Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow study
ABSTRACT: Background: Aortic dilation is seen in pediatric/young adult patients with bicuspid aortic valve (BAV), and hemodynamic markers to predict aortic dilation are necessary for monitoring. Although promising hemodynamic metrics, such as abnormal wall shear stress (WSS) magnitude, have been pr...
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Elsevier
2024-01-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664724011293 |
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| author | Takashi Fujiwara LaDonna J. Malone Kathryn C. Chatfield Alex Berthusen Brian Fonseca Lorna P. Browne Alex J. Barker |
| author_facet | Takashi Fujiwara LaDonna J. Malone Kathryn C. Chatfield Alex Berthusen Brian Fonseca Lorna P. Browne Alex J. Barker |
| author_sort | Takashi Fujiwara |
| collection | DOAJ |
| description | ABSTRACT: Background: Aortic dilation is seen in pediatric/young adult patients with bicuspid aortic valve (BAV), and hemodynamic markers to predict aortic dilation are necessary for monitoring. Although promising hemodynamic metrics, such as abnormal wall shear stress (WSS) magnitude, have been proposed for adult BAV patients using four-dimensional (4D) flow cardiovascular magnetic resonance, those for pediatric BAV patients have less frequently been reported, partly due to scarcity of data to define normal WSS range. To circumvent this challenge, this study aims to investigate if a recently proposed 4D flow-based hemodynamic measurement, abnormal flow directionality, is associated with aortic dilation in pediatric/young adult BAV patients. Methods: 4D flow scans for BAV patients (<20 years old) and age-matched controls were retrospectively enrolled. Static segmentation for the aorta and pulmonary arteries was obtained to quantify peak systolic hemodynamics and diameters in the proximal aorta. In addition to peak velocity, WSS, vorticity, helicity, and viscous energy loss, direction of aortic velocity and WSS in BAV patients were compared with that of control atlas using registration technique; angle differences of >60 deg and >120 deg were defined as moderately and severely abnormal, respectively. The association between the obtained metrics and normalized diameters (Z-scores) was evaluated at the sinotubular junction, mid-ascending aorta, and distal ascending aorta. Results: Fifty-three BAV patients, including 18 with history of repaired aortic coarctation, and 17 controls were enrolled. Correlation between moderately abnormal velocity/WSS direction and aortic Z-scores was moderate to strong at the sinotubular junction and mid-ascending aorta (R = 0.62–0.81; p < 0.001) while conventional measurements exhibited weaker correlation (|R| = 0.003–0.47, p = 0.009–0.99) in all subdomains. Multivariable regression analysis found moderately abnormal velocity direction and existence of aortic regurgitation (only for isolated BAV group) were independently associated with mid-ascending aortic Z-scores. Conclusion: Abnormal velocity and WSS directionality in the proximal aorta were strongly associated with aortic Z-scores in pediatric/young adult BAV patients. |
| format | Article |
| id | doaj-art-0d674036c1324d9ab1e6a7a5d3f58cfc |
| institution | Kabale University |
| issn | 1097-6647 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
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| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-0d674036c1324d9ab1e6a7a5d3f58cfc2024-12-16T05:34:53ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472024-01-01262101102Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow studyTakashi Fujiwara0LaDonna J. Malone1Kathryn C. Chatfield2Alex Berthusen3Brian Fonseca4Lorna P. Browne5Alex J. Barker6Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, Colorado 80045, USA; Corresponding author.Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, Colorado 80045, USADepartment of Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, 13123 E 16th Ave, Aurora, Colorado 80045, USADepartment of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, Colorado 80045, USADepartment of Pediatrics, Section of Pediatric Cardiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, Colorado 80045, USADepartment of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, Colorado 80045, USADepartment of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, Colorado 80045, USA; Department of Bioengineering, University of Colorado Anschutz Medical Campus, 12705 E Montview Blvd, Aurora, Colorado 80045, USAABSTRACT: Background: Aortic dilation is seen in pediatric/young adult patients with bicuspid aortic valve (BAV), and hemodynamic markers to predict aortic dilation are necessary for monitoring. Although promising hemodynamic metrics, such as abnormal wall shear stress (WSS) magnitude, have been proposed for adult BAV patients using four-dimensional (4D) flow cardiovascular magnetic resonance, those for pediatric BAV patients have less frequently been reported, partly due to scarcity of data to define normal WSS range. To circumvent this challenge, this study aims to investigate if a recently proposed 4D flow-based hemodynamic measurement, abnormal flow directionality, is associated with aortic dilation in pediatric/young adult BAV patients. Methods: 4D flow scans for BAV patients (<20 years old) and age-matched controls were retrospectively enrolled. Static segmentation for the aorta and pulmonary arteries was obtained to quantify peak systolic hemodynamics and diameters in the proximal aorta. In addition to peak velocity, WSS, vorticity, helicity, and viscous energy loss, direction of aortic velocity and WSS in BAV patients were compared with that of control atlas using registration technique; angle differences of >60 deg and >120 deg were defined as moderately and severely abnormal, respectively. The association between the obtained metrics and normalized diameters (Z-scores) was evaluated at the sinotubular junction, mid-ascending aorta, and distal ascending aorta. Results: Fifty-three BAV patients, including 18 with history of repaired aortic coarctation, and 17 controls were enrolled. Correlation between moderately abnormal velocity/WSS direction and aortic Z-scores was moderate to strong at the sinotubular junction and mid-ascending aorta (R = 0.62–0.81; p < 0.001) while conventional measurements exhibited weaker correlation (|R| = 0.003–0.47, p = 0.009–0.99) in all subdomains. Multivariable regression analysis found moderately abnormal velocity direction and existence of aortic regurgitation (only for isolated BAV group) were independently associated with mid-ascending aortic Z-scores. Conclusion: Abnormal velocity and WSS directionality in the proximal aorta were strongly associated with aortic Z-scores in pediatric/young adult BAV patients.http://www.sciencedirect.com/science/article/pii/S1097664724011293Bicuspid aortic valve4D flow MRIPediatricsCongenital heart diseaseAortic dilation |
| spellingShingle | Takashi Fujiwara LaDonna J. Malone Kathryn C. Chatfield Alex Berthusen Brian Fonseca Lorna P. Browne Alex J. Barker Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow study Journal of Cardiovascular Magnetic Resonance Bicuspid aortic valve 4D flow MRI Pediatrics Congenital heart disease Aortic dilation |
| title | Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow study |
| title_full | Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow study |
| title_fullStr | Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow study |
| title_full_unstemmed | Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow study |
| title_short | Assessment of abnormal transvalvular flow and wall shear stress direction for pediatric/young adults with bicuspid aortic valve: A cross-sectional four-dimensional flow study |
| title_sort | assessment of abnormal transvalvular flow and wall shear stress direction for pediatric young adults with bicuspid aortic valve a cross sectional four dimensional flow study |
| topic | Bicuspid aortic valve 4D flow MRI Pediatrics Congenital heart disease Aortic dilation |
| url | http://www.sciencedirect.com/science/article/pii/S1097664724011293 |
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