{"title":"射血分数保留的 d 型大动脉横断患者动脉转换手术后双心室血流动力学改变的特征:一项四维(4D)血流心血管磁共振(CMR)研究。","authors":"Li-Wei Hu, Xin-Rong Liu, Rong-Zhen Ouyang, Li-Jun Chen, Ai-Min Sun, Chen Guo, Xiao-Fen Yao, Yan-Yan Ma, Le Feng, Ting-Fan Wu, Qian Wang, Yu-Min Zhong","doi":"10.21037/qims-24-840","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The long-term monitoring of biventricular function is essential to identify potential functional decline in patients following the arterial switch operation (ASO). The underlying pathophysiological mechanisms responsible for altered biventricular hemodynamics in ASO patients are not yet well understood. This study sought to: (I) compare the biventricular kinetic energy (KE) and vorticity of ASO patients and age- and sex-matched controls; (II) investigate the associations of four-dimensional (4D) flow biventricular hemodynamics parameters and neo-aortic root dilation, supravalvular pulmonary stenosis, and pulmonary artery transvalvular pressure difference.</p><p><strong>Methods: </strong>A total of 34 patients with dextro-transposition of the great arteries (D-TGA) who underwent ASO, and 17 age- and gender-matched healthy controls were prospectively recruited for this study. All the subjects underwent cine and 4D flow and late gadolinium enhancement scans, and all the patients underwent echocardiography within two weeks of cardiovascular magnetic resonance (CMR) imaging. The following four flow components were analyzed: direct flow, retained inflow, delayed ejection flow, and residual volume. In addition, the following six phasic blood flow KE parameters, normalized to the end-diastolic volume (EDV) and vorticity, were analyzed for both the left ventricle (LV) and right ventricle (RV): peak systolic phase, average systolic phase, peak diastolic phase, average diastolic phase, peak E-wave phase, and peak A-wave phase. The independent sample Student's <i>t</i>-test, Mann-Whitney U-test, univariable and multivariable stepwise regression analyses, intra and inter-observer variability analyses were used to compare patients and controls.</p><p><strong>Results: </strong>In relation to the LV, the D-TGA patients had significantly decreased average vorticity, peak systolic vorticity, systolic vorticity, diastolic vorticity, and peak A-wave vorticity compared to the controls (all P<0.01). In relation to the RV, the pulmonary stenosis group had significantly increased peak E- and A-wave kinetic energy normalized to the end-diastolic volume (KEi<sub>EDV</sub>), and peak and average vorticity compared to the non-pulmonary stenosis group (all P<0.05). in the multivariable logistic regression model analysis, diastolic KEi<sub>EDV</sub>, peak E-wave KEi<sub>EDV</sub> peak A-wave KEi<sub>EDV,</sub> and average vorticity were associated a with transvalvular pressure difference (β=13.54, P<0.001 for diastolic KEi<sub>EDV</sub>; β=105.26, P<0.001 for peak E-wave KEi<sub>EDV</sub>; β=-49.36, P=0.027 for peak A-wave KEi<sub>EDV</sub>; and β=-56.37, P<0.001 for average vorticity).</p><p><strong>Conclusions: </strong>We found that 4D flow biventricular hemodynamics were more sensitive markers than the ejection fraction in the postoperative D-TGA patients. The RV diastolic KEi<sub>EDV</sub> parameters and average vorticity were risk factors for pulmonary artery obstruction in the multivariable model.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":"14 10","pages":"7200-7217"},"PeriodicalIF":2.9000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11485381/pdf/","citationCount":"0","resultStr":"{\"title\":\"Characteristics of altered biventricular hemodynamics after arterial switch operation for patients with d-transposition of the great arteries with preserved ejection fraction: a four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) study.\",\"authors\":\"Li-Wei Hu, Xin-Rong Liu, Rong-Zhen Ouyang, Li-Jun Chen, Ai-Min Sun, Chen Guo, Xiao-Fen Yao, Yan-Yan Ma, Le Feng, Ting-Fan Wu, Qian Wang, Yu-Min Zhong\",\"doi\":\"10.21037/qims-24-840\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The long-term monitoring of biventricular function is essential to identify potential functional decline in patients following the arterial switch operation (ASO). The underlying pathophysiological mechanisms responsible for altered biventricular hemodynamics in ASO patients are not yet well understood. This study sought to: (I) compare the biventricular kinetic energy (KE) and vorticity of ASO patients and age- and sex-matched controls; (II) investigate the associations of four-dimensional (4D) flow biventricular hemodynamics parameters and neo-aortic root dilation, supravalvular pulmonary stenosis, and pulmonary artery transvalvular pressure difference.</p><p><strong>Methods: </strong>A total of 34 patients with dextro-transposition of the great arteries (D-TGA) who underwent ASO, and 17 age- and gender-matched healthy controls were prospectively recruited for this study. All the subjects underwent cine and 4D flow and late gadolinium enhancement scans, and all the patients underwent echocardiography within two weeks of cardiovascular magnetic resonance (CMR) imaging. The following four flow components were analyzed: direct flow, retained inflow, delayed ejection flow, and residual volume. In addition, the following six phasic blood flow KE parameters, normalized to the end-diastolic volume (EDV) and vorticity, were analyzed for both the left ventricle (LV) and right ventricle (RV): peak systolic phase, average systolic phase, peak diastolic phase, average diastolic phase, peak E-wave phase, and peak A-wave phase. The independent sample Student's <i>t</i>-test, Mann-Whitney U-test, univariable and multivariable stepwise regression analyses, intra and inter-observer variability analyses were used to compare patients and controls.</p><p><strong>Results: </strong>In relation to the LV, the D-TGA patients had significantly decreased average vorticity, peak systolic vorticity, systolic vorticity, diastolic vorticity, and peak A-wave vorticity compared to the controls (all P<0.01). In relation to the RV, the pulmonary stenosis group had significantly increased peak E- and A-wave kinetic energy normalized to the end-diastolic volume (KEi<sub>EDV</sub>), and peak and average vorticity compared to the non-pulmonary stenosis group (all P<0.05). in the multivariable logistic regression model analysis, diastolic KEi<sub>EDV</sub>, peak E-wave KEi<sub>EDV</sub> peak A-wave KEi<sub>EDV,</sub> and average vorticity were associated a with transvalvular pressure difference (β=13.54, P<0.001 for diastolic KEi<sub>EDV</sub>; β=105.26, P<0.001 for peak E-wave KEi<sub>EDV</sub>; β=-49.36, P=0.027 for peak A-wave KEi<sub>EDV</sub>; and β=-56.37, P<0.001 for average vorticity).</p><p><strong>Conclusions: </strong>We found that 4D flow biventricular hemodynamics were more sensitive markers than the ejection fraction in the postoperative D-TGA patients. The RV diastolic KEi<sub>EDV</sub> parameters and average vorticity were risk factors for pulmonary artery obstruction in the multivariable model.</p>\",\"PeriodicalId\":54267,\"journal\":{\"name\":\"Quantitative Imaging in Medicine and Surgery\",\"volume\":\"14 10\",\"pages\":\"7200-7217\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11485381/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Quantitative Imaging in Medicine and Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/qims-24-840\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Quantitative Imaging in Medicine and Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/qims-24-840","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
背景:长期监测双心室功能对于识别动脉转流手术(ASO)后患者潜在的功能衰退至关重要。导致 ASO 患者双心室血流动力学改变的潜在病理生理学机制尚不十分清楚。本研究旨在(I)比较ASO患者与年龄和性别匹配的对照组的双心室动能(KE)和涡度;(II)研究四维(4D)血流双心室血流动力学参数与新主动脉根扩张、瓣上肺动脉狭窄和肺动脉跨瓣压差的关系:本研究前瞻性地招募了 34 名接受 ASO 手术的大动脉右侧横位(D-TGA)患者和 17 名年龄和性别匹配的健康对照者。所有受试者均接受了 cine 和 4D 血流扫描以及晚期钆增强扫描,所有患者均在心血管磁共振(CMR)成像后两周内接受了超声心动图检查。对以下四种血流成分进行了分析:直接血流、潴留血流、延迟射血血流和残余容积。此外,还分析了左心室(LV)和右心室(RV)的以下六个与舒张末容积(EDV)和涡度归一化的阶段性血流 KE 参数:收缩期峰值、平均收缩期峰值、舒张期峰值、平均舒张期峰值、E 波峰值和 A 波峰值。采用独立样本学生 t 检验、曼-惠特尼 U 检验、单变量和多变量逐步回归分析、观察者内和观察者间变异性分析来比较患者和对照组:就左心室而言,与对照组相比,D-TGA 患者的平均涡度、收缩期峰值涡度、收缩期涡度、舒张期涡度和 A 波峰值涡度均显著降低(均为 PEDV),与非肺动脉狭窄组相比,峰值涡度和平均涡度均显著降低(均为 PEDV),E 波峰值 KEiEDV、A 波峰值 KEiEDV 和平均涡度与跨瓣压差相关(β=13.54,PEDV;β=105.26,PEDV;β=-49.36,A 波峰值 KEiEDV,P=0.027;β=-56.37,PConclusions:我们发现,在术后D-TGA患者中,4D血流双心室血流动力学是比射血分数更敏感的指标。在多变量模型中,RV 舒张期 KEiEDV 参数和平均涡度是肺动脉阻塞的危险因素。
Characteristics of altered biventricular hemodynamics after arterial switch operation for patients with d-transposition of the great arteries with preserved ejection fraction: a four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) study.
Background: The long-term monitoring of biventricular function is essential to identify potential functional decline in patients following the arterial switch operation (ASO). The underlying pathophysiological mechanisms responsible for altered biventricular hemodynamics in ASO patients are not yet well understood. This study sought to: (I) compare the biventricular kinetic energy (KE) and vorticity of ASO patients and age- and sex-matched controls; (II) investigate the associations of four-dimensional (4D) flow biventricular hemodynamics parameters and neo-aortic root dilation, supravalvular pulmonary stenosis, and pulmonary artery transvalvular pressure difference.
Methods: A total of 34 patients with dextro-transposition of the great arteries (D-TGA) who underwent ASO, and 17 age- and gender-matched healthy controls were prospectively recruited for this study. All the subjects underwent cine and 4D flow and late gadolinium enhancement scans, and all the patients underwent echocardiography within two weeks of cardiovascular magnetic resonance (CMR) imaging. The following four flow components were analyzed: direct flow, retained inflow, delayed ejection flow, and residual volume. In addition, the following six phasic blood flow KE parameters, normalized to the end-diastolic volume (EDV) and vorticity, were analyzed for both the left ventricle (LV) and right ventricle (RV): peak systolic phase, average systolic phase, peak diastolic phase, average diastolic phase, peak E-wave phase, and peak A-wave phase. The independent sample Student's t-test, Mann-Whitney U-test, univariable and multivariable stepwise regression analyses, intra and inter-observer variability analyses were used to compare patients and controls.
Results: In relation to the LV, the D-TGA patients had significantly decreased average vorticity, peak systolic vorticity, systolic vorticity, diastolic vorticity, and peak A-wave vorticity compared to the controls (all P<0.01). In relation to the RV, the pulmonary stenosis group had significantly increased peak E- and A-wave kinetic energy normalized to the end-diastolic volume (KEiEDV), and peak and average vorticity compared to the non-pulmonary stenosis group (all P<0.05). in the multivariable logistic regression model analysis, diastolic KEiEDV, peak E-wave KEiEDV peak A-wave KEiEDV, and average vorticity were associated a with transvalvular pressure difference (β=13.54, P<0.001 for diastolic KEiEDV; β=105.26, P<0.001 for peak E-wave KEiEDV; β=-49.36, P=0.027 for peak A-wave KEiEDV; and β=-56.37, P<0.001 for average vorticity).
Conclusions: We found that 4D flow biventricular hemodynamics were more sensitive markers than the ejection fraction in the postoperative D-TGA patients. The RV diastolic KEiEDV parameters and average vorticity were risk factors for pulmonary artery obstruction in the multivariable model.