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Møller ELR, Hauge MG, Pham MHC, Damm P, Kofoed KF, Fuchs A, Kühl JT, Sigvardsen PE, Ersbøll AS, Johansen M, Nordestgaard BG, Køber LV, Gustafsson F, Linde JJ. Aortic dimensions in women with previous pre-eclampsia. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00343-5. [PMID: 38866633 DOI: 10.1016/j.jcct.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/23/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Pre-eclampsia is a pregnancy related disorder associated with hypertension and vascular inflammation, factors that are also involved in the pathological pathway of aortic dilatation and aneurysm development. It is, however, unknown if younger women with previous pre-eclampsia have increased aortic dimensions. We tested the hypothesis that previous pre-eclampsia is associated with increased aortic dimensions in younger women. METHODS The study was a cross-sectional cohort study of women with previous pre-eclampsia, aged 40-55, from the PRECIOUS population matched by age and parity with women from the general population. Using contrast-enhanced CT, aortic diameters were measured in the aortic root, ascending aorta, descending aorta, at the level of the diaphragm, suprarenal aorta, and infrarenal aorta. RESULTS 1355 women (684 with previous pre-eclampsia and 671 from the general population), with a mean (standard deviation) age of 46.9 (4.4) were included. The pre-eclampsia group had larger mean (standard deviation) aortic diameters (mm) in all measured segments from the ascending to the infrarenal aorta (ascending: 33.4 (4.0) vs. 31.4 (3.7), descending: 23.9 (2.1) vs. 23.3 (2.0), diaphragm: 20.8 (1.8) vs. 20.4 (1.8), suprarenal: 22.9 (1.9) vs. 22.0 (2.0), infrarenal: 19.3 (1.6) vs. 18.6 (1.7), p < 0.001 for all, also after adjustment for age, height, parity, menopause, dyslipidemia, smoking and chronic hypertension. Guideline-defined ascending aortic aneurysms were found in 8 vs 2 women (p = 0.12). CONCLUSIONS Women with previous pre-eclampsia have larger aortic dimensions compared with women from the general population. Pre-eclampsia was found to be an independent risk factor associated with a larger aortic diameter.
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Affiliation(s)
- Emma L R Møller
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria G Hauge
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael H C Pham
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, The Diagnostic Center, Rigshospitalet, Copenhagen, University Hospital, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen T Kühl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne S Ersbøll
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Miyagawa M, Kojima K, Takahashi K, Nakajima Y, Migita S, Mizobuchi S, Tanaka Y, Fukumoto K, Arai R, Morikawa T, Mineki T, Murata N, Sudo M, Fukamachi D, Okumura Y. Association Between Aortic Wall Parameters on Multidetector Computed Tomography and Ruptured Plaques By Nonobstructive General Angioscopy. J Am Heart Assoc 2024; 13:e033233. [PMID: 38497463 PMCID: PMC11010013 DOI: 10.1161/jaha.123.033233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Nonobstructive general angioscopy (NOGA) can identify vulnerable plaques in the aortic lumen that serve as potential risk factors for cardiovascular events such as embolism. However, the association between computed tomography (CT) images and vulnerable plaques detected on NOGA remains unknown. METHODS AND RESULTS We investigated 101 patients (67±11 years; women, 13.8%) who underwent NOGA and contrast-enhanced CT before or after 90 days in our hospital. On CT images, the aortic wall thickness, aortic wall area (AWA), and AWA in the vascular area were measured at the thickest point from the 6th to the 12th thoracic vertebral levels. Furthermore, the association between these measurements and the presence or absence of NOGA-derived aortic plaque ruptures (PRs) at the same vertebral level was assessed. NOGA detected aortic PRs in the aortic lumens at 145 (22.1%) of the 656 vertebral levels. The presence of PRs was significantly associated with greater aortic wall thickness (3.3±1.7 mm versus 2.1±1.2 mm), AWA (1.33±0.68 cm2 versus 0.89±0.49 cm2), and AWA in the vascular area (23.2%±9.3% versus 17.2%±7.6%) (P<0.001 for all) on the CT scans compared with the absence of PRs. The frequency of PRs significantly increased as the aortic wall thickness increased. Notably, a few NOGA-derived PRs were detected on CT in near-normal intima. CONCLUSIONS The presence of NOGA-derived PRs was strongly associated with increased aortic wall thickness, AWA, and AWA in the vascular area, measured using CT. NOGA can detect PRs in the intima that appear almost normal on CT scans.
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Affiliation(s)
- Masatsugu Miyagawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Keisuke Kojima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Kurara Takahashi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuki Nakajima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shohei Migita
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Saki Mizobuchi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yudai Tanaka
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Katsunori Fukumoto
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Riku Arai
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Tomoyuki Morikawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Takashi Mineki
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Nobuhiro Murata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Mitsumasa Sudo
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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3
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Mzayek F, Wang LE, Relyea G, Yu X, Terry JG, Carr J, Hundley GW, Hall ME, Correa A. Impact of Abdominal Obesity on Proximal and Distal Aorta Wall Thickness in African Americans: The Jackson Heart Study. Obesity (Silver Spring) 2019; 27:1527-1532. [PMID: 31328900 PMCID: PMC6707870 DOI: 10.1002/oby.22563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/27/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Abdominal obesity and wall thickness of the central arteries have been associated with higher risk of cardiovascular disease. Despite the higher burden of overweight and cardiovascular disease among African Americans, limited data are available on the association of abdominal obesity with aortic wall thickness in African Americans. We assessed the cross-sectional and the longitudinal associations of abdominal obesity with aortic intima-media thickness (aIMT) in a cohort of African Americans from the Jackson Heart Study. METHODS Data on aIMT and repeated measures of waist circumference (WC) and waist to height ratio from 1,572 participants, as well as on abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and aIMT from 1,223 participants, were analyzed. aIMT was measured at proximal ascending aorta (PA-aIMT), proximal descending aorta (PD-aIMT), and distal aorta (bifurcation) using cardiac magnetic resonance. SAT and VAT were measured using computerized tomography. RESULTS WC and WHtR were longitudinally associated with PA-aIMT and PD-aIMT; SAT and VAT were associated with PA-aIMT only. Only WC was associated with distal aIMT. CONCLUSIONS Abdominal obesity measures are associated with increased proximal aIMT in adult African Americans. Only WC is associated with wall thickness in all three segments of the aorta.
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Affiliation(s)
- Fawaz Mzayek
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, TN
| | - Lisa E. Wang
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, TN
| | - George Relyea
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, TN
| | - Xinhua Yu
- Division of Epidemiology, Biostatistics, and Environmental
Health, School of Public Health, University of Memphis, Memphis, TN
| | - James G. Terry
- Department of Radiology and Vanderbilt Translational and
Clinical Cardiovascular Research Center, Vanderbilt University Medical Center,
Nashville, TN
| | - Jeffrey Carr
- Department of Radiology and Vanderbilt Translational and
Clinical Cardiovascular Research Center, Vanderbilt University Medical Center,
Nashville, TN
| | - Gregory W. Hundley
- Department of Internal Medicine, Section on Cardiovascular
Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael E. Hall
- Department of Medicine, University of Mississippi Medical
Center, Jackson, MS
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical
Center, Jackson, MS
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4
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Butler CG, Ho Luxford JM, Huang CC, Ejiofor JI, Rawn JD, Wilusz K, Fox JA, Shernan SK, Muehlschlegel JD. Aortic Atheroma Increases the Risk of Long-Term Mortality in 20,000 Patients. Ann Thorac Surg 2017; 104:1325-1331. [PMID: 28577841 DOI: 10.1016/j.athoracsur.2017.02.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The association between long-term survival and aortic atheroma in cardiac surgical patients has not been comprehensively investigated. In this study we determine the relation between grade of atheroma and the risk of long-term mortality in a retrospective cohort of more than 20,000 patients undergoing cardiac operation during a 20-year period. METHODS We included 22,304 consecutive intraoperative transesophageal and epiaortic ultrasound examinations performed at Brigham and Women's Hospital between 1995 and 2014, with long-term follow-up. The extent of atheromatous disease recorded in each examination was used for analysis. Mortality data were obtained from our institution's data registry. Mortality analyses were done using Cox proportional hazard regression models with follow-up as a time scale. We repeated the analysis in a subgroup of 14,728 patients with more detailed demographic characteristics, including postoperative stroke, queried from the institutional Society of Thoracic Surgeons database. RESULTS A total of 7,722 mortality events and 872 stroke events occurred. Patients with atheromatous disease demonstrated a significant increase in mortality across all grades of severity, both for the ascending and descending aorta. This relation remained unchanged after adjusting for additional covariates. Adjustments for postoperative stroke resulted in only minimal attenuation in the risk of postoperative mortality related to aortic atheroma. CONCLUSIONS Aortic atheromatous disease of any grade in the ascending and descending aorta is a significant long-term risk of long-term, all-cause mortality in cardiac operation patients. This association remains independent of other conventional risk factors and is not related to postoperative cerebrovascular accidents.
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Affiliation(s)
- Carolyn Goldberg Butler
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jamahal Maeng Ho Luxford
- Department of Anaesthesia and Pain Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Chuan-Chin Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Julius I Ejiofor
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - James D Rawn
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Kerry Wilusz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - John A Fox
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Jochen Daniel Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston.
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5
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Ittermann T, Lorbeer R, Dörr M, Schneider T, Quadrat A, Heßelbarth L, Wenzel M, Lehmphul I, Köhrle J, Mensel B, Völzke H. High levels of thyroid-stimulating hormone are associated with aortic wall thickness in the general population. Eur Radiol 2016; 26:4490-4496. [PMID: 26973144 DOI: 10.1007/s00330-016-4316-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/26/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Our aim was to investigate the association of thyroid function defined by serum concentrations of thyroid-stimulating hormone (TSH) with thoracic aortic wall thickness (AWT) as a marker of atherosclerotic processes. METHODS We pooled data of 2,679 individuals from two independent population-based surveys of the Study of Health in Pomerania. Aortic diameter and AWT measurements were performed on a 1.5-T MRI scanner at the concentration of the right pulmonary artery displaying the ascending and the descending aorta. RESULTS TSH, treated as continuous variable, was significantly associated with descending AWT (β = 0.11; 95 % confidence interval (CI) 0.02-0.21), while the association with ascending AWT was not statistically significant (β = 0.20; 95 % CI -0.01-0.21). High TSH (>3.29 mIU/L) was significantly associated with ascending (β = 0.12; 95 % CI 0.02-0.23) but not with descending AWT (β = 0.06; 95 % CI -0.04-0.16). There was no consistent association between TSH and aortic diameters. CONCLUSIONS Our study demonstrated that AWT values increase with increasing serum TSH concentrations. Thus, a hypothyroid state may be indicative for aortic atherosclerosis. These results fit very well to the findings of previous studies pointing towards increased atherosclerotic risk in the hypothyroid state. KEY POINTS • Serum TSH concentrations are positively associated with aortic wall thickness. • Serum TSH concentrations are not associated with the aortic diameters. • Serum 3,5-diiodothyronine concentrations may be positively associated with aortic wall thickness.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany.
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
| | - Roberto Lorbeer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Marcus Dörr
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany
| | - Tobias Schneider
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Quadrat
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Lydia Heßelbarth
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Michael Wenzel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Ina Lehmphul
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Josef Köhrle
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
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Computational Analysis of the Mechanical Behaviors of Hemiarch and Total Arch Replacements. Ann Biomed Eng 2015; 43:2881-91. [PMID: 26014364 DOI: 10.1007/s10439-015-1345-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
Surgery for aortic dissections or aneurysms can be extended into the aortic arch by hemiarch replacement (HAR) or total arch replacement (TAR). Although cardiovascular surgeons have been performing HAR and TAR for decades, the mechanical properties of HAR and TAR are not well understood. This study investigates the mechanical behaviors and stress distributions in HAR and TAR using a hybrid fluid-structure interaction analysis that combines computational fluid dynamics and structural static analysis. Geometrical information on the aortas of 11 subjects was extracted from contrast-enhanced computed tomography (CT) scan data. The CT images were imported into medical image processing software to reconstruct 3D models of the aortas. A 3D finite element model was employed to simulate aortas that receive HAR or TAR. The deformation of the great vessels and the stress distributions at both the vessels and the aortic grafts were calculated. The numerical results revealed that the aortas following TAR exhibited a lower level of stress than those following HAR. Higher stresses may cause arterial wall injury and increase the risk of rupture. Finite element analysis of the aortas and the aortic grafts provides useful information that helps physicians better understand the potential problems that may arise after various surgical procedures.
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Tresoldi S, Di Leo G, Zoffoli E, Munari A, Primolevo A, Cornalba G, Sardanelli F. Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events. Acta Radiol 2014; 55:1040-9. [PMID: 24292898 DOI: 10.1177/0284185113513978] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a significant association between aortic atherosclerosis and previous major cardiovascular events. Particularly, thoracic aortic atherosclerosis is closely related to the degree of coronary and carotid artery disease. Thus, there is a rationale for screening the thoracic aorta in patients who undergo a chest computed tomography (CT) for any clinical question, in order to detect patients at increased risk of cerebro-cardiovascular (CCV) events. PURPOSE To estimate the association between either thoracic aortic wall thickness (AWT) or aortic total calcium score (ATCS) and CCV events. MATERIAL AND METHODS One hundred and forty-eight non-cardiac patients (78 men; 67 ± 12 years) underwent chest contrast-enhanced multidetector CT (MDCT). The AWT was measured at the level of the left atrium (AWTref) and at the maximum AWT (AWTmax). Correlation with clinical CCV patients' history was estimated. The value of AWTmax and of a semi-quantitative ATCS as a marker for CCV events was assessed using receiver-operating characteristic curve (ROC) analysis and multivariate regression analysis. RESULTS Out of 148 patients, 59% reported sedentary lifestyle, 44% hypertension, 32% smoking, 23% hypercholesterolemia, 13% family history of cardiac disease, 12% diabetes, and 10% BMI ≥ 30 kg/m(2); 9% reported myocardial infarction, 8% aortic aneurism, 8% myocardial revascularization, and 2% ischemic stroke. Twenty-six percent of patients had a medium-to-high ATCS. Both AWTmax and AWTref correlated with hypertension and age (P < 0.002). At the ROC analysis, a 4.8 mm threshold was associated to a 90% specificity and an odds ratio of 6.3 (AUC = 0.735). Assuming as threshold the AWTmax median value (4.3 mm) of patients who suffered from at least one CCV event in their history, a negative predictive value of 90%, a RR of 3.6 and an OR of 6.3 were found. At the multivariate regression analysis, AWTmax was the only independent variable associated to the frequency of CCV events. CONCLUSION Patients with increased thoracic AWTmax on chest MDCT could be considered at risk for CCV disease.
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Affiliation(s)
- Silvia Tresoldi
- Servizio di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Milan, Italy
| | - Giovanni Di Leo
- Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elena Zoffoli
- Unità di Radiologia, Ospedale San Carlo Borromeo, Milan, Italy
| | - Alice Munari
- Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Primolevo
- Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Gianpaolo Cornalba
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Nah HW, Lee JW, Chung CH, Choo SJ, Kwon SU, Kim JS, Warach S, Kang DW. New brain infarcts on magnetic resonance imaging after coronary artery bypass graft surgery: Lesion patterns, mechanism, and predictors. Ann Neurol 2014; 76:347-55. [DOI: 10.1002/ana.24238] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/26/2014] [Accepted: 07/26/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Hyun-Wook Nah
- Department of Neurology, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
- Busan-Ulsan Regional Cerebrovascular Center and Department of Neurology; Dong-A University College of Medicine; Busan South Korea
| | - Jae-Won Lee
- Department of Cardiovascular Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Cheol-Hyun Chung
- Department of Cardiovascular Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Suk-Jung Choo
- Department of Cardiovascular Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Sun U. Kwon
- Department of Neurology, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Jong S. Kim
- Department of Neurology, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Steven Warach
- Department of Neurology and Neurotherapeutics; Seton/University of Texas Southwestern Clinical Research Institute; Austin TX
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
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Yüce G, Türkvatan A, Yener Ö. Can aortic atherosclerosis or epicardial adipose tissue volume be used as a marker for predicting coronary artery disease? J Cardiol 2014; 65:143-9. [PMID: 24954286 DOI: 10.1016/j.jjcc.2014.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 01/18/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate whether aortic atherosclerosis or epicardial adipose tissue (EAT) volume on multidetector computed tomography (CT) can predict the presence of significant coronary artery disease (CAD). MATERIALS AND METHODS Coronary CT angiography was performed in 202 cases of CAD that were known or based on suspicion. Based on coronary CT angiography results, the patients with significant stenosis (≥50%) and without significant stenosis (<50%) were compared in terms of demographic characteristics, traditional cardiovascular risk factors, aortic atherosclerosis, and EAT volume. RESULTS Significant coronary artery stenosis was detected in 92 cases (45.5%). Although EAT volume was higher in the patients with significant stenosis, the difference between the two groups was not statistically significant. The presence of calcification in the descending aorta was significantly higher in the patients with significant stenosis than the patients without significant stenosis (50.4% and 15.4%, respectively, p=0.0001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates of the presence of calcification in the descending aorta in predicting the presence of significant coronary artery stenosis were respectively found as 53.8%, 84.4%, 74.6%, 68.1%, and 70.3%. The sensitivity, specificity, PPV, NPV, and accuracy rates of the ≥2.45mm wall thickness of the descending aorta in predicting the presence of significant coronary artery stenosis were respectively found as 75.3%, 74.3%, 71.4%, 77.9%, and 74.8%. CONCLUSION There is a strong relationship between thoracic aortic atherosclerosis and CAD. However, the relationship between EAT volume and CAD is not significant. The presence of aortic atherosclerosis can be used as an additional marker together with traditional cardiovascular risk factors for predicting CAD.
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Affiliation(s)
- Gökhan Yüce
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Aysel Türkvatan
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.
| | - Özlem Yener
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
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10
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Atkins SK, Cao K, Rajamannan NM, Sucosky P. Bicuspid aortic valve hemodynamics induces abnormal medial remodeling in the convexity of porcine ascending aortas. Biomech Model Mechanobiol 2014; 13:1209-25. [PMID: 24599392 DOI: 10.1007/s10237-014-0567-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/24/2014] [Indexed: 12/21/2022]
Abstract
The type-I bicuspid aortic valve (BAV), which differs from the normal tricuspid aortic valve (TAV) most commonly by left-right coronary cusp fusion, is frequently associated with secondary aortopathies. While BAV aortic dilation has been linked to a genetic predisposition, hemodynamics has emerged as a potential alternate etiology. However, the link between BAV hemodynamics and aortic medial degeneration has not been established. The objective of this study was to compare the regional wall shear stresses (WSS) in a TAV and BAV ascending aorta (AA) and to isolate ex vivo their respective impact on aortic wall remodeling. The WSS environments generated in the convex region of a TAV and BAV AA were predicted through fluid-structure interaction (FSI) simulations in an aorta model subjected to both valvular flows. Remodeling of porcine aortic tissue exposed to TAV and BAV AA WSS for 48 h in a cone-and-plate bioreactor was investigated via immunostaining, immunoblotting and zymography. FSI simulations revealed the existence of larger and more unidirectional WSS in the BAV than in the TAV AA convexity. Exposure of normal aortic tissue to BAV AA WSS resulted in increased MMP-2 and MMP-9 expressions and MMP-2 activity but similar fibrillin-1 content and microfibril organization relative to the TAV AA WSS treatment. This study confirms the sensitivity of aortic tissue to WSS abnormalities and demonstrates the susceptibility of BAV hemodynamic stresses to focally mediate aortic medial degradation. The results provide compelling support to the important role of hemodynamics in BAV secondary aortopathy.
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Affiliation(s)
- Samantha K Atkins
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN, USA
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11
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Shakeri A, Hafez Quran F, Javadrashid R, Abdekarimi MH, Ghojazadeh M, Abolghassemi Fakhree MB. Correlation between Aortic Wall Thickness and Coronary Artery Disease by 64 Slice Multidetector Computed Tomography. J Cardiovasc Thorac Res 2013; 5:91-5. [PMID: 24252983 DOI: 10.5681/jcvtr.2013.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/14/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease is a dispersed pathology involving the coronary arteries, carotid arteries, aorta and peripheral arteries. It has been previously suggested that coronary and aortic atherosclerosis may be associated. Imaging of the aorta and the aortic wall can be performed by various imaging modalities including state-of-the-art multidetector computer tomography (MDCT). This study aimed to investigate a possible association between the MDCT-measured thickness of the thoracic aorta and the presence of coronary artery disease (CAD) as well as its severity. METHODS Three hundred and fifty candidates of coronary computer tomography angiography (CTA) with signs and symptoms suggestive of CAD were recruited in Tabriz Parsian and Iran CTA Centers. Contrast-enhanced MDCT examinations were performed using a 64 detector scanner. Maximum aortic wall thickness in the mid-portion of descending thoracic aorta (region of pulmonary trunk to diaphragm) was measured perpendicular to the center of the vessel. RESULTS CAD was confirmed in 189 cases (54%) and the remaining 161 cases served as controls. The mean age of the cases, as well as the percentage of male subjects was significantly higher in the CAD group. The mean aortic wall thickness was also significantly higher in the patient group (2.21±0.63 mm vs. 1.88±0.58 mm; P<0.001). In multivariate analysis, however, the two groups turned up comparable as to the aortic wall thickness (P=0.31). The optimal cut-off point of aortic wall thickness was ≥2 mm in discriminating between CAD+ and CAD- groups, with a corresponding sensitivity and specificity of 65% and 57%, respectively. There was no significant association between aortic wall thickness and the severity of CAD (the number of significantly occluded coronary arteries). CONCLUSION Aortic wall thickness is apparently neither an independent predictor of CAD nor is it associated with the severity of CAD in candidates of CTA.
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Affiliation(s)
- Abolhassan Shakeri
- Tuberculosis and Pulmonary Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Association of atherosclerosis in the descending thoracic aorta with coronary artery disease on multi detector row computed tomography coronary angiography in patients with suspected coronary artery disease. Int J Cardiovasc Imaging 2013; 29:1829-37. [DOI: 10.1007/s10554-013-0266-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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13
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Jang S, Yong HS, Doo KW, Kang EY, Woo OH, Choi EJ. Relation of aortic calcification, wall thickness, and distensibility with severity of coronary artery disease: evaluation with coronary CT angiography. Acta Radiol 2012; 53:839-44. [PMID: 22821955 DOI: 10.1258/ar.2012.110604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Three known risk factors for aortic atherosclerosis predict the severity of coronary artery disease (CAD): aortic calcification (AC), aortic wall thickness (AWT), and aortic distensibility (AD). PURPOSE To determine the relationship of AC, AWT, and AD with the severity of CAD. MATERIAL AND METHODS A total of 104 patients who underwent both coronary CT angiography (CCTA) and invasive coronary angiography were enrolled. The severity of CAD was assessed by three methods: the segment involvement score (SIS), the segment stenosis score (SSS), and the modified Gensini score (mG). We quantified AC using the Agatston method on low-dose ungated chest CT (LDCT). We measured AWT at the thickest portion of the descending thoracic aorta on CCTA. AD was calculated as the difference between the maximum and minimum areas of the ascending aorta and the pulse pressure. The relationships between the severity of CAD and the three aortic factors were assessed. RESULTS The AC and AWT of the thoracic aorta were significantly higher in the occlusive CAD (OCAD) group (1984.21 ± 2986.10 vs. 733.00 ± 1648.71, P = 0.01; 4.13 ± 1.48 vs. 3.40 ± 1.01, P = 0.22). Patients with OCAD had more than one epicardial coronary artery with >50% luminal stenosis. The AC (r = 0.453 with SIS; r = 0.454 with SSS; r = 0.427 with mG) and the AWT (r = 0.279 with SIS; r = 0.324 with SSS; r = 0.304 with mG) were significantly correlated with all three methods, and the AD was negatively correlated with the SIS (r = - 0.221, P < 0.05, respectively) in the unadjusted model. After adjustment for cardiovascular risk factors, only the correlations between AC and all three methods assessing CAD remained significant. CONCLUSION There are significant relationships between AC, AWT and AD and severity of CAD. In particular, AC measured on LDCT is the most consistent predictor of severity of CAD.
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Affiliation(s)
- Seonah Jang
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung Won Doo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun-Young Kang
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Jung Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kim SJ, Ryoo S, Hwang J, Noh HJ, Park JH, Choe YH, Bang OY. Characterization of the infarct pattern caused by vulnerable aortic arch atheroma: DWI and multidetector row CT study. Cerebrovasc Dis 2012; 33:549-57. [PMID: 22688060 DOI: 10.1159/000338018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/05/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aortic arch atheroma (AAA) has been accepted as a possible embolic source in patients with ischemic stroke, especially cryptogenic stroke. However, despite its well-known role as a risk factor for stroke, research focused on the mechanism or characteristics of stroke caused by AAA is insufficient. In this study, we aimed to evaluate clinical and radiological characteristics including lesion pattern on DWI in acute stroke patients associated with vulnerable AAA detected by multidetector row computed tomography (MDCT). METHODS From September 2008 through May 2011, patients who presented with acute ischemic stroke and underwent MDCT were found in a prospective stroke registry. Patients without evident stroke etiology were included and classified by presence of vulnerable AAA. Vulnerable AAA was defined as (i) at least 6 mm thick adjacent to the aortic wall; (ii) ulcerated plaque, or (iii) soft plaque. Soft plaque was defined as the presence of clearly visualized area of hypoattenuation (<80 Hounsfield units) suggestive of thrombus. The patients without vulnerable AAA were classified as no/simple AAA group. The characteristics of diffusion-weighted MRI (DWI) lesions were analyzed in terms of the number and size of the lesions, and the involved vascular territories. RESULTS A total of 63 cryptogenic stroke patients were included in this study. Vulnerable AAA was observed in 15 (23.8%) patients. The patients with vulnerable AAA were older than those with no/simple AAA (p = 0.026). DWI analysis revealed that the vulnerable AAA group had a greater chance of having multiple and small lesions in multiple vascular territories that were mainly located in cortical and border-zone regions than the no/simple AAA group. Multiple logistic regression analysis showed that age (odds ratio 1.17; 95% confidence interval 1.02-1.34) and multiple small lesions in multiple vascular territories (odds ratio 33.18; 95% confidence interval 4.26-258.45) were independently associated with vulnerable AAA. CONCLUSION Vulnerable AAA is independently associated with a DWI pattern characterized by multiple small scattered lesions in multiple vascular territories in conjunction with age. It may help determine stroke mechanism quickly and easily, and provide more information about the pathomechanism of vulnerable AAA-related stroke.
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Affiliation(s)
- Suk Jae Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Grodin JL, Powell-Wiley TM, Ayers CR, Kumar DS, Rohatgi A, Khera A, McGuire DK, de Lemos JA, Das SR. Circulating levels of matrix metalloproteinase-9 and abdominal aortic pathology: from the Dallas Heart Study. Vasc Med 2011; 16:339-45. [PMID: 22002999 PMCID: PMC3523319 DOI: 10.1177/1358863x11422110] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prior reports have associated increased circulating levels of matrix metalloproteinase-9 (MMP-9), an endopeptidase active in the extracellular matrix, with the formation and rupture of aortic aneurysms, raising the possibility that MMP-9 may be a useful diagnostic or therapeutic target for aortic pathology. However, associations between MMP-9 and pathological abdominal aortic phenotypes in the general population have not been reported. In the Dallas Heart Study, a population-based sample of Dallas County residents (n = 2304), we measured MMP-9 and performed magnetic resonance imaging (MRI) of the abdominal aorta, measuring aortic compliance, plaque, wall thickness and luminal diameter. After adjustment for traditional cardiac risk factors and body size, higher MMP-9 quartiles were independently associated with higher aortic wall thickness and larger luminal diameter (p < 0.0001 for each), but not abdominal aortic plaque (p = 0.08), coronary artery calcium (p = 0.20) or the aortic luminal diameter/aortic wall thickness ratio (p = 0.37), supporting the hypothesis that therapies targeting MMP-9 may affect the abdominal aortic wall and modify aortic pathology.
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Affiliation(s)
- Justin L Grodin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tiffany M Powell-Wiley
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darpan S Kumar
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anand Rohatgi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amit Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandeep R Das
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Nathan DP, Xu C, Gorman JH, Fairman RM, Bavaria JE, Gorman RC, Chandran KB, Jackson BM. Pathogenesis of acute aortic dissection: a finite element stress analysis. Ann Thorac Surg 2011; 91:458-63. [PMID: 21256291 DOI: 10.1016/j.athoracsur.2010.10.042] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Type A and type B aortic dissections typically result from intimal tears above the sinotubular junction and distal to the left subclavian artery (LSA) ostium, respectively. We hypothesized that this pathology results from elevated pressure-induced regional wall stress. METHODS We identified 47 individuals with normal thoracic aortas by electrocardiogram-gated computed tomography angiography. The thoracic aorta was segmented, reconstructed, and triangulated to create a geometric mesh. Finite element analysis using a systolic pressure load of 120 mm Hg was performed to predict regional thoracic aortic wall stress. RESULTS There were local maxima of wall stress above the sinotubular junction in the ascending aorta and distal to the ostia of the supraaortic vessels, including the LSA, in the aortic arch. No local maximum of wall stress was found in the descending thoracic aorta. Comparison of the mean peak wall stress above the sinotubular junction (0.43 ± 0.07 MPa), distal to the LSA (0.21 ± 0.07 MPa), and in the descending thoracic aorta (0.06 ± 0.01 MPa) showed a significant effect for wall stress by aortic region (p < 0.001). CONCLUSIONS In the normal thoracic aorta, there are peaks in wall stress above the sinotubular junction and distal to the LSA ostium. This stress distribution may contribute to the pathogenesis of aortic dissections, given their colocalization. Future investigations to determine the utility of image-derived biomechanical calculations in predicting aortic dissection are warranted, and therapies designed to reduce the pressure load-induced wall stress in the thoracic aorta are rational.
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Affiliation(s)
- Derek P Nathan
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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17
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Evered LA, Silbert BS, Scott DA. Postoperative cognitive dysfunction and aortic atheroma. Ann Thorac Surg 2010; 89:1091-7. [PMID: 20338312 DOI: 10.1016/j.athoracsur.2009.11.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 11/17/2009] [Accepted: 11/19/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship of aortic atheroma to postoperative cognitive dysfunction (POCD), a common complication of coronary artery bypass graft surgery, has not been resolved. We undertook assessment of aortic atheroma using intraoperative ultrasonography and related the degree of aortic atheroma to POCD. METHODS Aortic atheroma was assessed using intraoperative transesophageal and epiaortic echocardiography in 311 patients who underwent coronary artery bypass graft surgery. Atheroma was graded from 0 (normal or minimal) to 3 (mobile or rough) in each of four quadrants of the proximal ascending to proximal descending thoracic aorta. Atheroma burden was defined as the atheroma score divided by the total possible score for that patient. Patients also completed a neuropsychological battery consisting of eight tests taken the week before surgery and at 1 week and 3 and 12 months afterward. Decreased cognitive function for each test was defined as an individual decrease of at least 1 standard deviation of the group baseline mean for that test, and POCD was defined as a decrease in two or more tests. RESULTS The atheroma burden (%) was greater in the patients with POCD. The difference was greatest at 1 week (10.4+/-14.7 versus 4.4+/-9.0, p=0.0002) and diminished progressively at 3 months (8.9+/-14.1 versus 5.4+/-10.1, p=0.06) and 12 months (6.6+/-12.0 versus 5.6+/-10.2, p=0.56). Multivariable analysis showed that atheroma burden strongly predicted POCD at 1 week. CONCLUSIONS Aortic atheroma burden predicts POCD at 1 week but has less impact on POCD as time progresses. Atheroma burden is highly correlated with age and may be a good predictor of early POCD.
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Affiliation(s)
- Lisbeth A Evered
- Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
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