Key result
Higher false lumen rotational flow, PWV, and thrombus percentage link to faster aortic growth.
Why the study?
False lumen patency in chronic aortic dissection is associated with dilation and adverse events, but predictors of adverse outcomes in this population remain limited.
Are false lumen flow dynamics and biomechanics assessed by 4D flow CMR associated with aortic growth rate in patients with chronic aortic dissection?
Cohort (n=54)
No
Are false lumen flow dynamics and biomechanics assessed by 4D flow CMR associated with aortic growth rate in patients with chronic aortic dissection?
In patients with chronic aortic dissection, 4D flow CMR-derived rotational flow, pulse wave velocity, and thrombus burden are associated with aortic growth rate and may help identify patients at higher risk of adverse events.
Answers are grounded in this paper and cite their sources.
Advanced CMR hemodynamics may help stratify risk in chronic aortic dissection; leaves open whether.
BACKGROUND: Patency of the false lumen in chronic aortic dissection (AD) is associated with aortic dilation and long-term aortic events. However, predictors of adverse outcomes in this population are limited. The aim of this study was to evaluate the relationship between aortic growth rate and false lumen flow dynamics and biomechanics in patients with chronic, patent AD. METHODS: Patients with a chronic AD with patent false lumen in the descending aorta and no genetic connective tissue disorder underwent an imaging follow-up including a contrast-enhanced 4D flow cardiovascular magnetic resonance (CMR) protocol and two consecutive computed tomography angiograms (CTA) acquired at least 1 year apart. A comprehensive analysis of anatomical features (including thrombus quantification), and false lumen flow dynamics and biomechanics (pulse wave velocity) was performed. RESULTS: Fifty-four consecutive patients with a chronic, patent false lumen in the descending aorta were included (35 surgically-treated type A AD with residual tear and 19 medically-treated type B AD). Median follow-up was 40 months. The in-plane rotational flow, pulse wave velocity and the percentage of thrombus in the false lumen were positively related to aortic growth rate (p = 0.006, 0.017, and 0.037, respectively), whereas wall shear stress showed a trend for a positive association (p = 0.060). These results were found irrespectively of the type of AD. CONCLUSIONS: In patients with chronic AD and patent false lumen of the descending aorta, rotational flow, pulse wave velocity and wall shear stress are positively related to aortic growth rate, and should be implemented in the follow-up algorithm of these patients. Further prospective studies are needed to confirm if the assessment of these parameters helps to identify patients at higher risk of adverse clinical events.
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Guala et al. (2022) conducted a cohort in Chronic aortic dissection of the descending aorta (n=54). False lumen flow dynamics and biomechanics (in-plane rotational flow, pulse wave velocity, thrombus) was evaluated on Aortic growth rate (R = 0.393, p=0.006). In patients with chronic descending aortic dissection, false lumen in-plane rotational flow, pulse wave velocity, and thrombus percentage were positively associated with aortic growth rate.
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