使用有创、无创和计算技术研究正常主动脉瓣对压力的血流动力学反应。

European heart journal. Imaging methods and practice Pub Date : 2025-05-16 eCollection Date: 2025-01-01 DOI:10.1093/ehjimp/qyaf061
Rob Eerdekens, Vijay Govindarajan, Nils P Johnson, Jesse P A Demandt, Mohamed El Farissi, Fabienne E Vervaat, Daniel T Johnson, Richard L Kirkeeide, Pim A L Tonino
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引用次数: 0

摘要

目的:经导管主动脉瓣植入术(TAVI)后,主动脉瓣的血流动力学生理学引起了人们的重新关注。了解正常的瓣膜功能,特别是在应激条件下,可以识别早期病理和量化TAVI恢复正常的程度。我们的目的是通过侵入性、非侵入性和计算技术来描述正常主动脉瓣在压力下的血流动力学行为。方法和结果:我们的队列包括已经接受有创冠状动脉造影临床指征的受试者。血流动力学测量是有创和无创的同时,多巴酚丁胺输注。此外,从计算机断层成像中获得的患者特异性解剖作为输入,使用流固相互作用分析计算流体动力学模型。我们研究了10名受试者,同时使用有创传感器和无创超声心动图给药多巴酚丁胺。大多数正常瓣膜(10个中有7个)在压力期间表现出侵入梯度下降,与多普勒评估所显示的升高相反。主动脉瓣压力指数(主动脉瓣在射血过程中压力损失的相对度量)均超过0.90,中位数为0.96,四分位数区间为0.94-1.00。通过加快心率来增加经瓣血流的模拟结果与平均经瓣压力梯度呈高度线性关系(决定系数r2等于0.95)。结论:正常主动脉瓣即使在多巴酚丁胺输注引起的高瓣膜流量期间也表现出最小的压力损失。使用正常主动脉瓣解剖的计算模拟表现得像一个电阻,因为平均梯度直接与跨瓣流量成比例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Haemodynamic response of normal aortic valves to stress using invasive, non-invasive, and computational techniques.

Aims: The haemodynamic physiology of the aortic valve has attracted renewed attention after the introduction of transcatheter aortic valve implantation (TAVI). Understanding normal valve function, especially under stress conditions, permits identification of early pathology and quantification of the extent to which TAVI restores normalcy. We aimed to describe the haemodynamic behaviour of a normal aortic valve during stress via invasive, non-invasive, and computational techniques.

Methods and results: Our cohort included subjects already undergoing invasive coronary angiography for clinical indications. Haemodynamic measurements were made invasively and non-invasively along with dobutamine infusion. Additionally, patient-specific anatomy from computed tomographic imaging served as input to a computational fluid dynamics model using fluid-structure interaction analysis. We studied 10 subjects with simultaneous invasive sensors and non-invasive echocardiography during dobutamine administration. The majority of normal valves (7 of 10) demonstrated a fall in the invasive gradient during stress, in contrast to the increase noted by Doppler assessment. The stress aortic valve index, a relative measure of pressure loss over the valve during ejection, uniformly exceeded 0.90 with median value of 0.96 and interquartile range 0.94-1.00. Simulation of increased transvalvular flow via faster heart rates produced a highly linear relationship (coefficient of determination R 2 equal to 0.95) with the mean transvalvular pressure gradient.

Conclusion: Normal aortic valves demonstrated minimal pressure loss even during the high transvalvular flow generated by dobutamine infusion. Computational simulation using anatomy from a normal aortic valve behaved like a resistor, since mean gradient scaled directly with transvalvular flow.

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