Aortic flow is abnormal in HFpEF
Wellcome Open Research, vol. 8, pp. 577
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 four-dimensional flow cardiovascular magnetic resonance derived, two-dimensional phase-contrast reformatted plane 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.
Authors 19
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Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
. University College 2
University College London, London, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
. University College 2
University College London, London, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
. University College 2
University College London, London, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
. University College 2
University College London, London, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
. University College 2
University College London, London, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
. University College 2
University College London, London, UK
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Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
. University College 2
University College London, London, UK
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National Heart Centre Singapore
Affiliation as printed
National Heart Research Institute, National Heart Centre Singapore, Singapore, 169609, Singapore
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National University of Singapore · Duke-NUS Medical School · National Heart Centre Singapore
Affiliation as printed
Cardiovascular Sciences Academic Clinical Program & Cardiovascular Metabolic Disorder Program, Duke National University of Singapore Medical School, Singapore, 169857, Singapore
Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
National Heart Research Institute, National Heart Centre Singapore, Singapore, 169609, Singapore
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St Bartholomew's Hospital · Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute
Affiliation as printed
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BS, UK
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, EC1M 6BQ, UK
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Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
. University College 2
University College London, London, UK
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Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
. University College 2
University College London, London, UK
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Affiliation as printed
Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
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Affiliation as printed
Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
. University College 2
University College London, London, UK
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Manchester Academic Health Science Centre · University of Manchester
Affiliation as printed
Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
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St Bartholomew's Hospital · Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute
Affiliation as printed
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BS, UK
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, EC1M 6BQ, UK
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Pankaj Garg corresponding
University of East Anglia · Norfolk and Norwich University Hospital · Norfolk and Norwich University Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
. University College 2
University College London, London, UK
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