Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study
Abstract Background Diseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease...
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2019-10-01
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Series: | Journal of Cardiovascular Magnetic Resonance |
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Online Access: | http://link.springer.com/article/10.1186/s12968-019-0572-1 |
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English |
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author |
A. Guala G. Teixido-Tura L. Dux-Santoy C. Granato A. Ruiz-Muñoz F. Valente L. Galian-Gay L. Gutiérrez T. González-Alujas K. M. Johnson O. Wieben A. Sao Avilés A. Evangelista J. Rodriguez-Palomares |
spellingShingle |
A. Guala G. Teixido-Tura L. Dux-Santoy C. Granato A. Ruiz-Muñoz F. Valente L. Galian-Gay L. Gutiérrez T. González-Alujas K. M. Johnson O. Wieben A. Sao Avilés A. Evangelista J. Rodriguez-Palomares Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study Journal of Cardiovascular Magnetic Resonance Marfan syndrome 4D flow CMR Helical flow Descending aorta Aortic aneurysm Wall shear stress (WSS) |
author_facet |
A. Guala G. Teixido-Tura L. Dux-Santoy C. Granato A. Ruiz-Muñoz F. Valente L. Galian-Gay L. Gutiérrez T. González-Alujas K. M. Johnson O. Wieben A. Sao Avilés A. Evangelista J. Rodriguez-Palomares |
author_sort |
A. Guala |
title |
Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study |
title_short |
Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study |
title_full |
Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study |
title_fullStr |
Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study |
title_full_unstemmed |
Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study |
title_sort |
decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in marfan syndrome: a 4d flow cmr study |
publisher |
BMC |
series |
Journal of Cardiovascular Magnetic Resonance |
issn |
1532-429X |
publishDate |
2019-10-01 |
description |
Abstract Background Diseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease in Marfan patients has been suggested, whether flow characteristics may be useful as early markers remains to be determined. Methods Seventy-five Marfan patients and 48 healthy subjects were prospectively enrolled. In- and through-plane vortexes were computed by 4D flow cardiovascular magnetic resonance (CMR) in the thoracic aorta through the quantification of in-plane rotational flow and systolic flow reversal ratio, respectively. Regional pulse wave velocity and axial and circumferential wall shear stress maps were also computed. Results In-plane rotational flow and circumferential wall shear stress were reduced in Marfan patients in the distal ascending aorta and in proximal descending aorta, even in the 20 patients free of aortic dilation. Multivariate analysis showed reduced in-plane rotational flow to be independently related to descending aorta pulse wave velocity. Conversely, systolic flow reversal ratio and axial wall shear stress were altered in unselected Marfan patients but not in the subgroup without dilation. In multivariate regression analysis proximal descending aorta axial (p = 0.014) and circumferential (p = 0.034) wall shear stress were independently related to local diameter. Conclusions Reduced rotational flow is present in the aorta of Marfan patients even in the absence of dilation, is related to aortic stiffness and drives abnormal circumferential wall shear stress. Axial and circumferential wall shear stress are independently related to proximal descending aorta dilation beyond clinical factors. In-plane rotational flow and circumferential wall shear stress may be considered as an early marker of descending aorta dilation in Marfan patients. |
topic |
Marfan syndrome 4D flow CMR Helical flow Descending aorta Aortic aneurysm Wall shear stress (WSS) |
url |
http://link.springer.com/article/10.1186/s12968-019-0572-1 |
work_keys_str_mv |
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doaj-5bc5b58405b541c6baa09248c7459b532020-11-25T03:45:08ZengBMCJournal of Cardiovascular Magnetic Resonance1532-429X2019-10-0121111110.1186/s12968-019-0572-1Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR studyA. Guala0G. Teixido-Tura1L. Dux-Santoy2C. Granato3A. Ruiz-Muñoz4F. Valente5L. Galian-Gay6L. Gutiérrez7T. González-Alujas8K. M. Johnson9O. Wieben10A. Sao Avilés11A. Evangelista12J. Rodriguez-Palomares13Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaDepartments of Medical Physics & Radiology, University of Wisconsin – MadisonDepartments of Medical Physics & Radiology, University of Wisconsin – MadisonHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaHospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaAbstract Background Diseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease in Marfan patients has been suggested, whether flow characteristics may be useful as early markers remains to be determined. Methods Seventy-five Marfan patients and 48 healthy subjects were prospectively enrolled. In- and through-plane vortexes were computed by 4D flow cardiovascular magnetic resonance (CMR) in the thoracic aorta through the quantification of in-plane rotational flow and systolic flow reversal ratio, respectively. Regional pulse wave velocity and axial and circumferential wall shear stress maps were also computed. Results In-plane rotational flow and circumferential wall shear stress were reduced in Marfan patients in the distal ascending aorta and in proximal descending aorta, even in the 20 patients free of aortic dilation. Multivariate analysis showed reduced in-plane rotational flow to be independently related to descending aorta pulse wave velocity. Conversely, systolic flow reversal ratio and axial wall shear stress were altered in unselected Marfan patients but not in the subgroup without dilation. In multivariate regression analysis proximal descending aorta axial (p = 0.014) and circumferential (p = 0.034) wall shear stress were independently related to local diameter. Conclusions Reduced rotational flow is present in the aorta of Marfan patients even in the absence of dilation, is related to aortic stiffness and drives abnormal circumferential wall shear stress. Axial and circumferential wall shear stress are independently related to proximal descending aorta dilation beyond clinical factors. In-plane rotational flow and circumferential wall shear stress may be considered as an early marker of descending aorta dilation in Marfan patients.http://link.springer.com/article/10.1186/s12968-019-0572-1Marfan syndrome4D flow CMRHelical flowDescending aortaAortic aneurysmWall shear stress (WSS) |