Characterization of abnormal wall shear stress using 4D flow MRI in human bicuspid aortopathy

P van Ooij, WV Potters, J Collins, M Carr, J Carr… - Annals of biomedical …, 2015 - Springer
P van Ooij, WV Potters, J Collins, M Carr, J Carr, SC Malaisrie, PWM Fedak, PM McCarthy…
Annals of biomedical engineering, 2015Springer
There exists considerable controversy surrounding the timing and extent of aortic resection
for patients with BAV disease. Since abnormal wall shear stress (WSS) is potentially
associated with tissue remodeling in BAV-related aortopathy, we propose a methodology
that creates patient-specific 'heat maps' of abnormal WSS, based on 4D flow MRI. The heat
maps were created by detecting outlier measurements from a volumetric 3D map of
ensemble-averaged WSS in healthy controls. 4D flow MRI was performed in 13 BAV …
Abstract
There exists considerable controversy surrounding the timing and extent of aortic resection for patients with BAV disease. Since abnormal wall shear stress (WSS) is potentially associated with tissue remodeling in BAV-related aortopathy, we propose a methodology that creates patient-specific ‘heat maps’ of abnormal WSS, based on 4D flow MRI. The heat maps were created by detecting outlier measurements from a volumetric 3D map of ensemble-averaged WSS in healthy controls. 4D flow MRI was performed in 13 BAV patients, referred for aortic resection and 10 age-matched controls. Systolic WSS was calculated from this data, and an ensemble-average and standard deviation (SD) WSS map of the controls was created. Regions of the individual WSS maps of the BAV patients that showed a higher WSS than the mean + 1.96SD of the ensemble-average control WSS map were highlighted. Elevated WSS was found on the greater ascending aorta (35% ± 15 of the surface area), which correlated significantly with peak systolic velocity (R 2 = 0.5, p = 0.01) and showed good agreement with the resected aortic regions. This novel approach to characterize regional aortic WSS may allow clinicians to gain unique insights regarding the heterogeneous expression of aortopathy and may be leveraged to guide patient-specific resection strategies for aorta repair.
Springer
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