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Dux-Santoy L, Rodríguez-Palomares JF, Teixidó-Turà G, Garrido-Oliver J, Carrasco-Poves A, Morales-Galán A, Ruiz-Muñoz A, Casas G, Valente F, Galian-Gay L, Fernández-Galera R, Oliveró R, Cuéllar-Calabria H, Roque A, Burcet G, Barrabés JA, Ferreira-González I, Guala A. Three-dimensional aortic geometry mapping via registration of non-gated contrast-enhanced or gated and respiratory-navigated MR angiographies. J Cardiovasc Magn Reson 2024; 26:100992. [PMID: 38211655 DOI: 10.1016/j.jocmr.2024.100992] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The measurement of aortic dimensions and their evolution are key in the management of patients with aortic diseases. Manual assessment, the current guideline-recommended method and clinical standard, is subjective, poorly reproducible, and time-consuming, limiting the capacity to track aortic growth in everyday practice. Aortic geometry mapping (AGM) via image registration of serial computed tomography angiograms outperforms manual assessment, providing accurate and reproducible 3D maps of aortic diameter and growth rate. This observational study aimed to evaluate the accuracy and reproducibility of AGM on non-gated contrast-enhanced (CE-) and cardiac- and respiratory-gated (GN-) magnetic resonance angiographies (MRA). METHODS Patients with thoracic aortic disease followed with serial CE-MRA (n = 30) or GN-MRA (n = 15) acquired at least 1 year apart were retrospectively and consecutively identified. Two independent observers measured aortic diameters and growth rates (GR) manually at several thoracic aorta reference levels and with AGM. Agreement between manual and AGM measurements and their inter-observer reproducibility were compared. Reproducibility for aortic diameter and GR maps assessed with AGM was obtained. RESULTS Mean follow-up was 3.8 ± 2.3 years for CE- and 2.7 ± 1.6 years for GN-MRA. AGM was feasible in the 93% of CE-MRA pairs and in the 100% of GN-MRA pairs. Manual and AGM diameters showed excellent agreement and inter-observer reproducibility (ICC>0.9) at all anatomical levels. Agreement between manual and AGM GR was more limited, both in the aortic root by GN-MRA (ICC=0.47) and in the thoracic aorta, where higher accuracy was obtained with GN- than with CE-MRA (ICC=0.55 vs 0.43). The inter-observer reproducibility of GR by AGM was superior compared to manual assessment, both with CE- (thoracic: ICC= 0.91 vs 0.51) and GN-MRA (root: ICC=0.84 vs 0.52; thoracic: ICC=0.93 vs 0.60). AGM-based 3D aortic size and growth maps were highly reproducible (median ICC >0.9 for diameters and >0.80 for GR). CONCLUSION Mapping aortic diameter and growth on MRA via 3D image registration is feasible, accurate and outperforms the current manual clinical standard. This technique could broaden the possibilities of clinical and research evaluation of patients with aortic thoracic diseases.
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Affiliation(s)
| | - Jose F Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Gisela Teixidó-Turà
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juan Garrido-Oliver
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alejandro Carrasco-Poves
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Guillem Casas
- 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
- CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ruperto Oliveró
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Hug Cuéllar-Calabria
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Albert Roque
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gemma Burcet
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - José A Barrabés
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ignacio Ferreira-González
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, 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 de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
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2
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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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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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4
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Muñoz AR, Guala A, Dux-Santoy L, Teixidó-Turà G, Garrido-Oliver J, Garcia-Duran A, Valente F, Galian-Gay L, Gutierrez L, Cuellar-Calabria H, Johnson K, Wieven O, Ferreira-Gonzalez I, Evangelista A, Rodriguez-Palomares J. Poster No. 116 Hemodynamic characteristics associated with partial thrombosis of the false lumen in patients with chronic aortic dissection of the descending aorta: a 4D flow CMR study. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Partial thrombosis of the false lumen (FL) in patients with chronic aortic dissection (AD) of the descending aorta has been associated with faster aortic dilation. Four-dimensional phase-contrast cardiovascular magnetic resonance (4D flow CMR) studies analyzing flow dynamics and biomechanics in the FL and their relationship with partial thrombosis are lacking. This study aimed to compare FL flow dynamics and biomechanics between patients with a patent and partially thrombosed FL.
Materials and methods
Patients with a chronic, patent (no thrombus) or partially thrombosed FL in the descending aorta after an AD underwent an imaging follow-up including a magnetic resonance angiography (MRA) and a 4D flow CMR study. FL thrombosis was quantified as the ratio of thrombus volume and FL volume on MRA. FL flow dynamics was assessed in terms of forward flow, wall shear stress (WSS), maximum kinetic energy (KE) and acceleration, and flow stasis on 4D flow CMR. Aortic stiffness in the FL was quantified using pulse wave velocity (PWV).
Results and conclusions
Sixty-five patients with a complete imaging protocol were included in the study (patency in 34 patients, partial thrombosis in 31). Partial thrombosis of the FL was associated with a reduction in the amount and energy of flow in the FL (reduced forward systolic flow, KE and acceleration), and a more stagnated flow in the FL (increased flow stasis). Axial WSS showed a tendency to be lower in the partial thrombosis group compared to the patency group, while PWV were similar in both of them.
Funding
IJC2018-037349-I.
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5
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Rodriguez-Palomares J, Dux-Santoy L, Teixidó-Turà G, Ruiz-Muñoz A, Garrido-Oliver J, Johnson K, Wieven O, Galian L, Valente F, Gutierrez L, Gonzalez-Alujas T, Sao-Aviles A, Evangelista A, Ferreira-Gonzalez I, Guala A. Poster No. 122 Predicting the rate of progressive dilation by wall shear stress in bicuspidaortic valve patients. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Despite the high prevalence of ascending aorta (AAo) dilation in bicuspid aortic valve (BAV) patients there is limited evidence of dilation aetiology. Several cross-sectional studies pointed to a role for wall shear stress (WSS), but this hypothesis has not been tested. Recently, a technique for 3D-maps of aortic growth from two contrast-enhanced computed tomography angiograms (CTA) was presented and validated. We aim to test if local WSS predicts local dilation rates in BAV patients.
Materials and methods
Forty BAV patients free from aortic valve disease and previous relevant interventions underwent a baseline 4D flow CMR followed by two CTA. WSS, and its axial and circumferential components, and growth rate (GR) were computed at 64 standardized regions in the ascending aortic (AAo). A two-tailed p-value < 0.05 was considered statistically significant.
Results and conclusions
Patients were relatively young (51 ± 13 yeas) and follow-up duration was 44.8 ± 2.6 months. Growth rate was heterogeneous in the AAo, with fastest progression located in the outer mid AAo region and in the inner region of the proximal-mid AAo. WSS magnitude and WSS axial component were maximum in the right region of the mid AAo while circumferential WSS was highest in the outer region of the mid AAo, the region experiencing fastest growth. Significant associations between GR and circumferential WSS were located in the regions with fastest progressive dilation, while WSS magnitude and its axial component resulted in limited predictive capacity. In conclusion, circumferential WSS is related to fast progressive dilation in BAV patients.
Funding
PI17/00381,SEC/FEC-INV-CLI20/015,LCF/BQ/PR22/11920008,RTC2019-007280-1.
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Muñoz AR, Guala A, Cilla M, Martínez M, Dux-Santoy L, Teixidó-Turà G, Garrido-Oliver J, Galian L, Sao-Aviles A, Evangelista A, Ferreira-Gonzalez I, Peña E, Rodriguez-Palomares J. Oral Presentation No. 121 Aortic stiffness descriptors by cardiac magnetic resonance are correlated with mechanical testing of ex-vivo aortic aneurysms specimens. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stiffness independently predicts mayor adverse cardiovascular events and mortality in the general population. Cardiovascular magnetic resonance (CMR) permits the assessment of a number of parameters theoretically linked to aortic stiffness, such as distensibility (AD), pulse wave velocity (PWV) and proximal aorta longitudinal strain. However, no previous study validates these parameters as descriptors of aortic wall stiffness against ex-vivo mechanical testing.
Materials and methods
Ascending aorta (AAo) specimens were collected from 20 patients undergoing AAo replacement for aneurysms. Patients underwent a CMR protocol in the days leading to the surgery, including 4D flow CMR. Two 15×5 mm specimens (one oriented in the circumferential and the other in the longitudinal aortic direction) were extracted during surgery, and later tested controlling for extension force. Elongation was measured by laser video extensometer and the tangent of the stress-strain curve at diastolic pressure was extracted. AAo PWV and the Eh product (E being Young modulus and h wall thickness) were measured from 4D flow CMR while AD and AAo longitudinal were quantified from cine images.
Results and conclusions
Marked correlations were found between circumferential elastic modulus and AAo AD (R = −0.502), PWV(R = 0.652) and Eh (R = 0.602). Similarly, strong correlation was identified between AAo longitudinal strain and longitudinal elastic modulus(R = −0.513). In conclusion, PWV and the Eh product are positively related to aortic wall stiffness while aortic distensibility and strain show negative relationships. Thus, these biomarkers are a reliable expression of aortic wall stiffness.
Funding
PI17/00381,SEC/FEC-INV-CLI20/015,LCF/BQ/PR22/11920008.
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Ruiz Munoz A, Guala A, Dux-Santoy L, Rodriguez-Palomares JF, Garcia-Duran A, Garrido-Oliver J, Galian-Gay L, Valente F, Casas G, Fernandez-Galera R, Johnson K, Wieben O, Ferreira-Gonzalez I, Evangelista A, Teixido-Tura G. Aortic flow patterns by 4D flow CMR in Marfan and Loeys-Dietz patients before and after valve sparing aortic root replacement: a comparison with healthy volunteers. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Abnormal aortic flow patterns in patients with a connective tissue disorder (CTD), such as Marfan or Loeys-Dietz syndrome, may contribute to aortic root dilation [1,2]. Valve sparing aortic root replacement, which is effective in reducing the risk of aortic dissection in case of severe dilation, may also normalize flow patterns beyond the replaced aorta and potentially slow its progressive aortic dilation.
Purpose
To assess aortic flow dynamics in patients with a CTD by 4D flow cardiovascular magnetic resonance (CMR) before and after valve sparing aortic root replacement, and to compare the results with those of healthy volunteers (HV).
Methods
Patients with Marfan or Loeys-Dietz syndrome underwent two non-contrast enhanced 4D flow CMR, one before and another after undergoing valve sparing aortic root replacement. Healthy volunteers matched for age, sex and BSA were also included for comparison. Maximum velocity, in-plane rotational flow (IRF), systolic flow reversal ratio (SFRR) and wall shear stress (WSS) magnitude and its axial and circumferential components were obtained at 24 planes covering the thoracic aorta from the sinotubular junction to the descending aorta at the diaphragmatic level [3–5].
Results
Sixteen patients and 21 healthy volunteers were included. Demographic and clinical data is presented in Table. The mean time between the CMR prior and posterior to surgery was 15 months. Compared to HV, patients with CTD before intervention presented lower maximum velocity at the proximal ascending aorta (Fig. 1A), lower IRF and circumferential WSS at the arch and the proximal descending aorta (Fig. 1B and F), lower magnitude and axial WSS at the proximal ascending and descending aorta (Fig. 1E and D), and increased SFRR at the proximal descending aorta (Fig. 1C). The intervention completely restored maximum velocity and partially-restored physiological helical flow and circumferential WSS, but barely improved axial WSS and SFRR.
Conclusion
Valve sparing aortic root replacement in patients with Marfan or Loeys-Dietz syndrome partially restore to physiological level both in-plane rotational flow and circumferential wall shear stress in the descending aorta. This flow normalization may contribute to prevent progressive dilation after the surgery.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III (Spain) (PI17/00381)Spanish Society of Cardiology (SEC/FEC-INV-CLI 20/015)
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Affiliation(s)
- A Ruiz Munoz
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - A Guala
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - L Dux-Santoy
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | | | - A Garcia-Duran
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - J Garrido-Oliver
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - L Galian-Gay
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - F Valente
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - G Casas
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | | | - K Johnson
- University of Wisconsin , Wisconsin , United States of America
| | - O Wieben
- University of Wisconsin , Wisconsin , United States of America
| | | | - A Evangelista
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - G Teixido-Tura
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
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Dux-Santoy L, Garrido-Oliver J, Rodriguez-Palomares JF, Teixido-Tura G, Ruiz-Munoz A, Casas G, Valente F, Galian-Gay L, Gutierrez L, Gonzalez-Alujas T, Fernandez-Galera R, Cuellar H, Evangelista A, Ferreira-Gonzalez I, Guala A. Mapping of thoracic aorta growth rate on serial self-navigated 3D whole-heart magnetic resonance angiographies by image registration. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Accurate and reproducible assessment of aortic diameters and their growth rate is of key importance for the management of patients with thoracic aortic aneurysms [1,2]. It has been recently shown that image registration permits the assessment of progressive aortic dilation on ECG-gated contrast-enhanced CT angiography, outperforming manual quantification and allowing for 3D aortic size and growth mapping [3]. However, exposure to radiation makes it convenient to limit the use of CT for serial follow-up, especially in young patients. Self-navigated 3D whole-heart CMR acquisitions provides excellent image quality overcoming these limitations [4].
Purpose
To evaluate the accuracy and reproducibility of registration-based assessment of aortic dilation using self-navigated 3D whole-heart CMR acquisitions.
Methods
Fifteen patients with two self-navigated 3D whole-heart CMR images obtained at least 1 year apart were included. Aortic root and thoracic aorta diameters were measured by 2 independent observers both manually (multiplanar reconstruction) and with the registration-based technique. To perform registration-based assessment, the aorta was semi-automatically segmented and typical anatomical landmarks were placed by each observer at baseline [3]. Geometrical mapping between baseline and follow-up acquisitions was obtained using deformable image registration, and applied to the baseline aortic surface points to obtain their location at follow-up. Finally, aortic diameters and their growth rate were automatically measured and used to calculated 3D aortic dilation maps. Agreement between techniques and their inter-observer reproducibility were calculated.
Results
Patients age was 27.2±14.5 years and 40% were male. Mean follow-up duration was 2.7±1.6 years. Compared to manual assessment, the registration-based technique presented low bias and excellent agreement for aortic diameters (Table 1), and low bias and moderate agreement for growth rates both in the aortic root and the thoracic aorta (Table, Fig. 1A). The techniques presented similar inter-observer reproducibility in the assessment of aortic diameters (Table 1), while the registration-based method demonstrated much higher inter-observer reproducibility in the assessment of growth rates in the aortic root and the thoracic aorta (Table 1, Fig. 1A and B). Three-dimensional mapping of thoracic aortic diameters and growth was highly reproducible (mean regional ICC=0.90 for diameters; 0.82 for growth rate).
Conclusion
The assessment of the dilation rate of the thoracic aorta via registration of serial self-navigated 3D whole-heart CMR acquisitions is accurate and reproducible in the aortic root and the thoracic aorta. Thus, it allows to assess local aortic growth without the drawbacks of CT.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III and Ministerio de Ciencia e Innovaciόn (Spain)
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Affiliation(s)
- L Dux-Santoy
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - J Garrido-Oliver
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - J F Rodriguez-Palomares
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - G Teixido-Tura
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - A Ruiz-Munoz
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - G Casas
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - F Valente
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - L Galian-Gay
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - L Gutierrez
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - T Gonzalez-Alujas
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - R Fernandez-Galera
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - H Cuellar
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - A Evangelista
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - I Ferreira-Gonzalez
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
| | - A Guala
- University Hospital Vall d'Hebron, VHIR, Universtitat Autonoma De Barcelona , Barcelona , Spain
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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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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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