Skip to main content
Top
Published in: Journal of Cardiovascular Magnetic Resonance 1/2017

Open Access 01-12-2016 | Research

Age dependence of pulmonary artery blood flow measured by 4D flow cardiovascular magnetic resonance: results of a population-based study

Authors: Thomas Wehrum, Paul Hagenlocher, Thomas Lodemann, Werner Vach, Iulius Dragonu, Anja Hennemuth, Constantin von zur Mühlen, Judith Stuplich, Ba Thanh Truc Ngo, Andreas Harloff

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Login to get access

Abstract

Background

It was our aim to systematically analyze pulmonary artery blood flow within different age-groups in the general population using 4D flow cardiovascular magnetic resonance (CMR) in order to provide a context for interpreting results of future studies (e.g., in pulmonary hypertension) using this technique.

Methods

An age-stratified sample (n = 126) of the population of the city of Freiburg, Germany, underwent ECG-triggered and navigator-gated 4D flow CMR at 3 T of the pulmonary arteries and the thoracic aorta. Analysis planes were placed in the main, left, and right pulmonary artery using dedicated software. Study participants were divided into three groups (1:20–39; 2:40–59; and 3:60–80 years of age). Subsequently, pulmonary blood flow was visualized, quantified and compared between groups.

Results

Time-to-peak of systolic antegrade flow was shorter, peak and average velocities and flow volumes were lower in older subjects. At the end of systole, retrograde flow in the main pulmonary artery was observed in all but one subject. Subsequently, a second antegrade flow peak occurred in diastole which was lower in older subjects. Age was an independent predictor of hemodynamic change after adjustment for cardiovascular risk factors and body-mass-index. During systole, abnormal vortices occurred in the main pulmonary artery in four male subjects.

Conclusions

Comprehensive analysis of pulmonary blood flow was feasible in all subjects. We were able to detect an independent effect of ageing on pulmonary hemodynamics reflecting increased vessel stiffness and reduced pulmonary circulation. Findings of this study may be helpful for discriminating physiological from pathological flow in patients with pulmonary diseases in the future.
Appendix
Available only for authorised users
Literature
1.
go back to reference Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, Denton CP, Elliott CG, Gaine SP, Gladwin MT, Jing Z, Krowka MJ, Langleben D, Nakanishi N, Souza R. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2009;54:S43–54.CrossRefPubMed Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, Denton CP, Elliott CG, Gaine SP, Gladwin MT, Jing Z, Krowka MJ, Langleben D, Nakanishi N, Souza R. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2009;54:S43–54.CrossRefPubMed
2.
go back to reference Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62:D42–50.CrossRefPubMed Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62:D42–50.CrossRefPubMed
3.
go back to reference Taleb M, Khuder S, Tinkel J, Khouri SJ. The diagnostic accuracy of Doppler echocardiography in assessment of pulmonary artery systolic pressure: a meta-analysis. Echocardiography. 2013;30:258–65.CrossRefPubMed Taleb M, Khuder S, Tinkel J, Khouri SJ. The diagnostic accuracy of Doppler echocardiography in assessment of pulmonary artery systolic pressure: a meta-analysis. Echocardiography. 2013;30:258–65.CrossRefPubMed
4.
go back to reference Markl M, Schnell S, Barker AJ. 4D flow imaging: current status to future clinical applications. Curr Cardiol Rep. 2014;16:481.CrossRefPubMed Markl M, Schnell S, Barker AJ. 4D flow imaging: current status to future clinical applications. Curr Cardiol Rep. 2014;16:481.CrossRefPubMed
5.
go back to reference Barker AJ, Roldán-Alzate A, Entezari P, Shah SJ, Chesler NC, Wieben O, Markl M, François CJ. Four-dimensional flow assessment of pulmonary artery flow and wall shear stress in adult pulmonary arterial hypertension: results from two institutions. Magn Reson Med. 2015;73:1904–13.CrossRefPubMedPubMedCentral Barker AJ, Roldán-Alzate A, Entezari P, Shah SJ, Chesler NC, Wieben O, Markl M, François CJ. Four-dimensional flow assessment of pulmonary artery flow and wall shear stress in adult pulmonary arterial hypertension: results from two institutions. Magn Reson Med. 2015;73:1904–13.CrossRefPubMedPubMedCentral
6.
go back to reference Boerrigter B, Mauritz GJ, Marcus JT, Helderman F, Postmus PE, Westerhof N, Vonk-Noordegraaf A. Progressive dilatation of the main pulmonary artery is a characteristic of pulmonary arterial hypertension and is not related to changes in pressure. Chest. 2010;138:1395–401.CrossRefPubMed Boerrigter B, Mauritz GJ, Marcus JT, Helderman F, Postmus PE, Westerhof N, Vonk-Noordegraaf A. Progressive dilatation of the main pulmonary artery is a characteristic of pulmonary arterial hypertension and is not related to changes in pressure. Chest. 2010;138:1395–401.CrossRefPubMed
7.
go back to reference Sanz J, Kariisa M, Dellegrottaglie S, Prat-González S, Garcia MJ, Fuster V, Rajagopalan S. Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance. JACC Cardiovasc Imaging. 2009;2:286–95.CrossRefPubMed Sanz J, Kariisa M, Dellegrottaglie S, Prat-González S, Garcia MJ, Fuster V, Rajagopalan S. Evaluation of pulmonary artery stiffness in pulmonary hypertension with cardiac magnetic resonance. JACC Cardiovasc Imaging. 2009;2:286–95.CrossRefPubMed
8.
go back to reference Helderman F, Mauritz G, Andringa KE, Vonk-Noordegraaf A, Marcus JT. Early onset of retrograde flow in the main pulmonary artery is a characteristic of pulmonary arterial hypertension. J Magn Reson Imaging. 2011;33:1362–8.CrossRefPubMed Helderman F, Mauritz G, Andringa KE, Vonk-Noordegraaf A, Marcus JT. Early onset of retrograde flow in the main pulmonary artery is a characteristic of pulmonary arterial hypertension. J Magn Reson Imaging. 2011;33:1362–8.CrossRefPubMed
9.
go back to reference Reiter G, Reiter U, Kovacs G, Kainz B, Schmidt K, Maier R, Olschewski H, Rienmueller R. Magnetic resonance-derived 3-dimensional blood flow patterns in the main pulmonary artery as a marker of pulmonary hypertension and a measure of elevated mean pulmonary arterial pressure. Circ Cardiovasc Imaging. 2008;1:23–30.CrossRefPubMed Reiter G, Reiter U, Kovacs G, Kainz B, Schmidt K, Maier R, Olschewski H, Rienmueller R. Magnetic resonance-derived 3-dimensional blood flow patterns in the main pulmonary artery as a marker of pulmonary hypertension and a measure of elevated mean pulmonary arterial pressure. Circ Cardiovasc Imaging. 2008;1:23–30.CrossRefPubMed
10.
go back to reference Reiter U, Reiter G, Kovacs G, Stalder AF, Gulsun M a, Greiser A, Olschewski H, Fuchsjäger M. Evaluation of elevated mean pulmonary arterial pressure based on magnetic resonance 4D velocity mapping: comparison of visualization techniques. PLoS One. 2013;8:e82212. Reiter U, Reiter G, Kovacs G, Stalder AF, Gulsun M a, Greiser A, Olschewski H, Fuchsjäger M. Evaluation of elevated mean pulmonary arterial pressure based on magnetic resonance 4D velocity mapping: comparison of visualization techniques. PLoS One. 2013;8:e82212.
11.
go back to reference Nogami M, Ohno Y, Koyama H, Kono A, Takenaka D, Kataoka T, Kawai H, Kawamitsu H, Onishi Y, Matsumoto K, Matsumoto S, Sugimura K. Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: comparison with right heart catheterization and echocardiography. J Magn Reson Imaging. 2009;30:973–80.CrossRefPubMed Nogami M, Ohno Y, Koyama H, Kono A, Takenaka D, Kataoka T, Kawai H, Kawamitsu H, Onishi Y, Matsumoto K, Matsumoto S, Sugimura K. Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: comparison with right heart catheterization and echocardiography. J Magn Reson Imaging. 2009;30:973–80.CrossRefPubMed
12.
13.
go back to reference Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, St John Sutton M, Stewart WJ. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiograph. J Am Soc Echocardiogr. 2005;18(12):1440–63.CrossRefPubMed Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, St John Sutton M, Stewart WJ. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiograph. J Am Soc Echocardiogr. 2005;18(12):1440–63.CrossRefPubMed
14.
go back to reference Markl M, Harloff A, Bley TA, Zaitsev M, Jung B, Weigang E, Langer M, Hennig J, Frydrychowicz A.. Time-resolved 3D MR velocity mapping at 3T: improved navigator-gated assessment of vascular anatomy and blood flow. J Magn Reson Imaging. 2007;25:824–31.CrossRefPubMed Markl M, Harloff A, Bley TA, Zaitsev M, Jung B, Weigang E, Langer M, Hennig J, Frydrychowicz A.. Time-resolved 3D MR velocity mapping at 3T: improved navigator-gated assessment of vascular anatomy and blood flow. J Magn Reson Imaging. 2007;25:824–31.CrossRefPubMed
15.
go back to reference Wehrum T, Kams M, Schroeder L, Drexl J, Hennemuth A, Harloff A. Accelerated analysis of three-dimensional blood flow of the thoracic aorta in stroke patients. Int J Cardiovasc Imaging. 2014;30:1571–7.CrossRefPubMed Wehrum T, Kams M, Schroeder L, Drexl J, Hennemuth A, Harloff A. Accelerated analysis of three-dimensional blood flow of the thoracic aorta in stroke patients. Int J Cardiovasc Imaging. 2014;30:1571–7.CrossRefPubMed
16.
go back to reference Frydrychowicz A, Wieben O, Niespodzany E, Reeder SB, Johnson KM, François CJ. Quantification of thoracic blood flow using volumetric magnetic resonance imaging with radial velocity encoding: in vivo validation. Invest Radiol. 2013;48:819–25.CrossRefPubMed Frydrychowicz A, Wieben O, Niespodzany E, Reeder SB, Johnson KM, François CJ. Quantification of thoracic blood flow using volumetric magnetic resonance imaging with radial velocity encoding: in vivo validation. Invest Radiol. 2013;48:819–25.CrossRefPubMed
17.
go back to reference Gan CT, Lankhaar JW, Westerhof N, Marcus JT, Becker A, Twisk JW, Boonstra A, Postmus PE, Vonk-Noordegraaf A. Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension. Chest. 2007;132:1906–12.CrossRefPubMed Gan CT, Lankhaar JW, Westerhof N, Marcus JT, Becker A, Twisk JW, Boonstra A, Postmus PE, Vonk-Noordegraaf A. Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension. Chest. 2007;132:1906–12.CrossRefPubMed
18.
go back to reference Rajaram S, Swift AJ, Condliffe R, Johns C, Elliot CA, Hill C, Davies C, Hurdman J, Sabroe I, Wild JM, Kiely DG. CT features of pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry. Thorax. 2015;70:382–7.CrossRefPubMedPubMedCentral Rajaram S, Swift AJ, Condliffe R, Johns C, Elliot CA, Hill C, Davies C, Hurdman J, Sabroe I, Wild JM, Kiely DG. CT features of pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry. Thorax. 2015;70:382–7.CrossRefPubMedPubMedCentral
19.
go back to reference Swift AJ, Rajaram S, Condliffe R, Capener D, Hurdman J, Elliot C, Kiely DG, Wild JM. Pulmonary artery relative area change detects mild elevations in pulmonary vascular resistance and predicts adverse outcome in pulmonary hypertension. Invest Radiol. 2012;47:571–7.CrossRefPubMed Swift AJ, Rajaram S, Condliffe R, Capener D, Hurdman J, Elliot C, Kiely DG, Wild JM. Pulmonary artery relative area change detects mild elevations in pulmonary vascular resistance and predicts adverse outcome in pulmonary hypertension. Invest Radiol. 2012;47:571–7.CrossRefPubMed
21.
go back to reference Lorenz MW, Von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: Prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke. 2006;37:87–92.CrossRefPubMed Lorenz MW, Von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: Prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke. 2006;37:87–92.CrossRefPubMed
Metadata
Title
Age dependence of pulmonary artery blood flow measured by 4D flow cardiovascular magnetic resonance: results of a population-based study
Authors
Thomas Wehrum
Paul Hagenlocher
Thomas Lodemann
Werner Vach
Iulius Dragonu
Anja Hennemuth
Constantin von zur Mühlen
Judith Stuplich
Ba Thanh Truc Ngo
Andreas Harloff
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-016-0252-3

Other articles of this Issue 1/2017

Journal of Cardiovascular Magnetic Resonance 1/2017 Go to the issue