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Cluster analysis of 100 Marfan patients based on aortic 4D flow MRI and Z-score: insights into disease heterogeneity and stratification of subgroups.

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Title: Cluster analysis of 100 Marfan patients based on aortic 4D flow MRI and Z-score: insights into disease heterogeneity and stratification of subgroups.
Authors: Lenz, Alexander1 (AUTHOR) a.lenz@uke.de, Bahr, Flora1 (AUTHOR), Riedel, Christoph1 (AUTHOR), Wright, Felicia1 (AUTHOR), Sinn, Martin1 (AUTHOR), Zhang, Shuo2 (AUTHOR), Schuett, Marion3 (AUTHOR), Well, Lennart1 (AUTHOR), Adam, Gerhard1 (AUTHOR), von Kodolitsch, Yskert4 (AUTHOR), Schoennagel, Bjoern P.1 (AUTHOR), Bannas, Peter1 (AUTHOR)
Source: European Radiology. Apr2025, Vol. 35 Issue 4, p2200-2212. 13p.
Subjects: Thoracic aorta, Cardiac aneurysms, Congenital heart disease, Hierarchical clustering (Cluster analysis), Cluster analysis (Statistics), Four-dimensional imaging
Abstract: Objectives: 4D flow MRI-derived variables from Marfan patients are highly heterogeneous. Our aim was to identify distinct Marfan patient subgroups based on aortic 4D flow MRI and Z-score for stratification of distinct hemodynamic profiles and clinical features by means of hierarchical cluster analysis. Materials and methods: One hundred Marfan patients underwent baseline aortic 4D flow MRI at 3 T. Z-scores, degree of helical and vortical flow, wall shear stress, flow displacement, and peak velocity were determined in the ascending aorta. Sex, age, BMI, antihypertensive medication, and dural ectasia were recorded. Hierarchical cluster analysis was performed using 4D flow MRI variables and Z-scores as input. Results: Cluster analysis resulted in three distinct clusters characterized by different Z-scores (mean ± SD); cluster 1: 0.4 ± 1.1 vs. cluster 2: 3.1 ± 1.1 vs. cluster 3: 3.6 ± 1.9. The three clusters delivered differences in helical and vortical flow patterns (global p = 0.003 and p < 0.001, respectively), wall shear stress (0.49 ± 0.11 vs. 0.44 ± 0.12 vs. 0.37 ± 0.09 N/m2, global p < 0.001), flow displacement (0.11 ± 0.05 vs. 0.16 ± 0.08 vs. 0.15 ± 0.07, global p = 0.006), and peak velocity (76.3 ± 9.0 vs. 60.1 ± 7.3 vs. 56.0 ± 7.8 cm/s, global p < 0.001). Patients in cluster 1 and 2 were relevantly younger than in cluster 3 (32.3 ± 13.8 vs. 32.8 ± 12.6 vs. 40.2 ± 15.0 years, all pairwise ∆p < 0.0297). Conclusion: Hierarchical cluster analysis based on aortic 4D flow MRI and Z-score revealed three distinct subgroups of Marfan patients, each characterized by specific hemodynamic profiles and clinical features. Follow-up of our patients is warranted to assess if 4D flow MRI- and Z-score-based stratification can predict future aortic diameter growth and ultimately improve outcomes. Clinical relevance statement: A combination of Z-score and 4D flow MRI-derived parameters may help identify subgroups of Marfan patients representing different stages or phenotypes of aortic disease, which require specific management strategies. Key Points: Four-dimensional (4D) flow MRI-derived variables of Marfan patients are highly heterogeneous across varying Z-scores. Cluster analysis based on 4D flow MRI and Z-score revealed three distinct subgroups of Marfan patients. A combination of Z-score and 4D flow MRI-derived parameters may identify different stages of aortic disease in Marfan patients. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Cluster analysis of 100 Marfan patients based on aortic 4D flow MRI and Z-score: insights into disease heterogeneity and stratification of subgroups.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Lenz%2C+Alexander%22&quot;&gt;Lenz, Alexander&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;i&gt; a.lenz@uke.de&lt;/i&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Bahr%2C+Flora%22&quot;&gt;Bahr, Flora&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Riedel%2C+Christoph%22&quot;&gt;Riedel, Christoph&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Wright%2C+Felicia%22&quot;&gt;Wright, Felicia&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sinn%2C+Martin%22&quot;&gt;Sinn, Martin&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Zhang%2C+Shuo%22&quot;&gt;Zhang, Shuo&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Schuett%2C+Marion%22&quot;&gt;Schuett, Marion&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Well%2C+Lennart%22&quot;&gt;Well, Lennart&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Adam%2C+Gerhard%22&quot;&gt;Adam, Gerhard&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22von+Kodolitsch%2C+Yskert%22&quot;&gt;von Kodolitsch, Yskert&lt;/searchLink&gt;&lt;relatesTo&gt;4&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Schoennagel%2C+Bjoern+P%2E%22&quot;&gt;Schoennagel, Bjoern P.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Bannas%2C+Peter%22&quot;&gt;Bannas, Peter&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22European+Radiology%22&quot;&gt;European Radiology&lt;/searchLink&gt;. Apr2025, Vol. 35 Issue 4, p2200-2212. 13p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Thoracic+aorta%22&quot;&gt;Thoracic aorta&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cardiac+aneurysms%22&quot;&gt;Cardiac aneurysms&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Congenital+heart+disease%22&quot;&gt;Congenital heart disease&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Hierarchical+clustering+%28Cluster+analysis%29%22&quot;&gt;Hierarchical clustering (Cluster analysis)&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cluster+analysis+%28Statistics%29%22&quot;&gt;Cluster analysis (Statistics)&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Four-dimensional+imaging%22&quot;&gt;Four-dimensional imaging&lt;/searchLink&gt;
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  Data: Objectives: 4D flow MRI-derived variables from Marfan patients are highly heterogeneous. Our aim was to identify distinct Marfan patient subgroups based on aortic 4D flow MRI and Z-score for stratification of distinct hemodynamic profiles and clinical features by means of hierarchical cluster analysis. Materials and methods: One hundred Marfan patients underwent baseline aortic 4D flow MRI at 3 T. Z-scores, degree of helical and vortical flow, wall shear stress, flow displacement, and peak velocity were determined in the ascending aorta. Sex, age, BMI, antihypertensive medication, and dural ectasia were recorded. Hierarchical cluster analysis was performed using 4D flow MRI variables and Z-scores as input. Results: Cluster analysis resulted in three distinct clusters characterized by different Z-scores (mean &#177; SD); cluster 1: 0.4 &#177; 1.1 vs. cluster 2: 3.1 &#177; 1.1 vs. cluster 3: 3.6 &#177; 1.9. The three clusters delivered differences in helical and vortical flow patterns (global p = 0.003 and p &lt; 0.001, respectively), wall shear stress (0.49 &#177; 0.11 vs. 0.44 &#177; 0.12 vs. 0.37 &#177; 0.09 N/m2, global p &lt; 0.001), flow displacement (0.11 &#177; 0.05 vs. 0.16 &#177; 0.08 vs. 0.15 &#177; 0.07, global p = 0.006), and peak velocity (76.3 &#177; 9.0 vs. 60.1 &#177; 7.3 vs. 56.0 &#177; 7.8 cm/s, global p &lt; 0.001). Patients in cluster 1 and 2 were relevantly younger than in cluster 3 (32.3 &#177; 13.8 vs. 32.8 &#177; 12.6 vs. 40.2 &#177; 15.0 years, all pairwise ∆p &lt; 0.0297). Conclusion: Hierarchical cluster analysis based on aortic 4D flow MRI and Z-score revealed three distinct subgroups of Marfan patients, each characterized by specific hemodynamic profiles and clinical features. Follow-up of our patients is warranted to assess if 4D flow MRI- and Z-score-based stratification can predict future aortic diameter growth and ultimately improve outcomes. Clinical relevance statement: A combination of Z-score and 4D flow MRI-derived parameters may help identify subgroups of Marfan patients representing different stages or phenotypes of aortic disease, which require specific management strategies. Key Points: Four-dimensional (4D) flow MRI-derived variables of Marfan patients are highly heterogeneous across varying Z-scores. Cluster analysis based on 4D flow MRI and Z-score revealed three distinct subgroups of Marfan patients. A combination of Z-score and 4D flow MRI-derived parameters may identify different stages of aortic disease in Marfan patients. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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