The preliminary value of vector flow mapping on assessment of left intraventricular pressure difference in patients with paroxysmal atrial fibrillation_Journal of Biomedical Engineering

Authors：

LIU Mei , CAI Yuyan ,  HUANG He , ZHONG Yue , WANG Fang

Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

HUANG He, Email: huanghe@wchscu.cn

Keywords：

vector flow mapping; relative pressure imaging; intraventricular pressure difference; paroxysmal atrial fibrillation

DOI：

10.7507/1001-5515.202011004

Video：

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This study aims to explore the intraventricular pressure difference (IVPD) within left ventricle in patients with paroxysmal atrial fibrillation (PAF) by using the relative pressure imaging (RPI) of vector flow mapping (VFM). Twenty patients with paroxysmal atrial fibrillation (PAF) and thirty control subjects were enrolled in the study. Systolic and diastolic IVPD derived from VFM within left ventricle and conventional echocardiographic parameters were analyzed. It was found that the B-A IVPD of left ventricle in PAF patients showed the same pattern as controls—single peak and single valley during systole and double peaks and double valleys during diastole. Basal IVPD was the main component of base to apex IVPD (B-A IVPD). The isovolumetric systolic IVPD was associated with early systolic IVPD, early systolic IVPD was associated with late systolic IVPD, and late systolic IVPD was associated with isovolumic diastolic IVPD (all P < 0.05). The B-A IVPD and basal IVPD during isovolumetric systole, early systole, late systole and isovolumetric diastole in PAF patients significantly decreased (all P < 0.05). The study shows that the B-A IVPD pattern of the PAF group is the same as controls, but systolic B-A IVPD and basal IVPD are significantly reduced in PAF patients. VFM-derived RPI can evaluate left ventricular IVPD in PAF patients, providing a visually quantitative method for evaluating left ventricular hemodynamic mechanics in the patients with PAF.

Citation： LIU Mei, CAI Yuyan, HUANG He, ZHONG Yue, WANG Fang. The preliminary value of vector flow mapping on assessment of left intraventricular pressure difference in patients with paroxysmal atrial fibrillation. Journal of Biomedical Engineering, 2021, 38(2): 310-316. doi: 10.7507/1001-5515.202011004 Copy

1.	Chugh S S, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 2014, 129(8): 837-847.
2.	Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace, 2016, 18(11): 1609-1678.
3.	Jahangir A, Lee V, Friedman P A, et al. Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation, 2007, 115(24): 3050-3056.
4.	Flint A C, Banki N M, Ren X, et al. Detection of paroxysmal atrial fibrillation by 30-day event monitoring in cryptogenic ischemic stroke: the Stroke and Monitoring for PAF in Real Time (SMART) Registry. Stroke, 2012, 43(10): 2788-2790.
5.	Falsetti H L, Verani M S, Chen C J, et al. Regional pressure differences in the left ventricle. Cathet Cardiovasc Diagn, 1980, 6(2): 123-134.
6.	Iwano H, Kamimura D, Fox E, et al. Altered spatial distribution of the diastolic left ventricular pressure difference in heart failure. J Am Soc Echocardiogr, 2015, 28(5): 597-605.
7.	Courtois M, Kovács S J, Ludbrook P A. Physiological early diastolic intraventricular pressure gradient is lost during acute myocardial ischemia. Circulation, 1990, 81(5): 1688-1696.
8.	Rovner A, Smith R, Greenberg N L, et al. Improvement in diastolic intraventricular pressure gradients in patients with HOCM after ethanol septal reduction. Am J Physiol Heart Circ Physiol, 2003, 285(6): H2492-H2499.
9.	Yotti R, Bermejo J, Benito Y, et al. Validation of noninvasive indices of global systolic function in patients with normal and abnormal loading conditions: a simultaneous echocardiography pressure-volume catheterization study. Circ Cardiovasc Imaging, 2014, 7(1): 164-172.
10.	Minami S, Masuda K, Stugaard M, et al. Noninvasive assessment of intraventricular pressure difference in left ventricular dyssynchrony using vector flow mapping. Heart Vessels, 2021, 36(1): 92-98.
11.	Pasipoularides A, Murgo J P, Miller J W, et al. Nonobstructive left ventricular ejection pressure gradients in man. Circ Res, 1987, 61(2): 220-227.
12.	Steine K, Stugaard M, Smiseth O. Mechanisms of diastolic intraventricular regional pressure differences and flow in the inflow and outflow tracts. J Am Coll Cardiol, 2002, 40(5): 983-990.
13.	Ha H, Kim G B, Kweon J, et al. Hemodynamic measurement using four-dimensional phase-contrast MRI: Quantification of hemodynamic parameters and clinical applications. Korean J Radiol, 2016, 17(4): 445-462.
14.	Jain S, Londono F J, Segers P, et al. MRI assessment of diastolic and systolic intraventricular pressure gradients in heart failure. Curr Heart Fail Rep, 2016, 13(1): 37-46.
15.	Asami R, Tanaka T, Kawabata K I, et al. Accuracy and limitations of vector flow mapping: left ventricular phantom validation using stereo particle image velocimetory. J Echocardiogr, 2017, 15(2): 57-66.
16.	Rodriguez Munoz D, Markl M, Moya Mur J L, et al. Intracardiac flow visualization: current status and future directions. Eur Heart J Cardiovasc Imaging, 2013, 14(11): 1029-1038.
17.	Tanaka T, Okada T, Nishiyama T, et al. Relative pressure imaging in left ventricle using ultrasonic vector flow mapping. Jpn J Appl Phys, 2017, 56(7): 07JF26-1-07JF26-9.
18.	Mitchell C, Rahko P S, Blauwet L A, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr, 2019, 32(1): 1-64.
19.	Thompson R B, Mcveigh E R. Fast measurement of intracardiac pressure differences with 2D breath-hold phase-contrast MRI. Magn Reson Med, 2003, 49(6): 1056-1066.
20.	Londono-Hoyos F, Segers P, Hashmath Z, et al. Non-invasive intraventricular pressure differences estimated with cardiac MRI in subjects without heart failure and with heart failure with reduced and preserved ejection fraction. Open Heart, 2019, 6(2): e001088.
21.	Eriksson J, Bolger A F, Carlhäll C J, et al. Spatial heterogeneity of four-dimensional relative pressure fields in the human left ventricle. Magn Reson Med, 2015, 74(6): 1716-1725.
22.	Itatani K, Okada T, Uejima T, et al. Intraventricular flow velocity vector visualization based on the continuity equation and measurements of vorticity and wall shear stress. Jpn J Appl Phys, 2013, 52(07): 07HF16-1-07HF16-6.
23.	Qin D, Mansour M C, Ruskin J N, et al. Atrial fibrillation-mediated cardiomyopathy. Circ Arrhythm Electrophysiol, 2019, 12(12): e007809.
24.	Kotecha D, Piccini J P. Atrial fibrillation in heart failure: what should we do?. Eur Heart J, 2015, 36(46): 3250-3257.
25.	Dzeshka M S, Lip G Y, Snezhitskiy V, et al. Cardiac fibrosis in patients with atrial fibrillation: Mechanisms and clinical implications. J Am Coll Cardiol, 2015, 66(8): 943-959.
26.	Yotti R, Bermejo J, Desco M M, et al. Doppler-derived ejection intraventricular pressure gradients provide a reliable assessment of left ventricular systolic chamber function. Circulation, 2005, 112(12): 1771-1779.

1. Chugh S S, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 2014, 129(8): 837-847.
2. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace, 2016, 18(11): 1609-1678.
3. Jahangir A, Lee V, Friedman P A, et al. Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation, 2007, 115(24): 3050-3056.
4. Flint A C, Banki N M, Ren X, et al. Detection of paroxysmal atrial fibrillation by 30-day event monitoring in cryptogenic ischemic stroke: the Stroke and Monitoring for PAF in Real Time (SMART) Registry. Stroke, 2012, 43(10): 2788-2790.
5. Falsetti H L, Verani M S, Chen C J, et al. Regional pressure differences in the left ventricle. Cathet Cardiovasc Diagn, 1980, 6(2): 123-134.
6. Iwano H, Kamimura D, Fox E, et al. Altered spatial distribution of the diastolic left ventricular pressure difference in heart failure. J Am Soc Echocardiogr, 2015, 28(5): 597-605.
7. Courtois M, Kovács S J, Ludbrook P A. Physiological early diastolic intraventricular pressure gradient is lost during acute myocardial ischemia. Circulation, 1990, 81(5): 1688-1696.
8. Rovner A, Smith R, Greenberg N L, et al. Improvement in diastolic intraventricular pressure gradients in patients with HOCM after ethanol septal reduction. Am J Physiol Heart Circ Physiol, 2003, 285(6): H2492-H2499.
9. Yotti R, Bermejo J, Benito Y, et al. Validation of noninvasive indices of global systolic function in patients with normal and abnormal loading conditions: a simultaneous echocardiography pressure-volume catheterization study. Circ Cardiovasc Imaging, 2014, 7(1): 164-172.
10. Minami S, Masuda K, Stugaard M, et al. Noninvasive assessment of intraventricular pressure difference in left ventricular dyssynchrony using vector flow mapping. Heart Vessels, 2021, 36(1): 92-98.
11. Pasipoularides A, Murgo J P, Miller J W, et al. Nonobstructive left ventricular ejection pressure gradients in man. Circ Res, 1987, 61(2): 220-227.
12. Steine K, Stugaard M, Smiseth O. Mechanisms of diastolic intraventricular regional pressure differences and flow in the inflow and outflow tracts. J Am Coll Cardiol, 2002, 40(5): 983-990.
13. Ha H, Kim G B, Kweon J, et al. Hemodynamic measurement using four-dimensional phase-contrast MRI: Quantification of hemodynamic parameters and clinical applications. Korean J Radiol, 2016, 17(4): 445-462.
14. Jain S, Londono F J, Segers P, et al. MRI assessment of diastolic and systolic intraventricular pressure gradients in heart failure. Curr Heart Fail Rep, 2016, 13(1): 37-46.
15. Asami R, Tanaka T, Kawabata K I, et al. Accuracy and limitations of vector flow mapping: left ventricular phantom validation using stereo particle image velocimetory. J Echocardiogr, 2017, 15(2): 57-66.
16. Rodriguez Munoz D, Markl M, Moya Mur J L, et al. Intracardiac flow visualization: current status and future directions. Eur Heart J Cardiovasc Imaging, 2013, 14(11): 1029-1038.
17. Tanaka T, Okada T, Nishiyama T, et al. Relative pressure imaging in left ventricle using ultrasonic vector flow mapping. Jpn J Appl Phys, 2017, 56(7): 07JF26-1-07JF26-9.
18. Mitchell C, Rahko P S, Blauwet L A, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr, 2019, 32(1): 1-64.
19. Thompson R B, Mcveigh E R. Fast measurement of intracardiac pressure differences with 2D breath-hold phase-contrast MRI. Magn Reson Med, 2003, 49(6): 1056-1066.
20. Londono-Hoyos F, Segers P, Hashmath Z, et al. Non-invasive intraventricular pressure differences estimated with cardiac MRI in subjects without heart failure and with heart failure with reduced and preserved ejection fraction. Open Heart, 2019, 6(2): e001088.
21. Eriksson J, Bolger A F, Carlhäll C J, et al. Spatial heterogeneity of four-dimensional relative pressure fields in the human left ventricle. Magn Reson Med, 2015, 74(6): 1716-1725.
22. Itatani K, Okada T, Uejima T, et al. Intraventricular flow velocity vector visualization based on the continuity equation and measurements of vorticity and wall shear stress. Jpn J Appl Phys, 2013, 52(07): 07HF16-1-07HF16-6.
23. Qin D, Mansour M C, Ruskin J N, et al. Atrial fibrillation-mediated cardiomyopathy. Circ Arrhythm Electrophysiol, 2019, 12(12): e007809.
24. Kotecha D, Piccini J P. Atrial fibrillation in heart failure: what should we do?. Eur Heart J, 2015, 36(46): 3250-3257.
25. Dzeshka M S, Lip G Y, Snezhitskiy V, et al. Cardiac fibrosis in patients with atrial fibrillation: Mechanisms and clinical implications. J Am Coll Cardiol, 2015, 66(8): 943-959.
26. Yotti R, Bermejo J, Desco M M, et al. Doppler-derived ejection intraventricular pressure gradients provide a reliable assessment of left ventricular systolic chamber function. Circulation, 2005, 112(12): 1771-1779.

Journal of Biomedical Engineering

The preliminary value of vector flow mapping on assessment of left intraventricular pressure difference in patients with paroxysmal atrial fibrillation

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