scholarly journals Unilateral branch pulmonary artery stenting in tetralogy of fallot improves ventricular function

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
MM Bissell ◽  
L Mills ◽  
DGW Cave ◽  
R Foley ◽  
JP Greenwood ◽  
...  
Keyword(s):  
Kinetic Energy ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Energy Curve ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Background Pulmonary artery stenosis (PAS) occurs commonly in patients with tetralogy of fallot (ToF). Cardiac function and especially left ventricular longitudinal strain has been identified as an important prognostic factor for long term survival in ToF. The clinical relevance of unilateral PAS to long-term bi-ventricular function is poorly understood. Purpose We sought to evaluate the effect of resolving unilateral pulmonary artery obstruction on right and left ventricular performance. Methods We prospectively included 40 patients with TOF between 2016 and 2020, 20 who underwent unilateral PAS stenting and as comparison 20 who underwent surgical pulmonary valve replacement (PVR). MRI data was acquired during routine clinical care before and around 6-12 months after the procedure. 4 PAS patients attended additional research scans acquiring ventricular 4D flow MRI data. 4D flow MRI data was compared to the average kinetic energy curve of 10 age-matched healthy volunteers. Results Of the 20 patients undergoing PAS, 2 also underwent percutaneous PVR and were excluded from the comparison analysis. All patients in the PAs group showed an improvement in branch PA flow differential post procedure. Patients undergoing PAS were younger than those undergoing PVR (median 12 vs 19 years, p < 0.001). Other baseline anatomical and functional parameters including right ventricular (RV) volume indexed to body surface are (RVEDV/BSA) were comparable (pre PAS median 151 [122,170] vs pre PVR 162 [140,191]; p = 0.217). While in the PVR group the right ventricular volumes reduced in both end-diastole and end-systole, in the PAS group RV function improved due to reduced end-systolic volume with largely stable end-diastolic volumes. Changes in the left ventricle (LV) were even more interesting. In the PVR group ejection fraction improved due to an increase in end-diastolic volume with no improvement in ventricular longitudinal strain. In contrast, in the PAS group LV ejection fraction improved by a reduction in end-systolic volume and the PAS group showed a small but significant improvement in LV longitudinal strain. In addition, ¾ patients undergoing 4D flow MRI assessment showed LV kinetic energy curve more similar to the healthy volunteer averaged  LV kinetic energy curve after PAS. The 4th patient already had a near normal LV kinetic energy curve prior to PAS. Conclusion Unilateral PAS does not alter RV end-diastolic volumes but improves RV function. LV ejection fraction improvement is similar to that seen after PVR, but importantly PAS also improved LV longitudinal strain. This suggests that PAS might positively influence long term morbidity and mortality risk in ToF patients, but a larger multi-centre long term follow-up study is needed to confirm this.

scholarly journals Scan–rescan reproducibility of diastolic left ventricular kinetic energy, viscous energy loss and vorticity assessment using 4D flow MRI: analysis in healthy subjects

2018 ◽  
Vol 34 (6) ◽  
pp. 905-920 ◽  
Author(s):  
Vivian P. Kamphuis ◽  
Jos J. M. Westenberg ◽  
Roel L. F. van der Palen ◽  
Pieter J. van den Boogaard ◽  
Rob J. van der Geest ◽  
...  
Keyword(s):  
Kinetic Energy ◽  
Energy Loss ◽  
Healthy Subjects ◽  
Left Ventricular ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri

scholarly journals Quantification of left ventricular kinetic energy using 4D flow MRI

2010 ◽  
Vol 12 (S1) ◽  
Author(s):  
Thomas A Wåxnäs ◽  
Einar Heiberg ◽  
Johannes Togert ◽  
Marten Larsson ◽  
Hakan Arheden ◽  
...  
Keyword(s):  
Kinetic Energy ◽  
Left Ventricular ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri

scholarly journals Altered Diastolic Flow Patterns and Kinetic Energy in Subtle Left Ventricular Remodeling and Dysfunction Detected by 4D Flow MRI

PLoS ONE ◽  
2016 ◽  
Vol 11 (8) ◽  
pp. e0161391 ◽  
Author(s):  
Emil Svalbring ◽  
Alexandru Fredriksson ◽  
Jonatan Eriksson ◽  
Petter Dyverfeldt ◽  
Tino Ebbers ◽  
...  
Keyword(s):  
Kinetic Energy ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Flow Patterns ◽  
Left Ventricular ◽  
4D Flow Mri ◽  
4D Flow ◽  
Diastolic Flow ◽  
Flow Mri

scholarly journals Stent interventions for pulmonary artery stenosis improve bi-ventricular flow efficiency in a swine model

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Ryan J. Pewowaruk ◽  
Gregory P. Barton ◽  
Cody Johnson ◽  
J. Carter Ralphe ◽  
Christopher J. Francois ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Ventricular Function ◽  
Intervention Group ◽  
Left Ventricular ◽  
Pulmonary Artery Stenosis ◽  
Swine Model ◽  
4D Flow ◽  
4D Flow Cmr ◽  
The Impact

Abstract Background Branch pulmonary artery (PA) stenosis (PAS) commonly occurs in patients with congenital heart disease (CHD). Prior studies have documented technical success and clinical outcomes of PA stent interventions for PAS but the impact of PA stent interventions on ventricular function is unknown. The objective of this study was to utilize 4D flow cardiovascular magnetic resonance (CMR) to better understand the impact of PAS and PA stenting on ventricular contraction and ventricular flow in a swine model of unilateral branch PA stenosis. Methods 18 swine (4 sham, 4 untreated left PAS, 10 PAS stent intervention) underwent right heart catheterization and CMR at 20 weeks age (55 kg). CMR included ventricular strain analysis and 4D flow CMR. Results 4D flow CMR measured inefficient right ventricular (RV) and left ventricular (LV) flow patterns in the PAS group (RV non-dimensional (n.d.) vorticity: sham 82 ± 47, PAS 120 ± 47; LV n.d. vorticity: sham 57 ± 5, PAS 78 ± 15 p < 0.01) despite the PAS group having normal heart rate, ejection fraction and end-diastolic volume. The intervention group demonstrated increased ejection fraction that resulted in more efficient ventricular flow compared to untreated PAS (RV n.d. vorticity: 59 ± 12 p < 0.01; LV n.d. vorticity: 41 ± 7 p < 0.001). Conclusion These results describe previously unknown consequences of PAS on ventricular function in an animal model of unilateral PA stenosis and show that PA stent interventions improve ventricular flow efficiency. This study also highlights the sensitivity of 4D flow CMR biomarkers to detect earlier ventricular dysfunction assisting in identification of patients who may benefit from PAS interventions.

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.

Abstract 14534: In vitro Assessment of Transvalvular Peak Velocity Measurement for Various Orifice Shapes: Comparison Between 4D Flow MRI vs. Doppler Echocardiography

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jeesoo Lee ◽  
Nadia El hangouche ◽  
Liliana Ma ◽  
Michael Scott ◽  
Michael Markl ◽  
...  
Keyword(s):  
Temporal Resolution ◽  
Continuous Wave ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Patient Specific ◽  
Maximal Velocity ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Phantom ◽  
Flow Mri

Introduction: 4D flow MRI can assess transvalvular velocity, but validation against continuous wave (CW) Doppler echo is limited in high-velocity regurgitation and stenosis situations. We sought to compare 4D flow MRI and echo peak velocity using a pulsatile echo-MRI flow phantom. Materials and Methods: An MRI-compatible flow phantom with restrictive orifice situated was driven by a left ventricular assist device at 50 bpm (figure 1A). Three orifice shapes were tested: circular, elliptical and 3D-printed patient-specific mitral regurgitant orifice model of prolapse with areas of 0.5, 0.41 and 0.35 cm 2 , respectively. CW Doppler was acquired with peak velocity extracted from the profile. Retrospectively-gated 4D flow MRI was performed (spatial resolution = 2 mm isotropic, temporal resolution = 36 ms, encoding velocity = 400 cm/s). Maximal velocity magnitude was extracted volumetrically (figure 1B). An echo-mimicking profile was also obtained with a “virtual” ultrasound beam in the 4D flow data to simulate CW Doppler (figure 1C). Bland-Altman analysis was used to assess the agreement of temporal peak velocities. Results: 4D flow MRI demonstrated a centrally directed jet for the circular and elliptical orifices and an oblique jet for the prolapse orifice (figure 1B). Peak velocities were in excellent agreement between 4D flow MRI vs. echo for the circular (peak: 5.13 vs. 5.08 m/s, bias = 0.06 ± 0.66 m/s, figure 1D) and the elliptical orifice (peak: 4.95 vs. 4.79 m/s, bias = 0.07 ± 0.87 m/s, figure 1E). The prolapse orifice velocity was underestimated somewhat by MRI by ~10% (peak: 4.41 vs. 4.90 m/s, bias=0.26±1.18, figure 1F). Conclusion: 4D flow MRI can quantify high velocities like echo for simple geometries while underestimating for more complex geometry, likely due to partial volume effects. Further investigation is warranted to systematically investigate the effects of 4D flow MRI spatial and temporal resolution as well as the jet angle on velocity quantification accuracy.

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.

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