Four-dimensional flow magnetic resonance imaging-based characterization of aortic morphometry and haemodynamics: impact of age, aortic diameter, and valve morphology

García, Julio; Barker, Alex J.; Murphy, Ian; Jarvis, Kelly; Schnell, Susanne; Collins, Jeremy D.; Carr, James C.; Malaisrie, S. Chris; Markl, Michael

doi:10.1093/ehjci/jev228

Cited by 61 publications

(57 citation statements)

References 30 publications

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“…The demographics of the study cohort are summarized in Table 1 (note: the method in Garcia et al was used to measure the mid‐ascending aorta [MAA] in the control population) 26. Of the 515 patients, 88 (17%) had mild AS: 19 with TAV‐TAA (8% of all TAV‐TAA); 54 with RL‐BAV (26% of all RL‐BAV); and 15 with RN‐BAV (25% of all RN‐BAV).…”

Section: Resultsmentioning

confidence: 99%

“…AS indicates aortic stenosis; IQR, interquartile range; MAA, mid‐ascending aorta; RL‐BAV, right and left coronary leaflet fusion BAV; RN‐BAV, right and noncoronary leaflet fusion BAV; SOV, sinuses of Valslava; TAV‐TAA, tricuspid aortic valve with aortic dilation.aSignificantly different vs controls.bSignificantly different vs TAV‐TAA.Significantly different vs RL‐BAV (note: no significances found for all subjects).cSignificantly different vs RN‐BAV (Fisher exact test with Bonferroni correction).dNo CE‐MRA available, SOV diameter inaccurate with the method described by Garcia et al 26e

No CE‐MRA available, MAA diameter accurate with the method described by Garcia et al 26

…”

Section: Resultsmentioning

confidence: 99%

“…However, regions of slow and recirculating flow can be difficult to capture with the phase‐contrast magnetic resonance angiography approach. This has not been shown to affect the ability to capture the root geometry downstream from the sinotubular junction; however, some error may be present for WSS values measured in the region of the sinus of Valsalva 26. 4D flow MRI is lengthy (≈10 minutes) and involves time‐consuming data analysis; however, improvements in software tools, sequence implementation, and compressed sensing methods have positioned this technique to be clinically viable in the near future.…”

Section: Discussionmentioning

confidence: 99%

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Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4‐Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects

Ooij

Markl

Collins

et al. 2017

JAHA

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133

104

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BackgroundWall shear stress (WSS) is a stimulus for vessel wall remodeling. Differences in ascending aorta (AAo) hemodynamics have been reported between bicuspid aortic valve (BAV) and tricuspid aortic valve patients with aortic dilatation, but the confounding impact of aortic valve stenosis (AS) is unknown.Methods and ResultsFive hundred seventy‐one subjects underwent 4‐dimensional flow magnetic resonance imaging in the thoracic aorta (210 right‐left BAV cusp fusions, 60 right‐noncoronary BAV cusp fusions, 245 tricuspid aortic valve patients with aortic dilatation, and 56 healthy controls). There were 166 of 515 (32%) patients with AS. WSS atlases were created to quantify group‐specific WSS patterns in the AAo as a function of AS severity. In BAV patients without AS, the different cusp fusion phenotypes resulted in distinct differences in eccentric WSS elevation: right‐left BAV patients exhibited increased WSS by 9% to 34% (P<0.001) at the aortic root and along the entire outer curvature of the AAo whereas right‐noncoronary BAV patients showed 30% WSS increase (P<0.001) at the distal portion of the AAo. WSS in tricuspid aortic valve patients with aortic dilatation patients with no AS was significantly reduced by 21% to 33% (P<0.01) in 4 of 6 AAo regions. In all patient groups, mild, moderate, and severe AS resulted in a marked increase in regional WSS (P<0.001). Moderate‐to‐severe AS further increased WSS magnitude and variability in the AAo. Differences between valve phenotypes were no longer apparent.Conclusions AS significantly alters aortic hemodynamics and WSS independent of aortic valve phenotype and over‐rides previously described flow patterns associated with BAV and tricuspid aortic valve with aortic dilatation. Severity of AS must be considered when investigating valve‐mediated aortopathy.

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Section: Resultsmentioning

confidence: 99%

No CE‐MRA available, MAA diameter accurate with the method described by Garcia et al 26

…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4‐Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects

Ooij

Markl

Collins

et al. 2017

JAHA

Self Cite

133

104

View full text Add to dashboard Cite

show abstract

“…As further development, the proposed morphometric analysis could be integrated with a in vivo quantitative hemodynamics based on 4D flow MRI. Such technique would allow to estimate hemodynamic quantities like pulse wave velocity [51,52] , and helical flow [17,43] .…”

Section: Discussionmentioning

confidence: 99%

“…Examples include the detection of anatomical abnormalities [1] , preoperative planning and follow-up of patients with cardiovascular diseases [2][3][4] , risk prediction associated with atherosclerosis development [5][6][7][8] , and cardiovascular devices design support [9] . In particular, morphometry-based analysis finds massive adoption for current research of mapping the effects of natural aging on the structural and functional properties of the aorta [10][11][12][13][14][15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular morphometry with high-resolution 3D magnetic resonance: First application to left ventricle diastolic dysfunction

Gallo

Vardoulis

Monney

et al. 2017

Medical Engineering & Physics

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a b s t r a c tIn this study, an image-based morphometry toolset quantifying geometric descriptors of the left ventricle, aorta and their coupling is applied to investigate whether morphological information can differentiate between subjects affected by diastolic dysfunction (patient group) and their age-matched controls (control group). The ventriculo-aortic region of 20 total participants (10 per group) were segmented from highresolution 3D magnetic resonance images, from the left ventricle to the descending aorta. Each geometry was divided into segments in correspondence of anatomical landmarks. The orientation of each segment was estimated by least-squares fitting of the respective centerline segment to a plane. Curvature and torsion of vessels' centerlines were automatically extracted, and aortic arch was characterized in terms of height and width.Tilt angle between subsequent best-fit planes in the left ventricle and ascending aorta regions, curvature and cross-sectional area in the descending aorta resulted significantly different between patient and control groups ( P -values < 0.05). Aortic volume ( P = 0.04) and aortic arch width ( P = 0.03) resulted significantly different between the two groups. The observed morphometric differences underlie differences in hemodynamics, by virtue of the influence of geometry on blood flow patterns.The present exploratory analysis does not determine if aortic geometric changes precede diastolic dysfunction, or vice versa. However, this study (1) underlines differences between healthy and diastolic dysfunction subjects, and (2) provides geometric parameters that might help to determine early aortic geometric alterations and potentially prevent evolution toward advanced diastolic dysfunction.

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Ascending aortic elongation and correlative change in overall configuration of the proximal aorta in elderly patients with severe aortic stenosis

et al. 2020

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Background: Configurational changes in the proximal aorta are relevant to the procedural difficulty of transcatheter aortic valve implantation (TAVI). Among several morphological changes involving the ascending aorta, elongation is characteristics of elderly patients with aortic stenosis and can compromise the success and safety of TAVI. However, the effect of ascending aortic elongation on the overall morphology of the proximal aorta has not been established. Aims: Our primary purpose was to investigate the effect of ascending aortic elongation on structural changes in the proximal aorta in TAVI candidates. Materials & Methods: In total, 121 consecutive patients with severe aortic stenosis (mean age, 84.5 ± 5.3 years; 69% women) who had undergone preprocedural computed tomography before TAVI were enrolled. We examined the structural anatomy of the proximal aorta in detail, focusing on its elongation, dilatation, tilting, rotation, and wedging. Results: The mean length of the ascending aorta was 68.0 ± 9.2 mm, and the length was significantly correlated with dilatation (R = .278, p = .002), rightward tilting (R = .437, p < .001), clockwise rotation (R = .228, p = .018), and deep wedging (R = −.366, p < .001) of the proximal aorta. Elongation of the ascending aorta was correlated with dilatation, rightward tilting, clockwise rotation, and deep wedging of the proximal aorta in an elderly population with severe aortic stenosis. Discussion: Appreciation of the clinical anatomy around the proximal aorta is required for clinicians involved in TAVI to estimate the procedural difficulty. Conclusion: Elongation of the ascending aorta was associated with dilatation, rightward tilting, clockwise rotation, and deep wedging of the proximal aorta.

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Four-dimensional flow magnetic resonance imaging-based characterization of aortic morphometry and haemodynamics: impact of age, aortic diameter, and valve morphology

Cited by 61 publications

References 30 publications

Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4‐Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects

Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4‐Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects

Cardiovascular morphometry with high-resolution 3D magnetic resonance: First application to left ventricle diastolic dysfunction

Ascending aortic elongation and correlative change in overall configuration of the proximal aorta in elderly patients with severe aortic stenosis

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