Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK.
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Open Heart. 2024 Aug 19;11(2):e002713. doi: 10.1136/openhrt-2024-002713.
Aortic conduit and reservoir functions can be directly measured by four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR).
Twenty healthy controls (10 young and 10 age-gender-matched old controls) and 20 patients with heart failure with preserved ejection fraction (HFpEF) were recruited. All had 4D flow CMR. Flow was quantified at the ascending and descending aorta levels. In addition, at the ascending aorta level, we quantified systolic flow displacement (FDs) and systolic flow reversal ratio (sFRR). The aortic conduit function was defined as the relative drop in systolic flow from the ascending to the descending aorta (∆Fs). Aortic reservoir function was defined as descending aortic diastolic stroke volume (DAo SV).
Both ∆Fs (R=0.51, p=0.001) and DAo SV (R=-0.68, p=0.001) were significantly associated with ageing. Native T1 (R=0.51, p=0.001) and extracellular volume (R=0.51, p=0.001) showed maximum association with ∆Fs. ∆Fs significantly increased in HFpEF versus age-gender-matched controls (41±8% vs 52±12%, p=0.02). In multiple regression, only ∆Fs and DAo SV were independent predictors of the estimated glomerular filtration rate (model R=0.77, p=0.0001). FDs was significantly associated with ∆Fs (R=0.4, p=0.01) and DAo SV (R=-0.48, p=0.002), whereas sFRR was mainly associated with DAo SV (R=-0.46, p=0.003).
Both aortic conduit and reservoir function decline with age and this decline in aortic function is also independently associated with renal functional decline. Ascending aortic turbulent flow signatures are associated with loss of aortic conduit and reservoir functions. Finally, in HFpEF, aortic conduit and reservoir function demonstrate progressive decline.
NCT05114785.
四维血流（4D flow）心血管磁共振（CMR）可直接测量主动脉管腔和储器功能。
共纳入 20 名健康对照者（10 名年轻对照者和 10 名年龄、性别匹配的老年对照者）和 20 名射血分数保留的心力衰竭（HFpEF）患者。所有患者均进行 4D flow CMR 检查。在升主动脉和降主动脉水平定量测量血流。此外，在升主动脉水平，我们定量测量收缩期血流位移（FDs）和收缩期血流反转率（sFRR）。主动脉管腔功能定义为从升主动脉到降主动脉收缩期血流的相对下降（∆Fs）。主动脉储器功能定义为降主动脉舒张期每搏量（DAo SV）。
∆Fs（R=0.51，p=0.001）和 DAo SV（R=-0.68，p=0.001）均与年龄显著相关。固有 T1（R=0.51，p=0.001）和细胞外容积（R=0.51，p=0.001）与 ∆Fs 相关性最大。与年龄匹配的对照组相比，HFpEF 患者的 ∆Fs 显著增加（41±8% vs 52±12%，p=0.02）。多元回归分析显示，只有 ∆Fs 和 DAo SV 是估算肾小球滤过率的独立预测因子（模型 R=0.77，p=0.0001）。FDs 与 ∆Fs（R=0.4，p=0.01）和 DAo SV（R=-0.48，p=0.002）显著相关，而 sFRR 主要与 DAo SV 相关（R=-0.46，p=0.003）。
主动脉管腔和储器功能随年龄增长而下降，这种主动脉功能下降也与肾功能下降独立相关。升主动脉湍流血流特征与主动脉管腔和储器功能丧失相关。最后，在 HFpEF 中，主动脉管腔和储器功能逐渐下降。
NCT05114785。
