Peak Systolic Wall Shear Stress Research Articles

Phase-contrast magnetic resonance imaging for the evaluation of wall shear stress in the common carotid artery of a spontaneously hypertensive rat model at 7 T: Location-specific change, regional distribution along the vascular circumference, and reproducibility analysis

PurposeTo measure wall shear stress (WSS) in the common carotid arteries (CCA) of a spontaneously hypertensive rat (SHR) model and a normotensive Wistar Kyoto rat (WKY) model by 2D phase-contrast magnetic resonance imaging (PC-MRI). Materials and methodsPC-MRI was performed on 7 SHR and 7 WKY at ages of 4 and 7months at a 7T scanner. Images in the middle CCA (CCAmid) and in the bifurcation of CCA (CCAbifur) were acquired. The WSS values for differentiating characteristics between two models were calculated. Further, its location-specific change, regional distribution along the CCA circumference, and the reproducibility were evaluated. ResultsIn the 4-month-old rats, SHR showed lower temporal averaged WSS (WSSavg) and peak systolic WSS (WSSs) in the CCAbifur in comparison with WKY (WSSavg: 0.95±0.18 vs. 1.30±0.36N/m2 (P<0.01); WSSs: 1.68±0.70 vs. 3.22±2.49N/m2 (P<0.05)). We observed the same trends in the 7-month-old rats. In the SHR model, the WSSavg was lower in the CCAbifur than in the CCAmid. The regional distribution of WSSavg along the circumference of CCA showed lower values in WKY, particularly in posterior segments of CCAbifur. The intra-observer, intra-scan and inter-scan reproducibility was acceptable and the disagreements were ranged from −0.05 to 0.06N/m2. ConclusionThis study evaluated WSS in SHR and WKY models by 2D PC-MRI. High reproducibility analyses further indicated the reliability of measurements of WSS in the CCA of SHR and WKY models using PC-MRI at 7T.

Age-related changes in aortic 3D blood flow velocities and wall shear stress: Implications for the identification of altered hemodynamics in patients with aortic valve disease.

To investigate age-related changes in peak systolic aortic 3D velocity and wall shear stress (WSS) in healthy controls and to investigate the importance of age-matching for 3D mapping of abnormal aortic hemodynamics in bicuspid aortic valve disease (BAV). 4D flow MRI (fields strengths = 1.5-3T; resolution = 2.2-3.9 × 1.7-2.6 × 2.2-4.0 mm(3) ; Venc = 150-250 cm/s; TE/TR/FA = 2.3-2.8/4.7-5.4msec/7-15°) was performed in 56 controls (age range: 19-78 years) and in two BAV patient groups each consisting of 10 subjects (group 1: 20-29 years, group 2: 52-57 years). Heat maps showing abnormal 3D velocity and WSS were created for the BAV patients by comparison with an age-matched and with an unmatched control group. The fraction of the aorta exposed to abnormal velocity/WSS was calculated relative to the total aortic volume/surface. Significant inverse relationships between age and healthy velocity/WSS were found (R(2) = 0.32/0.39, P < 0.001). For BAV group 1, abnormally elevated velocity/WSS was overestimated when compared with older controls (51-60 years) than when correctly age-matched (∼25 ± 14% vs. ∼8 ± 5%). For BAV group 2, abnormally decreased velocity/WSS was overestimated when compared with younger controls (21-30 years) than when correctly age-matched (∼9 ± 7% vs. 1 ± 1%). Significant correlations exist between age and peak systolic velocity and WSS. Therefore, robust age-matching is important when creating abnormal 3D aortic velocity and WSS maps for patients with BAV.

Peak systolic or maximum intra-aneurysmal hemodynamic condition? Implications on normalized flow variables

Background: CFD has been used to assess intra-aneurysmal hemodynamics. Nevertheless, the lack of patient-specific flow information has triggered the possibility of implementing a wide variety of physiological flow conditions. Due to these uncertainties in the patient flow conditions, the normalization of the intra-aneurysmal hemodynamics is generally conducted.Purpose: To investigate how intra-aneurysmal and arterial hemodynamics change over time when different physiological flow conditions are imposed.Material and method: Eleven image-based aneurysm models were used in this study. CFD simulations were performed under pulsatile flows. Velocity magnitude and wall shear stress (WSS) were calculated during one cardiac cycle.Results: Maximum hemodynamic condition does not necessarily occurred at peak systole. The shifted time from peak systole to the time where the maximum hemodynamic condition occurs inside the aneurysm depends on the aneurysm size, flow rate, surrounding vasculature and the stabilities of flow patterns. Larger shifted times were observed with increasing aneurysm size as well as with reducing the flow rate. Moreover, the maximum hemodynamic condition can occur earlier than peak systole if flow patterns at parent artery change. Differences between peak systolic WSS and maximum WSS can be up to 65%. Moreover, the velocity magnitude and WSS depend on the selected segment of the parent artery, with relatively larger variability near peak systole than the rest of the cardiac cycle. More than 50% of differences were found between two arterial segments arbitrary selected for a given flow rate.Conclusions: Our results indicate that if the highest intra-aneurysmal stress is calculated, then it is preferable to use the time instance where the maximum WSS occurred instead of the peak systolic WSS. Additionally, the normalization of intra-aneurysmal hemodynamics should be done with variables that do not depend on any arbitrary segment of the parent artery.

Wall morphology, blood flow and wall shear stress: MR findings in patients with peripheral artery disease

To investigate the influence of atherosclerotic plaques on femoral haemodynamics assessed by two-dimensional (2D) phase-contrast (PC) magnetic resonance imaging (MRI) with three-directional velocity encoding. During 1year, patients with peripheral artery disease and an ankle brachial index <1.00 were enrolled. After institutional review board approval and written informed consent, 44 patients (age, 70 ± 12years) underwent common femoral artery MRI. Patients with contra-indications for MRI were excluded. Sequences included 2D time-of-flight, proton-density, T1-weighted and T2-weighted MRI. Electrocardiogram (ECG)-gated 2D PC-MRI with 3D velocity encoding was acquired. A radiologist classified images in five categories. Blood flow, velocity and wall shear stress (WSS) along the vessel circumference were quantified from the PC-MRI data. The acquired images were of good quality for interpretation. There were no image quality problems related to poor ECG-gating or slice positioning. Velocities, oscillatory shear stress and total flow were similar between patients with normal arteries and wall thickening/plaque. Patients with plaques demonstrated regionally increased peak systolic WSS and enhanced WSS eccentricity. Combined multi-contrast morphological imaging of the peripheral arterial wall with PC-MRI with three-directional velocity encoding is a feasible technique. Further study is needed to determine whether flow is an appropriate marker for altered endothelial cell function, vascular remodelling and plaque progression. • Femoral plaques are associated with altered dynamics of peripheral blood flow. • Multi-contrast MRI can investigate the presence and type of atherosclerotic plaques. • Three-dimensional velocity-encoding phase-contrast MRI can investigate flow and wall shear stress. • Atherosclerotic peripheral arteries demonstrate increased systolic velocities and wall shear stress.

Blood flow characteristics in the ascending aorta after aortic valve replacement—a pilot study using 4D-flow MRI

BackgroundAortic remodeling after aortic valve replacement (AVR) might be influenced by the postoperative blood flow pattern in the ascending aorta. This pilot study used flow-sensitive four-dimensional magnetic resonance imaging (4D-flow) to describe ascending aortic flow characteristics after various types of AVR. Methods4D-flow was acquired in 38 AVR patients (n=9 mechanical, n=8 stentless bioprosthesis, n=14 stented bioprosthesis, n=7 autograft) and 9 healthy controls. Analysis included grading of vortex and helix flow (0–3 point scale), assessment of systolic flow eccentricity (1–3 point scale), and quantification of the segmental distribution of peak systolic wall shear stress (WSSpeak) in the ascending aorta. ResultsCompared to controls, mechanical prostheses showed the most distinct vorticity (2.7±0.5 vs. 0.7±0.7; p<0.001), while stented bioprostheses exhibited most distinct helicity (2.6±0.7 vs. 1.6±0.5; p=0.002). Instead of a physiologic central flow, all stented, stentless and mechanical prostheses showed eccentric flow jets mainly directed towards the right-anterior aortic wall. Stented and stentless prostheses showed an asymmetric distribution of WSSpeak along the aortic circumference, with significantly increased local WSSpeak where the flow jet impinged on the aortic wall. Local WSSpeak was higher in stented (1.4±0.7N/m2) and stentless (1.3±0.7N/m2) compared to autografts (0.6±0.2N/m2; p=0.005 and p=0.008) and controls (0.7±0.1N/m2; p=0.017 and p=0.027). Autografts exhibited lower absolute WSSpeak than controls (0.4±0.1N/m2 vs. 0.7±0.2N/m2; p=0.003). ConclusionsFlow characteristics in the ascending aorta after AVR are different from native aortic valves and differ between various types of AVR.

Type of aortic valve replacement influences ascending aortic flow characteristics - a pilot study using 4D flow MRI

Methods Flow-sensitive four-dimensional magnetic resonance imaging (4D-flow) was acquired in 38 AVR patients (n=9 mechanical, n=8 stentless bioprosthesis, n=14 stented bioprosthesis, n=7 autograft) and 9 healthy controls. Analysis included grading of vortex and helix flow (0-3 point scale), assessment of systolic flow eccentricity (1-3 point scale), and quantification of the segmental distribution of peak systolic wall shear stress (WSSpeak) in the ascending aorta.

Aortic wall shear stress in Marfan syndrome

The aim of this study was to quantify changes in thoracic aortic wall shear stress (WSS) in asymptomatic patients with Marfan syndrome (MFS) compared with healthy controls. WSS in the thoracic aorta was quantified based on time-resolved 3D phase contrast MRI with three-directional velocity encoding (4D flow MRI, temporal resolution ∼44 ms, spatial resolution ∼2.5 mm) in 24 patients with confirmed MFS (age = 18 ± 12 years) and in 12 older healthy volunteers (age = 25 ± 3 years). Diameters of the thoracic aorta normalized to body surface area were similar for both groups. Peak systolic velocity, absolute WSS, time-averaged WSS, circumferential WSS, peak systolic WSS, and WSS eccentricity were calculated in eight analysis planes distributed along the thoracic aorta. Plane-wise comparison revealed significant differences between MFS patients and volunteers in the proximal ascending aorta for peak systolic velocities (1.11 ± 0.23 m/s vs. 1.34 ± 0.18 m/s, P = 0.004) and circumferential WSS (0.14 ± 0.03 N/m(2) vs. 0.11 ± 0.02 N/m(2), P = 0.007). WSS eccentricity was altered in most of the ascending aorta and proximal arch (P = 0.009-0.020). MFS patients demonstrated segmental differences in peak systolic WSS with a significantly higher WSS at the inner curvature in the proximal ascending aorta and at the anterior part in the more distal ascending aorta (P < 0.01). These findings indicate differences in WSS associated with MFS despite similar aortic dimensions compared to controls.

Evaluation of 3D blood flow patterns and wall shear stress in the normal and dilated thoracic aorta using flow-sensitive 4D CMR.

BackgroundThe purpose of this study was to investigate 3D flow patterns and vessel wall parameters in patients with dilated ascending aorta, age-matched subjects, and healthy volunteers.MethodsThoracic time-resolved 3D phase contrast CMR with 3-directional velocity encoding was applied to 33 patients with dilated ascending aorta (diameter ≥40 mm, age=60±16 years), 15 age-matched normal controls (diameter ≤37 mm, age=68±7.5 years) and 15 young healthy volunteers (diameter ≤30 mm, age=23±2 years). 3D blood flow was visualized and flow patterns were graded regarding presence of supra-physiologic-helix and vortex flow using a semi-quantitative 3-point grading scale. Blood flow velocities, regional wall shear stress (WSS), and oscillatory shear index (OSI) were quantified.ResultsIncidence and strength of supra-physiologic-helix and vortex flow in the ascending aorta (AAo) was significantly higher in patients with dilated AAo (16/33 and 31/33, grade 0.9±1.0 and 1.5±0.6) than in controls (2/15 and 7/15, grade 0.2 ± 0.6 and 0.6 ± 0.7, P<.05) or healthy volunteers (1/15 and 0/15, grade 0.1 ± 0.3 P<.05). Greater strength of the ascending aortic helix and vortex flow were associated with significant differences in AAo diameters (P<.05). Peak systolic WSS in the ascending aorta and aortic arch was significantly lower in patients with dilated AAo (P<.0157-.0488). AAo diameter positively correlated to time to peak systolic velocities (r=0.30-0.53, P<.04), OSI (r=0.33-0.49, P<0.02) and inversely correlated to peak systolic WSS (r=0.32-0.40, P<.03). Peak systolic WSS was significantly lower in AAo aneurysms at the right and outer curvature within the AAo and proximal arch (P<.01-.05).ConclusionsIncrease in AAo diameter is significantly correlated with the presence and strength of supra-physiologic-helix and vortex formation in the AAo, as well with decrease in systolic WSS and increase in OSI.

Diastolic Carotid Artery Wall Shear Stress Is Associated With Cerebral Infarcts and Periventricular White Matter Lesions

Low wall shear stress (WSS) is an early marker in the development of vascular lesions. The present study aims to assess the relationship between diastolic and systolic WSS in the internal carotid artery and periventricular (PWML), deep white matter lesions, and cerebral infarcts (CI). Early, mid, and late diastolic and peak systolic WSS were derived from shear rate obtained by gradient echo phase contrast magnetic resonance sequences multiplied by individually modeled viscosity. PWML, deep white matter lesions, and CI were derived from proton density (PD), T2, and fluid attenuated inversion recovery (FLAIR) MRI in 329 participants (70-82 years; PROSPER baseline). Analyses were adjusted, if appropriate, for age, gender, intracranial volume, and multiple cardiovascular risk factors. Mid-diastolic WSS was significantly correlated with the presence of PWML (B=-10.15; P=0.006) and CI (B=-2.06; P=0.044), but not with deep white matter lesions (B=-1.30; P=0.050; adjusted for age, gender, WML, and intracranial volume). After adjustment for cardiovascular risk factors, these correlations weakened but remained significant. Systolic WSS was not correlated with any of the cerebrovascular parameters. This study is the first to our knowledge to present a cross-sectional correlation between carotid artery WSS and cerebrovascular pathology such as PWML and CI in a large population. Furthermore, it shows that diastolic hemodynamics may be more important than systolic or mean hemodynamics. Future studies exploring vascular hemodynamic damage should focus on diastolic WSS.

In vivo three‐dimensional MR wall shear stress estimation in ascending aortic dilatation

To estimate surface-based wall shear stress (WSS) and evaluate flow patterns in ascending aortic dilatation (AscAD) using a high-resolution, time-resolved, three-dimensional (3D), three-directional velocity encoded, radially undersampled phase contrast MR sequence (4D PC-MRI). 4D PC-MRI was performed in 11 patients with AscAD (46.3 ± 22.0 years) and 10 healthy volunteers (32.9 ± 13.4 years) after written informed consent and institutional review board approval. Following manual vessel wall segmentation of the ascending aorta (MATLAB, The Mathworks, Natick, MA), a 3D surface was created using spline interpolation. Spatial WSS variation based on surface division in 12 segments and temporal variation were evaluated in AscAD and normal aortas. Visual analysis of flow patterns was performed based on streamlines and particle traces using EnSight (v9.0, CEI, Apex, NC). AscAD was associated with significantly increased diastolic WSS, decreased systolic to diastolic WSS ratio, and delayed onset of peak WSS (all P < 0.001). Temporally averaged WSS was increased and peak systolic WSS was decreased. The maximum WSS in AscAD was on the anterior wall of the ascending aorta. Vortical flow with highest velocities along the anterior wall and increased helical flow during diastole were observed in AscAD compared with controls. Changes in WSS in the ascending aorta of AscAD correspond to observed alterations in flow patterns compared to controls.

The relationship between vascular wall shear stress and flow-mediated dilation: endothelial function assessed by phase-contrast magnetic resonance angiography

OBJECTIVESWe sought: 1) to investigate the relationship between vascular wall shear stress and flow-mediated dilation (FMD) in humans, and 2) to investigate whether this relationship could explain why FMD is greater in small arteries.BACKGROUNDArterial wall shear stress (WSS) is considered to be the primary stimulus for the endothelial-dependent FMD response. However, the relationship between WSS and FMD has not been investigated in humans. Furthermore, FMD is greater in small arteries, though the reasons for this phenomenon are unclear.METHODSUsing phase-contrast magnetic resonance angiography (PMRCA), we measured hyperemic WSS and FMD in 18 healthy volunteers. Peak systolic WSS was calculated assuming a blunted parabolic velocity profile. Diameter by PCMRA and by ultrasound was compared in nine subjects.RESULTSFlow-mediated dilation was linearly proportional to hyperemic peak systolic WSS (r = 0.79, p = 0.0001). Flow-mediated dilation was inversely related to baseline diameter (r = 0.62, p = 0.006), but the hyperemic peak WSS stimulus was also inversely related to baseline diameter (r = 0.47, p = 0.049). Phase-contrast magnetic resonance angiography and ultrasound diameters were compared in nine subjects and correlated well (r = 0.84, p < 0.0001), but diameter by PCMRA was greater (4.1 ± 0.7 mm vs. 3.7 ± 0.5 mm, p = 0.009).CONCLUSIONSArterial FMD is linearly proportional to peak hyperemic WSS in normal subjects. Thus, the endothelial response is linearly proportional to the stimulus. Furthermore, the greater FMD response in small arteries is accounted for, at least partially, by a greater hyperemic WSS stimulus in small arteries. By allowing the calculation of vascular WSS, which is the stimulus for FMD, and by imaging a fixed arterial cross-section, thus reducing operator dependence, PCMRA enhances the assessment of vascular endothelial function.

Mean Wall Shear Stress in the Femoral Arterial Bifurcation Is Low and Independent of Age at Rest

In elastic arteries, mean wall shear stress appears to be close to 1.5 Pa, the value predicted by the theory of minimal energy loss. This finding in elastic arteries does not necessarily represent the situation in muscular arteries. Elastic arteries have to store potential energy, while muscular arteries have mainly a conductive function. Therefore, we determined wall shear stress and its age dependency in the common and superficial femoral arteries, 2–3 cm from the flow divider in 54 presumed healthy volunteers between 21 and 74 years of age, using a non-invasive ultrasound system. Prior to the study, the reliability of this system was determined in terms of intrasubject variation. Mean wall shear stress was significantly lower in the common femoral artery (0.35 ± 0.18 Pa) than in the superficial femoral artery (0.49 ± 0.15 Pa). In all age categories, peak systolic wall shear stress and the maximal cyclic change in wall shear stress were not significantly different in the common and the superficial femoral arteries. Peak systolic wall shear stress in the common and the superficial femoral arteries was not significantly different from the value previously determined in the common carotid artery, but mean wall shear stress was lower in the common and superficial femoral arteries than in the common carotid artery by a factor of 2–4. In both the common and the superficial femoral arteries, mean, peak systolic and maximal cyclic change in wall shear stress did not change significantly with age, nor did diameter. We conclude that, as compared to elastic arteries, mean wall shear stress is low in the conductive arteries of a resting leg, due to backflow during the first part of the diastolic phase of the cardiac cycle and the absence of flow during the rest of the diastolic phase. Mean wall shear stress is lower in the common than in the superficial femoral artery due to additional reflections from the deep femoral artery.