Four-dimensional flow MRI quantification study of the pulmonary artery hemodynamics in patients with repaired tetralogy of Fallot
10.3760/cma.j.cn112149-20240307-00109
- VernacularTitle:法洛四联症矫正术后肺动脉血流动力学的四维血流MRI定量研究
- Author:
Jing XU
1
;
Shiqin YU
;
Gang YIN
;
Shoujun LI
;
Shihua ZHAO
;
Minjie LU
Author Information
1. 国家心血管病中心 北京协和医学院 中国医学科学院阜外医院磁共振影像科 中国医学科学院心血管影像重点实验室，北京 100037
- Publication Type:Journal Article
- Keywords:
Tetralogy of Fallot;
Magnetic resonance imaging;
Four-dimensional flow;
Viscous energy loss;
Hemodynamics
- From:
Chinese Journal of Radiology
2025;59(3):277-285
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To comprehensively evaluate the changes in pulmonary artery hemodynamics in patients with repaired tetralogy of Fallot (rTOF) using four-dimensional flow (4D Flow) MRI, and to explore the value of viscous energy loss (EL) as an evaluation parameter of the right heart in patients with rTOF.Methods:A total of 30 rTOF patients who were prospectively admitted at Fuwai Hospital between October 2017 and November 2019, and 19 healthy controls who were prospectively recruited on March 2023, were enrolled in this study. All participants underwent a comprehensive 4D Flow MRI evaluation, and indicators of comparison between the two groups including quantitative flow analysis, wall shear stress (WSS) assessment, and EL evaluation in four planes: the right ventricular outflow tract (RVOT), main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA). The correlation between EL and traditional right ventricular (RV) function parameters, as well as WSS, was analyzed.Results:The RV function was generally decreased in rTOF patients, with an RV ejection fraction of 41.42 (35.85, 43.33) %. Compared with healthy controls, the volumes of backward flow, peak velocities, and both axial and circumferential WSS at the RVOT, MPA, RPA, and LPA were significantly increased in rTOF patients (all P<0.05). The EL in the pulmonary artery was extremely low in healthy controls, with the maximum EL values for the MPA-RPA and MPA-LPA segments during cardiac cycle being 0.51 (0.42, 0.73) and 0.68 (0.40, 0.94) mW, respectively. However, in rTOF patients, the EL values were as high as 63.63 (35.35, 82.15) and 56.41 (34.96, 88.76) mW, respectively. There was a significant moderate negative correlation between EL and RV ejection fraction, and a moderate to high positive correlation between EL with RV volume index, regurgitation fraction, as well as peak velocities (all P<0.05). Additionally, there was a significant positive correlation between EL and axial and circumferential WSS, with the correlation coefficients at MPA ranging from 0.67 to 0.88 (all P<0.05). Conclusions:Disordered flow in the pulmonary artery is common in patients with rTOF and should not be overlooked. The extensive viscous EL is closely associated with traditional RV function parameters and WSS. EL is expected to become an crucial parameter for evaluating right heart function in rTOF patients.
