4D Flow Cardiac MR in Primary Mitral Regurgitation

Background Four-dimensional-flow cardiac MR (4DF-MR) offers advantages in primary mitral regurgitation. The relationship between 4DF-MR-derived mitral regurgitant volume (MR-Rvol) and the post-operative left ventricular (LV) reverse remodeling has not yet been established. Purpose To ascertain if the 4DF-MR-derived MR-Rvol correlates with the LV reverse remodeling in primary mitral regurgitation. Study Type Prospective, single-center, two arm, interventional vs. nonintervention observational study. Population Forty-four patients (male N = 30; median age 68 [59–75]) with at least moderate primary mitral regurgitation; either awaiting mitral valve surgery (repair [MVr], replacement [MVR]) or undergoing “watchful waiting” (WW). Field Strength/Sequence 5 T/Balanced steady-state free precession (bSSFP) sequence/Phase contrast imaging/Multishot echo-planar imaging pulse sequence (five shots). Assessment Patients underwent transthoracic echocardiography (TTE), phase-contrast MR (PMRI), 4DF-MR and 6-minute walk test (6MWT) at baseline, and a follow-up PMRI and 6MWT at 6 months. MR-Rvol was quantified by PMRI, 4DF-MR, and TTE by one observer. The pre-operative MR-Rvol was correlated with the post-operative decrease in the LV end-diastolic volume index (LVEDVi). Statistical Tests Included Student t-test/Mann–Whitney test/Fisher's exact test, Bland–Altman plots, linear regression analysis and receiver operating characteristic curves. Statistical significance was defined as P < 0.05. Results While Bland–Altman plots demonstrated similar bias between all the modalities, the limits of agreement were narrower between 4DF-MR and PMRI (bias 15; limits of agreement −36 mL to 65 mL), than between 4DF-MR and TTE (bias −8; limits of agreement −106 mL to 90 mL) and PMRI and TTE (bias −23; limits of agreement −105 mL to 59 mL). Linear regression analysis demonstrated a significant association between the MR-Rvol and the post-operative decrease in the LVEDVi, when the MR-Rvol was quantified by PMRI and 4DF-MR, but not by TTE (P = 0.73). 4DF-MR demonstrated the best diagnostic performance for reduction in the post-operative LVEDVi with the largest area under the curve (4DF-MR 0.83; vs. PMRI 0.78; and TTE 0.51; P = 0.89). Data Conclusion This study demonstrates the potential clinical utility of 4DF-MR in the assessment of primary mitral regurgitation

International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes

This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.Cardiolog

Acute vasodilator response testing in the adult Fontan circulation using non-invasive 4D Flow MRI: a proof-of-principle study

Background: Pulmonary vasodilator therapy in Fontan patients can improve exercise tolerance. We aimed to assess the potential for non-invasive testing of acute vasodilator response using four-dimensional (D) flow MRI during oxygen inhalation. Materials and Methods: Six patients with well-functioning Fontan circulations were prospectively recruited and underwent cardiac MRI. Ventricular anatomical imaging and 4D Flow MRI were acquired at baseline and during inhalation of oxygen. Data were compared with six age-matched healthy volunteers with 4D Flow MRI scans acquired at baseline. Results: All six patients tolerated the MRI scan well. The dominant ventricle had a left ventricular morphology in all cases. On 4D Flow MRI assessment, two patients (Patients 2 and 6) showed improved cardiac filling with improved preload during oxygen administration, increased mitral inflow, increased maximum E-wave kinetic energy, and decreased systolic peak kinetic energy. Patient 1 showed improved preload only. Patient 5 showed no change, and patient 3 had equivocal results. Patient 4, however, showed a decrease in preload and cardiac filling/function with oxygen. Discussion: Using oxygen as a pulmonary vasodilator to assess increased pulmonary venous return as a marker for positive acute vasodilator response would provide pre-treatment assessment in a more physiological state - the awake patient. This proof-of-concept study showed that it is well tolerated and has shown changes in some stable patients with a Fontan circulation.</p

4D flow magnetic resonance imaging in bicuspid aortic valve disease demonstrates altered distribution of aortic blood flow helicity

PURPOSE: Changes in aortic geometry or presence of aortic valve (AoV) disease can result in substantially altered aortic hemodynamics. Dilatation of the ascending aorta or AoV abnormalities can result in an increase in helical flow. METHODS: 4D flow magnetic resonance imaging was used to test the feasibility of quantitative helicity analysis using equidistantly distributed 2D planes along the entire aorta. The evaluation of the method included three parts: (1) the quantification of helicity in 12 healthy subjects, (2) an evaluation of observer variability and test-retest reliability, and (3) the quantification of helical flow in 16 patients with congenitally altered bicuspid AoVs. RESULTS: Helicity quantification in healthy subjects revealed consistent directions of flow rotation along the entire aorta with high clockwise helicity in the aortic arch and an opposite rotation sense in the ascending and descending aorta. The results demonstrated good scan-rescan and inter- and intraobserver agreement of the helicity parameters. Helicity quantification in patients revealed a significant increase in absolute peak relative helicity during systole and a considerably greater heterogeneous distribution of mean helicity in the aorta. CONCLUSION: The method has the potential to serve as a reference distribution for comparisons of helical flow between healthy subjects and patients or between different patient groups

Nuclear charge radii of potassium isotopes beyond N = 28

We report on the measurement of optical isotope shifts for 38, 39, 42, 44, 46–51 K relative to 47 K from which changes in the nuclear mean square charge radii across the N = 28 shell closure are deduced. The investigation was carried out by bunched-beam collinear laser spectroscopy at the CERN-ISOLDE radioactive ion-beam facility. Mean square charge radii are now known from 37K to 51K, covering all ν f7/2-shell as well as all νp3/2-shell nuclei. These measurements, in conjunction with those of Ca, Cr, Mn and Fe, provide a first insight into the Z dependence of the evolution of nuclear size above the shell closure at N = 28info:eu-repo/semantics/publishe

Nuclear charge radii of potassium isotopes beyond N = 28

We report on the measurement of optical isotope shifts for 38, 39, 42, 44, 46–51 K relative to 47 K from which changes in the nuclear mean square charge radii across the N = 28 shell closure are deduced. The investigation was carried out by bunched-beam collinear laser spectroscopy at the CERN-ISOLDE radioactive ion-beam facility. Mean square charge radii are now known from 37K to 51K, covering all ν f7/2-shell as well as all νp3/2-shell nuclei. These measurements, in conjunction with those of Ca, Cr, Mn and Fe, provide a first insight into the Z dependence of the evolution of nuclear size above the shell closure at N = 28info:eu-repo/semantics/publishe

High-accuracy liquid-sample β-NMR setup at ISOLDE

Recently there has been an increased interest to apply the sensitive $\beta$-decay asymmetry detected nuclear magnetic resonance ($\beta$-NMR) technique to biological studies. A liquid-sample $\beta$-NMR setup was build at ISOLDE to allow such investigations and to use the resolution gain of liquid-state NMR in nuclear physics. As part of this setup a magnetic field locking system, a set of printed circuit board shimming coils, a sample exchange system, a set of compact $\beta$-detectors and a custom experimental vacuum chamber were developed. The main magnetic field was stabilized down to the ppm level by the locking system while allowing the direct determination of the absolute magnetic field. The homogeneity of the magnetic field was improved to $\leq$~5~ppm over the sample volume by the shimming coils. Time spent on changing samples was reduced by a factor of five by the liquid sample exchange system. During experiments it was possible to continuously observe the liquid sample thanks to the custom chamber and compact $\beta$-detectors. The absolute field determination allows for a novel way to reference $\beta$-NMR measurements, removing the need for time consuming reference measurements. The improved accuracy and resolution resulting from these innovations allows the study of the distribution of nuclear magnetization and (bio)chemicals using high-accuracy liquid-sample $\beta$-NMR

High-precision quadrupole moment reveals significant intruder component in Al20 1333 ground state

The electric quadrupole moment of the Al201333 ground state, located at the border of the island of inversion, was obtained using continuous-beam β-detected nuclear quadrupole resonance (β-NQR). From the measured quadrupole coupling constant νQ=2.31(4) MHz in an α-Al2O3 crystal, a precise value for the electric quadrupole moment is extracted: QsAl33=141(3) mb. A comparison with large-scale shell model calculations shows that Al33 has at least 50% intruder configurations in the ground state wave function, favoring the excitation of two neutrons across the N=20 shell gap. Al33 therefore clearly marks the gradual transition north of the deformed Na and Mg nuclei towards the normal Z≥14 isotopes. © 2016 American Physical Society