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Abstract
Turbulent blood flow is implicated in the pathogenesis of several aortic diseases but the extent and degree of turbulent blood flow in the normal aorta is unknown. We aimed to quantify the extent and degree of turbulece in the normal aorta and to assess whether age impacts the degree of turbulence. 22 young normal males (23.7 ± 3.0 y.o.) and 20 old normal males (70.9 ± 3.5 y.o.) were examined using four dimensional flow magnetic resonance imaging (4D Flow MRI) to quantify the turbulent kinetic energy (TKE), a measure of the intensity of turbulence, in the aorta. All healthy subjects developed turbulent flow in the aorta, with total TKE of 3–19 mJ. The overall degree of turbulence in the entire aorta was similar between the groups, although the old subjects had about 73% more total TKE in the ascending aorta compared to the young subjects (young = 3.7 ± 1.8 mJ, old = 6.4 ± 2.4 mJ, p < 0.001). This increase in ascending aorta TKE in old subjects was associated with age-related dilation of the ascending aorta which increases the volume available for turbulence development. Conversely, age-related dilation of the descending and abdominal aorta decreased the average flow velocity and suppressed the development of turbulence. In conclusion, turbulent blood flow develops in the aorta of normal subjects and is impacted by age-related geometric changes. Non-invasive assessment enables the determination of normal levels of turbulent flow in the aorta which is a prerequisite for understanding the role of turbulence in the pathophysiology of cardiovascular disease.
Highlights
Turbulent blood flow in the human body is linked to the pathogenesis of various cardiovascular diseases
Recent advances in magnetic resonance (MR) flow imaging permit non-invasive quantification of turbulent blood flow invivo through measurements of the turbulent kinetic energy (TKE) (Dyverfeldt et al, 2006, 2008)
Two (10%) of the old subjects had a history of atrial fibrillation but were in sinus rhythm during MR imaging
Summary
Turbulent blood flow in the human body is linked to the pathogenesis of various cardiovascular diseases. Various acquired and congenital cardiovascular disorders, such as aortic valve stenosis and aortic coarctation, contribute to elevated levels of turbulent flow in the aorta (Stein and Sabbah, 1976; Yamaguchi et al, 1988; Dyverfeldt et al, 2013; Lantz et al, 2013). Turbulence appears to negatively impact several biological tissues While it is well-known that turbulence is present in patients with obstructive disease in the major vessels, the extent of turbulence in aortic blood flow in healthy normal subjects is relatively unexplored. Catheter-based measurements of human and dog blood flow have revealed that turbulence can develop in the aorta with diseased and with normal aortic valves (Stein and Sabbah, 1976; Yamaguchi et al, 1983; Hanai et al, 1991). Determining the normal or expected extent and degree of turbulent flow in the aorta is a prerequisite for understanding the role of turbulence in the pathophysiology and clinical riskstratification of pathological conditions in the cardiovascular system
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