经导管主动脉瓣置换术前后主动脉瓣狭窄患者四维血流心血管磁共振的血流动力学。
Blood flow dynamics with four-dimensional flow cardiovascular magnetic resonance in patients with aortic stenosis before and after transcatheter aortic valve replacement.
机构信息
Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
出版信息
J Cardiovasc Magn Reson. 2021 Jun 28;23(1):81. doi: 10.1186/s12968-021-00771-y.
BACKGROUND
Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR.
METHODS
We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR.
RESULTS
After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034).
CONCLUSIONS
In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.
背景
经导管主动脉瓣置换术（TAVR）治疗的主动脉瓣狭窄（AS）患者术前和术后的血流动力学变化可能会影响不良结局，但尚未得到充分研究。四维（4D）血流心血管磁共振（CMR）能够准确分析血流动力学，如血流速度、血流模式、壁切应力（WSS）和能量损失（EL）。我们试图检查接受 TAVR 的重度 AS 患者的血流动力学变化。
方法
我们检查了 2018 年 5 月至 2019 年 6 月期间接受 TAVR 的 32 例连续重度 AS 患者（17 名男性，82±5 岁，中位左心室射血分数 61%，6 个自膨式瓣膜），排除了由于禁忌证或成像不足而无法进行 CMR 的患者。我们使用 4D 流 CMR 分析了升主动脉（AAo）中的血流模式、WSS 和 EL，并分析了 TAVR 前后的变化。
结果
TAVR 后，AAo 中的半定量螺旋流明显减少（1.4±0.6 比 1.9±0.8，P=0.002），而涡流和偏心度无明显变化。在基础水平时，左（P=0.038）和左前（P=0.033）壁、中层时右后（P=0.011）和左（P=0.010）壁、上部时右（P=0.012）、左后（P=0.019）和左前（P=0.028）壁的 WSS 沿升主动脉周长明显降低。AAo 中的 EL 明显降低（15.6[10.8-25.1 比 25.8[18.6-36.2]mW，P=0.012）。此外，TAVR 后 EL 与有效瓣口面积指数呈显著负相关（r=-0.38，P=0.034）。
结论
在接受 TAVR 的重度 AS 患者中，4D 流 CMR 表明 TAVR 改善了血流动力学，尤其是当获得更大的有效瓣口面积指数时。
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