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Characterization of Abnormal Wall Shear Stress Using 4D Flow MRI in Human Bicuspid Aortopathy

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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.

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Acknowledgments

NIH NHLBI Grant R01HL115828; American Heart Association Scientist Development Grant 13SDG14360004; Dutch Technology Foundation (STW) Carisma Grant 11629.

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Authors and Affiliations

  1. Department of Radiology, Northwestern University, 737 N. Michigan Ave., Suite 1600, Chicago, IL, 60611, USA

    Pim van Ooij, Jeremy Collins, Maria Carr, James Carr, Michael Markl & Alex J. Barker

  2. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands

    Wouter V. Potters

  3. Department of Medicine-Cardiology, Northwestern University, Chicago, IL, USA

    S. Chris Malaisrie

  4. Department of Cardiac Surgery, University of Calgary, Calgary, Canada

    Paul W. M. Fedak

  5. Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, IL, USA

    Patrick M. McCarthy

  6. Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA

    Michael Markl

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  1. Pim van Ooij
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van Ooij, P., Potters, W.V., Collins, J. et al. Characterization of Abnormal Wall Shear Stress Using 4D Flow MRI in Human Bicuspid Aortopathy. Ann Biomed Eng 43, 1385–1397 (2015). https://doi.org/10.1007/s10439-014-1092-7

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