Turbulent Kinetic Energy Assessed by Multipoint 4-Dimensional Flow Magnetic Resonance Imaging Provides Additional Information Relative to Echocardiography for the Determination of Aortic Stenosis Severity.
- Binter C From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (S.K.).
- Gotschy A From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (S.K.).
- Sündermann SH From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (S.K.).
- Frank M From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (S.K.).
- Tanner FC From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (S.K.).
- Lüscher TF From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (S.K.).
- Manka R From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (S.K.).
- Kozerke S From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (S.K.). kozerke@biomed.ee.ethz.ch.
- 2017-06-15
Published in:
- Circulation. Cardiovascular imaging. - 2017
4D flow magnetic resonance imaging
aortic dilation
aortic stenosis
bicuspid aortic valve
echocardiography
magnetic resonance imaging
turbulent kinetic energy
Aged
Aged, 80 and over
Aorta
Aortic Valve
Aortic Valve Stenosis
Case-Control Studies
Dilatation, Pathologic
Echocardiography, Doppler
Echocardiography, Doppler, Pulsed
Female
Heart Valve Diseases
Hemodynamics
Humans
Image Interpretation, Computer-Assisted
Magnetic Resonance Imaging
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Severity of Illness Index
Time Factors
English
BACKGROUND
Turbulent kinetic energy (TKE), assessed by 4-dimensional (4D) flow magnetic resonance imaging, is a measure of energy loss in disturbed flow as it occurs, for instance, in aortic stenosis (AS). This work investigates the additional information provided by quantifying TKE for the assessment of AS severity in comparison to clinical echocardiographic measures.
METHODS AND RESULTS
Fifty-one patients with AS (67±15 years, 20 female) and 10 healthy age-matched controls (69±5 years, 5 female) were prospectively enrolled to undergo multipoint 4D flow magnetic resonance imaging. Patients were split into 2 groups (severe and mild/moderate AS) according to their echocardiographic mean pressure gradient. TKE values were integrated over the aortic arch to obtain peak TKE. Integrating over systole yielded total TKEsys and by normalizing for stroke volume, normalized TKEsys was obtained. Mean pressure gradient and TKE correlated only weakly (R2=0.26 for peak TKE and R2=0.32 for normalized TKEsys) in the entire study population including control subjects, while no significant correlation was observed in the AS patient group. In the patient population with dilated ascending aorta, both peak TKE and total TKEsys were significantly elevated (P<0.01), whereas mean pressure gradient was significantly lower (P<0.05). Patients with bicuspid aortic valves also showed significantly increased TKE metrics (P<0.01), although no significant difference was found for mean pressure gradient.
CONCLUSIONS
Elevated TKE levels imply higher energy losses associated with bicuspid aortic valves and dilated ascending aortic geometries that are not assessable by current echocardiographic measures. These findings indicate that TKE may provide complementary information to echocardiography, helping to distinguish within the heterogeneous population of patients with moderate to severe AS.
Turbulent kinetic energy (TKE), assessed by 4-dimensional (4D) flow magnetic resonance imaging, is a measure of energy loss in disturbed flow as it occurs, for instance, in aortic stenosis (AS). This work investigates the additional information provided by quantifying TKE for the assessment of AS severity in comparison to clinical echocardiographic measures.
METHODS AND RESULTS
Fifty-one patients with AS (67±15 years, 20 female) and 10 healthy age-matched controls (69±5 years, 5 female) were prospectively enrolled to undergo multipoint 4D flow magnetic resonance imaging. Patients were split into 2 groups (severe and mild/moderate AS) according to their echocardiographic mean pressure gradient. TKE values were integrated over the aortic arch to obtain peak TKE. Integrating over systole yielded total TKEsys and by normalizing for stroke volume, normalized TKEsys was obtained. Mean pressure gradient and TKE correlated only weakly (R2=0.26 for peak TKE and R2=0.32 for normalized TKEsys) in the entire study population including control subjects, while no significant correlation was observed in the AS patient group. In the patient population with dilated ascending aorta, both peak TKE and total TKEsys were significantly elevated (P<0.01), whereas mean pressure gradient was significantly lower (P<0.05). Patients with bicuspid aortic valves also showed significantly increased TKE metrics (P<0.01), although no significant difference was found for mean pressure gradient.
CONCLUSIONS
Elevated TKE levels imply higher energy losses associated with bicuspid aortic valves and dilated ascending aortic geometries that are not assessable by current echocardiographic measures. These findings indicate that TKE may provide complementary information to echocardiography, helping to distinguish within the heterogeneous population of patients with moderate to severe AS.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1161/CIRCIMAGING.116.005486
- PMID 28611119
- Persistent URL
- https://sonar.ch/global/documents/267300
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