Sex-Specific Normalized Reference Values of Heart and Great Vessel Dimensions in Cardiac CT Angiography

Nevsky, Gregory; Jacobs, Jill E.; Lim, Ruth; Donnino, Robert; Babb, James S.; Srichai, Monvadi B.

doi:10.2214/ajr.10.4990

Cited by 42 publications

(42 citation statements)

References 11 publications

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“…The increase in CO is mediated via increased IVC flow, with the SVC flow staying relatively constant. The values and trends of EF are consistent with previous literature reports [30,44,45]. The resulting atrial pressures are similar to values reported by Leupker et al, and remain relatively steady at different MET levels with some increases at high MET levels as clinically observed during continuous exercise [36].…”

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confidence: 90%

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A Simulation Protocol for Exercise Physiology in Fontan Patients Using a Closed Loop Lumped-Parameter Model

Kung

Pennati

Migliavacca

et al. 2014

Journal of Biomechanical Engineering

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Background: Reduced exercise capacity is nearly universal among Fontan patients, though its etiology is not yet fully understood. While previous computational studies have attempted to model Fontan exercise, they did not fully account for global physiologic mechanisms nor directly compare results against clinical and physiologic data. Methods: In this study, we developed a protocol to simulate Fontan lower-body exercise using a closed-loop lumped-parameter model describing the entire circulation. We analyzed clinical exercise data from a cohort of Fontan patients, incorporated previous clinical findings from literature, quantified a comprehensive list of physiological changes during exercise, translated them into a computational model of the Fontan circulation, and designed a general protocol to model Fontan exercise behavior. Using inputs of patient weight, height, and if available, patient-specific reference heart rate (HR) and oxygen consumption, this protocol enables the derivation of a full set of parameters necessary to model a typical Fontan patient of a given body-size over a range of physiologic exercise levels. Results: In light of previous literature data and clinical knowledge, the model successfully produced realistic trends in physiological parameters with exercise level. Applying this method retrospectively to a set of clinical Fontan exercise data, direct comparison between simulation results and clinical data demonstrated that the model successfully reproduced the average exercise response of a cohort of typical Fontan patients. Conclusion: This work is intended to offer a foundation for future advances in modeling Fontan exercise, highlight the needs in clinical data collection, and provide clinicians with quantitative reference exercise physiologies for Fontan patients. [DOI: 10.1115/1.4027271] IntroductionSingle ventricle physiology is one of the most severe forms of congenital heart disease, in which an infant has only one functional pumping chamber. The condition is not compatible with life without treatment and these infants require immediate surgical intervention after birth, typically followed by two additional palliative procedures within the first few years of life. The Fontan procedure, in its various technical modifications, represents the final stage of the multistaged surgery that achieves complete separation of the deoxygenated and oxygenated blood in the circulation. The procedure involves directly connecting the superior venae cavae and inferior venae cavae (SVC and IVC) to the pulmonary arteries, thus bypassing the heart and resulting in the total venous return flowing passively into the pulmonary circulation.Exercise intolerance is among the myriad complications that contribute to the gradual attrition of post-Fontan patients in the years following surgery. Other causes of decreased survival include ventricular dysfunction, atrial arrhythmias, protein-losing enteropathy, arteriovenous malformations, thrombotic complications, and poor neurodevelopmental outcomes [1]. While ...

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“…Based on literature data of end diastolic and systolic volume (EDV and ESV) measurements in humans [30,44,45], and clinical knowledge of ejection fractions (EF) that represent typical Fontan patients, we define an equation for V svo that results in realistic pressure-volume loops 081007-4 / Vol. 136, AUGUST 2014…”

Section: à2mentioning

confidence: 99%

A Simulation Protocol for Exercise Physiology in Fontan Patients Using a Closed Loop Lumped-Parameter Model

Kung

Pennati

Migliavacca

et al. 2014

Journal of Biomechanical Engineering

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“…However, it appears the gender differences could largely be accounted for by differences in the BSA between men and women [20,42] for the main PA size, with the exception of the right PA. Similarly, gender differences in the size of the aorta could also be explained by adjusting for the BSA, but notably not the ascending aorta [42].…”

Section: What Is the Normal Reference Value?mentioning

confidence: 99%

The Significance of Pulmonary Artery Size in Pulmonary Hypertension

et al. 2014

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Pulmonary hypertension (PH) has been found to have significant morbidity and mortality. The treatment of PH has advanced considerably with increasingly more effective and safer options. With an increasing effort to diagnose patients early, non-invasive techniques are often used to screen those patients likely to have PH. Computerized tomography (CT) chest scans are increasingly utilized in the evaluation of patients with exertional dyspnea, including those with suspected PH. The main role of the CT scan is to evaluate for any associated underlying diseases. There have been attempts to address the utility of CT to predict the presence of PH. This article reviews previously published investigations to summarize the relationship between pulmonary artery dimensions and PH to determine both the strength of the correlation and its discriminatory ability for use in clinical practice.

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“…Such noninvasive approach can reduce patient's risk and allow earlier PH diagnosis. Though management decisions strongly depends on comparison of measured parameters with normal values, little has been published in reference to normal CT limits of thoracic aorta and pulmonary trunk (PT) parameters, as well as their association to variable factors (Wolak et al;Lin et al, 2008;Nevsky et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Parameters of Ascending Aorta, Descending Aorta and Pulmonary Trunk by Computed Tomographic Angiography with Impact of Age, Hypertension, Smoking and Diabetes

et al. 2015

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SUMMARY:This study aims at establishing whether transverse diameter (TD) and cross sectional-area (CSA) of the ascending aorta (AA), descending aorta (DA) and pulmonary trunk (PT) measured by computerized tomographic angiography (CTA) altered by sex, age, hypertension, smoking and diabetes. CTA examinations of the TD and CSA of the AA, DA and PT of 100 patients aged 49.5±16.9 years (range 16-78 years) selected between January 2009 to May 2011 from those referred to Radiology Department, Jordan University Hospital, Faculty of Medicine, University of Jordan, Amman, Jordan for advanced evaluation. Measurements were made in the axial plane at the upper border of the six thoracic vertebrae. Patients were divided into three age groups. Significance of differences in parameters between age groups was calculated. Assessment ratios were considered. It was found that parameters of the three arteries were significantly larger in men than in women (P= < 0.05) and increased with age. Hypertension increased diameters of AA and DA in both genders (P= 0.001) and of PT in men (P= 0.01). Smoking significantly decreased parameters of PT in men (P= 0.01). Diabetes increased parameters of the three arteries in both genders, significantly increased parameters of PT in men (P= <0.05) and parameters of DA in women (P= <0.05). It is concluded that studied parameters were larger in men and increased with age of our patients. Distinctive differences in measurements appeared in hypertensive, smokers, and diabetic patients.

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Sex-Specific Normalized Reference Values of Heart and Great Vessel Dimensions in Cardiac CT Angiography

Abstract: Cardiac CTA measurements of the left cardiac chambers, thoracic aorta, and pulmonary arteries were established for a population without CAD or its risk factors.

Cited by 42 publications

References 11 publications

A Simulation Protocol for Exercise Physiology in Fontan Patients Using a Closed Loop Lumped-Parameter Model

A Simulation Protocol for Exercise Physiology in Fontan Patients Using a Closed Loop Lumped-Parameter Model

The Significance of Pulmonary Artery Size in Pulmonary Hypertension

Sex-Specific Parameters of Ascending Aorta, Descending Aorta and Pulmonary Trunk by Computed Tomographic Angiography with Impact of Age, Hypertension, Smoking and Diabetes

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