University of Oulu

Tarmo Korpela, S Petteri Kauhanen, Elina Kariniemi, Petri Saari, Timo Liimatainen, Pekka Jaakkola, Ritva Vanninen, Marja Hedman, Flow displacement and decreased wall shear stress might be associated with the growth rate of an ascending aortic dilatation, European Journal of Cardio-Thoracic Surgery, Volume 61, Issue 2, February 2022, Pages 395–402,

Flow displacement and decreased wall shear stress might be associated with the growth rate of an ascending aortic dilatation

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Author: Korpela, Tarmo1,2; Kauhanen, S. Petteri1,3; Kariniemi, Elina4;
Organizations: 1Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Finland
2Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Finland
3Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
4Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Clinical Imaging Center, Finland
5Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
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Language: English
Published: Oxford University Press, 2022
Publish Date: 2022-05-20


Objectives: Our goal was to evaluate whether four-dimensional (4D) flow magnetic resonance imaging (MRI) can predict the growth rate of dilatation of the ascending aorta (AA) in patients with a tricuspid, normally functioning aortic valve.

Methods: In this prospective clinical study, aortic 4D flow MRI was performed at the Kuopio University Hospital on 30 patients diagnosed with AA dilatation (maximum diameter >40 mm) between August 2017 and July 2020. The MRI was repeated after a 1-year follow-up, with AA dimensions and 4D flow parameters analysed retrospectively at both time points. The standard error of measurement was used to assess the statistical significance of the growth rate of AA dilatation. Flow displacement (FD) was transformed to a class-scaled parameter using FD ≥5% as a threshold.

Results: Statistically significant growth [median 2.1 mm (1.5–2.2 mm); P = 0.03] was detected in 6 male patients (20%); the AA diameter remained unchanged [0.2 mm (−0.3 to 0.9 mm)] in 24 patients (80%). An increased FD at the baseline was associated with significant growth during the 1-year follow-up in the proximal AA. An association was detected between decreased total wall shear stress and significant aortic growth in the inner curve of the sinotubular junction [529 mPa (449–664 mPa) vs 775 mPa (609–944 mPa); P = 0.03] and the anterior side of the proximal aortic arch [356 mPa (305–367 mPa) vs 493 mPa (390–586 mPa); P < 0.001].

Conclusions: FD and decreased wall shear stress seem to be associated with significant growth of AA dilatation at the 1-year follow-up. Thus, 4D flow MRI might be useful in assessing risk for AA diameter growth in patients with a tricuspid aortic valve.

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Series: European journal of cardio-thoracic surgery
ISSN: 1010-7940
ISSN-E: 1873-734X
ISSN-L: 1010-7940
Volume: 61
Issue: 2
Pages: 395 - 402
DOI: 10.1093/ejcts/ezab483
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: The study was supported by funding from Kuopio University Hospital research residue funding (KP 11620), Instrumentarium Science Foundation and the Oiva Vaittinen will donation.
Copyright information: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact