title: Vorticity is a marker of right ventricular diastolic dysfunction.
abstract: Right ventricular diastolic dysfunction (RVDD) is an important prognostic indicator in pulmonary arterial hypertension (PAH). RV vortex rings have been observed in healthy subjects, but their significance in RVDD is unknown. Vorticity, the local spinning motion of an element of fluid, may be a sensitive measure of RV vortex dynamics. Using four-dimensional (4D) flow cardiac magnetic resonance imaging (CMR), we investigated the relationship between right heart vorticity with echocardiographic indexes of RVDD. Thirteen (13) PAH subjects and 10 controls underwent same-day 4D flow CMR and echocardiography. RV diastolic function was assessed using trans-tricuspid valve (TV) early (E) and late (A) velocities, E/A ratio, and e' and a' tissue Doppler velocities. RV and right atrial (RA) integrated mean vorticity was calculated for E and A-wave filling periods using 4D datasets. Compared with controls, A-wave vorticity was significantly increased in RVDD subjects in both the RV [2343 (1,559-3,295) vs. 492 (267-2,649) 1/s, P = 0.028] and RA [30 (27-44) vs. 9 (5-27) 1/s, P = 0.005]. RA E vorticity was significantly decreased [13 (7-22) vs. 28 (15-31) 1/s, P = 0.038] in RVDD. E-wave vorticity correlated TV e', E-,and TV E/A (P < 0.05), and A-wave vorticity associated with both TV A and E/A (P < 0.02). RVDD is associated with alterations in E- and A-wave vorticity, and vorticity correlates with multiple echocardiographic markers of RVDD. Vorticity may be a robust noninvasive research tool for the investigation of RV fluid and tissue mechanical interactions in PAH.
authors.affiliation: Division of Cardiology, National Jewish Health, Denver, Colorado; fensterb@njhealth.org.
authors.forename: Brett E
authors.identifier: http://orcid.org/0000-0001-6137-1815
authors.initials: BE
authors.lastname: Fenster
authors.affiliation: Department of Mechanical Engineering, University of Colorado, Boulder, Colorado;
authors.forename: James
authors.initials: J
authors.lastname: Browning
authors.affiliation: Division of Cardiology, National Jewish Health, Denver, Colorado; Department of Mechanical Engineering, University of Colorado, Boulder, Colorado; Division of Radiology, National Jewish Health, Denver, Colorado; and Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado.
authors.forename: Joyce D
authors.initials: JD
authors.lastname: Schroeder
authors.affiliation: Division of Cardiology, National Jewish Health, Denver, Colorado;
authors.forename: Michal
authors.initials: M
authors.lastname: Schafer
authors.affiliation: Division of Cardiology, National Jewish Health, Denver, Colorado;
authors.forename: Chris A
authors.initials: CA
authors.lastname: Podgorski
authors.affiliation: Division of Radiology, National Jewish Health, Denver, Colorado; and Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado.
authors.forename: Jamie
authors.initials: J
authors.lastname: Smyser
authors.affiliation: Division of Cardiology, National Jewish Health, Denver, Colorado; Department of Mechanical Engineering, University of Colorado, Boulder, Colorado; Division of Radiology, National Jewish Health, Denver, Colorado; and Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Silveira
authors.affiliation: Division of Cardiology, National Jewish Health, Denver, Colorado;
authors.forename: J Kern
authors.initials: JK
authors.lastname: Buckner
authors.affiliation: Department of Mechanical Engineering, University of Colorado, Boulder, Colorado;
authors.forename: Jean R
authors.initials: JR
authors.lastname: Hertzberg
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003971:Diastole; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: 4D flow cardiac MRI; diastolic dysfunction; pulmonary arterial hypertension; right ventricle; vortex