Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study

Guala, Andrea; Teixidó-Turà, Gisela; Dux-Santoy, Lydia; Granato, Chiara; Ruiz-Muñoz, Aroa; Valente, Filipa; Galián-Gay, Laura; Gutiérrez, Laura; González‐Alujas, Teresa; Johnson, Kevin M.; Wieben, Oliver; Avilés, Augusto Sao; Evangelista, Artur; Rodríguez-Palomares, José F.

doi:10.1186/s12968-019-0572-1

Cited by 40 publications

(25 citation statements)

References 40 publications

(48 reference statements)

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“… 17 In this context, it is important to underline that flow in the aortic arch is impacted by aortic curvature and the presence of supra-aortic trunks. 28 , 32 These characteristics may promote local recirculation zones, 33 , 34 thus creating regions of low and oscillatory WSS 12 , 32 that may contribute to aortic arch aneurysm formation. 28 However, considering our results and previous investigations, we conclude that there is not sufficient evidence to support the contribution of this mechanism to aortic dilation in patients with BAV.…”

Section: Discussionmentioning

confidence: 99%

Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve

Dux-Santoy

Guala

Sotelo

et al. 2020

ATVB

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Objective: To assess the relationship between regional wall shear stress (WSS) and oscillatory shear index (OSI) and aortic dilation in patients with bicuspid aortic valve (BAV). Approach and Results: Forty-six consecutive patients with BAV (63% with right-left-coronary-cusp fusion, aortic diameter ≤ 45 mm and no severe valvular disease) and 44 healthy volunteers were studied by time-resolved 3-dimensional phase-contrast magnetic resonance imaging. WSS and OSI were quantified at different levels of the ascending aorta and the aortic arch, and regional WSS and OSI maps were obtained. Seventy percent of BAV had ascending aorta dilation. Compared with healthy volunteers, patients with BAV had increased WSS and decreased OSI in most of the ascending aorta and the aortic arch. In both BAV and healthy volunteers, regions of high WSS matched regions of low OSI and vice versa. No regions of both low WSS and high OSI were identified in BAV compared with healthy volunteers. Patients with BAV with dilated compared with nondilated aorta presented low and oscillatory WSS in the aortic arch, but not in the ascending aorta where dilation is more prevalent. Furthermore, no regions of concomitant low WSS and high OSI were identified when BAV were compared according to leaflet fusion pattern, despite the well-known differences in regional dilation prevalence. Conclusions: Regions with low WSS and high OSI do not match those with the highest prevalence of dilation in patients with BAV, thus providing no evidence to support the low and oscillatory shear stress theory in the pathogenesis of proximal aorta dilation in the presence of BAV.

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Section: Discussionmentioning

confidence: 99%

Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve

Dux-Santoy

Guala

Sotelo

et al. 2020

ATVB

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“…Altered flow patterns and decreased circumferential WSS have been reported in Marfan patients as well [ 22 , 43 ]. The maps of abnormally directed hemodynamics may have added value in diagnosis, timing of surgery and patient monitoring in the Marfan population.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, since vascular disease is promoted by low and oscillatory WSS [ 25 , 26 ], the multidirectionality of WSS has been extensively investigated by comparison with the curvature of the aorta [ 19 , 22 , 27 ]. However, the comparison of pathological axial and circumferential WSS with the normal situation may be confounded by an altered aortic shape in BAV disease [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Fully quantitative mapping of abnormal aortic velocity and wall shear stress direction in patients with bicuspid aortic valves and repaired coarctation using 4D flow cardiovascular magnetic resonance

Ooij

Farag

Blanken

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Helices and vortices in thoracic aortic blood flow measured with 4D flow cardiovascular magnetic resonance (CMR) have been associated with aortic dilation and aneurysms. Current approaches are semi-quantitative or when fully quantitative based on 2D plane placement. In this study, we present a fully quantitative and three-dimensional approach to map and quantify abnormal velocity and wall shear stress (WSS) at peak systole in patients with a bicuspid aortic valve (BAV) of which 52% had a repaired coarctation. Methods 4D flow CMR was performed in 48 patients with BAV and in 25 healthy subjects at a spatiotemporal resolution of 2.5 × 2.5 × 2.5mm3/ ~ 42 ms and TE/TR/FA of 2.1 ms/3.4 ms/8° with k-t Principal Component Analysis factor R = 8. A 3D average of velocity and WSS direction was created for the normal subjects. Comparing BAV patient data with the 3D average map and selecting voxels deviating between 60° and 120° and > 120° yielded 3D maps and volume (in cm3) and surface (in cm2) quantification of abnormally directed velocity and WSS, respectively. Linear regression with Bonferroni corrected significance of P < 0.0125 was used to compare abnormally directed velocity volume and WSS surface in the ascending aorta with qualitative helicity and vorticity scores, with local normalized helicity (LNH) and quantitative vorticity and with patient characteristics. Results The velocity volumes > 120° correlated moderately with the vorticity scores (R ~ 0.50, P < 0.001 for both observers). For WSS surface these results were similar. The velocity volumes between 60° and 120° correlated moderately with LNH (R = 0.66) but the velocity volumes > 120° did not correlate with quantitative vorticity. For abnormal velocity and WSS deviating between 60° and 120°, moderate correlations were found with aortic diameters (R = 0.50–0.70). For abnormal velocity and WSS deviating > 120°, additional moderate correlations were found with age and with peak velocity (stenosis severity) and a weak correlation with gender. Ensemble maps showed that more than 60% of the patients had abnormally directed velocity and WSS. Additionally, abnormally directed velocity and WSS was higher in the proximal descending aorta in the patients with repaired coarctation than in the patients where coarctation was never present. Conclusion The possibility to reveal directional abnormalities of velocity and WSS in 3D provides a new tool for hemodynamic characterization in BAV disease.

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“…This research was based mainly on CMR since this imaging technique is widely used in the clinical management of these patients. Most studies reported increased stiffness in MFS patients, either as reduced distensibility [26,[57][58][59][60][61] or longitudinal aortic strain [9], or as an increase in PWV [26,59,60,62]. However, despite the relatively large number of cross-sectional studies available, only two longitudinal CMR studies evaluated the potential predictive role of increased aortic stiffness in aortic dilation or aortic events in MFS patients.…”

Section: Magnetic Resonance Imaging In Marfan Syndrome Patientsmentioning

confidence: 99%

Magnetic Resonance Imaging for Aortic Function Evaluation in Thoracic Aortic Aneurysms

Guala¹,

Teixidó-Turà²,

Evangelista³

et al. 2020

Artery Res

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Thoracic aortic aneurysm is a common cardiovascular disease consisting of marked dilation of the aorta. Aortic aneurysms carry a high risk of life-threatening complications such as aortic dissection or rupture. Classically, maximum aortic diameter has been used as the sole descriptor of aneurysm severity and is considered the main predictor of complications. However, maximum aortic diameter measurement is often poorly reproducible and about 60% of type A and 80% of type B aortic dissections occurred in patients with an aortic diameter inferior to that recommended for the indication of elective surgical treatment. Therefore, new biomarkers for risk stratification in thoracic aortic aneurysm are needed. Cardiovascular magnetic resonance (CMR) imaging is a non-invasive imaging technique widely used for diagnosis, clinical follow-up and research in thoracic aortic aneurysms. CMR applications to thoracic aortic aneurysms are generally based on either cine CMR images, which are time-resolved images providing dynamic structural visualization, or phase-contrast images, which utilise a flow-encoding gradient to assess timeresolved velocity data. Particularly with 3D velocity encoding (4D flow MRI), phase-contrast imaging permits detailed study of haemodynamic in thoracic aortic aneurysms while cine CMR is often used to assess aortic geometry and its changes through the cardiac cycle or during follow-up. The possibilities offered by CMR for studying thoracic aortic aneurysms and a description of their applications in Bicuspid Aortic Valve (BAV) and Marfan patients are here reviewed.

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Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study

Cited by 40 publications

References 40 publications

Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve

Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve

Fully quantitative mapping of abnormal aortic velocity and wall shear stress direction in patients with bicuspid aortic valves and repaired coarctation using 4D flow cardiovascular magnetic resonance

Magnetic Resonance Imaging for Aortic Function Evaluation in Thoracic Aortic Aneurysms

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