MRI as a tool for non-invasive vascular profiling: a pilot study in patients with aortic coarctation

Abstract

Aim: While the overall concept of aortic coarctation has changed from one of simple obstruction to one that includes significant vascular dysfunction, this has not yet been translated into the diagnostic and treatment process. To close this gap, we sought to demonstrate the usefulness of an additional non-invasive vascular profile. Method: During a pilot study in eight coarctation patients, aortic area compliance, aortic distensibility, time phase shift and blood flow (distribution) were calculated from cine-MRI and 2D-/4D-velocity-encoded MRI sequences. Results: Compared to healthy individuals, a significantly lower aortic compliance and reduced flow to the descending aorta were found in patients with coarctation. Discussion: These differences underline the potential usefulness of a combined vascular profile in coarctation patients. Conclusion: It was successfully shown that functional vascular profiling of the aorta is feasible to be acquired non-invasively in a clinical setting and can provide additional diagnostic information. These can be the key input parameters for computational fluid dynamics-modeling.

Keywords:

• aortic coarctation
• aortic compliance
• aortic perfusion
• cardiac MRI
• catheterization
• congenital heart disease
• disease modeling
• vascular auto-regulation
• Windkessel function

Financial & competing interests disclosure

This study is partially funded by the European Commission under the ICT Program (Grant Agreement: 611232). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• The general concept of the pathophysiology in aortic coarctation has vastly changed during the last decades. However, this has not yet been translated to the bedside, where treatment decisions are usually based solely on pressure data.

• Parameters derived from 2D-/4D-velocity-encoded MRI and cine-MRI data have proven to be feasible in acquisition.

• Using an additional non-invasive vascular profile provides an opportunity to fill the gap between current clinical methods and advances in the understanding of the disease.

• Even in a small study cohort, significant alterations in the aortic function (Windkessel and blood flow distribution) were observed in comparison with a normal control group.

• Resulting data can already function as key input parameters in disease-specific models including image-based computational fluid dynamics simulations, offering an opportunity for more personalized clinical approaches.

Notes