Aortic flow is abnormal in HFpEF

Zia Mehmood; Hosamadin Assadi; Rui Li; Bahman Kasmai; Gareth Matthews; Ciaran Grafton-Clarke; Aureo Sanz-Cepero; Xiaodan Zhao; Liang Zhong; Nay Aung; Kristian Skinner; Charaka Hadinnapola; Peter Swoboda; Andrew j. Swift; Vassilios s Vassiliou; Christopher Miller; Rob j. Van der geest; Steffen Peterson; Pankaj Garg

doi:10.12688/wellcomeopenres.20192.1

Aortic flow is abnormal in HFpEF

Zia Mehmood, Hosamadin Assadi, Rui Li, Bahman Kasmai, Gareth Matthews, Ciaran Grafton-Clarke, Aureo Sanz-Cepero, Xiaodan Zhao, Liang Zhong, Nay Aung, Kristian Skinner, Charaka Hadinnapola, Peter Swoboda, Andrew j. Swift, Vassilios s Vassiliou, Christopher Miller, Rob j. Van der geest, Steffen Peterson, Pankaj Garg

Division of Cardiovascular Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

Aims
Turbulent aortic flow makes the cardiovascular system less effective. It remains unknown if patients with heart failure with preserved ejection fraction (HFpEF) have disturbed aortic flow. This study sought to investigate advanced markers of aortic flow disturbances in HFpEF.

Methods
This case-controlled observational study used two-dimensional phase-contrast cardiovascular magnetic resonance data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10).

Results
Differences were significant in mean age (P<0.001) among young HCs (22.9±3.5 years), old HCs (60.5±10.2 years) and HFpEF patients (73.7±9.7 years). FDsavg, sFRR and PWV varied significantly (P<0.001) in young HCs (8±4%, 2±2%, 4±2m/s), old HCs (16±5%, 7±6%, 11±8m/s), and HFpEF patients (23±10%, 11±10%, 8±3). No significant PWV differences existed between old HCs and HFpEF.HFpEF had significantly higher FDsavg versus old HCs (23±10% vs 16±5%, P<0.001). A FDsavg > 17.7% achieved 74% sensitivity, 70% specificity for differentiating them. sFRR was notably higher in HFpEF (11±10% vs 7±6%, P<0.001). A sFRR > 7.3% yielded 78% sensitivity, 70% specificity in differentiating these groups. In sub-group analysis, FDsavg remained distinctly elevated in HFpEF (22.4±9.7% vs 16±4.9%, P=0.029). FDsavg of >16% showed 100% sensitivity and 70% specificity (P=0.01). Similarly, sFRR remained significantly higher in HFpEF (11.3±9.5% vs 6.6±6.4%, P=0.007). A sFRR of >7.2% showed 100% sensitivity and 60% specificity (P<0.001).

Conclusion
Aortic flow haemodynamics namely FDsavg and sFRR are significantly affected in ageing and HFpEF patients.

Original language	English
Article number	577
Journal	Wellcome Open Research
Volume	8
Early online date	15 Dec 2023
DOIs	https://doi.org/10.12688/wellcomeopenres.20192.1
Publication status	E-pub ahead of print - 15 Dec 2023

Keywords

Magnetic Resonance Imaging
Aortic Flow
Haemodynamics
HFpEF
Cardiac Output

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Mehmood, Z., Assadi, H., Li, R., Kasmai, B., Matthews, G., Grafton-Clarke, C., Sanz-Cepero, A., Zhao, X., Zhong, L., Aung, N., Skinner, K., Hadinnapola, C., Swoboda, P., Swift, A. J., Vassiliou, V. S., Miller, C., Van der geest, R. J., Peterson, S., & Garg, P. (2023). Aortic flow is abnormal in HFpEF. Wellcome Open Research, 8, Article 577. Advance online publication. https://doi.org/10.12688/wellcomeopenres.20192.1

@article{4bde8139663f4ca4a417acea9fd582c4,

title = "Aortic flow is abnormal in HFpEF",

abstract = "AimsTurbulent aortic flow makes the cardiovascular system less effective. It remains unknown if patients with heart failure with preserved ejection fraction (HFpEF) have disturbed aortic flow. This study sought to investigate advanced markers of aortic flow disturbances in HFpEF.MethodsThis case-controlled observational study used two-dimensional phase-contrast cardiovascular magnetic resonance data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10).ResultsDifferences were significant in mean age (P<0.001) among young HCs (22.9±3.5 years), old HCs (60.5±10.2 years) and HFpEF patients (73.7±9.7 years). FDsavg, sFRR and PWV varied significantly (P<0.001) in young HCs (8±4%, 2±2%, 4±2m/s), old HCs (16±5%, 7±6%, 11±8m/s), and HFpEF patients (23±10%, 11±10%, 8±3). No significant PWV differences existed between old HCs and HFpEF.HFpEF had significantly higher FDsavg versus old HCs (23±10% vs 16±5%, P<0.001). A FDsavg > 17.7% achieved 74% sensitivity, 70% specificity for differentiating them. sFRR was notably higher in HFpEF (11±10% vs 7±6%, P<0.001). A sFRR > 7.3% yielded 78% sensitivity, 70% specificity in differentiating these groups. In sub-group analysis, FDsavg remained distinctly elevated in HFpEF (22.4±9.7% vs 16±4.9%, P=0.029). FDsavg of >16% showed 100% sensitivity and 70% specificity (P=0.01). Similarly, sFRR remained significantly higher in HFpEF (11.3±9.5% vs 6.6±6.4%, P=0.007). A sFRR of >7.2% showed 100% sensitivity and 60% specificity (P<0.001).ConclusionAortic flow haemodynamics namely FDsavg and sFRR are significantly affected in ageing and HFpEF patients.",

keywords = "Magnetic Resonance Imaging, Aortic Flow, Haemodynamics, HFpEF, Cardiac Output",

author = "Zia Mehmood and Hosamadin Assadi and Rui Li and Bahman Kasmai and Gareth Matthews and Ciaran Grafton-Clarke and Aureo Sanz-Cepero and Xiaodan Zhao and Liang Zhong and Nay Aung and Kristian Skinner and Charaka Hadinnapola and Peter Swoboda and Swift, {Andrew j.} and Vassiliou, {Vassilios s} and Christopher Miller and {Van der geest}, {Rob j.} and Steffen Peterson and Pankaj Garg",

year = "2023",

month = dec,

day = "15",

doi = "10.12688/wellcomeopenres.20192.1",

language = "English",

volume = "8",

journal = "Wellcome Open Research",

issn = "2398-502X",

publisher = "Faculty of 1000 Ltd",

}

TY - JOUR

T1 - Aortic flow is abnormal in HFpEF

AU - Mehmood, Zia

AU - Assadi, Hosamadin

AU - Li, Rui

AU - Kasmai, Bahman

AU - Matthews, Gareth

AU - Grafton-Clarke, Ciaran

AU - Sanz-Cepero, Aureo

AU - Zhao, Xiaodan

AU - Zhong, Liang

AU - Aung, Nay

AU - Skinner, Kristian

AU - Hadinnapola, Charaka

AU - Swoboda, Peter

AU - Swift, Andrew j.

AU - Vassiliou, Vassilios s

AU - Miller, Christopher

AU - Van der geest, Rob j.

AU - Peterson, Steffen

AU - Garg, Pankaj

PY - 2023/12/15

Y1 - 2023/12/15

N2 - AimsTurbulent aortic flow makes the cardiovascular system less effective. It remains unknown if patients with heart failure with preserved ejection fraction (HFpEF) have disturbed aortic flow. This study sought to investigate advanced markers of aortic flow disturbances in HFpEF.MethodsThis case-controlled observational study used two-dimensional phase-contrast cardiovascular magnetic resonance data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10).ResultsDifferences were significant in mean age (P<0.001) among young HCs (22.9±3.5 years), old HCs (60.5±10.2 years) and HFpEF patients (73.7±9.7 years). FDsavg, sFRR and PWV varied significantly (P<0.001) in young HCs (8±4%, 2±2%, 4±2m/s), old HCs (16±5%, 7±6%, 11±8m/s), and HFpEF patients (23±10%, 11±10%, 8±3). No significant PWV differences existed between old HCs and HFpEF.HFpEF had significantly higher FDsavg versus old HCs (23±10% vs 16±5%, P<0.001). A FDsavg > 17.7% achieved 74% sensitivity, 70% specificity for differentiating them. sFRR was notably higher in HFpEF (11±10% vs 7±6%, P<0.001). A sFRR > 7.3% yielded 78% sensitivity, 70% specificity in differentiating these groups. In sub-group analysis, FDsavg remained distinctly elevated in HFpEF (22.4±9.7% vs 16±4.9%, P=0.029). FDsavg of >16% showed 100% sensitivity and 70% specificity (P=0.01). Similarly, sFRR remained significantly higher in HFpEF (11.3±9.5% vs 6.6±6.4%, P=0.007). A sFRR of >7.2% showed 100% sensitivity and 60% specificity (P<0.001).ConclusionAortic flow haemodynamics namely FDsavg and sFRR are significantly affected in ageing and HFpEF patients.

AB - AimsTurbulent aortic flow makes the cardiovascular system less effective. It remains unknown if patients with heart failure with preserved ejection fraction (HFpEF) have disturbed aortic flow. This study sought to investigate advanced markers of aortic flow disturbances in HFpEF.MethodsThis case-controlled observational study used two-dimensional phase-contrast cardiovascular magnetic resonance data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10).ResultsDifferences were significant in mean age (P<0.001) among young HCs (22.9±3.5 years), old HCs (60.5±10.2 years) and HFpEF patients (73.7±9.7 years). FDsavg, sFRR and PWV varied significantly (P<0.001) in young HCs (8±4%, 2±2%, 4±2m/s), old HCs (16±5%, 7±6%, 11±8m/s), and HFpEF patients (23±10%, 11±10%, 8±3). No significant PWV differences existed between old HCs and HFpEF.HFpEF had significantly higher FDsavg versus old HCs (23±10% vs 16±5%, P<0.001). A FDsavg > 17.7% achieved 74% sensitivity, 70% specificity for differentiating them. sFRR was notably higher in HFpEF (11±10% vs 7±6%, P<0.001). A sFRR > 7.3% yielded 78% sensitivity, 70% specificity in differentiating these groups. In sub-group analysis, FDsavg remained distinctly elevated in HFpEF (22.4±9.7% vs 16±4.9%, P=0.029). FDsavg of >16% showed 100% sensitivity and 70% specificity (P=0.01). Similarly, sFRR remained significantly higher in HFpEF (11.3±9.5% vs 6.6±6.4%, P=0.007). A sFRR of >7.2% showed 100% sensitivity and 60% specificity (P<0.001).ConclusionAortic flow haemodynamics namely FDsavg and sFRR are significantly affected in ageing and HFpEF patients.

KW - Magnetic Resonance Imaging

KW - Aortic Flow

KW - Haemodynamics

KW - HFpEF

KW - Cardiac Output

U2 - 10.12688/wellcomeopenres.20192.1

DO - 10.12688/wellcomeopenres.20192.1

M3 - Article

SN - 2398-502X

VL - 8

JO - Wellcome Open Research

JF - Wellcome Open Research

M1 - 577

ER -

Aortic flow is abnormal in HFpEF

Abstract

Keywords

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