Magnetic resonance measurement of turbulent kinetic energy for the estimation of irreversible pressure loss in aortic stenosis.
Magnetic resonance measurement of turbulent kinetic energy for the estimation of irreversible pressure loss in aortic stenosis.
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DOI：
10.1016/j.jcmg.2012.07.017
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发表时间：
2013-01
影响因子：
14
通讯作者：
Saloner, David
中科院分区：
文献类型：
--
作者：
Dyverfeldt, Petter;Hope, Michael D.;Tseng, Elaine E.;Saloner, David
关键词：
作者试图测量主动脉瓣狭窄患者升主动脉中的湍流动能（TKE），并评估其与不可逆压力损失的关系。狭窄后血流能量耗散引起的不可逆压力损失是主动脉瓣狭窄血流动力学意义的重要决定因素。用于估计压力梯度的简化伯努利方程经常错误地分类由主动脉瓣狭窄引起的心室过载。目前估计不可逆压力损失的金标准是导管插入术，但由于其侵入性，这种方法很少使用。狭窄后的压力损失主要是由湍流动能耗散成热引起的。磁共振血流成像的最新发展允许无创估计TKE。该研究得到了当地伦理审查委员会的批准，所有受试者都提供了书面知情同意书。应用三维电影磁共振血流成像技术对18例受试者（4例正常志愿者，14例主动脉瓣狭窄伴或不伴扩张）的TKE进行了测量。对于每例受试者，将升主动脉中的峰值总TKE与压力损失指数进行比较。压力损失指数基于先前验证的理论，该理论将压力损失与超声心动图可获得的测量值相关联。总TKE没有出现相关的全球流动模式可视化的基础上磁共振测量的速度场。主动脉瓣狭窄组TKE明显高于正常对照组（P < 0.001）。升主动脉中的峰值总TKE与指数压力损失强相关（R2 = 0.91）。升主动脉中的峰值总TKE与通过公认方法估计的不可逆压力损失密切相关。通过磁共振血流成像直接测量TKE，经进一步验证，可用于估计主动脉瓣狭窄的不可逆压力损失。
The authors sought to measure the turbulent kinetic energy (TKE) in the ascending aorta of patients with aortic stenosis and to assess its relationship to irreversible pressure loss. Irreversible pressure loss caused by energy dissipation in post-stenotic flow is an important determinant of the hemodynamic significance of aortic stenosis. The simplified Bernoulli equation used to estimate pressure gradients often misclassifies the ventricular overload caused by aortic stenosis. The current gold standard for estimation of irreversible pressure loss is catheterization, but this method is rarely used due to its invasiveness. Post-stenotic pressure loss is largely caused by dissipation of turbulent kinetic energy into heat. Recent developments in magnetic resonance flow imaging permit noninvasive estimation of TKE. The study was approved by the local ethics review board and all subjects gave written informed consent. Three-dimensional cine magnetic resonance flow imaging was used to measure TKE in 18 subjects (4 normal volunteers, 14 patients with aortic stenosis with and without dilation). For each subject, the peak total TKE in the ascending aorta was compared with a pressure loss index. The pressure loss index was based on a previously validated theory relating pressure loss to measures obtainable by echocardiography. The total TKE did not appear to be related to global flow patterns visualized based on magnetic resonance–measured velocity fields. The TKE was significantly higher in patients with aortic stenosis than in normal volunteers (p < 0.001). The peak total TKE in the ascending aorta was strongly correlated to index pressure loss (R2 = 0.91). Peak total TKE in the ascending aorta correlated strongly with irreversible pressure loss estimated by a well-established method. Direct measurement of TKE by magnetic resonance flow imaging may, with further validation, be used to estimate irreversible pressure loss in aortic stenosis.
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