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

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David Marlevi, Julio A. Sotelo, Ross Grogan-Kaylor, Yunus Ahmed, Sergio Uribe, Himanshu J. Patel, Elazer R. Edelman, David A. Nordsletten, Nicholas S. Burris

Original languageEnglish
Article number51
JournalJournal of Cardiovascular Magnetic Resonance
Issue number1
PublishedDec 2021

Bibliographical note

Funding Information: We would like to acknowledge Drs. Bo Yang, Karen Kim, Shinichi Fukuhara and G. Michael Deeb, and clinical coordinators Mary Passow, Lynn Hendee, Susan Hooker and Maureen Daly for their assistance with patient enrollment, as well as our research MRI staff including James Pool, Ladonna Austin, Suzan Lowe and James O?Conner for their assistance with enrollment and CMR examinations. Funding Information: NSB—Radiologic Society of North America Research Scholar Grant (RSCH1801) and US National Institute of Health (R44 HL14595). DM—Wallenberg Foundation scholarship program for postdoctoral studies at Massachusetts Institute of Technology (MIT) and Broad Institute. JAS—ANID-FONDECYT de Iniciación en Investigación (#11200481). JAS/SU-ANID-Millennium Science Initiative Program, NCN17 129, PIA-ACT192064, CONICYT—FONDECYT (#1181057), ANID FONDECYT de Iniciación en Investigación (#1180832) and CONICYT—FONDECYT Postdoctorado 2017 (#3170737), all from the Chilean National Agency for Research and Development, ANID. DAN—Funding from the Engineering and Physical Sciences Research Council (EP/N011554/1 and EP/R003866/1). HJP- Joe D. Morris Collegiate Professorship, Phil Jenkins Breakthrough Fund and David Hamilton Fund in Cardiac Surgery. ERE—Funding from the US National Institute of Health (R01 49039). Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


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.

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