Age-related changes of right atrial morphology and inflow pattern assessed using 4D flow cardiovascular magnetic resonance: results of a population-based study

Abstract

BackgroundTo assess age-related changes of blood flow and geometry of the caval veins and right atrium (RA) using 4D flow cardiovascular magnetic resonance (CMR) data obtained in a population-based study.MethodsAn age-stratified sample (n = 126) of the population of the city of Freiburg, Germany, underwent transthoracic echocardiography and electrocardiogram-triggered and navigator-gated 4D flow CMR at 3 Tesla covering the caval veins and right heart. Study participants were divided into three age groups (1:20–39; 2:40–59; and 3:60–80 years of age). Analysis planes were placed in the superior and inferior caval vein. Subsequently, RA morphology and three-dimensional blood inflow pattern was assessed.ResultsBlood flow of the RA showed a clockwise rotating helix without signs of turbulence in younger subjects. By contrast, such rotation was absent in 12 subjects of group 3 and turbulences were significantly more frequent (p < 0.001). We observed an age-related shift of the caval vein axis. While the outlets of the superior and inferior caval veins were facing each other in group 1, lateralization occurred in older subjects (p < 0.001). A convergence of axes was observed from lateral view with facing axes in older subjects (p = 0.004). Finally, mean and peak systolic blood flow in the caval veins decreased with age (group 3 < 2 < 1).ConclusionsWe have provided reference values of 4D CMR blood flow for different age groups and demonstrated the significant impact of age on hemodynamics of the RA inflow tract. This effect of aging should be taken into account when assessing pathologic conditions of the heart in the future.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0456-9) contains supplementary material, which is available to authorized users.

Computational fluid dynamics of the right atrium: Assessment of modelling criteria for the evaluation of dialysis catheters

“…Our predictions yield maximum systolic flow rate values of 106 ml/s and 120 ml/s for the IVC and SVC. While the obtained waveform and maximum for the IVC are consistent with clinical predictions (maximum value of 151.1 ± 55.3 ml/s at systole for a group of healthy adults aged 20-39 years), the SVC waveform and maximum value are overestimated (maximum value increased by 22% in comparison with the maximum standard deviation observed in the literature [49]).…”

“…The time-evolution of flow rates through the SVC, IVC and TV over a cardiac cycle period are presented in Fig 11. Similar to the literature, both SVC and IVC have similar flow rate waveforms, with a two-peaked shape (a peak at ventricular systole and a smaller one at ventricular diastole) [42,49]. Literature shows that the range of these flow rate waveforms can greatly vary amongst a population sample and with age [49]. Our predictions yield maximum systolic flow rate values of 106 ml/s and 120 ml/s for the IVC and SVC.…”

“…The SVC blood flow rate waveform and maximum value were overestimated in comparison with the literature. However, there is elevated variability in patient data for blood flow rate through the SVC and IVC: for example, the difference between average and the maximum standard deviation values for the IVC in literature is 33% [ 49 ]. Moreover, since other hemodynamic features in the RA from our study are consistent with the literature, we accept this as a limitation of the study which does not greatly impact on the remaining computational predictions concerning the evaluation of catheter performance, especially since all catheters have been compared using the same model.…”

Journal of Cardiovascular Magnetic Resonance: 2017/2018 in review

“…To assess age-related changes of blood flow and geometry of the caval veins and right atrium, Wehrum et al [127] studied an age-stratified sample of 126 subjects in the city of Freiburg, Germany. They found right atrial blood flow had a clockwise rotating helix without signs of turbulence in younger subjects with absent rotation in older subjects.…”

Age‑related myocardial remodeling: myth or reality?

“…zvětšování objemu pravé síně a jejího indexu. Podrobné morfologické studie prokázaly také změnu geometrie vústění horní a dolní duté žíly v závislosti na věku (posun osy horní a dolní duté žíly, které vedou k narušení fyziologického plnění pravé síně)(9).Pohlavní rozdíly v procesu věkem podmíněné remodelace levé komory jsou významné. V porovnání se ženami přetrvává u mužů i v průběhu věku většinou větší absolutní masa levé komory a větší objemy srdečních oddílů, u žen dochází s věkem k významnějšímu poklesu objemu srdečních dutin.…”