Abnormal Wave Reflections and Left Ventricular Hypertrophy Late After Coarctation of the Aorta Repair

Abstract

Supplemental Digital Content is available in the text.

Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 1): Physiologic and Technical Considerations

“…12 In particular, the LV loading sequence (late vs. early systolic load), which is intrinsically neglected by analyses in the pressure-volume plane, is an important determinant of maladaptive remodeling, hypertrophy, diastolic dysfunction and heart failure risk. 30–37 In addition, the commonly made assumption that E A is a lumped parameter of resistive and pulsatile arterial load, is factually incorrect. 12,38–40 Despite its name, E A is not a true elastance (i.e., the inverse of a compliance) and is mostly dependent on vascular resistance (a microvascular, rather than a conduit artery property).…”

Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations

“…a relationship between reflection magnitude (approximated from measured pressure and an assumed physiologic flow waveform) and LV mass has been reported in large community-based studies that included normotensive and hypertensive individuals [15, 24]. Similarly, Quail et al recently demonstrated that in patients with repaired aortic coarctation, reflection magnitude assessed from the ascending aortic distension waveform (a surrogate of the aortic pressure waveform) and measured aortic flow (using phase-contrast MRI) was independently associated with LV hypertrophy [25]. When interpreted in the context of available animal data, available human studies support a role for wave reflections in the development of LV hypertrophy, independent of absolute blood pressure levels.…”

Children with kawasaki disease present elevated stiffness of great arteries: Phase‐contrast MRI study

“…Segmented tissue and phase contours were then transferred into the custom MatLab program (MathWorks, Natick, MA) for further PWV calculations as shown in our previous studies . We derived PWV using a flow‐area (QA) method that enables regionally specific assessment of vascular stiffness by calculating dQ/dA of the flow‐area loop at the early systolic phase under assumption of a backward reflection free environment . To meet this assumption, we considered data points at the early systolic phase without signs of plateauing or upstroke notch, which commonly signify the presence of impeding backward wave reflection.…”

“…Phase‐contrast MRI (PC‐MRI) enables accurate noninvasive measurement of aortic pulse‐wave velocity (PWV), considered to be the most validated marker of central aortic stiffness . PC‐MRI computed PWV allows for segment‐specific analysis of vascular stiffness, and considers the heterogeneity in vessel wall composition, vessel branching, and backward wave reflections, all typically unevaluated in tonometry‐based studies . Importantly, central aortic and MPA stiffness assessed by PWV have been shown to be prognostic of cardiovascular events with respect to both systemic and pulmonary vasculatures, including hypertension, atherosclerosis, and aneurysmal processes .…”