主动脉瓣疾病对主动脉扩张和三叶主动脉瓣形态患者三维血流动力学的影响。
Effect of Aortic Valve Disease on 3D Hemodynamics in Patients With Aortic Dilation and Trileaflet Aortic Valve Morphology.
作者信息
Suwa Kenichiro, Rahman Ozair Abdul, Bollache Emilie, Rose Michael J, Rahsepar Amir Ali, Carr James C, Collins Jeremy D, Barker Alex J, Markl Michael
机构信息
Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
出版信息
J Magn Reson Imaging. 2020 Feb;51(2):481-491. doi: 10.1002/jmri.26804. Epub 2019 Jun 6.
BACKGROUND
The effect of different expressions of aortic valve disease on 3D aortic hemodynamics is unclear.
PURPOSE
To investigate changes in aortic hemodynamics in patients with dilated ascending aorta (AAo) but different severity of aortic valve stenosis (AS) and/or regurgitation (AR).
STUDY TYPE
Retrospective.
POPULATION
A total of 111 subjects (86 patients with AAo diameter ≥ 40 mm and 25 healthy controls, all with trileaflet aortic valve [TAV]). Patients were further stratified by TAV dysfunction: n = 9 with combined moderate or severe AS and AR (ASR, 56 ± 13 years), n = 14 with moderate or severe AS (AS, 64 ± 14 years), n = 33 with moderate or severe AR (AR, 62 ± 14 years), n = 30 with neither AS nor AR (no AS/AR, 63 ± 9 years).
FIELD STRENGTH/SEQUENCE: 4D flow MRI on 1.5/3T systems for the in vivo analysis of aortic blood flow dynamics.
ASSESSMENT
Data analysis included grading of 3D AAo vortex/helix flow and AAo flow eccentricity as well as quantification of systolic peak velocities and wall shear stress (WSS).
STATISTICAL TESTS
Continuous variables were compared by one-way analysis of variance or Kruskal-Wallis, followed by a pairwise Tukey or Dunn test if there was a significant difference.
RESULTS
All patients demonstrated markedly elevated vortex and helix flow compared with controls (P < 0.05). Peak velocities were significantly elevated in ASR, AS, and AR patients compared with controls (P < 0.05). Increased flow eccentricity was observed in entire AAo for AR, at the mid and distal AAo for ASR and AS, and at the proximal AAo for no AS/AR. Compared with controls, WSS in the AAo was significantly elevated in ASR and AS patients (P < 0.05) and reduced in no AS/AR patients (P < 0.05).
DATA CONCLUSION
The presence of TAV dysfunction is associated with aberrant hemodynamics and altered WSS, which may play a role in the development of aortopathy.
LEVEL OF EVIDENCE
3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:481-491.
背景
主动脉瓣疾病的不同表现对三维主动脉血流动力学的影响尚不清楚。
目的
研究升主动脉扩张（AAo）但主动脉瓣狭窄（AS）和/或反流（AR）严重程度不同的患者的主动脉血流动力学变化。
研究类型
回顾性研究。
研究对象
共111名受试者（86例AAo直径≥40 mm的患者和25名健康对照者，均为三叶主动脉瓣 [TAV]）。患者根据TAV功能障碍进一步分层：9例合并中度或重度AS和AR（ASR，56±13岁），14例中度或重度AS（AS，64±14岁），33例中度或重度AR（AR，62±14岁），30例既无AS也无AR（无AS/AR，63±9岁）。
场强/序列：在1.5/3T系统上进行4D流动MRI，用于体内分析主动脉血流动力学。
评估
数据分析包括对三维AAo涡流/螺旋流和AAo血流偏心度进行分级，以及对收缩期峰值速度和壁面切应力（WSS）进行量化。
统计检验
连续变量采用单因素方差分析或Kruskal-Wallis检验进行比较，如果存在显著差异，则进行两两Tukey或Dunn检验。
结果
与对照组相比，所有患者的涡流和螺旋流均显著升高（P<0.05）。与对照组相比，ASR、AS和AR患者的峰值速度显著升高（P<0.05）。在整个AAo中，AR患者的血流偏心度增加；在AAo的中、远端，ASR和AS患者的血流偏心度增加；在AAo的近端，无AS/AR患者的血流偏心度增加。与对照组相比，ASR和AS患者的AAo中WSS显著升高（P<0.05），无AS/AR患者的WSS降低（P<0.05）。
数据结论
TAV功能障碍的存在与异常血流动力学和WSS改变有关，这可能在主动脉病变的发展中起作用。
证据水平
3 技术效能阶段：3 《磁共振成像杂志》2020年；51:481-491。
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