Assessment of biventricular hemodynamics and energy dynamics using lumen-tracking 4D flow MRI without contrast medium

Nakaji, Keisuke; Tamaki, Nagara; Morichi, Hiroko; Nakanishi, Naohiko; Takigami, Masao; Yamagishi, Masaaki; Yamada, Kazuo

doi:10.1016/j.jjcc.2021.01.004

Cited by 14 publications

(22 citation statements)

References 26 publications

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“…Other studies of rTOF patients reported derangements of LV and RV KE [ 14 , 15 ], abnormal LV diastolic direct flow and increased recirculating residual volume in mild to moderate RV dilation [ 16 ]. In a recent study of 58 rTOF [ 17 ], the RV was systematically segmented into RV outflow (RVOT) and inflow components, and the respective 4D flow data were analyzed that could quantify intracardiac vorticity and energy loss [ 18 ]. Diastolic to systolic quotients of RVOT vorticities and viscous energy losses, both attributable to PR, were found to be significant negatively correlated with peak VO 2 and % predicted peak VO 2 [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study

Zhao

Leng

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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Background Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows quantification of biventricular blood flow by flow components and kinetic energy (KE) analyses. However, it remains unclear whether 4D flow parameters can predict cardiopulmonary exercise testing (CPET) as a clinical outcome in repaired tetralogy of Fallot (rTOF). Current study aimed to (1) compare 4D flow CMR parameters in rTOF with age- and gender-matched healthy controls, (2) investigate associations of 4D flow parameters with functional and volumetric right ventricular (RV) remodelling markers, and CPET outcome. Methods Sixty-three rTOF patients (14 paediatric, 49 adult; 30 ± 15 years; 29 M) and 63 age- and gender-matched healthy controls (14 paediatric, 49 adult; 31 ± 15 years) were prospectively recruited at four centers. All underwent cine and 4D flow CMR, and all adults performed standardized CPET same day or within one week of CMR. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes. Four flow components were analyzed: direct flow, retained inflow, delayed ejection flow and residual volume. Additionally, three phasic KE parameters normalized to end-diastolic volume (KEiEDV), were analyzed for both LV and RV: peak systolic, average systolic and peak E-wave. Results In comparisons of rTOF vs. healthy controls, median LV retained inflow (18% vs. 16%, P = 0.005) and median peak E-wave KEiEDV (34.9 µJ/ml vs. 29.2 µJ/ml, P = 0.006) were higher in rTOF; median RV direct flow was lower in rTOF (25% vs. 35%, P < 0.001); median RV delayed ejection flow (21% vs. 17%, P < 0.001) and residual volume (39% vs. 31%, P < 0.001) were both greater in rTOF. RV KEiEDV parameters were all higher in rTOF than healthy controls (all P < 0.001). On multivariate analysis, RV direct flow was an independent predictor of RV function and CPET outcome. RV direct flow and RV peak E-wave KEiEDV were independent predictors of RV remodelling index. Conclusions In this multi-scanner multicenter 4D flow CMR study, reduced RV direct flow was independently associated with RV dysfunction, remodelling and, to a lesser extent, exercise intolerance in rTOF patients. This supports its utility as an imaging parameter for monitoring disease progression and therapeutic response in rTOF. Clinical Trial Registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT03217240.

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Section: Introductionmentioning

confidence: 99%

Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study

Zhao

Leng

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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“…A recent study showed that there was misalignment with only a few pixels between methods with and without breath holding in the cardiac PC images when no respiratory motion compensation was performed. 44 Sixth, the present method was not suitable for patients with transaortic flow higher than the VENC range because aliasing artifacts decrease the accuracy of flow quantification. However, when the VENC was set at a high velocity, the resolution of a moderate-flow field decreased, making discordant parameters and ambiguous or borderline judgments more probable.…”

Section: Limitationsmentioning

confidence: 85%

Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis

et al. 2022

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In aortic stenosis (AS), the discrepancy between moderately accelerated flow and effective orifice area (EOA) continues to pose a challenge. We developed a method of measuring the vena contracta area as hemodynamic EOA using cardiac MRI focusing on AS patients with a moderately accelerated flow to solve the problem that AS severity can currently be determined only by echocardiography.Methods: We investigated 40 patients with a peak transvalvular velocity > 3.0 m/s on transthoracic echocardiography (TTE). The patients were divided into highly accelerated and moderately accelerated AS groups according to whether or not the peak transvalvular velocity was ≥ 4.0 m/s. From the multislice 2D cine phase-contrast MRI data, the cross-sectional area of the vena contracta of the reconstructed streamline in the Valsalva sinus was defined as MRI-EOAs. Patient symptoms and echocardiography data, including EOA (defined as TTE-EOA), were derived from the continuity equation using TTE.Results: All participants in the highly accelerated AS group (n = 19) showed a peak velocity ≥ 4.0 m/s in MRI. Eleven patients in the moderately accelerated AS group (n = 21) had a TTE-EOA < 1.00 cm 2 . In the moderately accelerated AS group, MRI-EOAs demonstrated a strong correlation with TTE-EOAs (r = 0.76, P < 0.01). Meanwhile, in the highly accelerated AS group, MRI-EOAs demonstrated positivity but a moderate correlation with TTE-EOAs (r = 0.63, P = 0.004). MRI-EOAs were overestimated compared to TTE-EOAs. In terms of the moderately accelerated AS group, the best cut-off value for MRI-EOAs was < 1.23 cm 2 , compatible with TTE-EOAs < 1.00 cm 2 , with an excellent prediction of the New York Heart Association classification ≥ III (sensitivity 87.5%, specificity 76.9%). Conclusion:MRI-EOAs may be an alternative to conventional echocardiography for patients with moderately accelerated AS, especially those with discordant echocardiographic parameters.

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“…Each 4D flow dataset was imported into IT Flow (Cardioflow, Tokyo, Japan) [ 24 ] as separate segmentation masks to isolate velocity flow fields within the domains of interest. After background-phase correction, the masks were further screened to remove regions of noise artifact.…”

Section: Methodsmentioning

confidence: 99%

“…Viscous energy loss (VEL, mW) represent viscous dissipation across the flow field within each voxel, a combined effect of blood viscosity and velocity gradient (shear) [ 24 ]. For each direction, E is summated over repeated indices as: where is blood viscosity at 0.004 Pa·s.…”

Section: Methodsmentioning

confidence: 99%

“…This was performed by Cut #1 and Cut #2 as shown in A with corresponding landmarks. The resulting 3D models of the inflow and outflow components are shown in B Post-processing of 4D flow Each 4D flow dataset was imported into IT Flow (Cardioflow, Tokyo, Japan) [24] as separate segmentation masks to isolate velocity flow fields within the domains of interest. After background-phase correction, the masks were further screened to remove regions of noise artifact.…”

Section: D Modeling Of Rvot and Rv Inflowmentioning

confidence: 99%

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Moving beyond size: vorticity and energy loss are correlated with right ventricular dysfunction and exercise intolerance in repaired Tetralogy of Fallot

Loke

Capuano

Cleveland

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background The global effect of chronic pulmonary regurgitation (PR) on right ventricular (RV) dilation and dysfunction in repaired Tetralogy of Fallot (rTOF) patients is well studied by cardiovascular magnetic resonance (CMR). However, the links between PR in the RV outflow tract (RVOT), RV dysfunction and exercise intolerance are not clarified by conventional measurements. Not all patients with RV dilation share the same intracardiac flow characteristics, now measurable by time resolved three-dimensional phase contrast imaging (4D flow). In our study, we quantified regional vorticity and energy loss in rTOF patients and correlated these parameters with RV dysfunction and exercise capacity. Methods rTOF patients with 4D flow datasets were retrospectively analyzed, including those with transannular/infundibular repair and conduit repair. Normal controls and RV dilation patients with atrial-level shunts (Qp:Qs > 1.2:1) were included for comparison. 4D flow was post-processed using IT Flow (Cardioflow, Japan). Systolic/diastolic vorticity (ω, 1/s) and viscous energy loss (VEL, mW) in the RVOT and RV inflow were measured. To characterize the relative influence of diastolic vorticity in the two regions, an RV Diastolic Vorticity Quotient (ωRVOT-Diastole/ωRV Inflow-Diastole, RV-DVQ) was calculated. Additionally, RVOT Vorticity Quotient (ωRVOT-Diastole/ωRVOT-Systole, RVOT-VQ) and RVOT Energy Quotient (VELRVOT-Diastole/VELRVOT-Systole, RVOT-EQ) was calculated. In rTOF, measurements were correlated against conventional CMR and exercise stress test results. Results 58 rTOF patients, 28 RV dilation patients and 12 controls were included. RV-DVQ, RVOT-VQ, and RVOT-EQ were highest in rTOF patients with severe PR compared to rTOF patients with non-severe PR, RV dilation and controls (p < 0.001). RV-DVQ positively correlated with RV end-diastolic volume (0.683, p < 0.001), PR fraction (0.774, p < 0.001) and negatively with RV ejection fraction (− 0.521, p = 0.003). Both RVOT-VQ, RVOT-EQ negatively correlated with VO2-max (− 0.587, p = 0.008 and − 0.617, p = 0.005) and % predicted VO2-max (− 0.678, p = 0.016 and − 0.690, p = 0.001). Conclusions In rTOF patients, vorticity and energy loss dominate the RVOT compared to tricuspid inflow, correlating with RV dysfunction and exercise intolerance. These 4D flow-based measurements may be sensitive biomarkers to guide surgical management of rTOF patients.

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Assessment of biventricular hemodynamics and energy dynamics using lumen-tracking 4D flow MRI without contrast medium

Cited by 14 publications

References 26 publications

Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study

Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study

Estimating the Haemodynamic Streamline Vena Contracta as the Effective Orifice Area Measured from Reconstructed Multislice Phase-contrast MR Images for Patients with Moderately Accelerated Aortic Stenosis

Moving beyond size: vorticity and energy loss are correlated with right ventricular dysfunction and exercise intolerance in repaired Tetralogy of Fallot

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