Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: a cross-sectional 4D flow study.

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-09-24 DOI:10.1016/j.jocmr.2024.101102
Takashi Fujiwara, LaDonna J Malone, Kathryn C Chatfield, Alex Berthusen, Brian Fonseca, Lorna P Browne, Alex J Barker
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引用次数: 0

Abstract

Background: Aortic dilation is seen in pediatric/young adult patients with bicuspid aortic valve (BAV), and hemodynamic markers to predict aortic dilation are necessary for monitoring. Although promising hemodynamic metrics, such as abnormal wall shear stress (WSS) magnitude, have been proposed for adult BAV patients using 4D flow cardiovascular magnetic resonance, those for pediatric BAV patients have less frequently been reported, partly due to scarcity of data to define normal WSS range. To circumvent this challenge, this study aims to investigate if a recently proposed 4D flow-based hemodynamic measurement, abnormal flow directionality, is associated with aortic dilation in pediatric/young adult BAV patients.

Methods: 4D flow scans for BAV patients (<20 years old) and age-matched controls were retrospectively enrolled. Static segmentation for the aorta and pulmonary arteries was obtained to quantify peak systolic hemodynamics and diameters in the proximal aorta. In addition to peak velocity, wall shear stress (WSS), vorticity, helicity, and viscous energy loss, direction of aortic velocity and WSS in BAV patients was compared with that of control atlas using registration technique; angle differences of >60deg and >120deg were defined as moderately and severely abnormal, respectively. Association between the obtained metrics and normalized diameters (Z-scores) were evaluated at the sinotubular junction, mid ascending aorta, and distal ascending aorta.

Results: Fifty-three BAV patients, including eighteen with history of repaired aortic coarctation, and seventeen controls were enrolled. Correlation between moderately abnormal velocity/WSS direction and aortic Z-scores was moderate to strong at the sinotubular junction and mid ascending aorta (R=0.62-0.81; p<0.001) while conventional measurements exhibited weaker correlation (|R|=0.003-0.47, p=0.009-0.99) in all subdomains. Multivariable regression analysis found moderately abnormal velocity direction and existence of aortic regurgitation (only for isolated BAV group) were independently associated with mid ascending aortic Z-scores.

Conclusion: Abnormal velocity and WSS directionality in the proximal aorta was strongly associated with aortic Z-scores in pediatric/young adult BAV patients.

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评估患有二尖瓣主动脉瓣的小儿/青少年的异常跨瓣血流和瓣壁剪应力方向:横断面 4D 血流研究。
背景:患有双尖瓣主动脉瓣(BAV)的小儿/年轻成人患者会出现主动脉扩张,而预测主动脉扩张的血液动力学指标是监测所必需的。虽然已经提出了使用四维血流心血管磁共振检测成人 BAV 患者的血液动力学指标,如异常壁剪应力(WSS)大小,但针对小儿 BAV 患者的血液动力学指标却鲜有报道,部分原因是缺乏定义正常 WSS 范围的数据。为了规避这一挑战,本研究旨在调查最近提出的基于四维血流的血流动力学测量方法--异常血流方向性是否与小儿/年轻成人 BAV 患者的主动脉扩张有关。方法:BAV 患者的四维血流扫描(60 度和 >120 度分别定义为中度和重度异常。在窦管交界处、升主动脉中段和升主动脉远端评估所获得的指标与归一化直径(Z-scores)之间的关联:53 名 BAV 患者(包括 18 名曾接受主动脉瓣闭锁修补术的患者)和 17 名对照组患者参加了此次研究。在窦管交界处和升主动脉中段,中度异常的速度/WSS方向与主动脉Z-scores之间的相关性为中度至高度相关(R=0.62-0.81;p结论:中度异常的速度/WSS方向与主动脉Z-scores之间的相关性为中度至高度相关(R=0.62-0.81;p结论):小儿/年轻成人 BAV 患者近端主动脉的速度和 WSS 方向异常与主动脉 Z 评分密切相关。
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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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