Imaging-Based 4D Aortic Pressure Mapping in Marfan Syndrome Patients: A Matched Case-Control Study.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 15030100R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6259 (Electronic) Linking ISSN: 00034975 NLM ISO Abbreviation: Ann Thorac Surg Subsets: MEDLINE
    • Publication Information:
      Publication: Amsterdam : Elsevier
      Original Publication: Boston.
    • Subject Terms:
      Aorta, Thoracic/*diagnostic imaging ; Arterial Pressure/*physiology ; Blood Flow Velocity/*physiology ; Imaging, Three-Dimensional/*methods ; Magnetic Resonance Imaging, Cine/*methods ; Marfan Syndrome/*physiopathology; Adult ; Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Marfan Syndrome/diagnosis ; Prospective Studies ; Reproducibility of Results
    • Abstract:
      Background: Marfan syndrome predisposes to aortic aneurysm, dissection, and rupture. We sought to investigate aortic 4-dimensional (4D) relative pressure maps derived from 4D flow cardiovascular magnetic resonance to identify disease characteristic alterations of the intraaortic pressure field in Marfan patients with aortic root dilation compared with age- and sex-matched healthy controls.
      Methods: This prospective case-control study included 11 Marfan patients with aortic root dilation (31 ± 5 years, 5 female) and 11 age- and sex-matched healthy controls (31 ± 8 years, 5 female) undergoing 4D flow cardiovascular magnetic resonance of the thoracic aorta. 4D relative pressure maps were computed and compared between groups for 8 aortic regions.
      Results: Aortic root diameters were significantly larger in patients compared with controls (43 vs 31 mm, P < .001), but not in the proximal descending aorta (23 vs 21 mm, P = .19). Regional pressure gradients over the cardiac cycle were significantly altered in Marfan patients with significantly higher minimum pressure gradients in the proximal ascending aorta (-44.3 vs -97.0 mm Hg/m, P < .001) and significantly lower maximum pressure gradients in the proximal descending aorta (55.1 vs 82.3 mm Hg/m, P < .01). The latter finding was associated with pathologic vortical flow patterns. Regional pressure gradient at mid systole significantly correlated with aortic diameter (proximal ascending aorta: r = 0.73, P < .001; proximal descending aorta: r = -0.59, P = .004).
      Conclusions: Noninvasive 4D pressure mapping derived from 4D flow cardiovascular magnetic resonance revealed significant alterations of spatiotemporal pressure characteristics in the thoracic aorta of Marfan patients. These alterations were most pronounced in the proximal ascending aorta and the proximal descending aorta, corresponding to the regions where aortic dissections often originate in Marfan patients.
      (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: Ann Thorac Surg. 2020 May;109(5):1440-1441. (PMID: 31843637)
    • Publication Date:
      Date Created: 20191001 Date Completed: 20200618 Latest Revision: 20200618
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.athoracsur.2019.08.048
    • Accession Number:
      31568745