False lumen pressure estimation in type B aortic dissection using 4D flow cardiovascular magnetic resonance: comparisons with aortic growth

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dc.contributor.authorMarlevi, David
dc.contributor.authorSotelo Parraguez, Julio Andrés
dc.contributor.authorGrogan Kaylor, Andrew
dc.contributor.authorAhmed, Yunus
dc.contributor.authorUribe Arancibia, Sergio A.
dc.contributor.authorPatel, Himanshu J.
dc.contributor.authorEdelman, Elazer R.
dc.contributor.authorNordsletten, David A.
dc.contributor.authorBurris, Nicholas S.
dc.date.accessioned2021-05-18T15:41:40Z
dc.date.available2021-05-18T15:41:40Z
dc.date.issued2021
dc.date.updated2021-05-16T00:02:13Z
dc.description.abstractAbstract Background Chronic type B aortic dissection (TBAD) is associated with poor long-term outcome, and accurate risk stratification tools remain lacking. Pressurization of the false lumen (FL) has been recognized as central in promoting aortic growth. Several surrogate imaging-based metrics have been proposed to assess FL hemodynamics; however, their relationship to enlarging aortic dimensions remains unclear. We investigated the association between aortic growth and three cardiovascular magnetic resonance (CMR)-derived metrics of FL pressurization: false lumen ejection fraction (FLEF), maximum systolic deceleration rate (MSDR), and FL relative pressure (FL ΔPmax). Methods CMR/CMR angiography was performed in 12 patients with chronic dissection of the descending thoracoabdominal aorta, including contrast-enhanced CMR angiography and time-resolved three-dimensional phase-contrast CMR (4D Flow CMR). Aortic growth rate was calculated as the change in maximal aortic diameter between baseline and follow-up imaging studies over the time interval, with patients categorized as having either ‘stable’ (< 3 mm/year) or ‘enlarging’ (≥ 3 mm/year) growth. Three metrics relating to FL pressurization were defined as: (1) FLEF: the ratio between retrograde and antegrade flow at the TBAD entry tear, (2) MSDR: the absolute difference between maximum and minimum systolic acceleration in the proximal FL, and (3) FL ΔPmax: the difference in absolute pressure between aortic root and distal FL. Results FLEF was higher in enlarging TBAD (49.0 ± 17.9% vs. 10.0 ± 11.9%, p = 0.002), whereas FL ΔPmax was lower (32.2 ± 10.8 vs. 57.2 ± 12.5 mmHg/m, p = 0.017). MSDR and conventional anatomic variables did not differ significantly between groups. FLEF showed positive (r = 0.78, p = 0.003) correlation with aortic growth rate whereas FL ΔPmax showed negative correlation (r = − 0.64, p = 0.026). FLEF and FL ΔPmax remained as independent predictors of aortic growth rate after adjusting for baseline aortic diameter. Conclusion Comparative analysis of three 4D flow CMR metrics of TBAD FL pressurization demonstrated that those that focusing on retrograde flow (FLEF) and relative pressure (FL ΔPmax) independently correlated with growth and differentiated patients with enlarging and stable descending aortic dissections. These results emphasize the highly variable nature of aortic hemodynamics in TBAD patients, and suggest that 4D Flow CMR derived metrics of FL pressurization may be useful to separate patients at highest and lowest risk for progressive aortic growth and complications.
dc.format.extent13 páginas
dc.fuente.origenAutoarchivo
dc.identifier.citationJournal of Cardiovascular Magnetic Resonance. 2021 May 13;23(1):51
dc.identifier.doi10.1186/s12968-021-00741-4
dc.identifier.urihttps://doi.org/10.1186/s12968-021-00741-4
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/58539
dc.issue.numeroNo. 51
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final13
dc.pagina.inicio1
dc.revistaJournal of Cardiovascular Magnetic Resonancees_ES
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subjectType B aortic dissectiones_ES
dc.subject4D fow magnetic resonance imaginges_ES
dc.subject4D fow MRIes_ES
dc.subjectFalse lumenes_ES
dc.subjectAortic growth ratees_ES
dc.subjectFalse lumen ejection fractiones_ES
dc.subjectMaximum systolic deceleration ratees_ES
dc.subjectRelative pressurees_ES
dc.subject.ddc616.07548
dc.subject.deweyMedicina y saludes_ES
dc.titleFalse lumen pressure estimation in type B aortic dissection using 4D flow cardiovascular magnetic resonance: comparisons with aortic growthes_ES
dc.typeartículo
dc.volumenVol. 23
sipa.codpersvinculados213237
sipa.codpersvinculados16572
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