scholarly journals Circulation derived from 4D flow MRI correlates with right ventricular dysfunction in patients with tetralogy of Fallot

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nanae Tsuchiya ◽  
Michinobu Nagao ◽  
Yumi Shiina ◽  
Shohei Miyazaki ◽  
Kei Inai ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Main Pulmonary Artery ◽  
Vortex Formation ◽  
Cine Mri ◽  
Short Axis ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri ◽  
Rv Function

AbstractWe used 4D-flow MRI to investigate circulation, an area integral of vorticity, in the main pulmonary artery (MPA) as a new hemodynamic parameter for assessing patients with a repaired Tetralogy of Fallot (TOF). We evaluated the relationship between circulation, right ventricular (RV) function and the pulmonary regurgitant fraction (PRF). Twenty patients with a repaired TOF underwent cardiac MRI. Flow-sensitive 3D-gradient sequences were used to obtain 4D-flow images. Vortex formation in the MPA was visualized, with short-axis and longitudinal vorticities calculated by software specialized for 4D flow. The RV indexed end-diastolic/end-systolic volumes (RVEDVi/RVESVi) and RV ejection fraction (RVEF) were measured by cine MRI. The PR fraction (PRF) and MPA area were measured by 2D phase-contrast MRI. Spearman ρ values were determined to assess the relationships between circulation, RV function, and PRF. Vortex formation in the MPA occurred in 15 of 20 patients (75%). The longitudinal circulation (11.7 ± 5.1 m2/s) was correlated with the RVEF (ρ = − 0.85, p = 0.0002), RVEDVi (ρ = 0.62, p = 0.03), and RVESVi (ρ = 0.76, p = 0.003) after adjusting for the MPA size. The short-axis circulation (9.4 ± 3.4 m2/s) in the proximal MPA was positively correlated with the MPA area (ρ = 0.61, p = 0.004). The relationships between the PRF and circulation or RV function were not significant. Increased longitudinal circulation in the MPA, as demonstrated by circulation analysis using 4D flow MRI, was related to RV dysfunction in patients with a repaired TOF.

Sildenafil Administration Improves Right Ventricular Function on 4D Flow MRI in Young Adults Born Premature

2021 ◽  
Author(s):  
Philip A Corrado ◽  
Gregory P Barton ◽  
Christopher J François ◽  
Oliver Wieben ◽  
Kara N Goss
Keyword(s):  
Heart Rate ◽  
Young Adults ◽  
Kinetic Energy ◽  
Right Ventricular ◽  
Right Atrial ◽  
4D Flow Mri ◽  
4D Flow ◽  
Direct Flow ◽  
Flow Mri ◽  
Rv Function

Background: Extreme preterm birth conveys an elevated risk of heart failure by young adulthood. Smaller biventricular chamber size, diastolic dysfunction, and pulmonary hypertension may contribute to reduced ventricular-vascular coupling. However, how hemodynamic manipulations may affect right ventricular (RV) function and coupling remains unknown. Methods: As a pilot study, 4D flow MRI was used to assess the effect of afterload reduction and heart rate reduction on cardiac hemodynamics and function. Young adults born premature were administered sildenafil (a pulmonary vasodilator) and metoprolol (a beta blocker) on separate days, and MRI with 4D flow completed before and after each drug administration. Endpoints include cardiac index (CI), direct flow fractions, and ventricular kinetic energy including E/A wave kinetic energy ratio. Results: Sildenafil resulted in a median CI increase of 0.24 L/min/m2 (P=0.02), mediated through both an increase in heart rate (HR) and stroke volume. Although RV ejection fraction improved only modestly, there was a significant increase (4% of end diastolic volume) in RV direct flow fraction (P=0.04), consistent with hemodynamic improvement. Metoprolol administration resulted in a 5-bpm median decrease in HR (P=0.01), a 0.37 L/min/m2 median decrease in CI (P=0.04), and a reduction in time-averaged kinetic energy (KE) in both ventricles (P<0.01), despite increased RV diastolic E/A KE ratio (P=0.04). Conclusions: Despite reduced right atrial workload, metoprolol significantly depressed overall cardiac systolic function. Sildenafil, however, increased CI and improved RV function, as quantified by the direct flow fraction. The preterm heart appears dependent on HR, but sensitive to RV afterload manipulations.

scholarly journals Flow vorticity relationships with right ventricular geometry in adult tetralogy of Fallot

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Elsayed ◽  
C Mauger ◽  
E Ferdian ◽  
K Gilbert ◽  
M Scadeng ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Three Dimensional ◽  
Pulmonary Regurgitation ◽  
Disease Process ◽  
Cine Imaging ◽  
Tricuspid Annulus ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri

Abstract Background Repaired tetralogy of Fallot adults (rToF) undergo right ventricular (RV) remodeling, in part due to volume overload of residual pulmonary regurgitation volume (PRV). Time-resolved phase-contrast cardiac magnetic resonance imaging (4D Flow MRI) enables the qualitative and quantitative measurement of altered blood flow patterns, including vorticity. Cardiac atlases allow for complex three-dimensional heart shapes to be expressed as morphometric scores. Those scores show the extent of geometrical shift and can help explore uncharted relationships between vorticity and architecture. Purpose We aimed to quantify vorticity, incorporating deep learning to enhance 4D Flow data, and correlate this with global cardiac parameters and morphometric scores. Methods 12 Adult rToF patients and 10 age-matched controls underwent 4D flow MRI and cine imaging. RV interventricular vorticity was calculated for outflow and inflow tracts. EDV, ESV and SV were computed from cines which were also used to build three-dimensional shape models. The biventricular models were projected onto an atlas generated from 95 rToF patients, and twenty-one principal component analysis shape modes were correlated with cardiac metrics and vorticity to identify global shape variations. Association between biventricular shape and vorticity was further analysed using multivariate multiple regression models. Results Strong correlation was found between PRV and the right ventricular outflow tract (RVOT) vorticity. PRV and RVOT vorticity both correlated with the same 3 shape modes (r=−0.55, −0.50 and 0.6 (p&lt;0.05) respectively for PR and r=0.63, −0.82 and 0.60 (p&lt;0.05) respectively for vorticity) i.e., the RV dilates with an increase in basal bulging, apical bulging and tricuspid annulus tilting with more severe regurgitation, as well as a smaller LV, and a paradoxical movement of the septum (Figure 1). However, RV vorticity correlated with 2 modes that did not correlate with PRV, (r=−0.62, −0.69, p&lt;0.05). With higher vorticity the RV was longer, increased tilting of the tricuspid annulus and an increased basal bulge around the tricuspid area. The multivariate analysis model demonstrated that higher vorticity was associated with displacement of the pulmonary valve and change in the RVOT length and direction. A septal displacement towards the left ventricle was observed and increased apical flatness of the RV (Figure 1). Qualitatively, vorticity in rToF group was more heterogeneous than controls (Figure 2). Conclusions Vorticity is a novel marker based on the influence of blood motion providing new insight into early diagnosis and prognosis of cardiac disease. This is the first study to examine the relationships between vorticity and regional RV shape changes in rToF. Mode associations with vorticity were different to associations with PRV. More longitudinal studies are required for standardization of change in vorticity with the disease process. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The New Zealand heart foundation Mode variations and morphometric model Vorticity visualization and analysis

scholarly journals Disturbed left and right ventricular kinetic energy in patients with repaired tetralogy of Fallot: pathophysiological insights using 4D-flow MRI

2018 ◽  
Vol 28 (10) ◽  
pp. 4066-4076 ◽  
Author(s):  
Pia Sjöberg ◽  
Sebastian Bidhult ◽  
Jelena Bock ◽  
Einar Heiberg ◽  
Håkan Arheden ◽  
...  
Keyword(s):  
Kinetic Energy ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
4D Flow Mri ◽  
4D Flow ◽  
Repaired Tetralogy Of Fallot ◽  
Flow Mri ◽  
Left And Right

scholarly journals Non - invasive right ventricular efficiency using 4D flow MRI

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Alejandro Roldán-Alzate ◽  
Scott W Grogan ◽  
Heidi B Kellihan ◽  
Alessandro Bellofiore ◽  
Naomi C Chesler ◽  
...  
Keyword(s):  
Right Ventricular ◽  
4D Flow Mri ◽  
4D Flow ◽  
Non Invasive ◽  
Flow Mri ◽  
Ventricular Efficiency

Abstract 14367: Abnormal Pulmonary Flow is Associated With Impaired Right Ventricular Coupling in Patients With COPD

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ani Oganesyan ◽  
Alex J Barker ◽  
Benjamin S Frank ◽  
Dunbar D IVY ◽  
Lorna Browne ◽  
...  
Keyword(s):  
Strong Association ◽  
Pulmonary Arteries ◽  
Healthy Controls ◽  
4D Flow Mri ◽  
4D Flow ◽  
Pulmonary Flow ◽  
Copd Patients ◽  
Flow Mri ◽  
Pulmonary Arterial ◽  
Rv Function

Introduction: Cor Pulmonale or right ventricular (RV) dysfunction due to pulmonary disease is an expected complication of COPD resulting from increased afterload mediated by hypoxic pulmonary vasoconstriction as well as the destruction of the pulmonary vascular bed. Early detection of elevated RV afterload has been previously demonstrated by visualization of abnormal flow patterns in the proximal pulmonary arteries. Prior quantitative analysis of helicity in the pulmonary arteries of pulmonary hypertension patients has demonstrated a strong association between helicity and increased RV afterload. Hypothesis: Patients with COPD will have abnormal pulmonary flow as evaluated by 4D-Flow MRI and associated with RV function and pulmonary arterial stiffness. Methods: Patients with COPD (n=15) (65yrs ± 6) and controls (n=10) (58yrs ± 9) underwent 4D-Flow MRI to calculate helicity (Figure 1A). The helicity was calculated in 2 segments: 1) the main pulmonary artery (MPA) and 2) along the RV outflow tract (RVOT) - MPA axis. Main pulmonary arterial stiffness was measured using the relative area change (RAC). Results: COPD patients had decreased helicity relative to healthy controls in the MPA (19.4±7.8 vs 32.8±15.9 s -2 , P=0.007) (Figure 1B). Additionally, COPD patients had reduced helicity along the RVOT-MPA axis (33.2±9.0 vs 43.5±8.3 s -2 , P=0.010). The helicity measured in the MPA was associated with RV end-systolic volume (R=0.59, P = 0.002), RVEF (R=0.631, P<0.001), RAC (R=-0.61, P=0.001). e combined helicity along the MPA-RVOT axis was associated with RVEF (R=0.74, P<0.001), RVESV (R=-0.57, P=0.004), and RAC (R=0.42, P=0.005). Conclusion: Patients with COPD show quantitatively abnormal flow hemodynamics, when compared with healthy controls, as assessed by 4D-Flow MRI. A strong association between helicity along the MPA-RV outflow tract axis and RV function suggests that 4D-Flow MRI might be a sensitive tool in evaluating RV - pulmonary arterial coupling in COPD.

scholarly journals Reduced regional flow in the left ventricle after anterior acute myocardial infarction: a case control study using 4D flow MRI

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Philip A. Corrado ◽  
Jacob A. Macdonald ◽  
Christopher J. François ◽  
Niti R. Aggarwal ◽  
Jonathan W. Weinsaft ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Linear Models ◽  
Left Ventricular ◽  
Short Axis ◽  
Flow Data ◽  
4D Flow Mri ◽  
4D Flow ◽  
Regional Flow ◽  
Flow Mri

Abstract Background Acute myocardial infarction (AMI) alters left ventricular (LV) hemodynamics, resulting in decreased global LV ejection fraction and global LV kinetic energy. We hypothesize that anterior AMI effects localized alterations in LV flow and developed a regional approach to analyze these local changes with 4D flow MRI. Methods 4D flow cardiac magnetic resonance (CMR) data was compared between 12 anterior AMI patients (11 males; 66 ± 12yo; prospectively acquired in 2016–2017) and 19 healthy volunteers (10 males; 40 ± 16yo; retrospective from 2010 to 2011 study). The LV cavity was contoured on short axis cine steady-state free procession CMR and partitioned into three regions: base, mid-ventricle, and apex. 4D flow data was registered to the short axis segmentation. Peak systolic and diastolic through-plane flows were compared region-by-region between groups using linear models of flow with age, sex, and heart rate as covariates. Results Peak systolic flow was reduced in anterior AMI subjects compared to controls in the LV mid-ventricle (fitted reduction = 3.9 L/min; P = 0.01) and apex (fitted reduction = 1.4 L/min; P = 0.02). Peak diastolic flow was also lower in anterior AMI subjects compared to controls in the apex (fitted reduction = 2.4 L/min; P = 0.01). Conclusions A regional method to analyze 4D LV flow data was applied in anterior AMI patients and controls. Anterior AMI patients had reduced regional flow relative to controls.

4D flow MRI versus conventional 2D for measuring pulmonary flow after Tetralogy of Fallot repair

2020 ◽  
Vol 300 ◽  
pp. 132-136 ◽  
Author(s):  
M.A. Isorni ◽  
D. Martins ◽  
N. Ben Moussa ◽  
S. Monnot ◽  
N. Boddaert ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
4D Flow Mri ◽  
4D Flow ◽  
Pulmonary Flow ◽  
Flow Mri ◽  
Tetralogy Of Fallot Repair
Sign in / Sign up

Export Citation Format

Share Document