Wall Shear Stress Measured with 4D Flow CMR Correlates with Biomarkers of Inflammation and Collagen Synthesis in Mild-to-Moderate Ascending Aortic Dilation and Tricuspid Aortic Valves

Filip Hammaréus; Chiara Trenti; Hanna M Björck; Jan Engvall; Hanna Lekedal; Aleksandra Krzynska-Trzebiatowska; David Kylhammare; Marcus Lindenberger; Anna K Lundberg; Fredrik Nilsson; Lennart Nilsson; Eva Swahn; Lena Jonasson; Petter Dyverfeldt

doi:10.1093/ehjci/jeae130

Wall Shear Stress Measured with 4D Flow CMR Correlates with Biomarkers of Inflammation and Collagen Synthesis in Mild-to-Moderate Ascending Aortic Dilation and Tricuspid Aortic Valves

Eur Heart J Cardiovasc Imaging. 2024 May 15:jeae130. doi: 10.1093/ehjci/jeae130. Online ahead of print.

Authors

Filip Hammaréus^{1

2}, Chiara Trenti^{2

3}, Hanna M Björck⁴, Jan Engvall^{2

5}, Hanna Lekedal⁶, Aleksandra Krzynska-Trzebiatowska⁷, David Kylhammare^{5

8}, Marcus Lindenberger⁷, Anna K Lundberg², Fredrik Nilsson⁷, Lennart Nilsson^{1

2}, Eva Swahn^{1

7}, Lena Jonasson^{2

7}, Petter Dyverfeldt^{2

3}

Affiliations

¹ Department of Internal Medicine in Jönköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden.
² Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden.
³ Center for Medical Image Science and Visualization, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden.
⁴ Division of Cardiovascular Medicine, Center for Molecular Medicine, Department of Medicine, Karolinska Institute, Stockholm, Karolinska University Hospital, Visionsgatan 18, 171 76 Solna, Sweden.
⁵ Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden.
⁶ Östersund Hospital, Östersundssjukhus 831 83 Östersund, Sweden.
⁷ Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden.
⁸ Wallenberg Centre for Molecular Medicine, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden.

PMID: 38748858
DOI: 10.1093/ehjci/jeae130

Abstract

Aims: Understanding the mechanisms underlying ascending aortic dilation is imperative for refined risk stratification of these patients, particularly among incidentally identified patients, most commonly presenting with tricuspid valves. The aim of this study was to explore associations between ascending aortic hemodynamics, assessed using four-dimensional flow cardiovascular magnetic resonance imaging (4D Flow CMR), and circulating biomarkers in aortic dilation.

Methods and results: Forty-seven cases with aortic dilation (diameter ≥40 mm) and 50 sex-and age-matched controls (diameter <40 mm), all with tricuspid aortic valves, underwent 4D flow CMR and venous blood sampling. Associations between flow displacement, wall shear stress (WSS), and oscillatory shear index in the ascending aorta derived from 4D Flow CMR, and biomarkers including interleukin-6, collagen type I α1 chain, metalloproteinases (MMPs), and inhibitors of MMPs derived from blood plasma, were investigated. Cases with dilation exhibited lower peak systolic WSS, higher flow displacement, and higher mean oscillatory shear index compared to controls without dilation. No significant differences in biomarkers were observed between the groups. Correlations between hemodynamics and biomarkers were observed, particularly between maximum time-averaged WSS and interleukin-6 (r = 0.539, p < 0.001), and maximum oscillatory shear index and collagen type I α1 chain (r = -0.575, p < 0.001 in cases).

Conclusion: Significant associations were discovered between 4D flow CMR derived whole-cardiac cycle WSS and circulating biomarkers representing inflammation and collagen synthesis, suggesting an intricate interplay between hemodynamics and the processes of inflammation and collagen synthesis in patients with early aortic dilation and tricuspid aortic valves.

Keywords: 4D Flow CMR; Aortic dilation; cardiovascular magnetic resonance; circulating biomarkers; wall shear stress.