Emerging trends in CV flow visualization
TL;DR: This document provides a descriptive outline of the relevant concepts in cardiac fluid mechanics, including the emergence of rotation in flow and the variables that delineate vortical structures, and elaborate on the main methods developed to image and visualize multidirectional cardiovascular flow.
Abstract: Blood flow patterns are closely linked to the morphology and function of the cardiovascular system. These patterns reflect the exceptional adaptability of the cardiovascular system to maintain normal blood circulation under a wide range of workloads. Accurate retrieval and display of flow-related information remains a challenge because of the processes involved in mapping the flow velocity fields within specific chambers of the heart. We review the potentials and pitfalls of current approaches for blood flow visualization, with an emphasis on acquisition, display, and analysis of multidirectional flow. This document is divided into 3 sections. First, we provide a descriptive outline of the relevant concepts in cardiac fluid mechanics, including the emergence of rotation in flow and the variables that delineate vortical structures. Second, we elaborate on the main methods developed to image and visualize multidirectional cardiovascular flow, which are mainly based on cardiac magnetic resonance, ultrasound Doppler, and contrast particle imaging velocimetry, with recommendations for developing dedicated imaging protocols. Finally, we discuss the potential clinical applications and technical challenges with suggestions for further investigations.
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TL;DR: It is described that 4D Flow CMR can be clinically advantageous because placement of a single acquisition volume is straightforward and enables flow through any plane across it to be calculated retrospectively and with good accuracy.
Abstract: Pulsatile blood flow through the cavities of the heart and great vessels is time-varying and multidirectional. Access to all regions, phases and directions of cardiovascular flows has formerly been limited. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has enabled more comprehensive access to such flows, with typical spatial resolution of 1.5×1.5×1.5 – 3×3×3 mm3, typical temporal resolution of 30–40 ms, and acquisition times in the order of 5 to 25 min. This consensus paper is the work of physicists, physicians and biomedical engineers, active in the development and implementation of 4D Flow CMR, who have repeatedly met to share experience and ideas. The paper aims to assist understanding of acquisition and analysis methods, and their potential clinical applications with a focus on the heart and greater vessels. We describe that 4D Flow CMR can be clinically advantageous because placement of a single acquisition volume is straightforward and enables flow through any plane across it to be calculated retrospectively and with good accuracy. We also specify research and development goals that have yet to be satisfactorily achieved. Derived flow parameters, generally needing further development or validation for clinical use, include measurements of wall shear stress, pressure difference, turbulent kinetic energy, and intracardiac flow components. The dependence of measurement accuracy on acquisition parameters is considered, as are the uses of different visualization strategies for appropriate representation of time-varying multidirectional flow fields. Finally, we offer suggestions for more consistent, user-friendly implementation of 4D Flow CMR acquisition and data handling with a view to multicenter studies and more widespread adoption of the approach in routine clinical investigations.
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TL;DR: It is postulate that maladaptive intracardiac vortex dynamics might modulate the progressive remodelling of the left ventricle towards heart failure and presents a new paradigm in cardiac function analysis, with the potential for sensitive risk identification of cardiac abnormalities.
Abstract: Blood motion in the heart features vortices that accompany the redirection of jet flows towards the outlet tracks. Vortices have a crucial role in fluid dynamics. The stability of cardiac vorticity is vital to the dynamic balance between rotating blood and myocardial tissue and to the development of cardiac dysfunction. Moreover, vortex dynamics immediately reflect physiological changes to the surrounding system, and can provide early indications of long-term outcome. However, the pathophysiological relevance of cardiac fluid dynamics is still unknown. We postulate that maladaptive intracardiac vortex dynamics might modulate the progressive remodelling of the left ventricle towards heart failure. The evaluation of blood flow presents a new paradigm in cardiac function analysis, with the potential for sensitive risk identification of cardiac abnormalities. Description of cardiac flow patterns after surgery or device therapy provides an intrinsic qualitative evaluation of therapeutic procedures, and could enable early risk stratification of patients vulnerable to adverse cardiac remodelling.
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TL;DR: The inflammatory and autoimmune diseases should now be considered as new cardiovascular risk factors, result of the major consequences of oxidative stress and RAS (Renin Angiotensin System) imbalance associated with the deleterious effect of known risk factors that lead to the alteration of the arterial wall.
Abstract: Chronic inflammatory diseases are associated with increases in cardiovascular diseases (CVD) and subclinical atherosclerosis as well as early-stage endothelial dysfunction screening using the FMD method (Flow Mediated Dilation). This phenomenon, referred to as accelerated pathological remodeling of arterial wall, could be attributed to traditional risk factors associated with atherosclerosis. Several new non-invasive techniques have been used to study arterial wall's structural and functional alterations. These techniques (based of Radio Frequency, RF) allow for an assessment of artery age through calculations of intima-media thickness (RF- QIMT), pulse wave rate (RF- QAS) and endothelial dysfunction degree (FMD). The inflammatory and autoimmune diseases should now be considered as new cardiovascular risk factors, result of the major consequences of oxidative stress and RAS (Renin Angiotensin System) imbalance associated with the deleterious effect of known risk factors that lead to the alteration of the arterial wall. Inflammation plays a key role in all stages of the formation of vascular lesions maintained and exacerbated by the risk factors. The consequence of chronic inflammation is endothelial dysfunction that sets in and we can define it as an integrated marker of the damage to arterial walls by classic risk factors. The atherosclerosis, which develops among these patients, is the main cause for cardiovascular morbi-mortality and uncontrolled chronic biological inflammation, which quickly favors endothelial dysfunction. These inflammatory and autoimmune diseases should now be considered as new cardiovascular risk factors.
128 citations
Cites background from "Emerging trends in CV flow visualiz..."
...Such screening is justified with these patients in order to assess the degree of accelerated arterial wall aging associated with screening of the atheromatosis and its progression, and to also assess the state of the endothelial function and therefore the actual cardiovascular risk thereby allowing for a better care management strategy and a decrease in the occurrence of cardiovascular events [5-7]....
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TL;DR: In this article, a two-dimensional continuity equation was applied to color Doppler data using speckle tracking data as boundary conditions, and the velocity component perpendicular to the echo beam line was obtained.
Abstract: We have developed a system to estimate velocity vector fields inside the cardiac ventricle by echocardiography and to evaluate several flow dynamical parameters to assess the pathophysiology of cardiovascular diseases. A two-dimensional continuity equation was applied to color Doppler data using speckle tracking data as boundary conditions, and the velocity component perpendicular to the echo beam line was obtained. We determined the optimal smoothing method of the color Doppler data, and the 8-pixel standard deviation of the Gaussian filter provided vorticity without nonphysiological stripe shape noise. We also determined the weight function at the bilateral boundaries given by the speckle tracking data of the ventricle or vascular wall motion, and the weight function linear to the distance from the boundary provided accurate flow velocities not only inside the vortex flow but also around near-wall regions on the basis of the results of the validation of a digital phantom of a pipe flow model.
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TL;DR: The current understanding of flow phenomena induced by heart valves are summarized, their linkage with disease pathways are discussed, and the research advances required to translate in-depth understanding of valvular hemodynamics into effective patient treatment are emphasized.
Abstract: As the pulsatile cardiac blood flow drives the heart valve leaflets to open and close, the flow in the vicinity of the valve resembles a pulsed jet through a nonaxisymmetric orifice with a dynamically changing area. As a result, three-dimensional vortex rings with intricate topology emerge that interact with the complex cardiac anatomy and give rise to shear layers, regions of recirculation, and flow instabilities that could ultimately lead to transition to turbulence. Such complex flow patterns, which are inherently valve- and patient-specific, lead to mechanical forces at scales that can cause blood cell damage and thrombosis, increasing the likelihood of stroke, and can trigger the pathogenesis of various life-threatening valvular heart diseases. We summarize the current understanding of flow phenomena induced by heart valves, discuss their linkage with disease pathways, and emphasize the research advances required to translate in-depth understanding of valvular hemodynamics into effective patient ther...
114 citations
References
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TL;DR: A review of these methods can be found in articles by Lauterborn & Vogel (1984), Adrian (1986a), Hesselink (1988), and Dudderar et al..
Abstract: An important achievement of modern experimental fluid mechanics is the invention and development of techniques for the measurement of whole, instantaneous fields of scalars and vectors. These techniques include tomographic interferometry (Hesselink 1988) and planar laser-induced fluorescence for scalars (Hassa et al 1987), and nuclear-magnetic-resonance imaging (Lee et al 1987), planar laser-induced fluorescence, laser-speckle velocimetry, particle-tracking velocimetry, molecular-tracking velocimetry (Miles et al 1989), and particle-image velocimetry for velocity fields. Reviews of these methods can be found in articles by Lauterborn & Vogel (1984), Adrian (1986a), Hesselink (1988), and Dudderar et al (1988), in books written by Merzkirch (1987) and edited by Chiang & Reid (1988) and Gad-el-Hak (1989).
3,413 citations
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TL;DR: In this article, the directional ambiguity associated with PIV and LSV is resolved by implementing local spatial cross-correlations between two sequential single-exposed particle images, and the recovered velocity data are used to compute the spatial and temporal vorticity distribution and the circulation of the vortex ring.
Abstract: Digital particle image velocimetry (DPIV) is the digital counterpart of conventional laser speckle velocitmetry (LSV) and particle image velocimetry (PIV) techniques. In this novel, two-dimensional technique, digitally recorded video images are analyzed computationally, removing both the photographic and opto-mechanical processing steps inherent to PIV and LSV. The directional ambiguity generally associated with PIV and LSV is resolved by implementing local spatial cross-correlations between two sequential single-exposed particle images. The images are recorded at video rate (30 Hz or slower) which currently limits the application of the technique to low speed flows until digital, high resolution video systems with higher framing rates become more economically feasible. Sequential imaging makes it possible to study unsteady phenomena like the temporal evolution of a vortex ring described in this paper. The spatial velocity measurements are compared with data obtained by direct measurement of the separation of individual particle pairs. Recovered velocity data are used to compute the spatial and temporal vorticity distribution and the circulation of the vortex ring.
1,976 citations
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TL;DR: A flow sensitizing zeugmatographic phase-modulation interlace for NMR-imaging which is exactly analogous to Lauterbur's spatial-location-sensitizing magnetic field gradients and enables up to 6-D imaging of the joint density of spins delta (r,v).
771 citations
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TL;DR: Akt activation exerts a powerful cardioprotective effect after transient ischemia that probably reflects its ability to both inhibit cardiomyocyte death and improve function of survivingCardiomyocytes in ischemic and other heart disease.
Abstract: Background The serine-threonine kinase Akt is activated by several ligand-receptor systems previously shown to be cardioprotective. Akt activation reduces cardiomyocyte apoptosis in models of transient ischemia. Its role in cardiac dysfunction or infarction, however, remains unclear.
Methods and Results We examined the effects of a constitutively active Akt mutant (myr-Akt) in a rat model of cardiac ischemia-reperfusion injury. In vivo gene transfer of myr-Akt reduced infarct size by 64% and the number of apoptotic cells by 84% ( P <0.005 for each). Ischemia-reperfusion injury decreased regional cardiac wall thickening as well as the maximal rate of left ventricular pressure rise and fall (+dP/dt and −dP/dt). Akt activation restored regional wall thickening and +dP/dt and −dP/dt to levels seen in sham-operated rats. To better understand this benefit, we examined the effects of myr-Akt on hypoxic cardiomyocyte dysfunction in vitro. myr-Akt prevented hypoxia-induced abnormalities in cardiomyocyte calcium transients and shortening. Akt activation also enhanced sarcolemmal expression of Glut-4 in vivo and increased glucose uptake in vitro to the level seen with insulin treatment.
Conclusions Akt activation exerts a powerful cardioprotective effect after transient ischemia that probably reflects its ability to both inhibit cardiomyocyte death and improve function of surviving cardiomyocytes. Akt may represent an important nodal target for therapy in ischemic and other heart disease.
Received December 7, 2000; revision received March 15, 2001; accepted March 28, 2001.
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TL;DR: This work shows the asymmetric redirection of streaming blood in atrial and ventricular cavities of the adult human heart, with sinuous, chirally asymmetric paths of flow through the whole, and proposes that asymmetries and curvatures of the looped heart have potential fluidic and dynamic advantages.
Abstract: Through cardiac looping during embryonic development, paths of flow through the mature heart have direction changes and asymmetries whose topology and functional significance remain relatively unexplored. Here we show, using magnetic resonance velocity mapping, the asymmetric redirection of streaming blood in atrial and ventricular cavities of the adult human heart, with sinuous, chirally asymmetric paths of flow through the whole. On the basis of mapped flow fields and drawings that illustrate spatial relations between flow paths, we propose that asymmetries and curvatures of the looped heart have potential fluidic and dynamic advantages. Patterns of atrial filling seem to be asymmetric in a manner that allows the momentum of inflowing streams to be redirected towards atrio-ventricular valves, and the change in direction at ventricular level is such that recoil away from ejected blood is in a direction that can enhance rather than inhibit ventriculo-atrial coupling. Chiral asymmetry might help to minimize dissipative interaction between entering, recirculating and outflowing streams. These factors might combine to allow a reciprocating, sling-like, 'morphodynamic' mode of action to come into effect when heart rate and output increase during exercise.
691 citations