Effect of Aortic Valve Disease on 3D Hemodynamics in Patients With Aortic Dilation and Trileaflet Aortic Valve Morphology.
4D flow MRI
aortic dilatation
aortic valve regurgitation
aortic valve stenosis
hemodynamics
wall shear stress
Journal
Journal of magnetic resonance imaging : JMRI
ISSN: 1522-2586
Titre abrégé: J Magn Reson Imaging
Pays: United States
ID NLM: 9105850
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
01
11
2018
revised:
12
05
2019
accepted:
13
05
2019
pubmed:
7
6
2019
medline:
15
5
2021
entrez:
7
6
2019
Statut:
ppublish
Résumé
The effect of different expressions of aortic valve disease on 3D aortic hemodynamics is unclear. To investigate changes in aortic hemodynamics in patients with dilated ascending aorta (AAo) but different severity of aortic valve stenosis (AS) and/or regurgitation (AR). Retrospective. A total of 111 subjects (86 patients with AAo diameter ≥ 40 mm and 25 healthy controls, all with trileaflet aortic valve [TAV]). Patients were further stratified by TAV dysfunction: n = 9 with combined moderate or severe AS and AR (ASR, 56 ± 13 years), n = 14 with moderate or severe AS (AS, 64 ± 14 years), n = 33 with moderate or severe AR (AR, 62 ± 14 years), n = 30 with neither AS nor AR (no AS/AR, 63 ± 9 years). 4D flow MRI on 1.5/3T systems for the in vivo analysis of aortic blood flow dynamics. Data analysis included grading of 3D AAo vortex/helix flow and AAo flow eccentricity as well as quantification of systolic peak velocities and wall shear stress (WSS). Continuous variables were compared by one-way analysis of variance or Kruskal-Wallis, followed by a pairwise Tukey or Dunn test if there was a significant difference. All patients demonstrated markedly elevated vortex and helix flow compared with controls (P < 0.05). Peak velocities were significantly elevated in ASR, AS, and AR patients compared with controls (P < 0.05). Increased flow eccentricity was observed in entire AAo for AR, at the mid and distal AAo for ASR and AS, and at the proximal AAo for no AS/AR. Compared with controls, WSS in the AAo was significantly elevated in ASR and AS patients (P < 0.05) and reduced in no AS/AR patients (P < 0.05). The presence of TAV dysfunction is associated with aberrant hemodynamics and altered WSS, which may play a role in the development of aortopathy. 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:481-491.
Sections du résumé
BACKGROUND
The effect of different expressions of aortic valve disease on 3D aortic hemodynamics is unclear.
PURPOSE
To investigate changes in aortic hemodynamics in patients with dilated ascending aorta (AAo) but different severity of aortic valve stenosis (AS) and/or regurgitation (AR).
STUDY TYPE
Retrospective.
POPULATION
A total of 111 subjects (86 patients with AAo diameter ≥ 40 mm and 25 healthy controls, all with trileaflet aortic valve [TAV]). Patients were further stratified by TAV dysfunction: n = 9 with combined moderate or severe AS and AR (ASR, 56 ± 13 years), n = 14 with moderate or severe AS (AS, 64 ± 14 years), n = 33 with moderate or severe AR (AR, 62 ± 14 years), n = 30 with neither AS nor AR (no AS/AR, 63 ± 9 years).
FIELD STRENGTH/SEQUENCE
4D flow MRI on 1.5/3T systems for the in vivo analysis of aortic blood flow dynamics.
ASSESSMENT
Data analysis included grading of 3D AAo vortex/helix flow and AAo flow eccentricity as well as quantification of systolic peak velocities and wall shear stress (WSS).
STATISTICAL TESTS
Continuous variables were compared by one-way analysis of variance or Kruskal-Wallis, followed by a pairwise Tukey or Dunn test if there was a significant difference.
RESULTS
All patients demonstrated markedly elevated vortex and helix flow compared with controls (P < 0.05). Peak velocities were significantly elevated in ASR, AS, and AR patients compared with controls (P < 0.05). Increased flow eccentricity was observed in entire AAo for AR, at the mid and distal AAo for ASR and AS, and at the proximal AAo for no AS/AR. Compared with controls, WSS in the AAo was significantly elevated in ASR and AS patients (P < 0.05) and reduced in no AS/AR patients (P < 0.05).
DATA CONCLUSION
The presence of TAV dysfunction is associated with aberrant hemodynamics and altered WSS, which may play a role in the development of aortopathy.
LEVEL OF EVIDENCE
3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:481-491.
Identifiants
pubmed: 31169969
doi: 10.1002/jmri.26804
pmc: PMC6895394
mid: NIHMS1031244
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
481-491Subventions
Organisme : NHLBI NIH HHS
ID : K25 HL119608
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL115828
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL133504
Pays : United States
Informations de copyright
© 2019 International Society for Magnetic Resonance in Medicine.
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