Assessing atrial myopathy with cardiac magnetic resonance imaging in embolic stroke of undetermined source.

BACKGROUND: Left atrial myopathy has been implicated in atrial fibrillation (AF)-related stroke and embolic stroke of undetermined source (ESUS). OBJECTIVE: To use advanced cardiac magnetic resonance (CMR) imaging techniques, including left atrial (LA) strain and 4D flow CMR, to identify atrial myopathy in patients with ESUS. METHODS: 20 patients with ESUS and no AF or other cause for stroke, and 20 age and sex-matched controls underwent CMR with 4D flow analysis. Markers of LA myopathy were assessed including LA size, volume, ejection fraction, and strain. 4D flow CMR was performed to measure novel markers of LA stasis such as LA velocities and the LA residence time distribution time constant (RTDtc). These markers of LA myopathy were compared between the two groups. RESULTS: There was no significant difference in: CMR-calculated LA velocities or LA total, passive or active ejection fractions between the groups. There was no significant difference in CMR-derived reservoir, conduit or contractile average longitudinal strain between the ESUS and control groups (22.9 vs 22.6%, p=0.379, 11.2 ± 3.5 vs 12.4 ± 2.6% p=0.224, 10.8 ± 3.2 vs 10.4 ± 2.3%, p=0.625 respectively). Similarly, RTDtc was not significantly longer in ESUS patients compared to controls (1.3 ± 0.2 vs 1.2 ± 0.2, p=0.1). CONCLUSIONS: There were no significant differences in any CMR marker of atrial myopathy in ESUS patients compared to healthy controls, likely reflecting the multiple possible aetiologies of ESUS suggesting that the role LA myopathy plays in ESUS is smaller than previously thought.

Measuring atrial stasis during sinus rhythm in patients with paroxysmal atrial fibrillation using 4 Dimensional flow imaging: 4D flow imaging of atrial stasis.

BACKGROUND: Paroxysmal atrial fibrillation (PAF) is associated with cardioembolic risk, however events may occur during sinus rhythm (SR). 4D-flow cardiac magnetic resonance (CMR) imaging allows visualisation of left atrial blood flow, to determine the residence time distribution (RTD), an assessment of atrial transit time. OBJECTIVE: To determine if atrial transit time is prolonged in PAF patients during SR, consistent with underlying atrial stasis. METHOD: 91 participants with PAF and 18 healthy volunteers underwent 4D flow analysis in SR. Velocity fields were produced RTDs, calculated by seeding virtual 'particles' at the right upper pulmonary vein and counting them exiting the mitral valve. An exponential decay curve quantified residence time of particles in the left atrium, and atrial stasis was expressed as the derived constant (RTDTC) based on heartbeats. The RTDTC was evaluated within the PAF group, and compared to healthy volunteers. RESULTS: Patients with PAF (n = 91) had higher RTDTC compared with gender-matched controls (n = 18) consistent with greater atrial stasis (1.68 ±â€¯0.46 beats vs 1.51 ±â€¯0.20 beats; p = .005). PAF patients with greater thromboembolic risk had greater atrial stasis (median RTDTC of 1.72 beats in CHA2DS2-VASc≥2 vs 1.52 beats in CHA2DS2-VASc<2; p = .03), only female gender and left ventricular ejection fraction contributed significantly to the atrial RTDTC (p = .006 and p = .023 respectively). CONCLUSIONS: Atrial stasis quantified by 4D flow is greater in PAF, correlating with higher CHA2DS2-VASc scores. Female gender and systolic dysfunction are associated with atrial stasis. RTD offers an insight into atrial flow that may be developed to provide a personalised assessment of thromboembolic risk.

Global organization of three-dimensional, volume-preserving flows: Constraints, degenerate points, and Lagrangian structure.

Global organization of three-dimensional (3D) Lagrangian chaotic transport is difficult to infer without extensive computation. For 3D time-periodic flows with one invariant, we show how constraints on deformation that arise from volume-preservation and periodic lines result in resonant degenerate points that periodically have zero net deformation. These points organize all Lagrangian transport in such flows through coordination of lower-order and higher-order periodic lines and prefigure unique transport structures that arise after perturbation and breaking of the invariant. Degenerate points of periodic lines and the extended 3D structures associated with them are easily identified through the trace of the deformation tensor calculated along periodic lines. These results reveal the importance of degenerate points in understanding transport in one-invariant fluid flows.

The ventricular residence time distribution derived from 4D flow particle tracing: a novel marker of myocardial dysfunction.

4D flow cardiac magnetic resonance (CMR) imaging allows visualisation of blood flow in the cardiac chambers and great vessels. Post processing of the flow data allows determination of the residence time distribution (RTD), a novel means of assessing ventricular function, potentially providing additional information beyond ejection fraction. We evaluated the RTD measurement of efficiency of left and right ventricular (LV and RV) blood flow. 16 volunteers and 16 patients with systolic dysfunction (LVEF < 50%) underwent CMR studies including 4D flow. The RTDs were created computationally by seeding virtual 'particles' at the inlet plane in customised post-processing software, moving these particles with the measured blood velocity, recording and counting how many exited per unit of time. The efficiency of ventricular flow was determined from the RTDs based on the time constant (RTDc = - 1/B) of the exponential decay. The RTDc was compared to ejection fraction, T1 mapping and global longitudinal strain (GLS). There was a significant difference between groups in LV RTDc (healthy volunteers 1.2 ± 0.13 vs systolic dysfunction 2.2 ± 0.80, p < 0.001, C-statistic = 1.0) and RV RTDc (1.5 ± 0.15 vs 2.0 ± 0.57, p = 0.013, C-statistic = 0.799). The LV RTDc correlated significantly with LVEF (R = - 0.84, P < 0.001) and the RV RTDc had significant correlation with RVEF (R = - 0.402, p = 0.008). The correlation between LV RTDc and LVEF was similar to GLS and LVEF (0.926, p < 0.001). The ventricular residence time correlates with ejection fraction and can distinguish normal from abnormal systolic function. Further assessment of this method of assessment of chamber function is warranted.

Localized shear generates three-dimensional transport.

Understanding the mechanisms that control three-dimensional (3D) fluid transport is central to many processes, including mixing, chemical reaction, and biological activity. Here a novel mechanism for 3D transport is uncovered where fluid particles are kicked between streamlines near a localized shear, which occurs in many flows and materials. This results in 3D transport similar to Resonance Induced Dispersion (RID); however, this new mechanism is more rapid and mutually incompatible with RID. We explore its governing impact with both an abstract 2-action flow and a model fluid flow. We show that transitions from one-dimensional (1D) to two-dimensional (2D) and 2D to 3D transport occur based on the relative magnitudes of streamline jumps in two transverse directions.

Impact of discontinuous deformation upon the rate of chaotic mixing.

Mixing in smoothly deforming systems is achieved by repeated stretching and folding of material, and has been widely studied. However, for the classes of materials that also admit discontinuous deformation, the theory of mixing based on the assumption of smooth deformation does not apply. Discontinuous deformation provides additional topological freedom for material transport and results in different Lagrangian coherent structures forbidden in smoothly deforming systems. We uncover the impact of discontinuous deformation on mixing rates, showing that mixing can be either enhanced or impeded depending on the local stability of the underlying smooth map.

Control mechanisms for the global structure of scalar dispersion in chaotic flows.

Scalar dispersion has complex interactions between advection and diffusion that depend on the values of the scalar diffusivity and of the (possibly large) set of parameters controlling the flow. Using a spectral method which is three to four orders of magnitude faster than traditional methods, we calculate the fine-scale structure of the global solution space of the advection-diffusion equation for a physically realizable chaotic flow. The solution space is rich: spatial pattern locking, an order-disorder transition, and optima in dispersion rates that move discontinuously with Peclét number and boundary condition type are some of the discoveries. We uncover the mechanisms which control pattern locking and govern the global structure of dispersion across the parameter space and Peclét number spectrum.

An experimental and theoretical study of the mixing characteristics of a periodically reoriented irrotational flow.

The minimum-energy method to generate chaotic advection should be to use an irrotational flow. However, irrotational flows have no saddle connections to perturb in order to generate chaotic orbits. To the early work of Jones & Aref (Jones & Aref 1988 Phys. Fluids 31, 469-485 (doi:10.1063/1.866828)) on potential flow chaos, we add periodic reorientation to generate chaotic advection with irrotational experimental flows. Our experimental irrotational flow is a dipole potential flow in a disc-shaped Hele-Shaw cell called the rotated potential mixing flow; it leads to chaotic advection and transport in the disc. We derive an analytical map for the flow. This is a partially open flow, in which parts of the flow remain in the cell forever, and parts of it pass through with residence-time and exit-time distributions that have self-similar features in the control parameter space of the stirring. The theory compares well with the experiment.