B 型主动脉夹层患者主动脉生长的四维血流推导活体血流动力学分层变化

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Joshua Engel, Ozden Kilinc, Elizabeth Weiss, Justin Baraboo, Christopher Mehta, Andrew Hoel, S Chris Malaisrie, Michael Markl, Bradley D Allen
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引用次数: 0

摘要

背景:B 型主动脉夹层(TBAD)的主动脉直径增长与主动脉逐渐扩张有关,导致新发 TBAD(dnTBAD)和 A 型夹层修复后残余夹层(rTAAD)患者的死亡率增加。先发制人的胸腔内血管主动脉修复术可能会改善 TBAD 患者的死亡率,但目前还不清楚哪些患者可以从早期干预中获益最多。利用四维(4D)血流磁共振成像(MRI)进行的体内血流动力学评估已被用于描述主动脉正在生长的 TBAD 患者的特征。在这项纵向研究中,我们调查了四维血流得出的真腔和假腔(TL、FL)血流动力学参数随时间的变化是否与作为风险增加标志的主动脉生长率相关:我们回顾性地确定了基线和随访 4D 血流 MRI 相隔至少 120 天的 TBAD 患者。基线前或两次扫描之间进行过 TBAD 干预的患者被排除在外。四维血流 MRI 数据分析包括对 TL 和 FL 进行分割,然后按体素计算 TL 和 FL 的总动能 (KE)、最大速度 (MV)、平均正向血流 (FF) 和平均反向血流 (RF)。计算所有血液动力学参数随时间的变化(Δ)。降主动脉的最大直径是根据 4D 血流时采集的 MR 血管造影图像测量的。主动脉增长率定义为直径变化除以基线直径,并根据扫描间隔进行标准化:32名患者符合纳入标准(年龄:56.9±14.1岁,女性:13人,n=19 rTAAD,n=13 dnTBAD)。平均随访时间为 538 天(范围:135-1689)。主动脉基线直径与生长速度无关。在整个队列中,ΔFL MV(rho=0.37,p=.04)和ΔFL RF(rho=0.45,p=0.01)与生长速度相关。仅在 rTAAD 中,Δ FL MV(rho=0.48,p=.04)和 Δ FL RF(rho=0.51,p=0.03)与生长速度相关,而仅在 dnTBAD 中,Δ TL KE(rho=0.63,p=.02)和 Δ TL MV(rho=0.69,p=.01)与生长速度相关:结论:4D血流得出的纵向血流动力学变化与TBAD的主动脉生长速度相关,可为风险分层提供额外的预后价值。四维血流 MRI 可以整合到现有的成像方案中,以便识别哪些 TBAD 患者可以从先期手术或血管内介入治疗中获益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Interval changes in four-dimensional flow-derived in vivo hemodynamics stratify aortic growth in type B aortic dissection patients.

Background: Aortic diameter growth in type B aortic dissection (TBAD) is associated with progressive aortic dilation, resulting in increased mortality in patients with both de novo TBAD (dnTBAD) and residual dissection after type A dissection repair (rTAAD). Preemptive thoracic endovascular aortic repair may improve mortality in patients with TBAD, although it is unclear which patients may benefit most from early intervention. In vivo hemodynamic assessment using four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has been used to characterize TBAD patients with growing aortas. In this longitudinal study, we investigated whether changes over time in 4D flow-derived true and false lumen (TL and FL) hemodynamic parameters correlate with aortic growth rate, which is a marker of increased risk.

Methods: We retrospectively identified TBAD patients with baseline and follow-up 4D flow CMR at least 120 days apart. Patients with TBAD intervention before baseline or between scans were excluded. 4D flow CMR data analysis included segmentation of the TL and FL, followed by voxel-wise calculation of TL and FL total kinetic energy (KE), maximum velocity (MV), mean forward flow (FF), and mean reverse flow (RF). Changes over time (Δ) were calculated for all hemodynamic parameters. Maximal diameter in the descending aorta was measured from magnetic resonance angiogram images acquired at the time of 4D flow. Aortic growth rate was defined as the change in diameter divided by baseline diameter and standardized to scan interval.

Results: Thirty-two patients met inclusion criteria (age: 56.9 ± 14.1 years, female: 13, n = 19 rTAAD, n = 13 dnTBAD). Mean follow-up time was 538 days (range: 135-1689). Baseline aortic diameter did not correlate with growth rate. In the entire cohort, Δ FL MV (Spearman's rho [rho] = 0.37, p = 0.04) and Δ FL RF (rho = 0.45, p = 0.01) correlated with growth rate. In rTAAD only, Δ FL MV (rho = 0.48, p = 0.04) and Δ FL RF (rho = 0.51, p = 0.03) correlated with growth rate, while in dnTBAD only, Δ TL KE (rho = 0.63, p = 0.02) and Δ TL MV (rho = 0.69, p = 0.01) correlated with growth rate.

Conclusion: 4D flow-derived longitudinal hemodynamic changes correlate with aortic growth rate in TBAD and may provide additional prognostic value for risk stratification. 4D flow MRI could be integrated into existing imaging protocols to allow for the identification of TBAD patients who would benefit from preemptive surgical or endovascular intervention.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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