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.20192.2

Aortic flow is abnormal in HFpEF

Wellcome Open Res. 2024 Mar 6:8:577. doi: 10.12688/wellcomeopenres.20192.2. eCollection 2023.

Authors

Zia Mehmood¹, Hosamadin Assadi^{1

2}, Rui Li^{1

2}, Bahman Kasmai^{1

2}, Gareth Matthews^{1

2}, Ciaran Grafton-Clarke^{1

2}, Aureo Sanz-Cepero¹, Xiaodan Zhao³, Liang Zhong^{3

4

5}, Nay Aung^{6

7}, Kristian Skinner¹, Charaka Hadinnapola¹, Peter Swoboda⁸, Andrew J Swift⁹, Vassilios S Vassiliou^{1

2}, Christopher Miller¹⁰, Rob J van der Geest¹¹, Steffen Peterson^{6

7}, Pankaj Garg^{1

2}

Affiliations

¹ Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK.
² Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
³ National Heart Research Institute, National Heart Centre Singapore, Singapore, 169609, Singapore.
⁴ Cardiovascular Sciences Academic Clinical Program & Cardiovascular Metabolic Disorder Program, Duke National University of Singapore Medical School, Singapore, 169857, Singapore.
⁵ Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore.
⁶ William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, EC1M 6BQ, UK.
⁷ Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BS, UK.
⁸ Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
⁹ Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK.
¹⁰ 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.
¹¹ Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands.

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.

Keywords: Aortic Flow; Cardiac Output; HFpEF; Haemodynamics; Magnetic Resonance Imaging.

Grants and funding

PG and AJS are funded by Wellcome Trust Clinical Research Career Development Fellowships (220703/Z/20/Z & 205188/Z/16/Z). For the purpose of Open Access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, data collection, analysis, publishing decision, or manuscript preparation. This work acknowledges the support of the National Institute for Health and Care Research Barts Biomedical Research Centre (NIHR203330), a delivery partnership of Barts Health NHS Trust, Queen Mary University of London, St George’s University Hospitals NHS Foundation Trust and the St George’s University of London.