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Turbulent kinetic energy in the right ventricle: Potential MR marker for risk stratification of adults with repaired Tetralogy of Fallot
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
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2018 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 47, no 4, p. 1043-1053Article in journal (Refereed) Published
Abstract [en]

Purpose: To assess right ventricular (RV) turbulent kinetic energy (TKE) in patients with repaired Tetralogy of Fallot (rToF) and a spectrum of pulmonary regurgitation (PR), as well as to investigate the relationship between these 4D flow markers and RV remodeling.

Materials and Methods: Seventeen patients with rToF and 10 healthy controls were included in the study. Patients were divided into two groups based on PR fraction: one lower PR fraction group (11%) and one higher PR fraction group (>11%). Field strength/sequences: 3D cine phase contrast (4D flow), 2D cine phase contrast (2D flow), and balanced steady-state free precession (bSSFP) at 1.5T. Assessment: The RV volume was segmented in the morphologic short-axis images and TKE parameters were computed inside the segmented RV volume throughout diastole. Statistical tests: One-way analysis of variance with Bonferroni post-hoc test; unpaired t-test; Pearson correlation coefficients; simple and stepwise multiple regression models; intraclass correlation coefficient (ICC).

Results: The higher PR fraction group had more remodeled RVs (140 6 25 vs. 107 6 22 [lower PR fraction, P < 0.01] and 93 6 15 ml/m2[healthy, P < 0.001] for RV end-diastolic volume index [RVEDVI]) and higher TKE values (5.95 6 3.15 vs. 2.23 6 0.81 [lower PR fraction, P < 0.01] and 1.91 6 0.78 mJ [healthy, P < 0.001] for Peak Total RV TKE). Multiple regression analysis between RVEDVI and 4D/2D flow parameters showed that Peak Total RV TKE was the strongest predictor of RVEDVI (R25 0.47, P 5 0.002).

Conclusion: The 4D flow-specific TKE markers showed a slightly stronger association with RV remodeling than conventional 2D flow PR parameters. These results suggest novel hemodynamic aspects of PR in the development of late complications after ToF repair.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018. Vol. 47, no 4, p. 1043-1053
Keywords [en]
4D flow, MRI, Turbulence, Tetralogy of Fallot, Turbulent kinetic energy
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiac and Cardiovascular Systems Medical Laboratory and Measurements Technologies Anesthesiology and Intensive Care Medical Image Processing
Identifiers
URN: urn:nbn:se:liu:diva-143780DOI: 10.1002/jmri.25830ISI: 000427125300016PubMedID: 28766919Scopus ID: 2-s2.0-85026745981OAI: oai:DiVA.org:liu-143780DiVA, id: diva2:1167286
Note

Funding agencies:  European Research Council [310612]; Swedish Heart and Lung Foundation [20140398]; County Council of Ostergotland; Medical Research Council of Southeast Sweden (FORSS); Swedish Research Council [2013-6077, 2014-6191]

Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2018-04-12Bibliographically approved

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Fredriksson, Alexandru GrigorescuTrzebiatowska-Krzynska, AleksandraDyverfeldt, PetterEngvall, JanEbbers, TinoCarlhäll, Carljohan

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Fredriksson, Alexandru GrigorescuTrzebiatowska-Krzynska, AleksandraDyverfeldt, PetterEngvall, JanEbbers, TinoCarlhäll, Carljohan
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in LinköpingCenter for Medical Image Science and Visualization (CMIV)Department of Clinical Physiology in Linköping
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Journal of Magnetic Resonance Imaging
Radiology, Nuclear Medicine and Medical ImagingCardiac and Cardiovascular SystemsMedical Laboratory and Measurements TechnologiesAnesthesiology and Intensive CareMedical Image Processing

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