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Assessment of Regional Aortic Stiffness by Cardiac MRI using phase contrast sequence in Clinically Normal Asian population
성균관 의대 삼성서울병원 심장혈관센터¹ 심혈관이미징센터¹ 순환기내과¹ , 영상의학과² ,메이오 클리닉 순환기내과³
김은경¹ , 한혜진¹ , 장성아¹ , 김이슬¹ , 장신이¹ , 김성목² , 최연현² , 김덕경¹
Background: Cardiac magnetic resonance imaging (CMR) has emerged a noble method for regional aortic pulse wave velocity (PWV) and distensibility, which are indispensible predictors of cardiovascular (CV) risk. However, its clinical implementation has been limited by the lack of normal value and standardized calculation system. The aim of this study was to determine normal values and reliable methodology for aortic PWV and distensibility using cine and phase contrast CMR in a population with no CV risk and compare aortic PWV with peripheral PWV by applanation tonometry. Methods: A total of 124 subjects, aged 20 to 79 years and free of cardiovascular risk, were categorized by age decade. Using cine and phase contrast sequence of CMR, cross-sectional area for distensibility and average blood flow were measured at 4 levels: the ascending (D1), thoracic descending (D2), mid thoracic (D3) and abdominal aorta (D4). Regional PWV determined in 4 aortic segments: the arch (D1-2), thoracic descending (D2-3), abdominal aorta (D3-4) and across the entire aorta (PWV-total). Applanation tonometry was performed in all subjects for augmentation index and carotid-femoral PWV. Results: Distensibility at 4 levels of the aorta (D1-D4: 4.4 ± 2.5, 4.0 ± 1.6, 5.2 ± 1.9, 3.3 ± 1.7 10-3mmHg10-1, respectively) was higher in women (p < 0.001) and decreased with aging (r = 0.604, p < 0.001). The discrepancy of distensibility between genders was diminished after 50 years of age. Regional PWV value was highest in the thoracic-descending aorta (D1-2, D2-3, D3-4: 5.9 ± 3.6, 7.4 ± 4.5, 5.5 ± 2.6 m/s, respectively) and increased with age. Especially, PWV-total was significantly higher in older subjects and the age-PWV curve was well represented by second-order polynominal (PWV-total = 5.2723 -0.0847*age + 0.0018*age2, p = 0.001). Although overall PWV-total was significantly lower than PWV-tonometry (mean difference = 2.5 ± 1.1 m/s, p < 0.001), changes of PWV-total were strongly correlated and in good agreement with PWV-tonometry (r = 0.707, p < 0.001). Inter-observer reliability was very high (concordance correlation coefficient = 0.9618, CI 0.8740 – 0.9935). Conclusion: PWV by phase contrast CMR as a useful tool for assessing regional aortic stiffness not only correlates well with carotid-femoral PWV but proves to be considerably reliable. The present study is the first to show normal values for PWV and distensibility using CMR in Asian population.


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