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In vitro Assessment of Aortic Regurgitation Using Four-Dimensional Flow Magnetic Resonance Imaging
Published on: February 25, 2022
Aortic displacement and hemodynamics are abnormal in patients with Marfan syndrome: A combined four-dimensional
D Bosshardt1, R Merton2, A J Nederveen2
1Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Background:
Marfan syndrome (MFS) patients with a history of aortic root surgery (ARS) are at increased risk of type B aortic dissection, possibly because the noncompliant graft fails to absorb systolic forces, leading to undampened flow in the proximal descending aorta (pDAo). In this study, we investigated the magnitude and location of abnormal aortic displacement and wall shear stress (WSS) using cardiac magnetic resonance (CMR) imaging.
Methods:
We examined 82 MFS patients (32 with ARS, 34 ± 8 years, 36 women) and 45 age- and sex-matched controls, all undergoing four-dimensional high-resolution balanced steady-state free precession and flow CMR. Peak displacement and WSS were calculated using automated aortic segmentations. Heatmaps were created to identify and quantify regions with abnormal displacement and WSS. The surface areas of abnormal displacement and WSS were quantified in four aortic regions. The Wilcoxon signed-rank test was used for comparison of abnormal CMR parameter quantification, and Pearson correlation was used to assess correlations between displacement and WSS.
Results:
WSS was higher in the proximal (p < 0.001) and distal ascending aorta (Aao) (p = 0.031) of ARS MFS patients compared to native MFS patients. ARS MFS patients had significantly larger surface areas of decreased displacement (p < 0.001; present in 97% (31/32) of ARS MFS patients) and increased WSS (p < 0.001; present in 100% (32/32) of patients) in the proximal Aao. There was a trend toward a larger surface area of increased displacement in the pDAo of ARS MFS patients (p = 0.062; present in 72% (23/32) of patients), mainly located in the outer pDAo. pDAo displacement was positively correlated with pDAo WSS (Pearson r = 0.46 [95% confidence interval: 0.13, 0.70], p = 0.008).
Conclusion:
Aortic displacement and flow characteristics are abnormal in MFS patients, both with and without a history of ARS. ARS MFS patients exhibit distinct features in both the AAo and descending aorta (DAo), particularly in the proximal DAo, which is the region susceptible to type B aortic dissections.
Insights
Marfan syndrome patients with aortic root surgery show abnormal aortic displacement and wall shear stress, particularly in the proximal descending aorta, increasing dissection risk. These findings highlight distinct aortic changes in ARS MFS patients.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Medical Physics
Background:
- Marfan syndrome (MFS) patients with prior aortic root surgery (ARS) face elevated risks of type B aortic dissection.
- This increased risk may stem from noncompliant aortic grafts failing to absorb systolic forces, leading to undampened flow in the proximal descending aorta (pDAo).
Purpose of the Study:
- To investigate abnormal aortic displacement and wall shear stress (WSS) in MFS patients with and without ARS using cardiac magnetic resonance imaging (CMR).
- To identify the magnitude and location of these hemodynamic abnormalities, particularly in regions susceptible to dissection.
Main Methods:
- Eighty-two MFS patients (32 with ARS) and 45 controls underwent 4D high-resolution CINE and flow CMR.
- Automated segmentation was used to calculate peak displacement and WSS, with heatmaps visualizing abnormal regions.
- Surface areas of abnormal displacement and WSS were quantified in four aortic regions.
Main Results:
- ARS MFS patients exhibited higher WSS in the proximal and distal ascending aorta compared to native MFS patients.
- Significantly larger areas of decreased displacement and increased WSS were observed in the proximal ascending aorta of ARS MFS patients.
- A trend towards increased displacement in the pDAo of ARS MFS patients was noted, correlating positively with pDAo WSS.
Conclusions:
- Marfan syndrome patients, with or without ARS, display abnormal aortic displacement and flow dynamics.
- ARS MFS patients show unique hemodynamic features in the ascending aorta (AAo) and descending aorta (DAo), especially the pDAo.
- These distinct pDAo abnormalities in ARS MFS patients may predispose them to type B aortic dissections.
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