Evaluation of 4D Flow MRI-Derived Aortic Hemodynamics and Their Relationships With Left Ventricular Remodeling in Patients With Moderate Aortic Stenosis: A Preliminary Study

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-08-30 DOI:10.1111/echo.70280

Jeong-Eun Yi, Sungho Park, Osung Kwon, Dongyeop Han, Hyungkyu Huh, Bae Young Lee

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Abstract

Purpose

Identifying factors associated with left ventricular (LV) remodeling is important for risk stratification of patients with moderate aortic stenosis (AS). The aim of this preliminary study was to explore aortic hemodynamics in these patients and assess their relationships with LV remodeling using four-dimensional (4D) flow magnetic resonance imaging (MRI).

Method

Data from 17 patients with moderate AS involving the tricuspid aortic valves and normal LV ejection fraction (EF > 55%) were analyzed. All patients underwent 4D flow MRI of the ascending aorta and cardiac magnetic resonance (CMR) on the same day within 1 month of being diagnosed with moderate AS by transthoracic Doppler echocardiography. 4D flow MRI aortic parameters, including turbulent kinetic energy (TKE), both total and peak; peak wall shear stress (WSS); and the vortex and helix flow severity, were assessed. CMR measures comprised LV structure and function, late gadolinium enhancement (LGE), myocardial native T1 mapping, and extracellular volume fraction.

Results

The minimum and maximum values of total TKE, peak TKE, and peak WSS were 39.4/160.3 mJ, 876.6/2059.6 J/m³, and 2.0/4.9 Pa, respectively. More than 50% of the patients had vortex and helix flow of Grade 2. Peak TKE significantly correlated with LV end-diastolic volume index (r = 0.675, p = 0.003), LV end-systolic volume index (r = 0.666, p = 0.003), and LV mass index (r = 0.653, p = 0.004). LGE was not observed, and peak TKE also showed an inverse correlation with native T1 value (r = −0.571, p = 0.017).

Conclusions

Among patients with moderate AS, 4D flow MRI revealed heterogeneous aortic hemodynamic profiles and peak TKE was a significant hemodynamic parameter related to early LV remodeling. However, these findings need to be confirmed in further studies with larger sample sizes and a long-term serial follow-up data.

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中度主动脉狭窄患者4D血流mri主动脉血流动力学评价及其与左心室重构关系的初步研究

目的确定与左室重构相关的因素对中度主动脉瓣狭窄（AS）患者的风险分层具有重要意义。本初步研究的目的是利用四维（4D）血流磁共振成像（MRI）探讨这些患者的主动脉血流动力学，并评估其与左室重构的关系。方法分析17例累及三尖瓣主动脉瓣的中度AS患者左室射血分数正常（EF > 55%）的资料。所有患者均于经胸多普勒超声心动图诊断为中度AS后1个月内同日行升主动脉4D血流MRI及心脏磁共振（CMR）检查。4D血流MRI主动脉参数，包括总湍动能（TKE）和峰值湍动能；峰值壁剪应力；并对涡旋流和螺旋流的严重程度进行了评估。CMR测量包括左室结构和功能、晚期钆增强（LGE）、心肌原生T1定位和细胞外体积分数。结果总TKE最小值为39.4/160.3 mJ， TKE峰最小值为876.6/2059.6 J/m3， WSS峰最大值为2.0/4.9 Pa。2级漩涡流和螺旋流占50%以上。TKE峰值与左室舒张末期容积指数（r = 0.675, p = 0.003）、左室收缩末期容积指数（r = 0.666, p = 0.003）、左室质量指数（r = 0.653, p = 0.004）显著相关。未观察到LGE， TKE峰值也与原生T1值呈负相关（r = - 0.571, p = 0.017）。结论在中度AS患者中，4D血流MRI显示主动脉血流动力学特征不均匀，TKE峰值是与早期左室重构相关的重要血流动力学参数。然而，这些发现需要在更大样本量和长期连续随访数据的进一步研究中得到证实。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.