Evidence map›Paper›PMID 39098572›Full record

ArticleJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance2024

Interval changes in four-dimensional flow-derived in vivo hemodynamics stratify aortic growth in type B aortic dissection patients.

Joshua Engel, Ozden Kilinc, Elizabeth Weiss, Justin Baraboo, Christopher Mehta, Andrew Hoel, S Chris Malaisrie, Michael Markl, Bradley D Allen

Abstract read
In one paragraph

Article in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Joshua EngelDepartment of Radiology, Northwestern University, Chicago, Illinois, USA. Electronic address: Joshua.engel@northwestern.edu.
Ozden KilincDepartment of Radiology, Northwestern University, Chicago, Illinois, USA.
Elizabeth WeissDepartment of Radiology, Northwestern University, Chicago, Illinois, USA; Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA.
Justin BarabooDepartment of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA.
Christopher MehtaDepartment of Cardiac Surgery, Northwestern Medicine, Chicago, Illinois, USA.
Andrew HoelDepartment of Vascular Surgery, Northwestern Medicine, Chicago, Illinois, USA.
S Chris MalaisrieDepartment of Cardiac Surgery, Northwestern Medicine, Chicago, Illinois, USA.
Michael MarklDepartment of Radiology, Northwestern University, Chicago, Illinois, USA; Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA.
Bradley D AllenDepartment of Radiology, Northwestern University, Chicago, Illinois, USA.

Funding

Linking in vivo hemodynamics with outcomes in Type B aortic dissection using 4D flow MRIR01HL168700 · NHLBI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI Bradley David Allen · 2024 to 2026
$2.0M
NHLBI NIH HHS 1R01HL168700-01A1NHLBI NIH HHS R01 HL168700
6 · The paper itself

Abstract

backgroundAortic 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.

methodsWe 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.

resultsThirty-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.

conclusion4D 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.

Indexed as

Aortic Aneurysm, ThoracicAortic DissectionHemodynamicsPredictive Value of TestsAdultAgedAorta, ThoracicBlood Flow VelocityDisease ProgressionFemaleHumansImage Interpretation, Computer-AssistedLongitudinal StudiesMagnetic Resonance Imaging, CineMaleMiddle Aged4D flow imagingAortic dissectionFlowTEVAR

Identifiers

PMID39098572
PMCPMC11421234

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.