title: Wall shear stress measured by phase contrast cardiovascular magnetic resonance in children and adolescents with pulmonary arterial hypertension.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is a devastating disease with significant morbidity and mortality. At the macroscopic level, disease progression is observed as a complex interplay between mean pulmonary artery pressure, pulmonary vascular resistance, pulmonary vascular stiffness, arterial size, and flow. Wall shear stress (WSS) is known to mediate or be dependent on a number of these factors. Given that WSS is known to promote architectural vessel remodeling, it is imperative that the changes of this factor be quantified in the presence of PAH.
  
  
  METHODS
  In this study, we analyzed phase contrast imaging of the right pulmonary artery derived from cardiovascular magnetic resonance to quantify the local, temporal and circumferentially averaged WSS of a PAH population and a pediatric control population. In addition, information about flow and relative area change were derived.
  
  
  RESULTS
  Although the normotensive and PAH shear waveform exhibited a WSS profile which is uniform in magnitude and direction along the vessel circumference at systole, time-averaged WSS (2.2 ± 1.6 vs. 6.6 ± 3.4 dynes/cm(2), P = 0.018) and systolic WSS (8.2 ± 5.0 v. 20.0 ± 9.1 dynes/cm(2), P = 0.018) was significantly depressed in the PAH population as compared to the controls. BSA-indexed PA diameter was significantly larger in the PAH population (1.5 ± 0.4 vs. 0.7 ± 0.1 cm/m(2), P = 0.003).
  
  
  CONCLUSIONS
  In the presence of preserved flow rates through a large PAH pulmonary artery, WSS is significantly decreased. This may have implications for proximal pulmonary artery remodeling and cellular function in the progression of PAH.
authors.affiliation: Department for Bioengineering, University of Colorado, 13123 E, 16th Avenue B100, Aurora, CO 80045, USA. Kendall.Hunter@UCDenver.edu.
authors.forename: Uyen
authors.initials: U
authors.lastname: Truong
authors.forename: Brian
authors.initials: B
authors.lastname: Fonseca
authors.forename: Jamie
authors.initials: J
authors.lastname: Dunning
authors.forename: Shawna
authors.initials: S
authors.lastname: Burgett
authors.forename: Craig
authors.initials: C
authors.lastname: Lanning
authors.forename: D Dunbar
authors.initials: DD
authors.lastname: Ivy
authors.forename: Robin
authors.initials: R
authors.lastname: Shandas
authors.forename: Kendall
authors.initials: K
authors.lastname: Hunter
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology*; D011652:Pulmonary Circulation; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013314:Stress, Mechanical; D014664:Vasodilation; D055815:Young Adult
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