Wall shear stress measured by phase contrast cardiovascular magnetic resonance in children and adolescents with pulmonary arterial hypertension

Truong, Uyen; Fonseca, Brian; Dunning, Jamie; Burgett, Shawna; Lanning, Craig; Ivy, D. Dunbar; Shandas, Robin; Hunter, Kendall S.; Barker, Alex J.

doi:10.1186/1532-429x-15-81

Cited by 61 publications

(72 citation statements)

References 36 publications

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“…15,16 We found the in-plane systolic WSS to be 0. Representative four-dimensional flow cardiac magnetic resonance imaging main pulmonary artery (MPA) flow patterns in a control subject (top) and a subject with pulmonary arterial hypertension (PAH; bottom) at different stages of the cardiac cycle.…”

Section: Discussionmentioning

confidence: 79%

“…Furthermore, time-averaged WSS over the cardiac cycle (WSS TA ) was calculated as described elsewhere. 16 …”

Section: Wss Analysismentioning

confidence: 99%

“…[13][14][15][16][17] However, the clinical implications of decreased WSS in PH are essentially unknown. In the systemic circulation, endothelial response to abnormal WSS is known to lead to vascular disease, hypertension, thrombosis, and atherosclerosis.…”

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confidence: 99%

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Main Pulmonary Arterial Wall Shear Stress Correlates with Invasive Hemodynamics and Stiffness in Pulmonary Hypertension

et al. 2016

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Pulmonary hypertension (PH) is associated with proximal pulmonary arterial remodeling characterized by increased vessel diameter, wall thickening, and stiffness. In vivo assessment of wall shear stress (WSS) may provide insights into the relationships between pulmonary hemodynamics and vascular remodeling. We investigated the relationship between main pulmonary artery (MPA) WSS and pulmonary hemodynamics as well as markers of stiffness. As part of a prospective study, 17 PH patients and 5 controls underwent same-day fourdimensional flow cardiac magnetic resonance imaging (4-D CMR) and right heart catheterization. Streamwise velocity profiles were generated in the cross-sectional MPA in 45°increments from velocity vector fields determined by 4-D CMR. WSS was calculated as the product of hematocrit-dependent viscosity and shear rate generated from the spatial gradient of the velocity profiles. In-plane average MPA WSS was significantly decreased in the PH cohort compared with that in controls (0.18 ± 0.07 vs. 0.32 ± 0.08 N/m 2 ; P = 0.01). In-plane MPA WSS showed strong inverse correlations with multiple hemodynamic indices, including pulmonary resistance ( ρ = −0.74, P < 0.001), mean pulmonary pressure ( ρ = −0.64, P = 0.006), and elastance ( ρ = −0.70, P < 0.001). In addition, MPA WSS had significant associations with markers of stiffness, including capacitance ( ρ = 0.67, P < 0.001), distensibility ( ρ = 0.52, P = 0.013), and elastic modulus (ρ = −0.54, P = 0.01). In conclusion, MPA WSS is decreased in PH and is significantly associated with invasive hemodynamic indices and markers of stiffness. 4-D CMR-based assessment of WSS may represent a novel methodology to study blood-vessel wall interactions in PH.Keywords: 4-D cardiac magnetic resonance imaging, wall shear stress, pulmonary hypertension. Pulmonary hypertension (PH) is a progressive disorder defined by pathologic elevations in pulmonary arterial pressure and resistance that imparts a universally poor prognosis despite recent advances in pharmacologic therapy.1, 2 Increases in pulmonary pressure and resistance are hypothesized to result from remodeling of the distal pulmonary circulation as characterized by progressive pulmonary arteriolar medial hypertrophy, adventitial thickening, and neointimal lesions. However, PH is also associated with proximal pulmonary arterial accumulation of vascular smooth muscle cells and load-bearing proteins in the extracellular matrix. 4 These proximal histologic changes confer morphologic and functional changes, including increased vessel diameter, wall thickening, diminished compliance, reduced elastance, and increased stiffness. 5 Pulmonary arterial stiffness can be readily assessed using a multiple indices obtained from right heart catheterization (RHC) and cardiac magnetic resonance imaging, including capacitance, compliance, distensibility, elastic modulus, and stiffness index β. 6 Stiffness can account for up to 30%-40% of the right ventricular (RV) afterload due to the reactive component of impedance, and...

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Section: Discussionmentioning

confidence: 79%

“…Furthermore, time-averaged WSS over the cardiac cycle (WSS TA ) was calculated as described elsewhere. 16 …”

Section: Wss Analysismentioning

confidence: 99%

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Main Pulmonary Arterial Wall Shear Stress Correlates with Invasive Hemodynamics and Stiffness in Pulmonary Hypertension

et al. 2016

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“…20-23 Truong et al recently used 2D phase contrast of the right pulmonary artery to measure WSS in children with pulmonary artery hypertension. 24 However, the impact of BAV on changes in blood flow and the association with age and aortic size is poorly understood. In this pilot study, our aim was to describe the influence of BAV on thoracic aorta hemodynamic parameters in a group of pediatric and young adult patients using 4D flow MRI.…”

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confidence: 99%

Thoracic aorta 3D hemodynamics in pediatric and young adult patients with bicuspid aortic valve

Allen

Ooij

Barker

et al. 2015

Magnetic Resonance Imaging

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Background To evaluate the 3D hemodynamics in the thoracic aorta of pediatric and young adult bicuspid aortic valve (BAV) patients. Methods 4D flow MRI was performed in 30 pediatric and young adult BAV patients (age: 13.9 ± 4.4 (range: [3.4, 20.7]) years old, M:F = 17:13) as part of this Institutional Review Board-approved study. Nomogram-based aortic root Z-scores were calculated to assess aortic dilatation and degree of aortic stenosis (AS) severity was assessed on MRI. Data analysis included calculation of time-averaged systolic 3D wall shear stress (WSSsys) along the entire aorta wall, and regional quantification of maximum and mean WSSsys and peak systolic velocity (velsys) in the ascending aorta (AAo), arch, and descending aorta (DAo). The 4D flow MRI AAo velsys was also compared with echocardiography peak velocity measurements. Results There was a positive correlation with both mean and max AAo WSSsys and peak AAo velsys (mean: r = 0.84, P < 0.001, max: r = 0.94, P < 0.001) and AS (mean: rS = 0.43, P = 0.02, max: rS = 0.70, P < 0.001). AAo peak velocity was significantly higher when measured with echo compared with 4D flow MRI (2.1 ± 0.98 m/s versus 1.27 ± 0.49 m/s, P < 0.001). Conclusion In pediatric and young adult patients with BAV, AS and peak ascending aorta velocity are associated with increased AAo WSS, while aortic dilation, age, and body surface area do not significantly impact AAo hemodynamics. Prospective studies are required to establish the role of WSS as a risk-stratification tool in these patients.

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“…Others have looked at wall shear stress in pulmonary arteries by phase contrast imaging in CMR and identified that it is decreased in patients with PAH relative to controls due to greater pulmonary artery dilatation with preserved systolic flow. This abnormal shear stress is believed to affect cellular mechanics, with altered inflammatory cytokine expression in more distal vessels, resulting in the medial hypertrophy and vascular pathology seen in PH [28*]. …”

Section: Introductionmentioning

confidence: 99%

Progress in the diagnosis and management of pulmonary hypertension in children

Nicolarsen

Ivy

2014

Current Opinion in Pediatrics

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Purpose of Review Pulmonary hypertension (PH) is a complex disease that extends beyond merely elevated pulmonary blood pressures and right ventricular dysfunction. Its multiple etiologies and ever-expanding diagnostic tools and therapeutic approaches make it a heterogeneous disease with widely variable clinical sequelae. There are still many unanswered questions that challenge our understanding of this disease. Recent Findings The study of PH in the pediatric patient is as robust as ever, with the creation and inclusion of pediatric-specific disease characteristics in the most recent World Health Organization classification system, improved understanding of the pathophysiology of PH in pediatric diseases like bronchopulmonary dysplasia, and increasingly expanding diagnostic tools and management possibilities. While the use of PH therapies in children previously often relied on expert opinion and inferences from studies involving adults, pediatric-targeted research is becoming more widely supported and pursued, and even has come under recent debate, which at the very least stimulates further collaboration and discussion. Summary This review will highlight the changes in the PH classification system, briefly explore PH in bronchopulmonary dysplasia, and provide updates on the diagnostic and management tools used by experts in the field.

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Wall shear stress measured by phase contrast cardiovascular magnetic resonance in children and adolescents with pulmonary arterial hypertension

Cited by 61 publications

References 36 publications

Main Pulmonary Arterial Wall Shear Stress Correlates with Invasive Hemodynamics and Stiffness in Pulmonary Hypertension

Main Pulmonary Arterial Wall Shear Stress Correlates with Invasive Hemodynamics and Stiffness in Pulmonary Hypertension

Thoracic aorta 3D hemodynamics in pediatric and young adult patients with bicuspid aortic valve

Progress in the diagnosis and management of pulmonary hypertension in children

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