Preprint
Wall-Shear Stress in Outflow Tract Premature Ventricular Contraction Location: Opening Doors with 4D-Flow MRI
SSRN
01/20/2023
DOI: 10.2139/ssrn.4322688
Abstract
Background: Chronic parietal stress has been suggested as a possible mechanism to explain the unclear pathophysiology of outflow tract PVCs.Objectives: To assess wall shear stress (WSS) maps of the right ventricle outflow tract (RVOT) in patients with significant outflow tract premature ventricular contrac-tion (PVC).
Methods: We evaluated prospectively in a 2-centre study 15 patients undergoing first time outflow tract PVC ablation. All patients underwent gadolinium-enhanced 4D-flow cardiovascular MRI (CMR) before ablation. Flow patterns were visually ana-lyzed in RVOT long axis for vorticity and cross-sectional view for eccentricity. Pa-tients were compared to a sex and age 2:1 matched control population without car-diac disease and arrhythmia.
Results: Blood flow in the RVOT was often associated with eccentric systolic flow jet without any macroscopic vortex detected. RVOT WSS maps were heterogenous, with increased WSS zones suggesting areas of focal flow jet impingement, most of-ten localized in the posterior and posteroseptal walls. These abnormal areas corre-sponded in most of cases (66%) to the arrhythmogenic zones, as demonstrated by electrophysiological mapping. In control subjects, WSS was predominately in-creased in the same areas. Ventricular EGMs amplitude during sinus rhythm in in-creased WSS zones was non-significantly lower (1.4 ± 0.7 mV vs. 2.4 ± 1.9 mV, p=0.26) in patients with electrophysiological/fluid dynamics concordance.
Conclusions: 4D-flow CMR-derived WSS was locally increased at the posterior and posteroseptal RVOT walls in patients with outflow tract PVCs, corresponding mainly to the arrhythmogenic areas as demonstrated by electrophysiological mapping. Our findings suggest an electrophysiological/fluid dynamics relationship in patients with outflow tract PVCs.
Details
- Title: Subtitle
- Wall-Shear Stress in Outflow Tract Premature Ventricular Contraction Location: Opening Doors with 4D-Flow MRI
- Creators
- Virgile Chevance - University of GenevaArshid Azarine - Hôpital Paris Saint-JosephDavid A. Hamon - Hôpitaux Universitaires Henri MondorRefaat Nouri - University of GenevaJamal Khan - University Hospitals Coventry and Warwickshire NHS TrustTarvinder Dhanjal - University of WarwickEmmanuel Teiger - Hôpitaux Universitaires Henri-MondorJean-François Deux - University of GenevaNicolas Lellouche - Hôpitaux Universitaires Henri-Mondor
- Resource Type
- Preprint
- DOI
- 10.2139/ssrn.4322688
- eISSN
- 1556-5068
- Publisher
- SSRN
- Number of pages
- 35 pages
- Language
- English
- Date posted
- 01/20/2023
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984695675202771
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