Beyond Bernoulli: Improving the Accuracy and Precision of Noninvasive Estimation of Peak Pressure Drops.
Beyond Bernoulli: Improving the Accuracy and Precision of Noninvasive Estimation of Peak Pressure Drops.
复制标题
超越Bernoulli：提高峰值降低的非侵入性估计的准确性和精度。
DOI：
10.1161/circimaging.116.005207
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Lamata P
中科院分区：
文献类型：
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作者：
Donati F;Myerson S;Bissell MM;Smith NP;Neubauer S;Monaghan MJ;Nordsletten DA;Lamata P
补充数字内容可在文本中找到。跨瓣峰值压降通常采用伯努利原理通过超声心动图进行无创评估。然而，伯努利原理依赖于可能不合适的几个近似，包括大部分压降是由于血流的空间加速，并且喷射射流是单个流线（单个峰值速度值）。我们使用32名受试者的三维心血管磁共振血流数据评估了伯努利原理估计主动脉瓣处峰值压降的准确性。参考压降根据流场计算，考虑到物理原理（即Navier-Stokes方程）。压力分量的分析证实，通过瓣膜的血液射流的空间加速度最显著（占狭窄受试者总下降的99%）。然而，Bernoulli公式表明，由于使用单个峰值速度值（忽略了主动脉瓣平面上的速度分布），导致跨瓣压的一致高估（平均值为54%，范围为5%-136%）。这种假设是不受控制的变异性的来源。由于将血流近似为单一流线，伯努利公式的应用导致峰值压降的临床显著高估。提出了一种修正的公式，该公式考虑了血流的横截面轮廓，并适用于心血管磁共振和超声心动图数据。
Supplemental Digital Content is available in the text. Transvalvular peak pressure drops are routinely assessed noninvasively by echocardiography using the Bernoulli principle. However, the Bernoulli principle relies on several approximations that may not be appropriate, including that the majority of the pressure drop is because of the spatial acceleration of the blood flow, and the ejection jet is a single streamline (single peak velocity value). We assessed the accuracy of the Bernoulli principle to estimate the peak pressure drop at the aortic valve using 3-dimensional cardiovascular magnetic resonance flow data in 32 subjects. Reference pressure drops were computed from the flow field, accounting for the principles of physics (ie, the Navier–Stokes equations). Analysis of the pressure components confirmed that the spatial acceleration of the blood jet through the valve is most significant (accounting for 99% of the total drop in stenotic subjects). However, the Bernoulli formulation demonstrated a consistent overestimation of the transvalvular pressure (average of 54%, range 5%–136%) resulting from the use of a single peak velocity value, which neglects the velocity distribution across the aortic valve plane. This assumption was a source of uncontrolled variability. The application of the Bernoulli formulation results in a clinically significant overestimation of peak pressure drops because of approximation of blood flow as a single streamline. A corrected formulation that accounts for the cross-sectional profile of the blood flow is proposed and adapted to both cardiovascular magnetic resonance and echocardiographic data.