Age dependence of pulmonary artery blood flow measured by 4D flow cardiovascular magnetic resonance: results of a population-based study

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Abstract

Background

It was our aim to systematically analyze pulmonary artery blood flow within different age-groups in the general population using 4D flow cardiovascular magnetic resonance (CMR) in order to provide a context for interpreting results of future studies (e.g., in pulmonary hypertension) using this technique.

Methods

An age-stratified sample ( n = 126) of the population of the city of Freiburg, Germany, underwent ECG-triggered and navigator-gated 4D flow CMR at 3 T of the pulmonary arteries and the thoracic aorta. Analysis planes were placed in the main, left, and right pulmonary artery using dedicated software. Study participants were divided into three groups (1:20–39; 2:40–59; and 3:60–80 years of age). Subsequently, pulmonary blood flow was visualized, quantified and compared between groups.

Results

Time-to-peak of systolic antegrade flow was shorter, peak and average velocities and flow volumes were lower in older subjects. At the end of systole, retrograde flow in the main pulmonary artery was observed in all but one subject. Subsequently, a second antegrade flow peak occurred in diastole which was lower in older subjects. Age was an independent predictor of hemodynamic change after adjustment for cardiovascular risk factors and body-mass-index. During systole, abnormal vortices occurred in the main pulmonary artery in four male subjects.

Conclusions

Comprehensive analysis of pulmonary blood flow was feasible in all subjects. We were able to detect an independent effect of ageing on pulmonary hemodynamics reflecting increased vessel stiffness and reduced pulmonary circulation. Findings of this study may be helpful for discriminating physiological from pathological flow in patients with pulmonary diseases in the future.

Electronic supplementary material

The online version of this article (doi:10.1186/s12968-016-0252-3) contains supplementary material, which is available to authorized users.

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Most cited references 12

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Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance.

Javier Sanz, Mbabazi Kariisa, Santo Dellegrottaglie … (2009)

This study sought to evaluate indexes of pulmonary artery (PA) stiffness in patients with pulmonary hypertension (PH) using same-day cardiac magnetic resonance (CMR) and right heart catheterization (RHC). Pulmonary artery stiffness is increased in the presence of PH, although the relationship to PH severity has not been fully characterized. Both CMR and RHC were performed on the same day in 94 patients with known or suspected PH. According to the RHC, patients were classified as having no PH (n = 13), exercise-induced PH (EIPH) only (n = 6), or PH at rest (n = 75). On CMR, phase-contrast images were obtained perpendicular to the pulmonary trunk. From CMR and RHC data, PA areas and indexes of stiffness (pulsatility, compliance, capacitance, distensibility, elastic modulus, and the pressure-independent stiffness index beta) were measured at rest. All quantified indexes showed increased PA stiffness in patients with PH at rest in comparison with those with EIPH or no PH. Despite the absence of significant differences in baseline pressures, patients with EIPH had lower median compliance and capacitance than patients with no PH: 15 (interquartile range: 9 to 19.8) mm2/mm Hg versus 8.4 (interquartile range: 6 to 10.3) mm2/mm Hg, and 5.2 (interquartile range: 4.4 to 6.3) mm3/mm Hg versus 3.7 (interquartile range: 3.1 to 4.1) mm3/mm Hg, respectively (p < 0.05). The different measurements of PA stiffness, including stiffness index beta, showed significant correlations with PA pressures (r2 = 0.27 to 0.73). Reduced PA pulsatility (<40%) detected the presence of PH at rest with a sensitivity of 93% and a specificity of 63%. Pulmonary artery stiffness increases early in the course of PH (even when PH is detectable only with exercise and before overt pressure elevations occur at rest). These observations suggest a potential contributory role of PA stiffness in the development and progression of PH.

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Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension.

Victor Gan, P Postmus, Anton Vonk-Noordegraaf … (2007)

Decreased total compliance of the pulmonary vascular bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). We investigated whether proximal pulmonary artery stiffness, in terms of area distensibility and noninvasively assessed relative area change (RAC), calculated as relative cross-sectional area change, predicts mortality in patients with PAH. Eighty-six subjects underwent right-heart catheterization and MRI to assess area distensibility and RAC. Patients were followed up to 48 months. Kaplan-Meier plot and Cox proportional hazards regression analyses assessed the predictive value of area distensibility and RAC. In 70 patients, the diagnosis PAH was confirmed, and 16 subjects served as control subjects. In comparison with control subjects, proximal pulmonary arteries of patients were distended (685 +/- 214 mm2 vs 411 +/- 153 mm2, p 16% (log-rank p < 0.001). RAC predicted mortality better than area distensibility. Noninvasively measured pulmonary artery RAC predicts mortality in patients with PAH.

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Magnetic resonance-derived 3-dimensional blood flow patterns in the main pulmonary artery as a marker of pulmonary hypertension and a measure of elevated mean pulmonary arterial pressure.

R Rienmueller, Karin Massaro, Horst Olschewski … (2008)

Pulmonary hypertension is a disease characterized by an elevation in pulmonary arterial pressure that is diagnosed invasively via right heart catheterization. Such pathological altered pressures in the pulmonary vascular system should lead to changes in blood flow patterns in the main pulmonary artery. Forty-eight subjects (22 with manifest pulmonary hypertension, 13 with latent pulmonary hypertension, and 13 normal control subjects) underwent time-resolved 3D magnetic resonance phase-contrast imaging of the main pulmonary artery. Velocity fields that resulted from measurements were calculated, visualized, and analyzed with dedicated software. Main findings were as follows: (1) Manifest pulmonary hypertension coincides with the appearance of a vortex of blood flow in the main pulmonary artery (sensitivity and specificity of 1.00, 95% confidence intervals of 0.84 to 1.00 and 0.87 to 1.00, respectively), and (2) the relative period of existence of the vortex correlates significantly with mean pulmonary arterial pressure at rest (correlation coefficient of 0.94). To test the diagnostic performance of the vortex criterion, we furthermore investigated 55 patients in a blinded prospective study (22 with manifest pulmonary hypertension, 32 with latent pulmonary hypertension, and 1 healthy subject), which resulted in a sensitivity of 1.00 and specificity of 0.91 (95% confidence intervals of 0.84 to 1.00 and 0.76 to 0.98, respectively). Comparison of catheter-derived mean pulmonary artery pressure measurements and calculated mean pulmonary artery pressure values resulted in a standard deviation of differences of 3.6 mm Hg. Vortices of blood flow in the main pulmonary artery enable the identification of manifest pulmonary hypertension. Elevated mean pulmonary arterial pressures can be measured from the period of vortex existence.

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Author and article information

Contributors

Thomas Wehrum: +4976127053240 , thomas.wehrum@uniklinik-freiburg.de

Journal

Journal ID (nlm-ta): J Cardiovasc Magn Reson

Journal ID (iso-abbrev): J Cardiovasc Magn Reson

Title: Journal of Cardiovascular Magnetic Resonance

Publisher: BioMed Central (London )

ISSN (Print): 1097-6647

ISSN (Electronic): 1532-429X

Publication date (Electronic): 31 May 2016

Publication date PMC-release: 31 May 2016

Publication date Collection: 2016

Volume: 18

Electronic Location Identifier: 31

Affiliations

[ ]Department of Neurology, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany

[ ]Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany

[ ]Department of Diagnostic Radiology – Medical Physics, University Medical Center Freiburg, Freiburg, Germany

[ ]Fraunhofer MEVIS, Bremen, Germany

[ ]Department of Cardiology, University Heart Center Freiburg, Freiburg, Germany

Article

Publisher ID: 252

DOI: 10.1186/s12968-016-0252-3

PMC ID: 4888740

PubMed ID: 27245203

SO-VID: 4d269b97-4ad2-410a-8678-86717f2e0ed4

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 16 February 2016

Date accepted : 19 May 2016

Funding

Funded by: Deutsche Forschungsgemeinschaft (DFG)

Award ID: grant #HA5399/3-1

Award Recipient : Thomas Wehrum

Funded by: Deutsche Forschungsgemeinschaft (DFG)

Award ID: #HA5399/3-1

Award Recipient : Iulius Dragonu

Funded by: Deutsche Forschungsgemeinschaft (DFG)

Award ID: grant #MU2727/6-1 and #GU1289/1-1

Award Recipient : Constantin von zur Mühlen

Funded by: Deutsche Forschungsgemeinschaft (DFG)

Award ID: grant #HA5399/3-1

Award Recipient : Andreas Harloff

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: population,4d flow cmr,pulmonary arteries,pulmonary blood flow

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: population, 4d flow cmr, pulmonary arteries, pulmonary blood flow

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Age dependence of pulmonary artery blood flow measured by 4D flow cardiovascular magnetic resonance: results of a population-based study

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Abstract

Background

Methods

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Conclusions

Electronic supplementary material

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Cardiovascular Innovations and Applications

Most cited references 12

Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance.

Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension.

Magnetic resonance-derived 3-dimensional blood flow patterns in the main pulmonary artery as a marker of pulmonary hypertension and a measure of elevated mean pulmonary arterial pressure.

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Cited by 8

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