Hemodynamic assessment in patients with congenital heart disease using magnetic resonance imaging
(2019) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2019(56).- Abstract
- Around 1000 children are born with a heart disease in Sweden every year and today most of these children survive and reach adult age. There are around 2.3 million grownups with congenital heart disease in Europe today, a number that is expected to continue to increase. Further, the prevalence of patients with complex malformations has been growing significantly the last 10 years. There is thus a need to increase knowledge of the pathophysiology of these diseases to avoid and treat heart failure and complications, which could lead to great suffering for the patients but also great economic costs for the health care system. This thesis therefore aims to assess the cardiac function with new magnetic resonance techniques in order to increase... (More)
- Around 1000 children are born with a heart disease in Sweden every year and today most of these children survive and reach adult age. There are around 2.3 million grownups with congenital heart disease in Europe today, a number that is expected to continue to increase. Further, the prevalence of patients with complex malformations has been growing significantly the last 10 years. There is thus a need to increase knowledge of the pathophysiology of these diseases to avoid and treat heart failure and complications, which could lead to great suffering for the patients but also great economic costs for the health care system. This thesis therefore aims to assess the cardiac function with new magnetic resonance techniques in order to increase knowledge of the pathophysiology and to better individualize treatment and optimize the timing of intervention. The first study of this thesis investigated the ventricular kinetic energy in patients with Fontan circulation. The results showed that kinetic energy is dependent on the morphology of the heart and seems to be very specific for each individual. In study II, III and IV the cardiac pumping in patients with Tetralogy of Fallot and pulmonary regurgitation was explored by quantifying the intraventricular kinetic energy and hemodynamic forces, as well as the atrioventricular coupling. Kinetic energy was affected in both the right and left ventricle, even if left ventricular ejection fraction was normal. Patients with pulmonary regurgitation had higher right ventricular hemodynamic forces than controls, but also affected left ventricular forces, with less alignment of force and blood flow which has been suggested to lead to pathological cardiac remodelling. Further, pulmonary regurgitation resulted in decreased right ventricular longitudinal function, decreased left ventricular preload and lower left ventricular stroke volumes. Before pulmonary valve replacement patients, similar to controls, had a clear atrioventricular coupling with a strong correlation between atrial inflow and ventricular longitudinal function. After operation however this coupling was lost, possibly because the loss of pericardial integrity.After pulmonary valve replacement patients still had disturbed hemodynamic forces, pumping mechanics and loss of atrioventricular coupling, which is energetically unfavourable. Further studies will tell if these changes will normalize in time.The potential role of kinetic energy and hemodynamic forces for treatment evaluation and decision making in patients with Tetralogy of Fallot can be the aim for future studies. (Less)
- Abstract (Swedish)
- Cirka 1000 barn föds med hjärtfel i Sverige varje år och idag överlever de flesta och uppnår vuxen ålder. Det finns uppskattningsvis 2.3 miljoner vuxna med medfött hjärtfel i Europa idag, en siffra som förväntas öka. Samtidigt har prevalensen av patienter med komplexa medfödda hjärtfel också ökat de senaste 10 åren. Det finns således ett behov av att öka kunskapen om patofysiologin vid dessa sjukdomar för att både undvika och behandla hjärtsvikt och andra komplikationer, som både leder till stort lidande för patienterna men även till stora kostnader för sjukvården. Denna avhandling syftar till att undersöka hjärtfunktionen hos patienter med medfödda hjärtfel med magnetresonanstomografi för att öka kunskapen on patofysiologin för att bättre... (More)
- Cirka 1000 barn föds med hjärtfel i Sverige varje år och idag överlever de flesta och uppnår vuxen ålder. Det finns uppskattningsvis 2.3 miljoner vuxna med medfött hjärtfel i Europa idag, en siffra som förväntas öka. Samtidigt har prevalensen av patienter med komplexa medfödda hjärtfel också ökat de senaste 10 åren. Det finns således ett behov av att öka kunskapen om patofysiologin vid dessa sjukdomar för att både undvika och behandla hjärtsvikt och andra komplikationer, som både leder till stort lidande för patienterna men även till stora kostnader för sjukvården. Denna avhandling syftar till att undersöka hjärtfunktionen hos patienter med medfödda hjärtfel med magnetresonanstomografi för att öka kunskapen on patofysiologin för att bättre kunna individualisera behandlingen och optimera tidpunkten för intervention.
I Studie I undersöktes den intraventrikulära kinetiska energin hos patienter med Fontan cirkulation. Resultatet visar att kinetisk energi är beroende av hjärtats morfologi och verkar vara specifik för varje individ.
I studie II, III och IV undersöktes hjärtats pumpning hos patienter med Fallots Tetrad och pulmonalisinsufficiens genom att kvantifiera den kinetiska energin och de hemodynamiska krafterna, såvälsom den atrioventrikulära kopplingen. Kinetiska energin var på verkad i både höger och vänster kammare även om patienten hade bevarad vänsterkammarfunktion. Patienter med pulmonalisinsufficiens hade högre hemodynamiska krafter i höger kammare än kontroller men även påverkade krafter på vänster sida, där det sågs ökade krafter i riktningar som inte var i linje med det huvudsakliga blodflödet. Detta har förslagits kunna leda till patologisk remodellering. Pulmonalisinsufficiens ledde också till minskad longitudinell funktion i höger kammare, minskaad fyllnad av vänster kammare och lägre slagvolymer på vänster sida. Det fanns en tydlig koppling mellan förmak och kammare hos patienter före operation med klaffbyte och kontroller, med en stark korrelation mellan inflödet till höger förmak och kammarens longitudinella funktion. Denna koppling försvann efter operation möjligtvis pga att hjärtsäcken öppnats.
Efter operation med byte av pulmonalisklaffen kvarstod förändringar i de hemodynamiska krafterna och pumpfunktionen. Framtida studier får visa om dessa förändringar normaliseras efter längre tids uppföljning.
Fler studier behövs för att värdera om kinetisk energi och hemodynamiska krafter kan bidra till beslutsunderlag inför intervention och som utvärdering efter behandling.
(Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/ec0f1c55-8f2f-4477-917e-9fa4f29de1a2
- author
- Sjöberg, Pia LU
- supervisor
-
- Marcus Carlsson LU
- Erik Hedström LU
- Johannes Töger LU
- Petru Liuba LU
- opponent
-
- professor Beerbaum, Philipp, Hannover Medical School
- organization
- alternative title
- Hemodynamik mätt med magnetresonastomografi hos patienter med medfödd hjärtsjukdom
- publishing date
- 2019
- type
- Thesis
- publication status
- published
- subject
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- volume
- 2019
- issue
- 56
- pages
- 75 pages
- publisher
- Lund University: Faculty of Medicine
- defense location
- Föreläsningssal 3, Centralblocket, Entrégatan 7, Skånes Universitetssjukhus i Lund
- defense date
- 2019-05-29 13:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-7619-785-1
- language
- English
- LU publication?
- yes
- id
- ec0f1c55-8f2f-4477-917e-9fa4f29de1a2
- date added to LUP
- 2019-04-29 10:50:31
- date last changed
- 2021-04-16 13:33:16
@phdthesis{ec0f1c55-8f2f-4477-917e-9fa4f29de1a2,
abstract = {{Around 1000 children are born with a heart disease in Sweden every year and today most of these children survive and reach adult age. There are around 2.3 million grownups with congenital heart disease in Europe today, a number that is expected to continue to increase. Further, the prevalence of patients with complex malformations has been growing significantly the last 10 years. There is thus a need to increase knowledge of the pathophysiology of these diseases to avoid and treat heart failure and complications, which could lead to great suffering for the patients but also great economic costs for the health care system. This thesis therefore aims to assess the cardiac function with new magnetic resonance techniques in order to increase knowledge of the pathophysiology and to better individualize treatment and optimize the timing of intervention. The first study of this thesis investigated the ventricular kinetic energy in patients with Fontan circulation. The results showed that kinetic energy is dependent on the morphology of the heart and seems to be very specific for each individual. In study II, III and IV the cardiac pumping in patients with Tetralogy of Fallot and pulmonary regurgitation was explored by quantifying the intraventricular kinetic energy and hemodynamic forces, as well as the atrioventricular coupling. Kinetic energy was affected in both the right and left ventricle, even if left ventricular ejection fraction was normal. Patients with pulmonary regurgitation had higher right ventricular hemodynamic forces than controls, but also affected left ventricular forces, with less alignment of force and blood flow which has been suggested to lead to pathological cardiac remodelling. Further, pulmonary regurgitation resulted in decreased right ventricular longitudinal function, decreased left ventricular preload and lower left ventricular stroke volumes. Before pulmonary valve replacement patients, similar to controls, had a clear atrioventricular coupling with a strong correlation between atrial inflow and ventricular longitudinal function. After operation however this coupling was lost, possibly because the loss of pericardial integrity.After pulmonary valve replacement patients still had disturbed hemodynamic forces, pumping mechanics and loss of atrioventricular coupling, which is energetically unfavourable. Further studies will tell if these changes will normalize in time.The potential role of kinetic energy and hemodynamic forces for treatment evaluation and decision making in patients with Tetralogy of Fallot can be the aim for future studies.}},
author = {{Sjöberg, Pia}},
isbn = {{978-91-7619-785-1}},
issn = {{1652-8220}},
language = {{eng}},
number = {{56}},
publisher = {{Lund University: Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Hemodynamic assessment in patients with congenital heart disease using magnetic resonance imaging}},
url = {{https://lup.lub.lu.se/search/files/63516302/e_spik_ex_Pia.pdf}},
volume = {{2019}},
year = {{2019}},
}