MRI as a tool for non-invasive vascular profiling: a pilot study in patients with aortic coarctation

Kelm, Marcus; Goubergrits, Leonid; Fernandes, João Filipe; Biocca, Lucio; Pongiglione, Giacomo; Muthurangu, Vivek; Khushnood, Abbas; Secinaro, Aurelio; Chinali, Marcello; Schubert, Stephan; Berger, Felix; Küehne, Titus

doi:10.1586/17434440.2015.1090309

Cited by 8 publications

(9 citation statements)

References 34 publications

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“…Although volume flow was obtained by MRI, pressure measurements are currently typically based on invasive catheterization in order to compute pressure volume loops, carrying the risks of non-simultaneous assessment. In order to avoid post-interventional catheterization artefacts, where the MAP is often influenced by a the treatment procedure itself due to pain and vascular response [26], cuff pressures were used for the calculation of EHP. The integrity of the left subclavian artery was ensured by MR imaging.…”

Section: Discussionmentioning

confidence: 99%

Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation

et al. 2017

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BackgroundIn aortic coarctation, current guidelines recommend reducing pressure gradients that exceed given thresholds. From a physiological standpoint this should ideally improve the energy expenditure of the heart and thus prevent long term organ damage.ObjectivesThe aim was to assess the effects of interventional treatment on external and internal heart power (EHP, IHP) in patients with aortic coarctation and to explore the correlation of these parameters to pressure gradients obtained from heart catheterization.MethodsIn a collective of 52 patients with aortic coarctation 25 patients received stenting and/or balloon angioplasty, and 20 patients underwent MRI before and after an interventional treatment procedure. EHP and IHP were computed based on catheterization and MRI measurements. Along with the power efficiency these were combined in a cardiac energy profile.ResultsBy intervention, the catheter gradient was significantly reduced from 21.8±9.4 to 6.2±6.1mmHg (p<0.001). IHP was significantly reduced after intervention, from 8.03±5.2 to 4.37±2.13W (p < 0.001). EHP was 1.1±0.3 W before and 1.0±0.3W after intervention, p = 0.044. In patients initially presenting with IHP above 5W intervention resulted in a significant reduction in IHP from 10.99±4.74 W to 4.94±2.45W (p<0.001), and a subsequent increase in power efficiency from 14 to 26% (p = 0.005). No significant changes in IHP, EHP or power efficiency were observed in patients initially presenting with IHP < 5W.ConclusionIt was demonstrated that interventional treatment of coarctation resulted in a decrease in IHP. Pressure gradients, as the most widespread clinical parameters in coarctation, did not show any correlation to changes in EHP or IHP. This raises the question of whether they should be the main focus in coarctation interventions. Only patients with high IHP of above 5W showed improvement in IHP and power efficiency after the treatment procedure.Trial Registrationclinicaltrials.gov NCT02591940

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Section: Discussionmentioning

confidence: 99%

Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation

et al. 2017

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“…In patients with inadequately low resolution, flow rates to the descending aorta (19 ± 9.4%) were considerably lower than previously published flow rates in CoA patients with 46.7 ± 16.4% and in healthy controls with 67.7 ± 12.6%. 18 It was further demonstrated that the low flow cases were associated with a high degree of stenosis (cross-sectional area in percentage reduced by the stenosis: 77.1 ± 5.64%) as well as a formation of collateral vessels. In all "low flow" patients there was a clinical treatment indication according clinical guidelines, as all were associated with a higher degree of stenosis.…”

Section: Discussionmentioning

confidence: 90%

“…The noninvasive assessment of transstenotic pressure drop and flow distribution prior to heart catheterization has been previously described in patients with aortic coarctation. Our study adds a clinical validation of pressure drop based on pressure mapping computation against current clinical reference standards, as well as the proposed workflow to integrate the method in diagnostic approaches.…”

Section: Discussionmentioning

confidence: 99%

Patient‐specific requirements and clinical validation of MRI‐based pressure mapping: A two‐center study in patients with aortic coarctation

Goubergrits

Hellmeier

Neumann

et al. 2018

Magnetic Resonance Imaging

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Background Invasive peak‐to‐peak pressure gradients are the current clinical reference standard for assessing aortic coarctation. To obtain them, patients need to undergo arterial heart catheterization. Unless an intervention is performed, the procedure remains purely diagnostic, while the concomitant risks remain. Purpose To validate MRI‐based pressure mapping against pressure drop derived from heart catheterization and to define minimal clinical requirements. Study Type Prospective clinical validation study. Population Twenty‐seven coarctation patients with an indicated heart catheterization were enrolled at two clinical centers. MRI Sequences 1.5T including 4D velocity‐encoded MRI and 3D anatomical imaging of the aorta. Assessment Pressure drop across the stenosis was calculated by pressure mapping based on the pressure Poisson equation. Calculated pressure drops were compared with catheter measured data. Spatial and temporal resolution were analyzed using in silico phantom‐based data as well as in vivo measurements. Statistics Pressure drop was compared to peak‐to‐peak measurements. A two‐sample paired mean equivalence test was used. Results In patients without imaging artifacts and a required spatial resolution ≥5 voxel/diameter, significant equivalence of pressure mapping compared to heart catheterization was found (17.5 ± 6.49 vs. 16.6 ± 6.53 mmHg, P < 0.001). Data Conclusion Pressure mapping provides equivalent accuracy to pressure drop obtained from heart catheterization in patients 1) without previous stenting and 2) with sufficient spatial image resolution (at least 5 voxels/diameter). In these patients the method can reliably be performed prior to the actual procedure, and thus allows safe noninvasive treatment planning based on MRI. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:81–89.

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“…Although current guidelines recommend reintervention once gradient thresholds are reached, Computational Fluid Dynamic simulations carry the potential for more personalized decision making in the future. 54,55 Overall, our results focusing on short-term and midterm outcome may be seen as clear arguments toward stent placement. However, the issue of long-term outcome has only incompletely been studied and remains more difficult to assess.…”

Section: Immediate and Follow-up Outcomesmentioning

confidence: 61%

Balloon Dilatation and Stenting for Aortic Coarctation

Salcher‐Konrad

Naci

Law

et al. 2016

Circ: Cardiovascular Interventions

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Background— There is no systematic assessment of available evidence on effectiveness and comparative effectiveness of balloon dilatation and stenting for aortic coarctation. Methods and Results— We systematically searched 4 online databases to identify and select relevant studies of balloon dilatation and stenting for aortic coarctation based on a priori criteria (PROSPERO 2014:CRD42014014418). We quantitatively synthesized results for each intervention from single-arm studies and obtained pooled estimates for relative effectiveness from pairwise and network meta-analysis of comparative studies. Our primary analysis included 15 stenting (423 participants) and 12 balloon dilatation studies (361 participants), including patients ≥10 years of age. Post-treatment blood pressure gradient reduction to ≤20 and ≤10 mm Hg was achieved in 89.5% (95% confidence interval, 83.7–95.3) and 66.5% (44.1–88.9%) of patients undergoing balloon dilatation, and in 99.5% (97.5–100.0%) and 93.8% (88.5–99.1%) of patients undergoing stenting, respectively. Odds of achieving ≤20 mm Hg were lower with balloon dilatation as compared with stenting (odds ratio, 0.105 [0.010–0.886]). Thirty-day survival rates were comparable. Numerically more patients undergoing balloon dilatation experienced severe complications during admission (6.4% [2.6–10.2%]) compared with stenting (2.6% [0.5–4.7%]). This was supported by meta-analysis of head-to-head studies (odds ratio, 9.617 [2.654–34.845]) and network meta-analysis (odds ratio, 16.23, 95% credible interval: 4.27–62.77) in a secondary analysis in patients ≥1 month of age, including 57 stenting (3397 participants) and 62 balloon dilatation studies (4331 participants). Conclusions— Despite the limitations of the evidence base consisting predominantly of single-arm studies, our review indicates that stenting achieves superior immediate relief of a relevant pressure gradient compared with balloon dilatation.

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MRI as a tool for non-invasive vascular profiling: a pilot study in patients with aortic coarctation

Abstract: It was successfully shown that functional vascular profiling of the aorta is feasible to be acquired non-invasively in a clinical setting and can provide additional diagnostic information. These can be the key input parameters for computational fluid dynamics-modeling.

Cited by 8 publications

References 34 publications

Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation

Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation

Patient‐specific requirements and clinical validation of MRI‐based pressure mapping: A two‐center study in patients with aortic coarctation

Balloon Dilatation and Stenting for Aortic Coarctation

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