Original Research

4D flow MRI, cardiac function, and T₁-mapping: Association of valve-mediated changes in aortic hemodynamics with left ventricular remodeling

Corresponding Author

Julia Geiger MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland

Address reprint requests to: J.G., Northwestern University, 737 N. Michigan Ave., Chicago, IL 60611. E-mail: [email protected] or University Children's Hospital, Department of Diagnostic Imaging, Steinwiesstrasse 75, 8032 Zurich, Switzerland. E-mail: [email protected]Search for more papers by this author

Amir A. Rahsepar MD,

Amir A. Rahsepar MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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Kenichiro Suwa MD,

Kenichiro Suwa MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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Alex Powell BS,

Alex Powell BS

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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Ahmadreza Ghasemiesfe MD,

Ahmadreza Ghasemiesfe MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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Alex J. Barker PhD,

Alex J. Barker PhD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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Jeremy D. Collins MD,

Jeremy D. Collins MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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James C. Carr MD,

James C. Carr MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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Michael Markl PhD,

Michael Markl PhD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA

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Julia Geiger MD,

Corresponding Author

Julia Geiger MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland

Amir A. Rahsepar MD,

Amir A. Rahsepar MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Search for more papers by this author

Kenichiro Suwa MD,

Kenichiro Suwa MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Search for more papers by this author

Alex Powell BS,

Alex Powell BS

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Search for more papers by this author

Ahmadreza Ghasemiesfe MD,

Ahmadreza Ghasemiesfe MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Search for more papers by this author

Alex J. Barker PhD,

Alex J. Barker PhD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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Jeremy D. Collins MD,

Jeremy D. Collins MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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James C. Carr MD,

James C. Carr MD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

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Michael Markl PhD,

Michael Markl PhD

Department Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA

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First published: 05 December 2017

https://doi.org/10.1002/jmri.25916

Citations: 21

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Abstract

Background

Patients with bicuspid aortic valve (BAV) show altered hemodynamics in the ascending aorta that can be assessed by 4D flow MRI.

Purpose

Comprehensive cardiac MRI was applied to test the hypothesis that BAV-mediated changes in aortic hemodynamics (wall shear stress [WSS] and velocity) are associated with parameters of left ventricular (LV) remodeling.

Study Type

Retrospective data analysis.

Population

Forty-nine BAV patients (mean age = 50.2 ± 13.5, 62% male).

Field Strength/Sequence

Balanced steady-state free precession (bSSFP)-CINE, pre- and postcontrast T₁ mapping with modified Look–Locker inversion recovery (MOLLI), time-resolved 3D phase-contrast (PC) MRI with three-directional velocity encoding (4D flow MRI) at 1.5 and 3T.

Assessment

Quantification of LV volumetric data and myocardial mass, extracellular volume fraction (ECV), aortic valve stenosis (AS), and regurgitation (AR). 3D aortic segmentation, quantification of peak systolic velocities, and 3D WSS in the ascending aorta (AAo), arch, and descending aorta (DAo).

Statistical Tests

Two-sided nonpaired t-test to compare subgroups. Pearson correlation coefficient for correlations between aortic hemodynamics and LV parameters.

Results

Of the 49 BAV patients, 35 had aortic valve dysfunction (AS [n = 7], AR [n = 16], both AS and AR [n = 12]). Mean systolic WSS in the AAo, peak systolic velocities in the AAo and arch, and LV mass were significantly higher (P < 0.001) in the AS/AR group compared to the patients without AS/AR. In the complete group, we observed significant relationships between increased LV mass and elevated peak systolic velocity (r = 0.57, r = 0.58; P < 0.001) and WSS in the AAo and arch, respectively (r = 0.54, r = 0.46; P < 0.001). We detected an association between ECV and WSS in the AAo (r = 0.38, P = 0.02). These relations did not hold true for patients without AV dysfunction.

Data Conclusion

AS and AR in BAV patients have a major impact on elevated aortic peak velocities and WSS that were associated with parameters of LV remodeling.

Level of Evidence: 3

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2017.

References

1 Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol 2010; 55: 2789–2800.
10.1016/j.jacc.2009.12.068
PubMed Web of Science® Google Scholar
2 Michelena HI, Della Corte A, Prakash SK, Milewicz DM, Evangelista A, Enriquez-Sarano M. Bicuspid aortic valve aortopathy in adults: Incidence, etiology, and clinical significance. Int J Cardiol 2015; 201: 400–407.
10.1016/j.ijcard.2015.08.106
PubMed Web of Science® Google Scholar
3 Furukawa H, Tanemoto K. Current topics on bicuspid aortic valve: Clinical aspects and surgical management. Ann Thorac Cardiovasc Surg 2015; 21: 314–321.
10.5761/atcs.ra.15-00130
PubMed Web of Science® Google Scholar
4 Adamo L, Braverman AC. Surgical threshold for bicuspid aortic valve aneurysm: A case for individual decision-making. Heart 2015; 101: 1361–1367.
10.1136/heartjnl-2014-306601
CAS PubMed Web of Science® Google Scholar
5 Barker AJ, Markl M, Burk J, et al. Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging 2012; 5: 457–466.
10.1161/CIRCIMAGING.112.973370
PubMed Web of Science® Google Scholar
6 Meierhofer C, Schneider EP, Lyko C, et al. Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: A prospective study. Eur Heart J Cardiovasc Imaging 2013; 14: 797–804.
10.1093/ehjci/jes273
PubMed Web of Science® Google Scholar
7 van Ooij P, Potters WV, Collins J, et al. Characterization of abnormal wall shear stress using 4D flow MRI in human bicuspid aortopathy. Ann Biomed Eng 2015; 43: 1385–1397.
10.1007/s10439-014-1092-7
PubMed Web of Science® Google Scholar
8 Mahadevia R, Barker AJ, Schnell S, et al. Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression of aortopathy. Circulation 2014; 129: 673–682.
10.1161/CIRCULATIONAHA.113.003026
CAS PubMed Web of Science® Google Scholar
9 Guzzardi DG, Barker AJ, van Ooij P, et al. Valve-related hemodynamics mediate human bicuspid aortopathy: Insights from wall shear stress mapping. J Am Coll Cardiol 2015; 66: 892–900.
10.1016/j.jacc.2015.06.1310
PubMed Web of Science® Google Scholar
10 van Ooij P, Potters WV, Nederveen AJ, et al. A methodology to detect abnormal relative wall shear stress on the full surface of the thoracic aorta using four-dimensional flow MRI. Magn Reson Med 2015; 73: 1216–1227.
10.1002/mrm.25224
PubMed Web of Science® Google Scholar
11 von Knobelsdorff-Brenkenhoff F, Karunaharamoorthy A, Trauzeddel RF, et al. Evaluation of aortic blood flow and wall shear stress in aortic stenosis and its association with left ventricular remodeling. Circ Cardiovasc Imaging 2016; 9: e004038.
10.1161/CIRCIMAGING.115.004038
PubMed Web of Science® Google Scholar
12 Moon JC, Messroghli DR, Kellman P, et al. Myocardial T1 mapping and extracellular volume quantification: A Society for Cardiovascular Magnetic Resonance (SCMR) and CMR working group of the European Society of Cardiology Consensus Statement. J Cardiovasc Magn Reson 2013; 15: 92.
10.1186/1532-429X-15-92
PubMed Web of Science® Google Scholar
13 Flett AS, Hayward MP, Ashworth MT, et al. Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: Preliminary validation in humans. Circulation 2010; 122: 138–144.
10.1161/CIRCULATIONAHA.109.930636
PubMed Web of Science® Google Scholar
14 Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604–612.
10.7326/0003-4819-150-9-200905050-00006
PubMed Web of Science® Google Scholar
15 Kellman P, Arai AE, Xue H. T1 and extracellular volume mapping in the heart: Estimation of error maps and the influence of noise on precision. J Cardiovasc Magn Reson 2013; 15: 56.
10.1186/1532-429X-15-56
PubMed Web of Science® Google Scholar
16 Kellman P, Hansen MS. T1-mapping in the heart: Accuracy and precision. J Cardiovasc Magn Reson 2014; 16: 2.
10.1186/1532-429X-16-2
PubMed Web of Science® Google Scholar
17 Markl M, Harloff A, Bley TA, et al. Time-resolved 3D MR velocity mapping at 3T: Improved navigator-gated assessment of vascular anatomy and blood flow. J Magn Reson Imaging 2007; 25: 824–831.
10.1002/jmri.20871
CAS PubMed Web of Science® Google Scholar
18 Miller CA, Naish JH, Bishop P, et al. Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ Cardiovasc Imaging 2013; 6: 373–383.
10.1161/CIRCIMAGING.112.000192
PubMed Web of Science® Google Scholar
19 Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 2007; 133: 1226–1233.
10.1016/j.jtcvs.2007.01.039
PubMed Web of Science® Google Scholar
20 Bonow RO, Carabello BA, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e1–142.
10.1016/j.jacc.2008.05.007
PubMed Web of Science® Google Scholar
21 Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121: e266–369.
10.1161/CIR.0b013e3181d4739e
PubMed Web of Science® Google Scholar
22 Bock J KB, Hennig J, Markl M. Optimized pre-processing of time-resolved 2D and 3D phase contrast MRI data. In: Proc 15th Annual Meeting ISMRM, Berlin; 2007 (abstract 3138).
Google Scholar
23 Rose MJ, Jarvis K, Chowdhary V, et al. Efficient method for volumetric assessment of peak blood flow velocity using 4D flow MRI. J Magn Resonance Imaging 2016; 44: 1673–1682.
10.1002/jmri.25305
PubMed Web of Science® Google Scholar
24 Potters WV, van Ooij P, Marquering H, vanBavel E, Nederveen AJ. Volumetric arterial wall shear stress calculation based on CINE phase contrast MRI. J Magn Reson Imaging 2015; 41: 505–516.
10.1002/jmri.24560
PubMed Web of Science® Google Scholar
25 Hope MD, Hope TA, Meadows AK, et al. Bicuspid aortic valve: Four-dimensional MR evaluation of ascending aortic systolic flow patterns. Radiology 2010; 255: 53–61.
10.1148/radiol.09091437
PubMed Web of Science® Google Scholar
26 Bissell MM, Hess AT, Biasiolli L, et al. Aortic dilation in bicuspid aortic valve disease: Flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging 2013; 6: 499–507.
10.1161/CIRCIMAGING.113.000528
PubMed Web of Science® Google Scholar
27 Itagaki S, Chikwe JP, Chiang YP, Egorova NN, Adams DH. Long-term risk for aortic complications after aortic valve replacement in patients with bicuspid aortic valve versus Marfan syndrome. J Am Coll Cardiol 2015; 65: 2363–2369.
10.1016/j.jacc.2015.03.575
PubMed Web of Science® Google Scholar
28 Paterick TE, Humphries JA, Ammar KA, et al. Aortopathies: Etiologies, genetics, differential diagnosis, prognosis and management. Am J Med 2013; 126: 670–678.
10.1016/j.amjmed.2013.01.029
PubMed Web of Science® Google Scholar
29 Prakash SK, Bosse Y, Muehlschlegel JD, et al. A roadmap to investigate the genetic basis of bicuspid aortic valve and its complications: Insights from the International BAVCON (bicuspid aortic valve consortium). J Am Coll Cardiol 2014; 64: 832–839.
10.1016/j.jacc.2014.04.073
CAS PubMed Web of Science® Google Scholar
30 Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU. Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Magn Reson Imaging 2003; 17: 323–329.
10.1002/jmri.10262
CAS PubMed Web of Science® Google Scholar
31 Maceira AM, Prasad SK, Khan M, Pennell DJ. Normalized left ventricular systolic and diastolic function by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2006; 8: 417–426.
10.1080/10976640600572889
CAS PubMed Web of Science® Google Scholar
32 Bulluck H, Maestrini V, Rosmini S, et al. Myocardial T1 mapping. Circ J 2015; 79: 487–494.
10.1253/circj.CJ-15-0054
PubMed Web of Science® Google Scholar
33 White SK, Sado DM, Flett AS, Moon JC. Characterising the myocardial interstitial space: The clinical relevance of non-invasive imaging. Heart 2012; 98: 773–779.
10.1136/heartjnl-2011-301515
PubMed Web of Science® Google Scholar
34 Everett RJ, Stirrat CG, Semple SI, Newby DE, Dweck MR, Mirsadraee S. Assessment of myocardial fibrosis with T1 mapping MRI. Clin Radiol 2016; 71: 768–778.
10.1016/j.crad.2016.02.013
CAS PubMed Web of Science® Google Scholar
35 Grotenhuis HB, Ottenkamp J, Westenberg JJ, Bax JJ, Kroft LJ, de Roos A. Reduced aortic elasticity and dilatation are associated with aortic regurgitation and left ventricular hypertrophy in nonstenotic bicuspid aortic valve patients. J Am Coll Cardiol 2007; 49: 1660–1665.
10.1016/j.jacc.2006.12.044
PubMed Web of Science® Google Scholar
36 Flett AS, Sado DM, Quarta G, et al. Diffuse myocardial fibrosis in severe aortic stenosis: An equilibrium contrast cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging 2012; 13: 819–826.
10.1093/ehjci/jes102
PubMed Web of Science® Google Scholar
37 Kockova R, Kacer P, Pirk J, et al. Native T1 relaxation time and extracellular volume fraction as accurate markers of diffuse myocardial fibrosis in heart valve disease — Comparison with targeted left ventricular myocardial biopsy. Circ J 2016; 80: 1202–1209.
10.1253/circj.CJ-15-1309
PubMed Web of Science® Google Scholar
38 Singh A, Horsfield MA, Bekele S, Khan JN, Greiser A, McCann GP. Myocardial T1 and extracellular volume fraction measurement in asymptomatic patients with aortic stenosis: Reproducibility and comparison with age-matched controls. Eur Heart J Cardiovasc Imaging 2015; 16: 763–770.
10.1093/ehjci/jev007
PubMed Web of Science® Google Scholar
39 Briand M, Dumesnil JG, Kadem L, et al. Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: Implications for diagnosis and treatment. J Am Coll Cardiol J 2005; 46: 291–298.
10.1016/j.jacc.2004.10.081
PubMed Web of Science® Google Scholar
40 van Ooij P, Garcia J, Potters WV, et al. Age-related changes in aortic 3D blood flow velocities and wall shear stress: Implications for the identification of altered hemodynamics in patients with aortic valve disease. J Magn Reson Imaging 2016; 43: 1239–1249.
10.1002/jmri.25081
PubMed Web of Science® Google Scholar

Citing Literature

Volume48, Issue1

July 2018

Pages 121-131

4D flow MRI, cardiac function, and T₁-mapping: Association of valve-mediated changes in aortic hemodynamics with left ventricular remodeling

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature

References

Information

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4D flow MRI, cardiac function, and T1-mapping: Association of valve-mediated changes in aortic hemodynamics with left ventricular remodeling

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature

References

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4D flow MRI, cardiac function, and T₁-mapping: Association of valve-mediated changes in aortic hemodynamics with left ventricular remodeling