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Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study.
Journal of Cardiovascular Magnetic Resonance ( IF 6.4 ) Pub Date : 2019-10-14 , DOI: 10.1186/s12968-019-0572-1
A Guala 1 , G Teixido-Tura 1 , L Dux-Santoy 1 , C Granato 1 , A Ruiz-Muñoz 1 , F Valente 1 , L Galian-Gay 1 , L Gutiérrez 1 , T González-Alujas 1 , K M Johnson 2 , O Wieben 2 , A Sao Avilés 1 , A Evangelista 1 , J Rodriguez-Palomares 1
Affiliation  

BACKGROUND Diseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease in Marfan patients has been suggested, whether flow characteristics may be useful as early markers remains to be determined. METHODS Seventy-five Marfan patients and 48 healthy subjects were prospectively enrolled. In- and through-plane vortexes were computed by 4D flow cardiovascular magnetic resonance (CMR) in the thoracic aorta through the quantification of in-plane rotational flow and systolic flow reversal ratio, respectively. Regional pulse wave velocity and axial and circumferential wall shear stress maps were also computed. RESULTS In-plane rotational flow and circumferential wall shear stress were reduced in Marfan patients in the distal ascending aorta and in proximal descending aorta, even in the 20 patients free of aortic dilation. Multivariate analysis showed reduced in-plane rotational flow to be independently related to descending aorta pulse wave velocity. Conversely, systolic flow reversal ratio and axial wall shear stress were altered in unselected Marfan patients but not in the subgroup without dilation. In multivariate regression analysis proximal descending aorta axial (p = 0.014) and circumferential (p = 0.034) wall shear stress were independently related to local diameter. CONCLUSIONS Reduced rotational flow is present in the aorta of Marfan patients even in the absence of dilation, is related to aortic stiffness and drives abnormal circumferential wall shear stress. Axial and circumferential wall shear stress are independently related to proximal descending aorta dilation beyond clinical factors. In-plane rotational flow and circumferential wall shear stress may be considered as an early marker of descending aorta dilation in Marfan patients.

中文翻译:

旋转流和圆周壁切应力的降低是马凡氏综合征降主动脉扩张的早期标志:一项4D流CMR研究。

背景技术随着近端主动脉手术治疗的改善以及随之而来的预期寿命的增加,降主动脉疾病已经作为马凡氏综合征的临床问题出现。尽管已经有人提出血流动力学改变在马凡患者的降主动脉疾病的病因学中的作用,但是血流特征是否可以作为早期标志物有用,尚待确定。方法前瞻性纳入75例Marfan患者和48例健康受试者。通过分别量化平面内旋转流和收缩流逆转比,通过胸主动脉中的4D流动心血管磁共振(CMR)计算平面内和涡旋。还计算了区域脉搏波速度以及轴向和周向壁面剪应力图。结果Marfan患者升主动脉远端和降主动脉近端的平面内旋转流量和圆周壁切应力降低,即使20名无主动脉扩张的患者也是如此。多变量分析显示面内旋转流量的减少与主动脉脉搏波速度的下降独立相关。相反,未选择的Marfan患者的收缩流逆转率和轴向壁切应力改变了,而没有扩张的亚组则没有改变。在多元回归分析中,主动脉近端降支轴向(p = 0.014)和周向降主动脉(p = 0.034)与局部直径无关。结论即使没有扩张,马凡(Marfan)患者的主动脉旋转流量减少,与主动脉僵硬度有关,并驱动异常的周壁剪切应力。轴向和圆周壁切应力独立于临床因素而与近端降主动脉扩张相关。平面旋转流和周向壁切应力可被认为是马凡患者降主动脉扩张的早期标志。
更新日期:2020-04-22
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