Clinical relevance of aortic conduit and reservoir function

• Published in: Open heart 2024-08, Vol.11 (2), p.e002713
• Main Authors: Assadi, Hosamadin, Sawh, Chris, Spohr, Hilmar, Nelthorpe, Faye, Nair, Sunil, Hughes, Marina, Ashman, David, Ryding, Alisdair, Matthews, Gareth, Li, Rui, Grafton-Clarke, Ciaran, Mehmood, Zia, Al-Mohammad, Abdallah, Kasmai, Bahman, Vassiliou, Vassilios S, Garg, Pankaj
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aging; Aorta - diagnostic imaging; Aorta - physiopathology; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - physiopathology; Aortic and Vascular Disease; aortic diseases; Blood Flow Velocity - physiology; Cardiology; Cardiomyopathy; Cardiovascular disease; Clinical Relevance; Contrast agents; Coronary vessels; Ejection fraction; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - physiopathology; Humans; magnetic resonance imaging; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Original Research; Stroke Volume - physiology; Ventricular Function, Left - physiology; Workloads
• ISSN: 2053-3624; 2398-595X; 2053-3624
• DOI: 10.1136/openhrt-2024-002713

BackgroundAortic conduit and reservoir functions can be directly measured by four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR).MethodsTwenty healthy controls (10 young and 10 age-gender-matched old controls) and 20 patients with heart failure with preserved ejection fraction (HFpEF) were recruited. All had 4D flow CMR. Flow was quantified at the ascending and descending aorta levels. In addition, at the ascending aorta level, we quantified systolic flow displacement (FDs) and systolic flow reversal ratio (sFRR). The aortic conduit function was defined as the relative drop in systolic flow from the ascending to the descending aorta (∆Fs). Aortic reservoir function was defined as descending aortic diastolic stroke volume (DAo SVd).ResultsBoth ∆Fs (R=0.51, p=0.001) and DAo SVd (R=−0.68, p=0.001) were significantly associated with ageing. Native T1 (R=0.51, p=0.001) and extracellular volume (R=0.51, p=0.001) showed maximum association with ∆Fs. ∆Fs significantly increased in HFpEF versus age-gender-matched controls (41±8% vs 52±12%, p=0.02). In multiple regression, only ∆Fs and DAo SVd were independent predictors of the estimated glomerular filtration rate (model R=0.77, p=0.0001). FDs was significantly associated with ∆Fs (R=0.4, p=0.01) and DAo SVd (R=−0.48, p=0.002), whereas sFRR was mainly associated with DAo SVd (R=−0.46, p=0.003).ConclusionBoth aortic conduit and reservoir function decline with age and this decline in aortic function is also independently associated with renal functional decline. Ascending aortic turbulent flow signatures are associated with loss of aortic conduit and reservoir functions. Finally, in HFpEF, aortic conduit and reservoir function demonstrate progressive decline.Trials registration numberNCT05114785.