Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome : a 4D flow CMR study
Guala, Andrea (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Teixido-Tura, Gisela (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Dux-Santoy, Lydia (Hospital Universitari Vall d'Hebron)
Granato, C. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ruiz-Muñoz, Aroa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Valente, Filipa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Galian-Gay, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Gutiérrez García-Moreno, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
González-Alujas, Teresa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Johnson, K. M. (University of Wisconsin - Madison. Departments of Medical Physics & Radiology)
Wieben, Oliver (University of Wisconsin - Madison. Departments of Medical Physics & Radiology)
Sao-Avilés, Augusto (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Evangelista Masip, Arturo (Hospital Universitari Vall d'Hebron)
Rodriguez-Palomares, J. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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. 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. 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. 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. The online version of this article (10. 1186/s12968-019-0572-1) contains supplementary material, which is available to authorized users.
Ajuts:	Ministerio de Economía y Competitividad RTC-2016-5152-1 Instituto de Salud Carlos III PI14/0106
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Marfan syndrome ; 4D flow CMR ; Helical flow ; Descending aorta ; Aortic aneurysm ; Wall shear stress (WSS)
Publicat a:	Journal of Cardiovascular Magnetic Resonance, Vol. 21 (october 2019) , ISSN 1532-429X

DOI: 10.1186/s12968-019-0572-1
PMID: 31607265

11 p, 5.5 MB

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