Works in LUMC
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1 Works in LUMC 13th SPR Symposium on Advanced Pediatric Cardiovascular Imaging Arno AW Roest Pediatric Cardiology WILLEM-ALEXANDER CHILDREN S HOSPITAL
2 No financial disclosures 2 Insert > Header & footer
3 Works in LUMC Validation of 4D flow acquisitions-analyses Scan-rescan: LV in-outflow with valve tracking and particle tracing Scan-rescan: LV diastolic energetics Scan-rescan: Aortic wall shear stress (WSS) Improving clinical utilization Automated valve tracking 4D flow in Congenital Heart Disease COBRA 3 -study: Intracardiac Fontan, rest-stress FloArt-study: Aorta in pts with transposition of the great arteries, rest-stress Velocity-study: Fontan circulation vs complications 3 Insert > Header & footer
4 Scan-rescan analysis of in-outflow volume Planimetry vs Valve tracking vs Forward-backward particle tracing 4 Insert > Header & footer
5 Scan-rescan analysis of in-outflow volume 5 Insert > Header & footer
6 Scan-rescan energetics and vorticity Parameters tested: Kinetics Energy (KE) Energy Loss (EL) EL index: EL over KE Vorticity 6 Insert > Header & footer Vivian Kamphuis et al, submitted
7 4D Flow validation LV in- and outflow assessment by 4D flow MRI shows good in-scan consistency and strong scanrescan reproducibility (1) 4D Flow MRI assessment of LV diastolic kinetic energy, viscous energy loss and vorticity shows excellent in-scan consistency and overall good agreement between scans (2) Strong reproducibility is found in the dimensionless EL index : the amount of viscous energy lost relative to the average kinetic energy (2) Aortic outflow Mitral inflow Kinetic energy Viscous energy loss Vorticity 1. Kamphuis VP, van der Palen RLF, et al. J Magn Reson Imaging Jun 22. doi: /jmri Kamphuis VP, Westenberg JJM, et al. submitted Introduction Methods Results Conclusion Discussion
8 Scan-rescan Aorta WSS: Segmental WSS in five segments of the thoracic aorta Multiple phases Peak and mean WSS 8 Insert > Header & footer Roel vd Palen et al, submitted
9 WSS in patients with aortoparthy 13 yo male after coarctation repair 17yo male after ASO for TGA Area s of low or high WSS beyond scan-rescan variation 9 Insert > Header & footer Roel vd Palen et al, submitted
10 Improving clinical utilization: valve tracking Tricuspid valve Mitral valve 3D volume scan with 3-directional time-resolved velocity-encoded MRI Aortic valve Works in LUMC: clinical utility Pulmonary valve Courtesy Jos Westenberg
11 Speed up analysis: automated valve tracking 11
12 Clinical utilization: automated valve tracking Abstract submitted CMR patients: ischemic and CHD -manual vs automated valve tracking 12 Insert > Header & footer
13 4D flow in specific patientgroups COBRA 3 -study-collaboration with Rotterdam-Wim Helbing In addition to clinical status, new biomarkers from animal studies, echo MRI prior and after intervention: Fallot-PVR-biopsy Serial MRI in Fallots: rest-stress Serial MRI in Fontan: rest-stress LUMC addendum: 4D flow in Fontan pts: rest-stress FloArt-study 4D flow MRI in patients with TGA-rest-stress Special focus in ascending aorta dilatation vs pulmonary arteries Velocity-study: collaboration Utrecht-Heynric Grotenhuis Utrecht: TGA-patients: focus on pulmonary arteries LUMC: Fontan-patients: 4D flow TCPC-intracardiac vs complications 13 Insert > Header & footer
14 COBRA 3 -study 25 Fontan pts with intracardiac 4D flow 10 Fontan pts at rest and dobu-stress 14 Insert > Header & footer VP Kamphuis, submitted
15 COBRA 3 -study Relation between anatomy and energy loss Flow characteristics and energetics at rest and with dobutamine-stress Relation between abnormalities vs clinical status, exercise capacity, biomarkers Healthy Adult Subject Fontan Patient Courtesy: Mohammed S.M. Elbaz
16 FloArt-study 16 Insert > Header & footer
17 FloArt-study 17 Insert > Header & footer
18 FloArt-study Assessment of aorta flow dynamics after Arterial Switch Operation for TGA Dimensions vs flow characteristics vs WSS 18 Insert > Header & footer RL van der Palen, abstract submitted CMR2018
19 Velocity-study Myocardial dysfunction Liver cirrhosis Protein losing enteropathy Decreased exercise capacity Eur Heart J Cardiovasc Imaging Oct;15(10): Insert > Header & footer
20 Conlusions: LUMC Validation steps essential in knowing accuracy of 4D flow derived metrics Major step to clinical utilization: automated valve tracking Ongoing-New studies: COBRA 3 -study: Intracardiac anatomy dictates energy loss FloArt-study: Specific regions of altered WSS after ASO for TGA Velocity-study: Fontan circulation vs complications Unravelling pathophysiological mechanisms leading to complications Early detection of complications
21 Thanks for your attention! 4D LUMC Vivian Kamphuis Roel van der Palen Mohammed El Baz Pieter vd Boogaard Jos Westenberg Lucia Kroft Patrick de Koning Rob vd Geest Albert de Roos Department of Radiology Jos Westenberg Mohammed El Baz Pieter vd Boogaard Lucia Kroft Patrick de Koning Rob vd Geest Albert de Roos Current 4D flow PhD projects Vivian Kamphuis Roel van der Palen Friso Rijnberg Department of Pediatric Cardiology Arno Roest Department of Anatomy and Embryology Monique Jongbloed Department of Thoracic Surgery Mark Hazekamp
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