Magnetic Resonance Measurement of Turbulent Kinetic Energy for the Estimation of Irreversible Pressure Loss in Aortic Stenosis

Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California. Electronic address: .
JACC. Cardiovascular imaging (Impact Factor: 7.19). 01/2013; 6(1):64-71. DOI: 10.1016/j.jcmg.2012.07.017
Source: PubMed


OBJECTIVES: The authors sought to measure the turbulent kinetic energy (TKE) in the ascending aorta of patients with aortic stenosis and to assess its relationship to irreversible pressure loss. BACKGROUND: Irreversible pressure loss caused by energy dissipation in post-stenotic flow is an important determinant of the hemodynamic significance of aortic stenosis. The simplified Bernoulli equation used to estimate pressure gradients often misclassifies the ventricular overload caused by aortic stenosis. The current gold standard for estimation of irreversible pressure loss is catheterization, but this method is rarely used due to its invasiveness. Post-stenotic pressure loss is largely caused by dissipation of turbulent kinetic energy into heat. Recent developments in magnetic resonance flow imaging permit noninvasive estimation of TKE. METHODS: The study was approved by the local ethics review board and all subjects gave written informed consent. Three-dimensional cine magnetic resonance flow imaging was used to measure TKE in 18 subjects (4 normal volunteers, 14 patients with aortic stenosis with and without dilation). For each subject, the peak total TKE in the ascending aorta was compared with a pressure loss index. The pressure loss index was based on a previously validated theory relating pressure loss to measures obtainable by echocardiography. RESULTS: The total TKE did not appear to be related to global flow patterns visualized based on magnetic resonance-measured velocity fields. The TKE was significantly higher in patients with aortic stenosis than in normal volunteers (p < 0.001). The peak total TKE in the ascending aorta was strongly correlated to index pressure loss (R(2) = 0.91). CONCLUSIONS: Peak total TKE in the ascending aorta correlated strongly with irreversible pressure loss estimated by a well-established method. Direct measurement of TKE by magnetic resonance flow imaging may, with further validation, be used to estimate irreversible pressure loss in aortic stenosis.

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Available from: Michael D Hope, Oct 06, 2015
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    • "13 interaction and subjectivity of visualization [16] [19]. The proposed 3D flow displacement analysis does just this by using a semi-automatic, 3D segmentation (Amira software, 5 minutes per patient) to generate quantitative measurements of abnormal aortic flow. "
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    ABSTRACT: Flow displacement quantifies eccentric flow, a potential risk factor for aneurysms in the ascending aorta, but only at a single anatomic location. The aim of this study is to extend flow displacement analysis to 3D in patients with aortic and aortic valve pathologies. 43 individuals were studied with 4DFlow MRI in 6 groups: healthy, tricuspid aortic valve (TAV) with aortic stenosis (AS) but no dilatation, TAV with dilatation but no AS, and TAV with both AS and dilatation, BAV without AS or dilatation, BAV without AS but with dilation. The protocol was approved by our institutional review board, and informed consent was obtained. Flow displacement was calculated for multiple planes along the ascending aorta, and 2D and 3D analyses were compared. Good correlation was found between 2D flow displacement and both maximum and average 3D values (r>0.8). Healthy controls had significantly lower flow displacement values with all approaches (p<0.05). The highest flow displacement was seen with stenotic TAV and aortic dilation (0.24±0.02 with maximum flow displacement). The 2D approach underestimated the maximum flow displacement by more than 20% in 13 out of 36 patients (36%). The extended 3D flow displacement analysis offers a more comprehensive quantitative evaluation of abnormal systolic flow in the ascending aorta than 2D analysis. Differences between patient subgroups are better demonstrated, and maximum flow displacement is more reliable assessed. Copyright © 2015. Published by Elsevier Inc.
    Magnetic Resonance Imaging 02/2015; 33(5). DOI:10.1016/j.mri.2015.02.020 · 2.09 Impact Factor
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    • "A recent substudy of SEAS cohort [22] showed the potential usefulness of energy loss, pressure recovery and energy loss coefficient ([EOA×AAo] / [AAo-EOA]) for AS severity assessment, highlighting the importance of this parameter unexplored in CMR. A more accurate evaluation of energy loss and vorticity may be computed using CMR 4D flow velocity measurements [29,38-40]. "
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    ABSTRACT: Valve effective orifice area EOA and transvalvular mean pressure gradient (MPG) are the most frequently used parameters to assess aortic stenosis (AS) severity. However, MPG measured by cardiovascular magnetic resonance (CMR) may differ from the one measured by transthoracic Doppler-echocardiography (TTE). The objectives of this study were: 1) to identify the factors responsible for the MPG measurement discrepancies by CMR versus TTE in AS patients; 2) to investigate the effect of flow vorticity on AS severity assessment by CMR; and 3) to evaluate two models reconciling MPG discrepancies between CMR/TTE measurements. Eight healthy subjects and 60 patients with AS underwent TTE and CMR. Strouhal number (St), energy loss (EL), and vorticity were computed from CMR. Two correction models were evaluated: 1) based on the Gorlin equation (MPGCMR-Gorlin); 2) based on a multivariate regression model (MPGCMR-Predicted). MPGCMR underestimated MPGTTE (bias = -6.5 mmHg, limits of agreement from -18.3 to 5.2 mmHg). On multivariate regression analysis, St (p = 0.002), EL (p = 0.001), and mean systolic vorticity (p < 0.001) were independently associated with larger MPG discrepancies between CMR and TTE. MPGCMR-Gorlin and MPGTTE correlation and agreement were r = 0.7; bias = -2.8 mmHg, limits of agreement from -18.4 to 12.9 mmHg. MPGCMR-Predicted model showed better correlation and agreement with MPGTTE (r = 0.82; bias = 0.5 mmHg, limits of agreement from -9.1 to 10.2 mmHg) than measured MPGCMR and MPGCMR-Gorlin. Flow vorticity is one of the main factors responsible for MPG discrepancies between CMR and TTE.
    Journal of Cardiovascular Magnetic Resonance 09/2013; 15(1):84. DOI:10.1186/1532-429X-15-84 · 4.56 Impact Factor
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    ABSTRACT: Multidimensional blood flow imaging with magnetic resonance has rapidly evolved over the last decade. The technique, often referred to as 4-dimensional (4D) flow, can now reliably image the heart and principal vessels of the chest in ≤15 minutes. In addition to dynamic 3D flow visualization, a range of unique quantitative hemodynamic markers can be calculated from 4D flow data. In this review article, we describe some of the more promising of these hemodynamic markers, including pulse wave velocity, pressure, turbulent kinetic energy, wall shear stress, and flow eccentricity. Evaluation of a range of cardiothoracic disorders has been explored with 4D flow, and many applications have been proposed. We also review the potential clinical applications of 4D flow in 4 broad contexts: the aorta, the pulmonary artery, acquired heart disease, and complex congenital heart disease. Promising preliminary results will be highlighted, including the use of abnormal systolic blood flow to risk-stratify patients for progressive valve-related aortic disease, turbulent kinetic energy to directly assess the hemodynamic impact of a stenotic lesion, and altered intracardiac flow to identify early heart failure. We discuss ongoing research efforts in the context of the larger clinical goals of 4D flow: the use of unique hemodynamic markers to (1) identify cardiovascular disease processes early in their course before clinical manifestation so that preemptive treatment can be undertaken; (2) refine the assessment of cardiovascular disease so as to better identify optimal medical or surgical therapies; and (3) enhance the evaluation and monitoring of the hemodynamic impact of different treatment options.
    Journal of thoracic imaging 05/2013; 28(4). DOI:10.1097/RTI.0b013e31829192a1 · 1.74 Impact Factor
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