Right Ventricular Flow Vorticity Relationships With Biventricular Shape in Adult Tetralogy of Fallot.
Right Ventricular Flow Vorticity Relationships With Biventricular Shape in Adult Tetralogy of Fallot.
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DOI：
10.3389/fcvm.2021.806107
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发表时间：
2021
影响因子：
3.6
通讯作者：
Young AA
中科院分区：
文献类型：
--
作者：
Elsayed A;Mauger CA;Ferdian E;Gilbert K;Scadeng M;Occleshaw CJ;Lowe BS;McCulloch AD;Omens JH;Govil S;Pushparajah K;Young AA
法洛四联症修复成人 (rToF) 的重塑可能是由于慢性肺动脉瓣反流引起的，但也可能与血流模式的改变有关，包括涡流。我们的目的是关联和量化涡度和心室形状之间的关系，这些关系源自基于图集的双心室形状分析。成人 rToF (n = 12) 患者接受 4D 血流和电影 MRI 成像。使用神经网络降噪后计算 RV 中的涡度。使用由 95 名 rToF 患者构建的双心室形状图谱来推导主成分模式，该模式与使用单变量和多元线性回归的涡度和肺反流量 (PRV) 相关。单变量分析显示，索引 PRV 与 3 种模式相关（r = -0.55、-0.50 和 0.6，所有 p < 0.05），这些模式与 RV 扩张以及基底膨出、心尖膨出和三尖瓣环倾斜的增加以及更严重的反流、以及较小的 LV 和隔膜的矛盾运动相关。 RV 流出和流入涡度也与这些模式相关。然而，整个 RV 上的总涡度与两种不同的模式相关（r = -0.62，-0.69，均 p < 0.05）。较高的涡度与右心室和左心室形状的变化相关，包括心室长度更长、三尖瓣旁边更大的凸起以及明显的三尖瓣倾斜。 RV 流涡度与双心室几何形状的变化相关，与 PRV 的相关性不同。流动涡度可以在 rToF 重构中提供额外的机械信息。 LV 和 RV 形状在 rToF RV 血流模式中都很重要。
Remodeling in adults with repaired tetralogy of Fallot (rToF) may occur due to chronic pulmonary regurgitation, but may also be related to altered flow patterns, including vortices. We aimed to correlate and quantify relationships between vorticity and ventricular shape derived from atlas-based analysis of biventricular shape. Adult rToF (n = 12) patients underwent 4D flow and cine MRI imaging. Vorticity in the RV was computed after noise reduction using a neural network. A biventricular shape atlas built from 95 rToF patients was used to derive principal component modes, which were associated with vorticity and pulmonary regurgitant volume (PRV) using univariate and multivariate linear regression. Univariate analysis showed that indexed PRV correlated with 3 modes (r = −0.55,−0.50, and 0.6, all p < 0.05) associated with RV dilatation and an increase in basal bulging, apical bulging and tricuspid annulus tilting with more severe regurgitation, as well as a smaller LV and paradoxical movement of the septum. RV outflow and inflow vorticity were also correlated with these modes. However, total vorticity over the whole RV was correlated with two different modes (r = −0.62,−0.69, both p < 0.05). Higher vorticity was associated with both RV and LV shape changes including longer ventricular length, a larger bulge beside the tricuspid valve, and distinct tricuspid tilting. RV flow vorticity was associated with changes in biventricular geometry, distinct from associations with PRV. Flow vorticity may provide additional mechanistic information in rToF remodeling. Both LV and RV shapes are important in rToF RV flow patterns.