Altered hemodynamics by 4D flow cardiovascular magnetic resonance predict exercise intolerance in repaired coarctation of the aorta: an in vitro study.
Altered hemodynamics by 4D flow cardiovascular magnetic resonance predict exercise intolerance in repaired coarctation of the aorta: an in vitro study.
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DOI：
10.1186/s12968-021-00796-3
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发表时间：
2021-09-06
期刊：
影响因子：
--
通讯作者：
Olivieri LJ
中科院分区：
文献类型：
--
作者：
Mandell JG;Loke YH;Mass PN;Cleveland V;Delaney M;Opfermann J;Aslan S;Krieger A;Hibino N;Olivieri LJ
主动脉缩窄（CoA）与运动能力下降相关，尽管修复成功。由于主动脉弓几何结构异常，已确定血流模式改变。我们以前的工作表明，主动脉大小不匹配与运动不耐受有关。在这项研究中，我们研究了主动脉血流模式，在模拟运动修复CoA使用4D流心血管磁共振（CMR）使用主动脉复制品连接到体外流量泵和相关的结果与运动负荷试验结果，以确定运动不耐受的生物标志物。回顾性分析CoA修复患者CMR和运动负荷试验后的情况。每个主动脉都是手动分割和3D打印的。使用模拟循环流动回路在模拟休息和运动期间进行从升主动脉（AAo）到降主动脉（DAo）的压力梯度测量和4D流动CMR。壁面剪切应力（WSS）和二次流形成（涡度和螺旋度）从休息到运动的变化进行了量化，以及估计DAo雷诺数。参数与预测峰值氧耗量百分比（VO 2 max）和主动脉大小不匹配（DAAo/DDAo）相关。确定了15例患者（VO 2 max为预测值的47 - 126%）。压力梯度与休息或运动时的VO 2 max无关。VO 2 max与从休息到运动的峰值涡度（R = 0.55，p = 0.03）、峰值螺旋度（R = 0.54，p = 0.04）、Aao中的峰值WSS（R = 0.68，p = 0.005）的变化呈正相关，与DAo中的峰值WSS（R =-0.57，p = 0.03）呈负相关。DAAo/DDAo与涡度（R =-0.38，p = 0.01）、螺旋度（R =-0.66，p = 0.007）以及AAo（R =-0.73，p = 0.002）和DAo（R = 0.58，p = 0.02）中的WSS变化密切相关。估计的DAo雷诺数与运动时的最大摄氧量呈负相关（R =-0.59，p = 0.02），但与休息时的最大摄氧量无关（R =-0.28，p = 0.31）。流线型的可视化显示出更多的二次流形成在主动脉弓更好的运动能力，较大的DAo，和较低的雷诺数。在修复的CoA中，二次流特征和运动能力之间存在重要的关联，这可能是由于湍流增加和流动效率低下而不能被传统的压力梯度捕获。这些4D血流CMR参数是确定最佳主动脉弓几何结构和改善CoA修复后长期临床结局的研究目标。
Coarctation of the aorta (CoA) is associated with decreased exercise capacity despite successful repair. Altered flow patterns have been identified due to abnormal aortic arch geometry. Our previous work demonstrated aorta size mismatch to be associated with exercise intolerance in this population. In this study, we studied aortic flow patterns during simulations of exercise in repaired CoA using 4D flow cardiovascular magnetic resonance (CMR) using aortic replicas connected to an in vitro flow pump and correlated findings with exercise stress test results to identify biomarkers of exercise intolerance. Patients with CoA repair were retrospectively analyzed after CMR and exercise stress test. Each aorta was manually segmented and 3D printed. Pressure gradient measurements from ascending aorta (AAo) to descending aorta (DAo) and 4D flow CMR were performed during simulations of rest and exercise using a mock circulatory flow loop. Changes in wall shear stress (WSS) and secondary flow formation (vorticity and helicity) from rest to exercise were quantified, as well as estimated DAo Reynolds number. Parameters were correlated with percent predicted peak oxygen consumption (VO2max) and aorta size mismatch (DAAo/DDAo). Fifteen patients were identified (VO2max 47 to 126% predicted). Pressure gradient did not correlate with VO2max at rest or exercise. VO2max correlated positively with the change in peak vorticity (R = 0.55, p = 0.03), peak helicity (R = 0.54, p = 0.04), peak WSS in the AAo (R = 0.68, p = 0.005) and negatively with peak WSS in the DAo (R = − 0.57, p = 0.03) from rest to exercise. DAAo/DDAo correlated strongly with change in vorticity (R = − 0.38, p = 0.01), helicity (R = − 0.66, p = 0.007), and WSS in the AAo (R = − 0.73, p = 0.002) and DAo (R = 0.58, p = 0.02). Estimated DAo Reynolds number negatively correlated with VO2max for exercise (R = − 0.59, p = 0.02), but not rest (R = − 0.28, p = 0.31). Visualization of streamline patterns demonstrated more secondary flow formation in aortic arches with better exercise capacity, larger DAo, and lower Reynolds number. There are important associations between secondary flow characteristics and exercise capacity in repaired CoA that are not captured by traditional pressure gradient, likely due to increased turbulence and inefficient flow. These 4D flow CMR parameters are a target of investigation to identify optimal aortic arch geometry and improve long term clinical outcomes after CoA repair.
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影响因子：
6.7
作者：
Frydrychowicz, Alex;Markl, Michael;Arnold, Raoul
通讯作者：
Arnold, Raoul
影响因子：
1.5
作者：
Miyazaki S;Itatani K;Furusawa T;Nishino T;Sugiyama M;Takehara Y;Yasukochi S
通讯作者：
Yasukochi S
影响因子：
37.8
作者：
KILNER, PJ;YANG, GZ;LONGMORE, DB
通讯作者：
LONGMORE, DB
影响因子：
6.4
作者：
Kaiser, Thomas;Kellenberger, Christian J.;Buechel, Emanuela R. Valsangiacomo
通讯作者：
Buechel, Emanuela R. Valsangiacomo
DOI：
10.1186/1532-429x-15-51
发表时间：
2013-06-13
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Fratz S;Chung T;Greil GF;Samyn MM;Taylor AM;Valsangiacomo Buechel ER;Yoo SJ;Powell AJ
通讯作者：
Powell AJ