Non-invasive cardiovascular magnetic resonance assessment of pressure recovery distance after aortic valve stenosis

Journal of Cardiovascular Magnetic Resonance

Research

Malenka Bissell¹  Tino Ebbers²  Petter Dyverfeldt²  Hojin Ha³  David Marlevi⁴  Saul G. Myerson⁵  Peter Mortier⁶  Valeria Galli⁶  Amanda Nio⁷  Harminder Gill⁷  Alessandro Faraci⁷  Pablo Lamata⁷  Joao Filipe Fernandes⁷  Ronak Rajani⁸  David A. Nordsletten⁹ 

[1] Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK;Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden;Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden;Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Korea;Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden;Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA;Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK;FEops NV, Ghent, Belgium;School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK;School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK;Cardiovascular Directorate, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK;Department of Biomedical Engineering and Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA;

关键词: Aortic stenosis;    Pressure recovery;    Non-invasive pressure drop;    Turbulence;    4D Flow MRI;    Flow momentum;   

DOI  :  10.1186/s12968-023-00914-3

 received in 2022-09-02, accepted in 2023-01-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDecisions in the management of aortic stenosis are based on the peak pressure drop, captured by Doppler echocardiography, whereas gold standard catheterization measurements assess the net pressure drop but are limited by associated risks. The relationship between these two measurements, peak and net pressure drop, is dictated by the pressure recovery along the ascending aorta which is mainly caused by turbulence energy dissipation. Currently, pressure recovery is considered to occur within the first 40–50 mm distally from the aortic valve, albeit there is inconsistency across interventionist centers on where/how to position the catheter to capture the net pressure drop.MethodsWe developed a non-invasive method to assess the pressure recovery distance based on blood flow momentum via 4D Flow cardiovascular magnetic resonance (CMR). Multi-center acquisitions included physical flow phantoms with different stenotic valve configurations to validate this method, first against reference measurements and then against turbulent energy dissipation (respectively n = 8 and n = 28 acquisitions) and to investigate the relationship between peak and net pressure drops. Finally, we explored the potential errors of cardiac catheterisation pressure recordings as a result of neglecting the pressure recovery distance in a clinical bicuspid aortic valve (BAV) cohort of n = 32 patients.ResultsIn-vitro assessment of pressure recovery distance based on flow momentum achieved an average error of 1.8 ± 8.4 mm when compared to reference pressure sensors in the first phantom workbench. The momentum pressure recovery distance and the turbulent energy dissipation distance showed no statistical difference (mean difference of 2.8 ± 5.4 mm, R2 = 0.93) in the second phantom workbench. A linear correlation was observed between peak and net pressure drops, however, with strong dependences on the valvular morphology. Finally, in the BAV cohort the pressure recovery distance was 78.8 ± 34.3 mm from vena contracta, which is significantly longer than currently accepted in clinical practise (40–50 mm), and 37.5% of patients displayed a pressure recovery distance beyond the end of the ascending aorta.ConclusionThe non-invasive assessment of the distance to pressure recovery is possible by tracking momentum via 4D Flow CMR. Recovery is not always complete at the ascending aorta, and catheterised recordings will overestimate the net pressure drop in those situations. There is a need to re-evaluate the methods that characterise the haemodynamic burden caused by aortic stenosis as currently clinically accepted pressure recovery distance is an underestimation.

【 授权许可】

CC BY   
© The Author(s) 2023

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