Differences in pulmonary arterial flow hemodynamics between children and adults with pulmonary arterial hypertension as assessed by 4D-flow CMR studies
| Autor: | Vitaly O. Kheyfets, Madhukar Kollengode, Anar Shah, Lorna P. Browne, D. Dunbar Ivy, Neil Wilson, Brian Fonseca, Brett E. Fenster, Max B. Mitchell, Uyen Truong, Kendall S. Hunter, Kurt R. Stenmark, Gareth J. Morgan, Michal Schäfer, Alex J. Barker, Michael DiMaria, J. Kern Buckner, Steven H. Abman, Nivedita K. Naresh |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pulmonary Circulation medicine.medical_specialty Adolescent Physiology Perfusion Imaging Magnetic Resonance Imaging Cine Hemodynamics Pulmonary Artery 030204 cardiovascular system & hematology Severity of Illness Index cardiac magnetic resonance 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests pulmonary arterial hypertension Physiology (medical) Internal medicine medicine Humans magnetic resonance imaging Arterial Pressure Prospective Studies Child Hemodynamic forces Aged medicine.diagnostic_test Adult patients business.industry Age Factors Magnetic resonance imaging Middle Aged Arterial flow Case-Control Studies flow Cardiology Female Vascular Resistance pediatric and adult Stress Mechanical Cardiology and Cardiovascular Medicine Cardiac magnetic resonance business Blood Flow Velocity Research Article |
| Zdroj: | American Journal of Physiology-Heart and Circulatory Physiology |
| ISSN: | 1522-1539 0363-6135 |
| DOI: | 10.1152/ajpheart.00802.2018 |
| Popis: | Despite different developmental and pathological processes affecting lung vascular remodeling in both patient populations, differences in 4D MRI findings between children and adults with PAH have not been studied. The purpose of this study was to compare flow hemodynamic state, including flow-mediated shear forces, between pediatric and adult patients with PAH matched by severity of pulmonary vascular resistance index (PVRi). Adults ( n = 10) and children ( n = 10) with PAH matched by pulmonary vascular resistance index (PVRi) and healthy adult ( n = 10) and pediatric ( n = 10) subjects underwent comprehensive 4D-flow MRI to assess peak systolic wall shear stress (WSSmax) measured in the main (MPA), right (RPA), and left pulmonary arteries (LPA), viscous energy loss (EL) along the MPA-RPA and MPA-LPA tract, and qualitative analysis of secondary flow hemodynamics. WSSmax was decreased in all pulmonary vessels in children with PAH when compared with the same age group (all P < 0.05). Similarly, WSSmax was decreased in all pulmonary vessels in adult PAH patients when compared with healthy adult subjects (all P < 0.01). Average EL was increased in adult patients with PAH when compared with the same age group along both MPA-RPA ( P = 0.020) and MPA-LPA ( P = 0.025) tracts. There were no differences in EL indices between adults and pediatric patients. Children and adult patients with PAH have decreased shear hemodynamic forces. However, pathological flow hemodynamic formations appear to be more consistent in adult patients, whereas flow hemodynamic abnormalities appear to be more variable in children with PAH for comparable severity of PVRi. NEW & NOTEWORTHY Both children and adult patients with PAH have decreased shear hemodynamic forces inside the pulmonary arteries associated with the degree of vessel dilation and stiffness. These differences also exist between healthy normotensive children and adults. However, pathological flow hemodynamic formations appear to more uniform in adult patients, whereas in children with PAH flow, hemodynamic abnormalities appear to be more variable. Pathological flow formations appear not to have a major effect on viscous energy loss associated with the flow conduction through proximal pulmonary arteries. |
| Databáze: | OpenAIRE |
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