scholarly journals 108 4D-flow CMR demonstrates the regional distribution of aortic flow disturbance in Marfan syndrome

Heart ◽  
2011 ◽  
Vol 97 (Suppl 1) ◽  
pp. A62-A62 ◽  
Author(s):  
A. Pitcher ◽  
T. E. Cassar ◽  
J. Suttie ◽  
J. M. Francis ◽  
P. Leeson ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Regional Distribution ◽  
Aortic Flow ◽  
4D Flow ◽  
Flow Disturbance ◽  
4D Flow Cmr

scholarly journals Aortic rotational flow patterns and stiffness by 4D flow CMR in patients with Loeys-Dietz syndrome compared to healthy volunteers and patients with Marfan syndrome

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Ruiz Munoz ◽  
A Guala ◽  
JF Rodriguez-Palomares ◽  
L Dux-Santoy ◽  
L Servato ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Marfan Syndrome ◽  
Aortic Stiffness ◽  
Aortic Flow ◽  
Aortic Diameter ◽  
Rotational Flow ◽  
4D Flow ◽  
National Budget ◽  
4D Flow Cmr ◽  
Public Grant

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): La Marató de TV3, Instituto de Salud Carlos III through the project and Spanish Ministry of Science, Innovation and Universities. BACKGROUND Loeys-Dietz (LDS) and Marfan (MFS) syndromes are rare genetic connective tissue disorders associated with progressive aortic dilation, however, aortic dissections have been observed at lower aortic root diameters in LDS than in MFS. Recent CMR studies in MFS patients reported increased aortic stiffness (1–3) and altered rotational flow (4), but research on aortic flow dynamics and biomechanics in LDS is lacking. PURPOSE The aim of this study was to assess rotational aortic flow and aortic stiffness in LDS compared to healthy volunteers (HV) and MFS patients, using 4Dflow CMR. METHODS Twenty-one LDS and 44 MFS patients, without previous aortic dissection or surgery, and 43 HV underwent a non-contrast-enhanced 4D flow CMR. Aortic stiffness was quantified at the AAo and DAo using pulse wave velocity (PWV). In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR) (5) and local aortic diameters were obtained at 20 equidistant planes from the ascending (AAo) to the proximal descending aorta (DAo). RESULTS LDS patients had lower IRF at the distal AAo and proximal DAo compared to HV (p = 0.053 and 0.004, respectively), once adjusted for age, stroke volume and local aortic diameter; but no differences were found with respect to MFS (Figure). Although SFRR at the proximal DAo was increased in LDS patients compared to both HV (p = 0.037) and MFS populations (p = 0.015), once adjusted for age and aortic diameter, the difference in magnitude was small (Figure). On the other hand, AAo and DAo PWV revealed stiffer aortas in LDS patients compared to HV but no differences versus MFS patients (Table). CONCLUSIONS Patients with Loeys-Dietz syndrome showed decreased in-plane rotational flow and abnormally-high regional aortic stiffness compared to healthy controls, and similar hemodynamics and aortic stiffness with respect to patients with Marfan syndrome.

scholarly journals Aortic stiffness and hemodynamics in Loeys-Dietz syndrome by 4Dflow CMR: a comparison with healthy volunteers and patients with Marfan syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ruiz Munoz ◽  
A Guala ◽  
J.F Rodriguez-Palomares ◽  
L Dux-Santoy ◽  
L Servato ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Aortic Stiffness ◽  
Genetic Diseases ◽  
Aortic Flow ◽  
Public Institution ◽  
Aortic Diameter ◽  
Funding Source ◽  
Rotational Flow ◽  
4D Flow ◽  
4D Flow Cmr

Abstract Background Connective tissue disorders, such as Loeys-Dietz (LDS) and Marfan (MFS) syndromes, are rare genetic diseases associated with progressive aortic dilation. Aortic dissections have been observed at lower aortic root diameters in LDS than in MFS, and research on aortic flow dynamics and biomechanics in LDS is lacking. Purpose To evaluate rotational aortic flow and aortic stiffness in LDS compared to healthy volunteers (HV) and MFS patients, using 4Dflow CMR. Methods Twenty-one LDS and 44 MFS patients, without previous aortic dissection or surgery, and 44 HV underwent a non-contrast-enhanced 4D flow CMR. In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR) and local aortic diameters were obtained at 20 equidistant planes from the ascending (AAo) to the proximal descending aorta (DAo). Aortic stiffness was quantified at the AAo and DAo using pulse wave velocity (PWV). Results LDS patients had lower IRF at the distal AAo and proximal DAo compared to HV (p=0.053 and 0.004, respectively), once adjusted for age, stroke volume and local aortic diameter; but no differences were found with respect to MFS (Figure). Although SFRR at the proximal DAo was increased in LDS patients compared to both HV (p=0.037) and MFS populations (p=0.015), once adjusted for age and aortic diameter, the difference in magnitude was small (Figure). On the other hand, AAo and DAo PWV revealed stiffer aortas in LDS patients compared to HV but no differences versus MFS patients (Table). Conclusions LDS patients showed decreased in-plane rotational flow and abnormally-high regional aortic stiffness compared to healthy controls, and similar hemodynamics and aortic stiffness with respect to MFS patients Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III, La Maratό TV3

scholarly journals Visualisation of aortic flow disturbance in Marfan syndrome by 4D phase-contrast CMR

2011 ◽  
Vol 13 (S1) ◽  
Author(s):  
Alex Pitcher ◽  
Tom E Cassar ◽  
Joseph Suttie ◽  
Jane M Francis ◽  
Paul Leeson ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Phase Contrast ◽  
Aortic Flow ◽  
Flow Disturbance

scholarly journals P6022Aortic geometry in marfan syndrome in relation to age: a 4D-flow CMR-derived study

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
A. Guala ◽  
L. Dux-Santoy ◽  
G. Teixido-Tura ◽  
J. Rodriguez-Palomares ◽  
G. Maldonado ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
4D Flow ◽  
4D Flow Cmr

scholarly journals Quantitative 4D Flow CMR analysis of intracardiac blood flow energetics in ischemic cardiomyopathy patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Riva ◽  
A Camporeale ◽  
F Sturla ◽  
S Pica ◽  
L Tondi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Cardiomyopathy ◽  
Inverse Correlation ◽  
Lv Function ◽  
Funding Source ◽  
4D Flow ◽  
Anterior Myocardial Infarction ◽  
National Budget ◽  
4D Flow Cmr ◽  
Public Grant

Abstract Background Ischemic cardiomyopathy (ICM) is often associated with negative LV remodelling after myocardial infarction, sometimes resulting in impaired LV function and dilation (iDCM). 4D Flow CMR has been recently exploited to assess intracardiac hemodynamic changes in presence of LV remodelling. Purpose To quantify 4D Flow intracardiac kinetic energy (KE) and viscous energy loss (EL) and investigate their relation with LV dysfunction and remodelling. Methods Patients with prior anterior myocardial infarction underwent a CMR study with 4D Flow sequences acquisition; they were divided into ICM (n=10) and iDCM (n=10, EDV>208 ml and EF<40%). 10 controls were used for comparison. LV was semi-automatically segmented using short axis CMR stacks and co-registered with 4D Flow. Global KE and EL were computed over the cardiac cycle. NT-proBNP measurements were correlated with average and peak values, during systole and diastole. Results Both LV volume and EF significantly differ (P<0.0001) between iDCM (EDV=294±56 ml, EF=24±8%), ICM (EDV=181±32 ml, EF=34±6%) and controls (EDV=124±29 ml, EF=72±5%). If compared to controls, both ICM and iDCM showed significantly lower KE (P≤0.0008); though lower than controls, EL was higher in iDCM than ICM. Within the iDCM subgroup, diastolic mean KE and peak EL reported good inverse correlation with NT-proBNP (r=−0.75 and r=−0.69, respectively). EL indexed (ELI) to average KE during systole was higher in the entire ischemic group as compared to controls (ELI(ischemic) = 0.17 vs. ELI(controls) = 0.10, P=0.0054). Conclusions 4D Flow analyses effectively mapped post-ischemic LV energetic changes, highlighting the disproportionate intraventricular EL relative to produced KE; preliminary good correlation between LV energetic changes and NT-proBNP will deserve further investigation in order to contribute to early detection of heart failure. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health

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.

Aortic flow patterns in bicuspid aortic valve disease visualised with 4D flow imaging

2012 ◽  
Vol 97 (Suppl 1) ◽  
pp. A129.3-A130
Author(s):  
MM Gedicke ◽  
A Pitcher ◽  
A Barker ◽  
J Bock ◽  
R Lorenz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Flow Patterns ◽  
Aortic Flow ◽  
Valve Disease ◽  
Flow Imaging ◽  
4D Flow ◽  
4D Flow Imaging

4D flow MRI: impact of region of interest size, angulation and spatial resolution on aortic flow assessment

2021 ◽  
Vol 42 (3) ◽  
pp. 035004 ◽  
Author(s):  
M E Casciaro ◽  
A F Pascaner ◽  
F N Guilenea ◽  
J Alcibar ◽  
U Gencer ◽  
...  
Keyword(s):  
Spatial Resolution ◽  
Region Of Interest ◽  
Aortic Flow ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri

P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ribeyrolles ◽  
J L Monin ◽  
A Rohnean ◽  
C Diakov ◽  
C Caussin ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Stroke Volume ◽  
Left Ventricular ◽  
Left Ventricular Stroke Volume ◽  
4D Flow ◽  
Mitral Flow ◽  
4D Flow Cmr ◽  
Mr Quantification ◽  
Cine Cmr

Abstract Background Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification. Purpose Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach. Methods We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR. Results 33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]). Conclusion 4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery.

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