately in descending aorta (r = -0.53; P = 0.042). In addition, increased baseline WSS in the aortic arch was strongly related with narrowing of the coarctation zone at follow-up (r = -0.64, P = 0.011). CONCLUSION Measures of aortic hemodynamics and aortic WSS are stable over time in patients with BAV with coarctation repair. Increased peak velocity was associated with a progressive narrowing at the site of the coarctation repair.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Université Paris Centre, PARCC INSERM, 75015 Paris, France.
| | - Michael B Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
| | - Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Haben Berhane
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
| | - Bradley Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Ryan Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Alejandro Roldan Alsate
- Department of Mechanical Engineering, University of Wisconsin Madison, Madison 53706, WI, USA
| | - Cynthia K Rigsby
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago 60611, IL, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
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20
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Garrido-Oliver J, Aviles J, Córdova MM, Dux-Santoy L, Ruiz-Muñoz A, Teixido-Tura G, Maso Talou GD, Morales Ferez X, Jiménez G, Evangelista A, Ferreira-González I, Rodriguez-Palomares J, Camara O, Guala A. Machine learning for the automatic assessment of aortic rotational flow and wall shear stress from 4D flow cardiac magnetic resonance imaging. Eur Radiol 2022; 32:7117-7127. [PMID: 35976395 DOI: 10.1007/s00330-022-09068-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/09/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Three-dimensional (3D) time-resolved phase-contrast cardiac magnetic resonance (4D flow CMR) allows for unparalleled quantification of blood velocity. Despite established potential in aortic diseases, the analysis is time-consuming and requires expert knowledge, hindering clinical application. The present research aimed to develop and test a fully automatic machine learning-based pipeline for aortic 4D flow CMR analysis. METHODS Four hundred and four subjects were prospectively included. Ground-truth to train the algorithms was generated by experts. The cohort was divided into training (323 patients) and testing (81) sets and used to train and test a 3D nnU-Net for segmentation and a Deep Q-Network algorithm for landmark detection. In-plane (IRF) and through-plane (SFRR) rotational flow descriptors and axial and circumferential wall shear stress (WSS) were computed at ten planes covering the ascending aorta and arch. RESULTS Automatic aortic segmentation resulted in a median Dice score (DS) of 0.949 and average symmetric surface distance of 0.839 (0.632-1.071) mm, comparable with the state of the art. Aortic landmarks were located with a precision comparable with experts in the sinotubular junction and first and third supra-aortic vessels (p = 0.513, 0.592 and 0.905, respectively) but with lower precision in the pulmonary bifurcation (p = 0.028), resulting in precise localisation of analysis planes. Automatic flow assessment showed excellent (ICC > 0.9) agreement with manual quantification of SFRR and good-to-excellent agreement (ICC > 0.75) in the measurement of IRF and axial and circumferential WSS. CONCLUSION Fully automatic analysis of complex aortic flow dynamics from 4D flow CMR is feasible. Its implementation could foster the clinical use of 4D flow CMR. KEY POINTS • 4D flow CMR allows for unparalleled aortic blood flow analysis but requires aortic segmentation and anatomical landmark identification, which are time-consuming, limiting 4D flow CMR widespread use. • A fully automatic machine learning pipeline for aortic 4D flow CMR analysis was trained with data of 323 patients and tested in 81 patients, ensuring a balanced distribution of aneurysm aetiologies. • Automatic assessment of complex flow characteristics such as rotational flow and wall shear stress showed good-to-excellent agreement with manual quantification.
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Affiliation(s)
| | - Jordina Aviles
- Physense, BCN Medtech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Marcos Mejía Córdova
- Physense, BCN Medtech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Gisela Teixido-Tura
- Vall d'Hebron Institute of Research, Barcelona, Spain
- Department of Cardiology, Hospital Vall d'Hebron Universitat Autonoma de Barcelona, Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Xabier Morales Ferez
- Physense, BCN Medtech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Guillermo Jiménez
- Physense, BCN Medtech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institute of Research, Barcelona, Spain
- Department of Cardiology, Hospital Vall d'Hebron Universitat Autonoma de Barcelona, Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Ferreira-González
- Vall d'Hebron Institute of Research, Barcelona, Spain
- Department of Cardiology, Hospital Vall d'Hebron Universitat Autonoma de Barcelona, Barcelona, Spain
- CIBER-ESP, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Jose Rodriguez-Palomares
- Vall d'Hebron Institute of Research, Barcelona, Spain
- Department of Cardiology, Hospital Vall d'Hebron Universitat Autonoma de Barcelona, Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Oscar Camara
- Physense, BCN Medtech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Andrea Guala
- Vall d'Hebron Institute of Research, Barcelona, Spain.
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
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21
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Chongthammakun V, Pan AY, Earing MG, Damluji AA, Goot BH, Cava JR, Gerardin JF. The association between cardiac magnetic resonance-derived aortic stiffness parameters and aortic dilation in young adults with bicuspid aortic valve: With and without coarctation of aorta. Am Heart J Plus 2022; 20:100194. [PMID: 38560418 PMCID: PMC10978397 DOI: 10.1016/j.ahjo.2022.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 04/04/2024]
Abstract
Background Bicuspid aortic valve (BAV) is associated with progressive aortic dilation. Studies in aortopathies have shown a correlation between increased aortic stiffness and aortic dilation. We aimed to evaluate aortic stiffness measures as predictors of progressive aortic dilation by cardiac magnetic resonance (CMR) in BAV patients. Methods This is a retrospective study of 49 patients with BAV (median age 21.1 years at first CMR visit) with ≥2 CMR at the Wisconsin Adult Congenital Heart Disease Program (WAtCH). Circumferential aortic strain, distensibility, and β-stiffness index were obtained from CMR-derived aortic root cine imaging, and aortic dimensions were measured at aortic root and ascending aorta. A linear mixed-model and logistic regression were used to identify important predictors of progressive aortic dilation. Results Over a median of 3.8 years follow-up, the annual growth rates of aortic root and ascending aorta dimensions were 0.25 and 0.16 mm/year, respectively. Aortic strain and distensibility decreased while β-stiffness index increased with age. Aortic root strain and distensibility were associated with progressive dilation of the ascending aorta. Baseline aortic root diameter was an independent predictor of >1 mm/year growth rate of the aortic root (adjusted OR 1.34, 95 % CI 1.03-1.74, p = 0.028). Most patients (61 %) had coexisting coarctation of aorta. Despite the higher prevalence of hypertension in patients with aortic coarctation, hypertension or coarctation had no effect on baseline aorta dimensions, stiffness, or progressive aortic dilation. Conclusion Some CMR-derived aortic stiffness parameters correlated with progressive aortic dilation in BAV and should be further investigated in larger and older BAV cohorts.
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Affiliation(s)
- Vasutakarn Chongthammakun
- Adult Congenital Heart Disease Program, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States of America
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Amy Y. Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Michael G. Earing
- Sections of Cardiology and Pediatric Cardiology, University of Chicago, Chicago, IL, United States of America
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA, United States of America
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Benjamin H. Goot
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Joseph R. Cava
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jennifer F. Gerardin
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
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22
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Sotelo J, Franco P, Guala A, Dux-Santoy L, Ruiz-Muñoz A, Evangelista A, Mella H, Mura J, Hurtado DE, Rodríguez-Palomares JF, Uribe S. Fully Three-Dimensional Hemodynamic Characterization of Altered Blood Flow in Bicuspid Aortic Valve Patients With Respect to Aortic Dilatation: A Finite Element Approach. Front Cardiovasc Med 2022; 9:885338. [PMID: 35665243 PMCID: PMC9157575 DOI: 10.3389/fcvm.2022.885338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposePrognostic models based on cardiovascular hemodynamic parameters may bring new information for an early assessment of patients with bicuspid aortic valve (BAV), playing a key role in reducing the long-term risk of cardiovascular events. This work quantifies several three-dimensional hemodynamic parameters in different patients with BAV and ranks their relationships with aortic diameter.Materials and MethodsUsing 4D-flow CMR data of 74 patients with BAV (49 right-left and 25 right-non-coronary) and 48 healthy volunteers, aortic 3D maps of seventeen 17 different hemodynamic parameters were quantified along the thoracic aorta. Patients with BAV were divided into two morphotype categories, BAV-Non-AAoD (where we include 18 non-dilated patients and 7 root-dilated patients) and BAV-AAoD (where we include the 49 patients with dilatation of the ascending aorta). Differences between volunteers and patients were evaluated using MANOVA with Pillai's trace statistic, Mann–Whitney U test, ROC curves, and minimum redundancy maximum relevance algorithm. Spearman's correlation was used to correlate the dilation with each hemodynamic parameter.ResultsThe flow eccentricity, backward velocity, velocity angle, regurgitation fraction, circumferential wall shear stress, axial vorticity, and axial circulation allowed to discriminate between volunteers and patients with BAV, even in the absence of dilation. In patients with BAV, the diameter presented a strong correlation (> |+/−0.7|) with the forward velocity and velocity angle, and a good correlation (> |+/−0.5|) with regurgitation fraction, wall shear stress, wall shear stress axial, and vorticity, also for morphotypes and phenotypes, some of them are correlated with the diameter. The velocity angle proved to be an excellent biomarker in the differentiation between volunteers and patients with BAV, BAV morphotypes, and BAV phenotypes, with an area under the curve bigger than 0.90, and higher predictor important scores.ConclusionsThrough the application of a novel 3D quantification method, hemodynamic parameters related to flow direction, such as flow eccentricity, velocity angle, and regurgitation fraction, presented the best relationships with a local diameter and effectively differentiated patients with BAV from healthy volunteers.
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Affiliation(s)
- Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
| | - Pamela Franco
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Hernan Mella
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joaquín Mura
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Department of Mechanical Engineering, Universidad Técnica Federico Santa María, Santiago, Chile
| | - Daniel E. Hurtado
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Department of Structural and Geotechnical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José F. Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Sergio Uribe
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Ruiz-Muñoz A, Guala A, Dux-Santoy L, Teixidó-Turà G, Servato ML, Valente F, Garrido-Oliver J, Galian-Gay L, Gutiérrez L, Fernandez-Galera R, Casas G, González-Alujas T, Cuéllar-Calabria H, Johnson KM, Wieben O, Ferreira-Gonzalez I, Evangelista A, Rodriguez-Palomares J. False lumen rotational flow and aortic stiffness are associated with aortic growth rate in patients with chronic aortic dissection of the descending aorta: a 4D flow cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:20. [PMID: 35346239 PMCID: PMC8962590 DOI: 10.1186/s12968-022-00852-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/14/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Patency of the false lumen in chronic aortic dissection (AD) is associated with aortic dilation and long-term aortic events. However, predictors of adverse outcomes in this population are limited. The aim of this study was to evaluate the relationship between aortic growth rate and false lumen flow dynamics and biomechanics in patients with chronic, patent AD. METHODS Patients with a chronic AD with patent false lumen in the descending aorta and no genetic connective tissue disorder underwent an imaging follow-up including a contrast-enhanced 4D flow cardiovascular magnetic resonance (CMR) protocol and two consecutive computed tomography angiograms (CTA) acquired at least 1 year apart. A comprehensive analysis of anatomical features (including thrombus quantification), and false lumen flow dynamics and biomechanics (pulse wave velocity) was performed. RESULTS Fifty-four consecutive patients with a chronic, patent false lumen in the descending aorta were included (35 surgically-treated type A AD with residual tear and 19 medically-treated type B AD). Median follow-up was 40 months. The in-plane rotational flow, pulse wave velocity and the percentage of thrombus in the false lumen were positively related to aortic growth rate (p = 0.006, 0.017, and 0.037, respectively), whereas wall shear stress showed a trend for a positive association (p = 0.060). These results were found irrespectively of the type of AD. CONCLUSIONS In patients with chronic AD and patent false lumen of the descending aorta, rotational flow, pulse wave velocity and wall shear stress are positively related to aortic growth rate, and should be implemented in the follow-up algorithm of these patients. Further prospective studies are needed to confirm if the assessment of these parameters helps to identify patients at higher risk of adverse clinical events.
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Affiliation(s)
- Aroa Ruiz-Muñoz
- Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Gisela Teixidó-Turà
- Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Maria Luz Servato
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Filipa Valente
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | | | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | | | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | | | - Hug Cuéllar-Calabria
- Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Kevin M. Johnson
- Departments of Medical Physics & Radiology, University of Wisconsin, Madison, WI USA
| | - Oliver Wieben
- Departments of Medical Physics & Radiology, University of Wisconsin, Madison, WI USA
| | - Ignacio Ferreira-Gonzalez
- Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Arturo Evangelista
- Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Instituto del Corazón. Quirónsalud-Teknon, Barcelona, Spain
| | - Jose Rodriguez-Palomares
- Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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24
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Evangelista Masip A, Galian-Gay L, Guala A, Lopez-Sainz A, Teixido-Turà G, Ruiz Muñoz A, Valente F, Gutierrez L, Fernandez-Galera R, Casas G, Panaro A, Marigliano A, Huguet M, González-Alujas T, Rodriguez-Palomares J. Unraveling Bicuspid Aortic Valve Enigmas by Multimodality Imaging: Clinical Implications. J Clin Med 2022; 11:456. [PMID: 35054153 PMCID: PMC8778671 DOI: 10.3390/jcm11020456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
Multimodality imaging is the basis of the diagnosis, follow-up, and surgical management of bicuspid aortic valve (BAV) patients. Transthoracic echocardiography (TTE) is used in our clinical routine practice as a first line imaging for BAV diagnosis, valvular phenotyping and function, measurement of thoracic aorta, exclusion of other aortic malformations, and for the assessment of complications such are infective endocarditis and aortic. Nevertheless, TTE is less useful if we want to assess accurately other aortic segments such as mid-distal ascending aorta, where computed tomography (CT) and magnetic resonance (CMR) could improve the precision of aorta size measurement by multiplanar reconstructions. A major advantage of CT is its superior spatial resolution, which affords a better definition of valve morphology and calcification, accuracy, and reproducibility of ascending aorta size, and allows for coronary artery assessment. Moreover, CMR offers the opportunity of being able to evaluate aortic functional properties and blood flow patterns. In this setting, new developed sequences such as 4D-flow may provide new parameters to predict events during follow up. The integration of all multimodality information facilitates a comprehensive evaluation of morphologic and dynamic features, stratification of the risk, and therapy guidance of this cohort of patients.
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Affiliation(s)
- Arturo Evangelista Masip
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Teknon Heart Institute-Quiron Salud, 08022 Barcelona, Spain; (A.P.); (A.M.); (M.H.)
| | - Laura Galian-Gay
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Andrea Guala
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Angela Lopez-Sainz
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Gisela Teixido-Turà
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Aroa Ruiz Muñoz
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Filipa Valente
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Laura Gutierrez
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Ruben Fernandez-Galera
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Guillem Casas
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Alejandro Panaro
- Teknon Heart Institute-Quiron Salud, 08022 Barcelona, Spain; (A.P.); (A.M.); (M.H.)
| | - Alba Marigliano
- Teknon Heart Institute-Quiron Salud, 08022 Barcelona, Spain; (A.P.); (A.M.); (M.H.)
| | - Marina Huguet
- Teknon Heart Institute-Quiron Salud, 08022 Barcelona, Spain; (A.P.); (A.M.); (M.H.)
| | - Teresa González-Alujas
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
| | - Jose Rodriguez-Palomares
- Departament de Cardiologia, Hospital Vall d’Hebron.CIBERCV, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.); (A.G.); (A.L.-S.); (G.T.-T.); (A.R.M.); (F.V.); (L.G.); (R.F.-G.); (G.C.); (T.G.-A.); (J.R.-P.)
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25
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Rumman RK, Slorach C, Hui W, Lopez C, Larios G, Fan S, Franco-cereceda A, Loeys B, Mohamed SA, Dietz H, Mital S, Andelfinger G, Mertens L, Grattan M. Regional Vascular Changes and Aortic Dilatation in Pediatric Patients with Bicuspid Aortic Valve. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/04/2022] [Accepted: 01/18/2022] [Indexed: 12/31/2022] Open
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26
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Plunde O, Franco-Cereceda A, Bäck M. Cardiovascular Risk Factors and Hemodynamic Measures as Determinants of Increased Arterial Stiffness Following Surgical Aortic Valve Replacement. Front Cardiovasc Med 2021; 8:754371. [PMID: 34957246 PMCID: PMC8692982 DOI: 10.3389/fcvm.2021.754371] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022] Open
Abstract
Valvular and arterial function are tightly intertwined, both in terms of structural changes and hemodynamics. While proximal valvulo-vascular coupling contributes to the cardiovascular consequences of aortic stenosis, less is known on how peripheral arterial stiffness relates to aortic valve disease. Previous studies have shown conflicting results regarding the impact of aortic valve replacement on arterial stiffness. The aim of the present study was therefore to determine predictors of arterial stiffness in patients with and without aortic valve disease undergoing cardiac surgery. Cardio ankle vascular index (CAVI) and carotid femoral pulse wave velocity (cfPWV) were measured to determine arterial stiffness the day before and 3 days after surgery for either ascending aortic or aortic valve disease. Stratification on indication for surgery revealed that CAVI was significantly lower in patients with aortic valve stenosis (n = 45) and aortic valve regurgitation (n=30) compared with those with isolated ascending aortic dilatation (n = 13). After surgery, a significant increased CAVI was observed in aortic stenosis (median 1.34, IQR 0.74-2.26, p < 0.001) and regurgitation (median 1.04, IQR 0.01-1.49, p = 0.003) patients while cfPWV was not significantly changed. Age, diabetes, low body mass index, low pre-operative CAVI, as well as changes in ejection time were independently associated with increased CAVI after surgery. The results of the present study suggest aortic valve disease as cause of underestimation of arterial stiffness when including peripheral segments. We report cardiovascular risk factors and pinpoint the hemodynamic aspect ejection time to be associated with increased CAVI after aortic valve surgery.
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Affiliation(s)
- Oscar Plunde
- Unit of Cardiovascular Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Bäck
- Unit of Cardiovascular Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Theme Heart and Vessels, Division of Valvular and Coronary Disease, Karolinska University Hospital, Stockholm, Sweden
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27
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Spanos K, Nana P, von Kodolitsch Y, Behrendt CA, Kouvelos G, Panuccio G, Athanasiou T, Matsagkas M, Giannoukas A, Detter C, Kölbel T. Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines. J Endovasc Ther 2021; 29:667-677. [PMID: 34873944 DOI: 10.1177/15266028211061271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Ascending aorta and aortic arch diseases have an increasing interest among cardiovascular specialists regarding diagnosis and management. Innovations in endovascular surgery and evolution of open surgery have extended the indications for treatment in patients previously considered unfit for surgery. The aim of this systematic review of the literature was to present and analyze current cardiovascular guidelines for overlap and differences in their recommendations regarding ascending aorta and aortic arch diseases and the assessment of evidence. METHODS The English medical literature was searched using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from January 2009 to December 2020. Recommendations on selected topics were analyzed, including issues from definitions and diagnosis (imaging and biomarkers) and indications for treatment to management, including surgical techniques, of the most important ascending aorta and aortic arch diseases. RESULTS The initial search identified 2414 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from multidisciplinary, cardiovascular societies published between 2010 and 2019. The definition of non-A-non-B aortic dissection is lacking from most of the guidelines. There is a disagreement regarding the class of recommendation and level of evidence for the diameter of ascending aorta as an indication. The indication for treatment of aortic disease may be individualized in specific cases while the growth rate may also affect the decision making. The role of endovascular techniques has not been established in current guidelines except by 1 society. Supportive evidence level in the management of aortic arch diseases remains limited. CONCLUSION In current recommendations of cardiovascular societies, the ascending aorta and aortic arch remain a domain of open surgery despite the introduction of endovascular techniques. Recommendations of the included societies are mostly based on expert opinion, and the role of endovascular techniques has been highlighted only from 1 society. The chronological heterogeneity apparent among guidelines and the inconsistency in evidence level should be also acknowledged. More data are needed to develop more solid recommendations for the ascending aorta and aortic arch diseases.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Petroula Nana
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Yskert von Kodolitsch
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - George Kouvelos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios Giannoukas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christian Detter
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
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28
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Guala A, Dux-Santoy L, Teixido-Tura G, Ruiz-Muñoz A, Galian-Gay L, Servato ML, Valente F, Gutiérrez L, González-Alujas T, Johnson KM, Wieben O, Casas-Masnou G, Sao Avilés A, Fernandez-Galera R, Ferreira-Gonzalez I, Evangelista A, Rodríguez-Palomares JF. Wall Shear Stress Predicts Aortic Dilation in Patients With Bicuspid Aortic Valve. JACC Cardiovasc Imaging 2021; 15:46-56. [PMID: 34801463 DOI: 10.1016/j.jcmg.2021.09.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/17/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study sought to assess the predictive value of wall shear stress (WSS) for colocalized ascending aorta (AAo) growth rate (GR) in patients with bicuspid aortic valve (BAV). BACKGROUND BAV is associated with AAo dilation, but there is limited knowledge about possible predictors of aortic dilation in BAV patients with BAV. An increased WSS has been related to aortic wall damage in patients with BAV, but no previous prospective study tested its predictive value for dilation rate. Recently, a registration-based technique for the semiautomatic mapping of aortic GR has been presented and validated. METHODS Forty-seven patients with BAV free from valvular dysfunction prospectively underwent 4-dimensional flow cardiac magnetic resonance to compute WSS and subsequent follow-up with 2 electrocardiogram-gated high-resolution contrast-enhanced computed tomography angiograms for GR assessment. RESULTS During a median follow-up duration of 43 months, mid AAo GR was 0.24 mm/year. WSS and its circumferential component showed statistically significant association with mid AAo GR in bivariate (P = 0.049 and P = 0.014, respectively) and in multivariate analysis corrected for stroke volume and either baseline AAo diameter (P = 0.046 and P = 0.014, respectively) or z-score (P = 0.036 and P = 0.012, respectively). GR mapping further detailed that GR was heterogeneous in the AAo and that circumferential WSS, but not WSS magnitude, showed statistically significant positive associations with GR in the regions with the fastest growth. CONCLUSIONS 4D flow cardiac magnetic resonance-derived WSS and, in particular, its circumferential component predict progressive dilation of the ascending aorta in patients with BAV. Thus, the assessment of WSS may be considered in the follow-up of these patients.
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Affiliation(s)
- Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Gisela Teixido-Tura
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Luz Servato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Filipa Valente
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Kevin M Johnson
- Departments of Medical Physics and Radiology, University of Wisconsin, Wisconsin, USA
| | - Oliver Wieben
- Departments of Medical Physics and Radiology, University of Wisconsin, Wisconsin, USA
| | | | | | | | - Ignacio Ferreira-Gonzalez
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER-ESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Jose F Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
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29
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Dux-Santoy L, Rodríguez-Palomares JF, Teixidó-Turà G, Ruiz-Muñoz A, Casas G, Valente F, Servato ML, Galian-Gay L, Gutiérrez L, González-Alujas T, Fernández-Galera R, Evangelista A, Ferreira-González I, Guala A. Registration-based semi-automatic assessment of aortic diameter growth rate from contrast-enhanced computed tomography outperforms manual quantification. Eur Radiol 2021; 32:1997-2009. [PMID: 34655311 DOI: 10.1007/s00330-021-08273-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/29/2021] [Accepted: 08/14/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Manual assessment of aortic diameters on double-oblique reformatted computed tomography angiograms (CTA) is considered the current standard, although the reproducibility for growth rates has not been reported. Deformable registration of CTA has been proposed to provide 3D aortic diameters and growth maps, but validation is lacking. This study aimed to quantify accuracy and inter-observer reproducibility of registration-based and manual assessment of aortic diameters and growth rates. METHODS Forty patients with ≥ 2 CTA acquired at least 6 months apart were included. Aortic diameters and growth rate were obtained in the aortic root and the entire thoracic aorta using deformable image registration by two independent observers, and compared with the current standard at typical anatomical landmarks. RESULTS Compared with manual assessment, the registration-based technique presented low bias (0.46 mm), excellent agreement (ICC = 0.99), and similar inter-observer reproducibility (ICC = 0.99 for both) for aortic diameters; and low bias (0.10 mm/year), good agreement (ICC = 0.82), and much higher inter-observer reproducibility for growth rates (root: ICC = 0.96 vs 0.68; thoracic aorta: ICC = 0.96 vs 0.80). Registration-based growth rate reproducibility over a 6-month-long follow-up was similar to that obtained by manual assessment after 2.7 years (LoA = [- 0.01, 0.33] vs [- 0.13, 0.21] mm/year, respectively). Mapping of diameter and growth rate was highly reproducible (ICC > 0.9) in the whole thoracic aorta. CONCLUSIONS Registration-based assessment of aortic dilation on CTA is accurate and substantially more reproducible than the current standard, even at follow-up as short as 6 months, and provides robust 3D mapping of aortic diameters and growth rates beyond the pre-established anatomic landmarks. KEY POINTS • Registration-based semi-automatic assessment of progressive aortic dilation on CTA is accurate and substantially more reproducible than the current standard. • The registration-based technique allows robust growth rate assessment at follow-up as short as 6 months, with a similar reproducibility to that obtained by manual assessment at around 3 years. • The use of image registration provides robust 3D mapping of aortic diameters and growth rates beyond the pre-established anatomic landmarks.
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Affiliation(s)
| | - Jose F Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Gisela Teixidó-Turà
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Filipa Valente
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Maria Luz Servato
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Teresa González-Alujas
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Rubén Fernández-Galera
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Instituto del Corazón. Quirónsalud-Teknon, Barcelona, Spain
| | - Ignacio Ferreira-González
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Spain.
- CIBER de Epidemiología y Salud Pública, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain.
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
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30
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Gil-Sala D, Guala A, Garcia Reyes ME, Azancot MA, Dux-Santoy L, Allegue Allegue N, Teixido Turà G, Goncalves Martins G, Ruiz Muñoz A, Constenla García I, Evangelista A, Tello Díaz C, Ferreira González I, Rodríguez-Palomares JF, Bellmunt S. Geometric, Biomechanic and Haemodynamic Aortic Abnormalities Assessed by 4D Flow Cardiovascular Magnetic Resonance in Patients Treated by TEVAR Following Blunt Traumatic Thoracic Aortic Injury. Eur J Vasc Endovasc Surg 2021; 62:797-807. [PMID: 34511317 DOI: 10.1016/j.ejvs.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/29/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) is widely used for the treatment of patients with blunt traumatic thoracic aortic injury (BTAI). However, aortic haemodynamic and biomechanical implications of this intervention are poorly investigated. This study aimed to assess whether patients treated by TEVAR following BTAI have thoracic aortic abnormalities in geometry, stiffness, and haemodynamics. METHODS Patients with BTAI treated by TEVAR at Vall d'Hebron Hospital between 1999 and 2019 were compared with propensity score matched healthy volunteers (HVs). All subjects underwent cardiovascular magnetic resonance (CMR) comprising a 4D flow CMR sequence. Spatially resolved aortic diameter, length, volume, and curvature were assessed. Pulse wave velocity, distensibility, and longitudinal strain (all measurements of aortic stiffness) were determined regionally. Moreover, advanced haemodynamic descriptors were quantified: systolic flow reversal ratio (SFRR), quantifying backward flow during systole, and in plane rotational flow (IRF), measuring in plane strength of helical flow. RESULTS Twenty-six BTAI patients treated by TEVAR were included and matched with 26 HVs. They did not differ in terms of age, sex, and body surface area. Patients with TEVAR had a larger and longer ascending aorta (AAo) and marked abnormalities in local curvature. Aortic stiffness was greater in the aortic segments proximal and distal to TEVAR compared with controls. Moreover, TEVAR patients presented strongly altered flow dynamics compared with controls: a reduced IRF from the distal AAo to the proximal descending aorta and an increased SFRR in the whole thoracic aorta. These differences persisted adjusting for cardiovascular risk factors and were independent of time elapsed since TEVAR implantation. CONCLUSION At long term follow up, previously healthy patients who underwent TEVAR implantation following BTAI had increased diameter, length and volume of the ascending aorta, and increased aortic stiffness and abnormal flow patterns in the whole thoracic aorta compared with matched controls. Further studies should address whether these alterations have clinical implications.
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Affiliation(s)
- Daniel Gil-Sala
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Marvin E Garcia Reyes
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Maria A Azancot
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Gisela Teixido Turà
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriela Goncalves Martins
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Aroa Ruiz Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ivan Constenla García
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Arturo Evangelista
- Departament de Cirurgia. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Instituto del Corazón. Quirónsalud-Teknon. Barcelona, Spain
| | - Cristina Tello Díaz
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ignacio Ferreira González
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER-ESP, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jose F Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sergi Bellmunt
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
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Takahashi K, Sekine T, Ando T, Ishii Y, Kumita S. Utility of 4D Flow MRI in Thoracic Aortic Diseases: A Literature Review of Clinical Applications and Current Evidence. Magn Reson Med Sci 2021; 21:327-339. [PMID: 34497166 DOI: 10.2463/mrms.rev.2021-0046] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Despite the recent technical developments, surgery on the thoracic aorta remains challenging and is associated with significant mortality and morbidity. Decisions about when and if to operate are based on a balance between surgical risk and the hazard of aortic rupture. These decisions are sometimes difficult in elective cases of thoracic aortic diseases, including aneurysms and dissections. Abnormal wall stress derived from flow alterations influences disease progression. Therefore, a better understanding of the complex hemodynamic environment inside the aortic lumen will facilitate patient-specific risk assessments of complications, which enable clinicians to provide timely prophylactic interventions. Time-resolved 3D phase-contrast (4D flow) MRI has many advantages for the in vivo assessment of flow dynamics. Recent developments in 4D flow imaging techniques has led to significant advances in our understanding of physiological flow dynamics in healthy subjects and patients with thoracic aortic diseases. In this clinically focused review of thoracic aortic diseases, we demonstrate the clinical advances acquired with 4D flow MRI from published studies. We provide a systematic overview of key evidences and considerations regarding normal thoracic aortas, thoracic aortic aneurysms, aortic dissections, and thoracic aortas with prosthetic graft replacement.
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Affiliation(s)
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | | | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School
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Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is expanding to lower risk and younger patients with severe symptomatic aortic valve disease. Despite clinical and technological improvements, post-procedural aortic regurgitation (AR) remains a limitation of TAVR, particularly when compared to surgical aortic valve replacement. Although several methods for AR quantification after TAVR are currently available, its exact graduation in everyday clinical practice remains challenging.Areas covered: This review describes the currently available evaluation methods of AR after TAVR, with a special emphasis on the quantitative assessment using videodensitometric angiography, echocardiography and cardiac magnetic resonance imaging.Expert opinion: In the majority of clinical scenarios, satisfactory evaluation of post-TAVR AR can be achieved with a combination of post-procedural angiography, hemodynamic indices and transthoracic echocardiography. Nevertheless, some TAVR patients show 'intermediate' forms of post-procedural AR, in which quantitative evaluation is mandatory for prognostic purposes and further decision-making. Notably, interpretation of quantitative measures early post-TAVR is challenging because of the lack of left ventricular enlargement. Video-densitometric angiography is an emerging method that appears to be clinically attractive for immediate post-TAVR assessment, but requires further validation in everyday clinical practice.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maximilian Von Roeder
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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33
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Ruiz-Muñoz A, Guala A, Rodriguez-Palomares J, Dux-Santoy L, Servato L, Lopez-Sainz A, La Mura L, Granato C, Limeres J, Gonzalez-Alujas T, Galián-Gay L, Gutiérrez L, Johnson K, Wieben O, Sao-Aviles A, Ferreira-Gonzalez I, Evangelista A, Teixido-Tura G. Aortic flow dynamics and stiffness in Loeys-Dietz syndrome patients: a comparison with healthy volunteers and Marfan syndrome patients. Eur Heart J Cardiovasc Imaging 2021; 23:641-649. [PMID: 34104946 DOI: 10.1093/ehjci/jeab069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess aortic flow and stiffness in patients with Loeys-Dietz syndrome (LDS) by 4D flow and cine cardiovascular magnetic resonance (CMR) and compare the results with those of healthy volunteers (HV) and Marfan syndrome (MFS) patients. METHODS AND RESULTS Twenty-one LDS and 44 MFS patients with no previous aortic dissection or surgery and 35 HV underwent non-contrast-enhanced 4D flow CMR. In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR), and aortic diameters were obtained at 20 planes from the ascending (AAo) to the proximal descending aorta (DAo). IRF and SFRR were also quantified for aortic regions (proximal and distal AAo, arch and proximal DAo). Peak-systolic wall shear stress (WSS) maps were also estimated. Aortic stiffness was quantified using pulse wave velocity (PWV) and proximal AAo longitudinal strain. Compared to HV, LDS patients had lower rotational flow at the distal AAo (P = 0.002), arch (P = 0.002), and proximal DAo (P < 0.001) even after adjustment for age, stroke volume, and local diameter. LDS patients had higher SFRR in the proximal DAo compared to both HV (P = 0.024) and MFS patients (P = 0.015), even after adjustment for age and local diameter. Axial and circumferential WSS in LDS patients were lower than in HV. AAo circumferential WSS was lower in LDS compared to MFS patients. AAo and DAo PWV and proximal AAo longitudinal strain revealed stiffer aortas in LDS patients compared to HV (P = 0.007, 0.005, and 0.029, respectively) but no differences vs. MFS patients. CONCLUSION Greater aortic stiffness as well as impaired IRF and WSS were present in LDS patients compared to HV. Conversely, similar aortic stiffness and overlapping aortic flow features were found in Loeys-Dietz and Marfan patients.
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Affiliation(s)
- Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jose Rodriguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | | | - Luz Servato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Angela Lopez-Sainz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Lucia La Mura
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Advanced Biomedical Sciences, University Federico II. Naples, Naples, Italy
| | - Chiara Granato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Javier Limeres
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Teresa Gonzalez-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Galián-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Kevin Johnson
- Department of Medical Physics and Radiology, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics and Radiology, University of Wisconsin, Madison, WI, USA
| | - Augusto Sao-Aviles
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
- CIBER-ESP, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Instituto del Corazón. Quirónsalud-Teknon. Barcelona, Spain
| | - Gisela Teixido-Tura
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Calò K, Gallo D, Guala A, Rodriguez Palomares J, Scarsoglio S, Ridolfi L, Morbiducci U. Combining 4D Flow MRI and Complex Networks Theory to Characterize the Hemodynamic Heterogeneity in Dilated and Non-dilated Human Ascending Aortas. Ann Biomed Eng 2021. [PMID: 34080100 DOI: 10.1007/s10439-021-02798-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
Motivated by the evidence that the onset and progression of the aneurysm of the ascending aorta (AAo) is intertwined with an adverse hemodynamic environment, the present study characterized in vivo the hemodynamic spatiotemporal complexity and organization in human aortas, with and without dilated AAo, exploring the relations with clinically relevant hemodynamic and geometric parameters. The Complex Networks (CNs) theory was applied for the first time to 4D flow magnetic resonance imaging (MRI) velocity data of ten patients, five of them presenting with AAo dilation. The time-histories along the cardiac cycle of velocity-based quantities were used to build correlation-based CNs. The CNs approach succeeded in capturing large-scale coherent flow features, delimiting flow separation and recirculation regions. CNs metrics highlighted that an increasing AAo dilation (expressed in terms of the ratio between the maximum AAo and aortic root diameter) disrupts the correlation in forward flow reducing the correlation persistence length, while preserving the spatiotemporal homogeneity of secondary flows. The application of CNs to in vivo 4D MRI data holds promise for a mechanistic understanding of the spatiotemporal complexity and organization of aortic flows, opening possibilities for the integration of in vivo quantitative hemodynamic information into risk stratification and classification criteria.
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Lopez-Sainz A, Mila L, Rodriguez-Palomares J, Limeres J, Granato C, La Mura L, Sabaté A, Guala A, Gutiérrez L, Galian-Gay L, Sao-Aviles A, Bellmunt S, Rodriguez R, Cuellar-Calabria H, Roque A, Ferreira-González I, Evangelista A, Teixido-Tura G. Aortic Branch Aneurysms and Vascular Risk in Patients With Marfan Syndrome. J Am Coll Cardiol 2021; 77:3005-3012. [PMID: 34140103 DOI: 10.1016/j.jacc.2021.04.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aortic branch aneurysms are not included in the diagnostic criteria for Marfan syndrome (MFS); however, their prevalence and eventual prognostic significance are unknown. OBJECTIVES The goal of this study was to assess the prevalence of aortic branch aneurysms in MFS and their relationship with aortic prognosis. METHODS MFS patients with a pathogenic FBN1 genetic variant and at least one magnetic resonance or computed tomography angiography study assessing aortic branches were included. Aortic events and those related to aneurysm complications were recorded during follow-up. RESULTS A total of 104 aneurysms were detected in 50 (26.7%) of the 187 patients with MFS (mean age 37.9 ± 14.4 years; 54% male) included in this study, with the iliac artery being the most common location (45 aneurysms). Thirty-one patients (62%) had >1 peripheral aneurysm, and surgery was performed in 5 (4.8%). Patients with aneurysms were older (41.9 ± 12.7 years vs. 36.7 ± 14.8 years; p = 0.040) and had more dilated aortic root (42.2 ± 6.4 mm vs. 38.8 ± 8.0 mm; p = 0.044) and dyslipidemia (31.0% vs. 9.7%; p = 0.001). In a subgroup of 95 patients with no previous aortic surgery or dissection followed up for 3.3 ± 2.6 years, the presence of arterial aneurysms was associated with a greater need for aortic surgery (hazard ratio: 3.4; 95% confidence interval: 1.1 to 10.3; p = 0.028) in a multivariable Cox analysis adjusted for age and aortic diameter. CONCLUSIONS Aortic branch aneurysms are present in one-quarter of patients with MFS and are related to age and aortic dilation, and they independently predict the need for aortic surgery. The systematic use of whole-body vascular assessment is recommended to identify other sites of vascular involvement at risk for complications and to define the subgroup of patients with more aggressive aortic disease.
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Affiliation(s)
- Angela Lopez-Sainz
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Laia Mila
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Rodriguez-Palomares
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Limeres
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Chiara Granato
- Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Lucia La Mura
- Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Ana Sabaté
- Department of Pediatric Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Andrea Guala
- Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Galian-Gay
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Augusto Sao-Aviles
- Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Sergi Bellmunt
- Department of Angiology, Vascular and Endovascular Surgery, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Rafael Rodriguez
- Department of Cardiac Surgery, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Hug Cuellar-Calabria
- Department of Radiology, IDI (Institut de Diagnòstic per la Imatge), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Albert Roque
- Department of Radiology, IDI (Institut de Diagnòstic per la Imatge), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Ignacio Ferreira-González
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERESP Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Artur Evangelista
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.
| | - Gisela Teixido-Tura
- Department of Cardiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Grupo de Enfermedades Cardiovasculares, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.
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Möstl S, Orter S, Hoffmann F, Bachler M, Hametner B, Wassertheurer S, Rabineau J, Mulder E, Johannes B, Jordan J, Tank J. Limited Effect of 60-Days Strict Head Down Tilt Bed Rest on Vascular Aging. Front Physiol 2021; 12:685473. [PMID: 34122149 PMCID: PMC8194311 DOI: 10.3389/fphys.2021.685473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular risk may be increased in astronauts after long term space flights based on biomarkers indicating premature vascular aging. We tested the hypothesis that 60 days of strict 6° head down tilt bed rest (HDTBR), an established space analog, promotes vascular stiffening and that artificial gravity training ameliorates the response. Methods We studied 24 healthy participants (8 women, 24–55 years, BMI = 24.3 ± 2.1 kg/m2) before and at the end of 60 days HDTBR. 16 subjects were assigned to daily artificial gravity. We applied echocardiography to measure stroke volume and isovolumetric contraction time (ICT), calculated aortic compliance (stroke volume/aortic pulse pressure), and assessed aortic distensibility by MRI. Furthermore, we measured brachial-femoral pulse wave velocity (bfPWV) and pulse wave arrival times (PAT) in different vascular beds by blood pressure cuffs and photoplethysmography. We corrected PAT for ICT (cPAT). Results In the pooled sample, diastolic blood pressure (+8 ± 7 mmHg, p < 0.001), heart rate (+7 ± 9 bpm, p = 0.002) and ICT (+8 ± 13 ms, p = 0.036) increased during HDTBR. Stroke volume decreased by 14 ± 15 ml (p = 0.001). bfPWV, aortic compliance, aortic distensibility and all cPAT remained unchanged. Aortic area tended to increase (p = 0.05). None of the parameters showed significant interaction between HDTBR and artificial gravity training. Conclusion 60 days HDTBR, while producing cardiovascular deconditioning and cephalad fluid shifts akin to weightlessness, did not worsen vascular stiffness. Artificial gravity training did not modulate the response.
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Affiliation(s)
- Stefan Möstl
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Stefan Orter
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Fabian Hoffmann
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Martin Bachler
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Bernhard Hametner
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Jérémy Rabineau
- Laboratory of Physics and Physiology, University of Brussels, Brussels, Belgium
| | - Edwin Mulder
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Bernd Johannes
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Jens Jordan
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Chair of Aerospace Medicine, University Hospital Cologne, Cologne, Germany
| | - Jens Tank
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
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37
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Guala A, Evangelista A, Teixido-Tura G, La Mura L, Dux-Santoy L, Ruiz-Muñoz A, Valente F, Galian-Gay L, Gutiérrez L, González-Alujas T, Dentamaro I, Johnson KM, Wieben O, Sao Avilés A, Ferreira-Gonzalez I, Rodríguez-Palomares JF. Leaflet fusion length is associated with aortic dilation and flow alterations in non-dysfunctional bicuspid aortic valve. Eur Radiol 2021; 31:9262-9272. [PMID: 33977309 DOI: 10.1007/s00330-021-08016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/15/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Bicuspid aortic valve (BAV), the most common congenital valve defect, is associated with increased risk of aortic dilation and related complications; however, current risk assessment is not effective. Most of BAV have three leaflets with a fusion between two of them of variable length. This study aimed to ascertain whether the extent of leaflet fusion (often called raphe) is related to aortic dilation and flow abnormalities in BAV with no significant valvular dysfunction. METHODS One hundred and twenty BAV patients with no significant valvular dysfunction or history of surgical repair or aortic valve replacement were consecutively and prospectively enrolled (September 2014-October 2018). Cardiac magnetic resonance protocol included a 4D flow sequence for haemodynamic assessment. Moreover, a stack of double-oblique cine images of the aortic valve were used to quantify fusion length (in systole) and leaflet length (diastole). Inter- and intra-observer reproducibility was tested in 30 randomly selected patients. RESULTS Aortic valve leaflet fusion was measurable in 112 of 120 (93%) cases with good reproducibility (ICC = 0.826). Fusion length varied greatly (range: 2.3-15.4 mm; mean: 7.8 ± 3.2 mm). After correction for demographic and clinical conditions, fusion length was independently associated with diameter and z-score at the sinus of Valsalva (p = 0.002 and p = 0.002, respectively) and ascending aorta (p = 0.028 and p = 0.046). Fusion length was positively related to flow asymmetry, vortices and circumferential wall shear stress, thereby possibly providing a pathophysiological link with aortic dilation. CONCLUSIONS Aortic valve fusion length is related to aortic dilation and flow abnormalities in BAV patients. KEY POINTS • The length of the fusion between leaflets in non-dysfunctional bicuspid aortic valves varies substantially and can be reliably measured by cine CMR. • Aortic valve leaflet fusion length is independently related to aortic sinus and ascending aorta diameter. • Increased flow asymmetry, circumferential wall shear stress and presence of vortices are positively related to aortic valve leaflet fusion length.
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Affiliation(s)
- Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. .,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. .,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain. .,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. .,Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Gisela Teixido-Tura
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lucia La Mura
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Filipa Valente
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ilaria Dentamaro
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Cardiology, Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Kevin M Johnson
- Departments of Medical Physics & Radiology, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Departments of Medical Physics & Radiology, University of Wisconsin, Madison, WI, USA
| | | | - Ignacio Ferreira-Gonzalez
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER-ESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose F Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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38
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Casciaro ME, Pascaner AF, Guilenea FN, Alcibar J, Gencer U, Soulat G, Mousseaux E, Craiem D. 4D flow MRI: impact of region of interest size, angulation and spatial resolution on aortic flow assessment. Physiol Meas 2021; 42. [PMID: 33567412 DOI: 10.1088/1361-6579/abe525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/10/2021] [Indexed: 12/31/2022]
Abstract
Objectives.In cardiovascular magnetic resonance, the 3D time-resolved phase-contrast technique, also known as 4D flow, is gaining increasing attention due to applications that exploit three-directional velocity encoding throughout the cardiac cycle. Blood flow volume assessment usually requires an expert to draw regions of interest (ROI) around the vessel cross section, whereas the errors involved in this estimation have not been thoroughly investigated. Our objective is to quantify the influence of ROI sizing, angulation and spatial resolution of the reconstructed plane employed in blood flow measurements using 4D flow.Approach.Three circular ROIs were drawn around the ascending, arch and descending aorta of healthy volunteers (n= 27) and patients with a dilated ascending aorta or bicuspid valve (n= 37). We applied systematic changes of ROI diameter (up to ±10%), tilt angle (up to ±25°) and spatial resolution (from 0.25 to 2 mm) of the reconstructed oblique planes, calculating the effects on net, forward and backward blood flow volumes.Main results.Patients had a larger ascending aorta than healthy volunteers with similar ages and male sex proportion (60 ± 15 y.o. vs 58 ± 16 y.o. and 84% vs 70%, respectively). Higher forward and backward flow volumes were observed in the ascending aorta and the aortic arch of the patients with respect to controls (p< 0.001), whereas net volumes were similar: 74.0 ± 20.8 ml versus 75.7 ± 21.8 ml (p= 0.37), respectively. The ascending aorta was the most sensitive to ROI modifications. Changes of ±10% in the ROI diameter and ±25° in tilt angles produced flow volume differences of up to 9 ml (10%) and 18 ml (15%) in controls and patients, respectively. Modifying the reconstructed planes spatial resolution produced flow volume changes below 2 ml.Significance.Since the setting of the ROI size and plane angle could produce errors that represent up to 20% of the forward and/or backward aortic flow volume, a good standardization for vessel segmentation and plane positioning is desirable.
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Affiliation(s)
- M E Casciaro
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
| | - A F Pascaner
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
| | - F N Guilenea
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
| | - J Alcibar
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
| | - U Gencer
- Cardiovascular Imaging Unit, Hôpital Européen Georges Pompidou, INSERM U970, Paris, France
| | - G Soulat
- Cardiovascular Imaging Unit, Hôpital Européen Georges Pompidou, INSERM U970, Paris, France
| | - E Mousseaux
- Cardiovascular Imaging Unit, Hôpital Européen Georges Pompidou, INSERM U970, Paris, France
| | - D Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
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39
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Tosello F, Guala A, D'ascenzo F, Bollati M, Leone D, Sabia L, Bruno G, Mingrone G, Astarita A, Vallelonga F, Avenatti E, Moretti C, Veglio F, Ridolfi L, Milan A. Central pulse pressure is inversely associated with proximal aortic remodelling. J Hypertens 2021; 39:919-25. [PMID: 33710165 DOI: 10.1097/HJH.0000000000002730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Hypertension leads to aortic stiffening and dilatation but unexpected data from the Framingham Heart Study showed an inverse relationship between brachial pulse pressure and aortic diameter. Aortic dilatation would not only lead to lower pulse pressure but also to a worse prognosis (cardiac events, heart failure). Invasive pressure may be more informative but data are lacking. AIM This study evaluated the relationship between invasively measured central blood pressure and proximal aortic diameter. METHODS In 71 consecutive patients referred to invasive haemodynamic study, proximal aortic remodelling was evaluated in terms of Z-score, comparing diameters measured at the sinus of Valsalva to the diameter expected according to patients' age, sex and body height. Pressures were recorded directly in the proximal aorta by means of a catheter before coronary assessment. RESULTS The mean invasive aortic SBPs and DBPs were 146 ± 23 and 78 ± 13 mmHg, respectively, giving a central pulse pressure (cPP inv) of 68 ± 21 mmHg. Proximal aortic diameter was 34.9 ± 19.4 mm, whereas Z-score was -0.3 ± 1.7. Patients with higher cPPinv showed a significantly lower Z-score (-0.789 vs. 0.155, P = 0.001). cPPinv was inversely related to Z-score (R = -0.271, P = 0.022) independently from age, mean blood pressure and heart rate (β = -0.241, P = 0.011). CONCLUSION Aortic root Z-score is inversely associated with invasively measured central pulse pressure in a cohort of patients undergoing invasive coronary assessment. Remodelling at the sinuses of Valsalva may be a compensatory mechanism to limit pulse pressure.
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40
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Pascaner AF, Houriez-Gombaud-Saintonge S, Craiem D, Gencer U, Casciaro ME, Charpentier E, Bouaou K, Cesare AD, Dietenbeck T, Chenoune Y, Kachenoura N, Mousseaux E, Soulat G, Bollache E. Comprehensive assessment of local and regional aortic stiffness in patients with tricuspid or bicuspid aortic valve aortopathy using magnetic resonance imaging. Int J Cardiol 2020; 326:206-212. [PMID: 33259874 DOI: 10.1016/j.ijcard.2020.11.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND We aimed to provide a comprehensive aortic stiffness description using magnetic resonance imaging (MRI) in patients with ascending thoracic aorta aneurysm and tricuspid (TAV-ATAA) or bicuspid (BAV) aortic valve. METHODS This case-control study included 18 TAV-ATAA and 19 BAV patients, with no aortic valve stenosis/severe regurgitation, who were 1:1 age-, gender- and central blood pressures (BP)-matched to healthy volunteers. Each underwent simultaneous aortic MRI and BP measurements. 3D anatomical MRI provided aortic diameters. Stiffness indices included: regional ascending (AA) and descending (DA) aorta pulse wave velocity (PWV) from 4D flow MRI; local AA and DA strain, distensibility and theoretical Bramwell-Hill (BH) model-based PWV, as well as regional arch PWV from 2D flow MRI. RESULTS Patient groups had significantly higher maximal AA diameter (median[interquartile range], TAV-ATAA: 47.5[42.0-51.3]mm, BAV: 45.0[41.0-47.0]mm) than their respective controls (29.1[26.8-31.8] and 28.1[26.0-32.0]mm, p < 0.0001), while BP were similar (p ≥ 0.25). Stiffness indices were significantly associated with age (ρ ≥ 0.33), mean BP (arch PWV: ρ = 0.25, p = 0.05; DA distensibility: ρ = -0.30, p = 0.02) or AA diameter (arch PWV: ρ = 0.28, p = 0.03; DA PWV: ρ = 0.32, p = 0.009). None of them, however, was significantly different between TAV-ATAA or BAV patients and their matched controls. Finally, while direct PWV measures were significantly correlated to BH-PWV estimates in controls (ρ ≥ 0.40), associations were non-significant in TAV-ATAA and BAV groups (p ≥ 0.18). CONCLUSIONS The overlap of MRI-derived aortic stiffness indices between patients with TAV or BAV aortopathy and matched controls highlights another heterogeneous feature of aortopathy, and suggests the urgent need for more sensitive indices which might help better discriminate such diseases.
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Affiliation(s)
- Ariel F Pascaner
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina
| | - Sophia Houriez-Gombaud-Saintonge
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; ESME Sudria Research Lab, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Damian Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina
| | - Umit Gencer
- Département de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou - INSERM U970, PARCC, Paris, France
| | - Mariano E Casciaro
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina
| | - Etienne Charpentier
- Département de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou - INSERM U970, PARCC, Paris, France
| | - Kevin Bouaou
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Alain De Cesare
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Thomas Dietenbeck
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | | | - Nadjia Kachenoura
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Elie Mousseaux
- Département de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou - INSERM U970, PARCC, Paris, France
| | - Gilles Soulat
- Département de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou - INSERM U970, PARCC, Paris, France
| | - Emilie Bollache
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
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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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42
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Galian-Gay L, Rodríguez-Palomares J, Guala A, Michelena HI, Evangelista A. Multimodality imaging in bicuspid aortic valve. Prog Cardiovasc Dis 2020; 63:442-451. [PMID: 32531300 DOI: 10.1016/j.pcad.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
Bicuspid aortic valve (BAV) patients are at increased risk of valve dysfunction and ascending aorta aneurysm. Imaging techniques are essential to establish diagnosis, identify complications and indicate surgical treatment. Transthoracic echocardiography (TTE) is the imaging technique of choice to diagnose BAV, valve morphotype and valvular dysfunction in clinical practice. However, it can be less precise in assessing the aortic root and proximal ascending aorta, and visualization of the mid-distal ascending aorta and the arch may be difficult in some adults where cardiac magnetic resonance (CMR) and computed tomography, using multiplanar reconstructions, are better at assessing aortic diameters. Although valvular dysfunction is very variable, almost half of the patients have more than mild aortic valve disease. TTE is the most effective and accurate test for evaluating the severity of valvular dysfunction and guiding appropriate management decisions. Aorta dilation is a common finding in patients with BAV. The pattern of aortic dimensions has been categorized in three aortic phenotypes: no-dilation phenotype, ascending aorta phenotype and root phenotype. Controversial data exist regarding the relationship between BAV morphology and aorta dilation phenotype. The assessment of aortic stiffness (measuring distensibility or the velocity of propagation of flow) has raised special interest in order to predict progressive aorta dilation. However, current data indicates that BAV aortas do not show altered stiffness compared to those associated with a tricuspid valve with a similar aorta size. Moreover, novel 4D-flow CMR sequences have been crucial in the evaluation of abnormal ascending aorta flow, showing that flow in the aorta of BAV patients is asymmetric and includes the formation of large vortices. Such flow abnormalities are thought to produce changes in wall shear stress which has been associated with extracellular matrix dysregulation. The key points to understand familial screening and the recommendations for establishing the follow-up and therapeutic management of BAV patients are exposed in the review. The main objective of this article is to review the advantages and limitations of the imaging techniques in the diagnosis and management of BAV and the best strategies in the use of multimodality imaging.
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Affiliation(s)
- Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Cardiology Department, Heart Institute, Quirón-Teknon Medical Center, Barcelona, Spain.
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43
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Affiliation(s)
- Raymond Y Kwong
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Y Chandrashekhar
- Division of Cardiology, University of Minnesota/VAMC Minneapolis, Minneapolis, Minnesota.
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44
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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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45
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Dux-Santoy L, Guala A, Sotelo J, Uribe S, Teixidó-Turà G, Evangelista A, Rodríguez-Palomares JF. Response by Dux-Santoy et al to Letter Regarding Article, "Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve: A Time-Resolved 3-Dimensional Phase-Contrast Magnetic Resonance Imaging Study". Arterioscler Thromb Vasc Biol 2020; 40:e116-e117. [PMID: 32208996 DOI: 10.1161/atvbaha.120.314057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lydia Dux-Santoy
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-T., A.E., J.F.R.-P.)
| | - Andrea Guala
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-T., A.E., J.F.R.-P.)
| | - Julio Sotelo
- Biomedical Imaging Center (J.S., S.U.), Pontificia Universidad Católica de Chile, Santiago.,Department of Electrical Engineering, School of Engineering (J.S.), Pontificia Universidad Católica de Chile, Santiago.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile (J.S., S.U.)
| | - Sergio Uribe
- Biomedical Imaging Center (J.S., S.U.), Pontificia Universidad Católica de Chile, Santiago.,Department of Radiology, School of Medicine (S.U.), Pontificia Universidad Católica de Chile, Santiago.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile (J.S., S.U.)
| | - Gisela Teixidó-Turà
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-T., A.E., J.F.R.-P.)
| | - Arturo Evangelista
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-T., A.E., J.F.R.-P.)
| | - José F Rodríguez-Palomares
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-T., A.E., J.F.R.-P.)
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Pons R, Guala A, Rodríguez-Palomares JF, Cajas JC, Dux-Santoy L, Teixidó-Tura G, Molins JJ, Vázquez M, Evangelista A, Martorell J. Fluid-structure interaction simulations outperform computational fluid dynamics in the description of thoracic aorta haemodynamics and in the differentiation of progressive dilation in Marfan syndrome patients. R Soc Open Sci 2020; 7:191752. [PMID: 32257331 PMCID: PMC7062053 DOI: 10.1098/rsos.191752] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/09/2020] [Indexed: 06/02/2023]
Abstract
Abnormal fluid dynamics at the ascending aorta may be at the origin of aortic aneurysms. This study was aimed at comparing the performance of computational fluid dynamics (CFD) and fluid-structure interaction (FSI) simulations against four-dimensional (4D) flow magnetic resonance imaging (MRI) data; and to assess the capacity of advanced fluid dynamics markers to stratify aneurysm progression risk. Eight Marfan syndrome (MFS) patients, four with stable and four with dilating aneurysms of the proximal aorta, and four healthy controls were studied. FSI and CFD simulations were performed with MRI-derived geometry, inlet velocity field and Young's modulus. Flow displacement, jet angle and maximum velocity evaluated from FSI and CFD simulations were compared to 4D flow MRI data. A dimensionless parameter, the shear stress ratio (SSR), was evaluated from FSI and CFD simulations and assessed as potential correlate of aneurysm progression. FSI simulations successfully matched MRI data regarding descending to ascending aorta flow rates (R 2 = 0.92) and pulse wave velocity (R 2 = 0.99). Compared to CFD, FSI simulations showed significantly lower percentage errors in ascending and descending aorta in flow displacement (-46% ascending, -41% descending), jet angle (-28% ascending, -50% descending) and maximum velocity (-37% ascending, -34% descending) with respect to 4D flow MRI. FSI- but not CFD-derived SSR differentiated between stable and dilating MFS patients. Fluid dynamic simulations of the thoracic aorta require fluid-solid interaction to properly reproduce complex haemodynamics. FSI- but not CFD-derived SSR could help stratifying MFS patients.
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Affiliation(s)
- R. Pons
- Department of Chemical Engineering and Material Sciences, IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017 Barcelona, Spain
| | - A. Guala
- Hospital Universitari Vall d'Hebron, Department of Cardiology, CIBER-CV, Vall d'Hebron Institut de recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J. F. Rodríguez-Palomares
- Hospital Universitari Vall d'Hebron, Department of Cardiology, CIBER-CV, Vall d'Hebron Institut de recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J. C. Cajas
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, C/Jordi Girona 29, 08034 Barcelona, Spain
- Escuela Nacional de Estudios Superiors, Unidad Mérida, Universidad Nacional Autónoma de México, Carretera Mérida-Tetiz, Km 4, Ucú, Yucatán, 97357, México
| | - L. Dux-Santoy
- Hospital Universitari Vall d'Hebron, Department of Cardiology, CIBER-CV, Vall d'Hebron Institut de recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - G. Teixidó-Tura
- Hospital Universitari Vall d'Hebron, Department of Cardiology, CIBER-CV, Vall d'Hebron Institut de recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J. J. Molins
- Department of Chemical Engineering and Material Sciences, IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017 Barcelona, Spain
| | - M. Vázquez
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, C/Jordi Girona 29, 08034 Barcelona, Spain
- ELEM Biotech, Calle Rossello 36, 08029 Barcelona, Spain
| | - A. Evangelista
- Hospital Universitari Vall d'Hebron, Department of Cardiology, CIBER-CV, Vall d'Hebron Institut de recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J. Martorell
- Department of Chemical Engineering and Material Sciences, IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017 Barcelona, Spain
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Guala A, Dux-Santoy L, Teixido-Tura G, Johnson KM, Evangelista A, Rodríguez-Palomares J. La presencia de rafe en la válvula aórtica bicúspide normofuncionante no altera la hemodinámica ni la rigidez aórtica. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Soulat G, Gencer U, Kachenoura N, Villemain O, Messas E, Boutouyrie P, Laurent S, Mousseaux E. Changes in segmental pulse wave velocity of the thoracic aorta with age and left ventricular remodelling. An MRI 4D flow study. J Hypertens 2020; 38:118-26. [DOI: 10.1097/hjh.0000000000002224] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dux-Santoy L, Guala A, Sotelo J, Uribe S, Teixidó-Turà G, Ruiz-Muñoz A, Hurtado DE, Valente F, Galian-Gay L, Gutiérrez L, González-Alujas T, Johnson KM, Wieben O, Ferreira I, Evangelista A, Rodríguez-Palomares JF. Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve: A Time-Resolved 3-Dimensional Phase-Contrast Magnetic Resonance Imaging Study. Arterioscler Thromb Vasc Biol 2019; 40:e10-e20. [PMID: 31801375 PMCID: PMC7771642 DOI: 10.1161/atvbaha.119.313636] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Supplemental Digital Content is available in the text. Objective: To assess the relationship between regional wall shear stress (WSS) and oscillatory shear index (OSI) and aortic dilation in patients with bicuspid aortic valve (BAV). Approach and Results: Forty-six consecutive patients with BAV (63% with right-left-coronary-cusp fusion, aortic diameter ≤ 45 mm and no severe valvular disease) and 44 healthy volunteers were studied by time-resolved 3-dimensional phase-contrast magnetic resonance imaging. WSS and OSI were quantified at different levels of the ascending aorta and the aortic arch, and regional WSS and OSI maps were obtained. Seventy percent of BAV had ascending aorta dilation. Compared with healthy volunteers, patients with BAV had increased WSS and decreased OSI in most of the ascending aorta and the aortic arch. In both BAV and healthy volunteers, regions of high WSS matched regions of low OSI and vice versa. No regions of both low WSS and high OSI were identified in BAV compared with healthy volunteers. Patients with BAV with dilated compared with nondilated aorta presented low and oscillatory WSS in the aortic arch, but not in the ascending aorta where dilation is more prevalent. Furthermore, no regions of concomitant low WSS and high OSI were identified when BAV were compared according to leaflet fusion pattern, despite the well-known differences in regional dilation prevalence. Conclusions: Regions with low WSS and high OSI do not match those with the highest prevalence of dilation in patients with BAV, thus providing no evidence to support the low and oscillatory shear stress theory in the pathogenesis of proximal aorta dilation in the presence of BAV.
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Affiliation(s)
- Lydia Dux-Santoy
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Andrea Guala
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Julio Sotelo
- Biomedical Imaging Center (J.S., S.U.), Pontificia Universidad Católica de Chile, Santiago.,Department of Electrical Engineering, School of Engineering (J.S.), Pontificia Universidad Católica de Chile, Santiago.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile (J.S., S.U., D.E.H.)
| | - Sergio Uribe
- Biomedical Imaging Center (J.S., S.U.), Pontificia Universidad Católica de Chile, Santiago.,Department of Radiology, School of Medicine (S.U.), Pontificia Universidad Católica de Chile, Santiago.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile (J.S., S.U., D.E.H.)
| | - Gisela Teixidó-Turà
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Aroa Ruiz-Muñoz
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Daniel E Hurtado
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine, and Biological Sciences (D.E.H.), Pontificia Universidad Católica de Chile, Santiago.,Department of Structural and Geotechnical Engineering, Schools of Engineering (D.E.H.), Pontificia Universidad Católica de Chile, Santiago.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile (J.S., S.U., D.E.H.)
| | - Filipa Valente
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Laura Galian-Gay
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Laura Gutiérrez
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Teresa González-Alujas
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Kevin M Johnson
- Department of Medical Physics (K.M.J., O.W.), University of Wisconsin-Madison.,Department of Radiology (K.M.J., O.W.), University of Wisconsin-Madison
| | - Oliver Wieben
- Department of Medical Physics (K.M.J., O.W.), University of Wisconsin-Madison.,Department of Radiology (K.M.J., O.W.), University of Wisconsin-Madison
| | - Ignacio Ferreira
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Arturo Evangelista
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - José F Rodríguez-Palomares
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
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50
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Climie RE, Gallo A, Picone DS, Di Lascio N, van Sloten TT, Guala A, Mayer CC, Hametner B, Bruno RM. Measuring the Interaction Between the Macro- and Micro-Vasculature. Front Cardiovasc Med 2019; 6:169. [PMID: 31824963 PMCID: PMC6882776 DOI: 10.3389/fcvm.2019.00169] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023] Open
Abstract
Structural and functional dysfunction in both the macro- and microvasculature are a feature of essential hypertension. In a healthy cardiovascular system, the elastic properties of the large arteries ensure that pulsations in pressure and flow generated by cyclic left ventricular contraction are dampened, so that less pulsatile pressure and flow are delivered at the microvascular level. However, in response to aging, hypertension, and other disease states, arterial stiffening limits the buffering capacity of the elastic arteries, thus exposing the microvasculature to increased pulsatile stress. This is thought to be particularly pertinent to high flow/low resistance organs such as the brain and kidney, which may be sensitive to excess pressure and flow pulsatility, damaging capillary networks, and resulting in target organ damage. In this review, we describe the clinical relevance of the pulsatile interaction between the macro- and microvasculature and summarize current methods for measuring the transmission of pulsatility between the two sites.
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Affiliation(s)
- Rachel E Climie
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Antonio Gallo
- Cardiovascular Prevention Unit, Department of Endocrinology and Metabolism, Pitié-Salpêtrière Hospital, Paris, France.,Laboratoire d'imagerie Biomédicale, INSERM 1146 - CNRS 7371, Sorbonne University, Paris, France
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Nicole Di Lascio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Thomas T van Sloten
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Bernhard Hametner
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Rosa Maria Bruno
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France
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