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Rosnel C, Sivera R, Cervi E, Danton M, Schievano S, Capelli C, Aggarwal A. Are aortic biomechanical properties early markers of dilatation in patients with Marfan syndrome? A systematic review and meta-analysis. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01881-z. [PMID: 39073692 DOI: 10.1007/s10237-024-01881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
Although tissue stiffness is known to play an important role in aortic dilatation, the current guidelines for offering preventative surgery in patients with Marfan syndrome rely solely on the aortic diameter. In this systematic review and meta-analysis, we analyze and compare literature on in vivo aortic stiffness measures in Marfan patients. Our aim is to assess the potential of these measurements as early indicators of aortic dilatation. Following the PRISMA guidelines, we collected literature on diameter and three in vivo stiffness measures: Pulse wave velocity (PWV), β -stiffness index (SI) and distensibility, at five different aortic locations in patients with Marfan syndrome. Results were reviewed and compared against each other. For meta-analysis, an augmented dataset was created by combining data from the literature. Regression with respect to age and statistical comparisons were performed. Thirty articles reporting data from 1925 patients with Marfan and 836 patients without Marfan were reviewed. PWV was found to be higher in Marfan, but only in dilated aortas. Distensibility was found to be lower even in non-dilated aortas, and its decrease was associated with higher chances of developing aortic dilatation. β -SI was higher in Marfan patients and was positively correlated with the rate of aortic dilatation, emphasizing its role as a valuable indicator. In our meta-analysis, all stiffness measures showed a significant variation with age. Distensibility and β -stiffness index were different in Marfan patients at all locations, and the difference was more pronounced after accounting for age-related variation. From the literature, β -SI and distensibility emerge as the best predictors of future aortic dilatation. Our meta-analysis quantifies age-related changes in aortic stiffness and highlights the importance of accounting for age in comparing these measurements. Missing diameter values in the literature limited our analysis. Further investigation of criteria combining stiffness and diameter is recommended to better assist clinical decisions for prophylactic surgery.
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Affiliation(s)
- Claire Rosnel
- Glasgow Computational Engineering Centre, James Watt School of Engineering, University of Glasgow, Glasgow, Scotland, UK
| | - Raphael Sivera
- Institute of Cardiovascular Science, University College London, London, England, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, England, UK
| | - Mark Danton
- Department of Paediatric Cardiac Services, Royal Hospital for Children, Glasgow, Scotland, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, England, UK
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, England, UK
| | - Ankush Aggarwal
- Glasgow Computational Engineering Centre, James Watt School of Engineering, University of Glasgow, Glasgow, Scotland, UK.
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2
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Fortunato RN, Huckaby LV, Emerel LV, Schlosser V, Yang F, Phillippi JA, Vorp DA, Maiti S, Gleason TG. The predictive capability of aortic stiffness index for aortic dissection among dilated ascending aortas. J Thorac Cardiovasc Surg 2024; 167:2015-2024. [PMID: 36207164 PMCID: PMC10225159 DOI: 10.1016/j.jtcvs.2022.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/19/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE We created a finite element model to predict the probability of dissection based on imaging-derived aortic stiffness and investigated the link between stiffness and wall tensile stress using our model. METHODS Transthoracic echocardiogram measurements were used to calculate aortic diameter change over the cardiac cycle. Aortic stiffness index was subsequently calculated based on diameter change and blood pressure. A series of logistic models were developed to predict the binary outcome of aortic dissection using 1 or more series of predictor parameters such as aortic stiffness index or patient characteristics. Finite element analysis was performed on a subset of diameter-matched patients exhibiting patient-specific material properties. RESULTS Transthoracic echocardiogram scans of patients with type A aortic dissection (n = 22) exhibited elevated baseline aortic stiffness index when compared with aneurysmal patients' scans with tricuspid aortic valve (n = 83, P < .001) and bicuspid aortic valve (n = 80, P < .001). Aortic stiffness index proved an excellent discriminator for a future dissection event (area under the curve, 0.9337, odds ratio, 2.896). From the parametric finite element study, we found a correlation between peak longitudinal wall tensile stress and stiffness index (ρ = .6268, P < .001, n = 28 pooled). CONCLUSIONS Noninvasive transthoracic echocardiogram-derived aortic stiffness measurements may serve as an impactful metric toward predicting aortic dissection or quantifying dissection risk. A correlation between longitudinal stress and stiffness establishes an evidence-based link between a noninvasive stiffness parameter and stress state of the aorta with clinically apparent dissection events.
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Affiliation(s)
- Ronald N Fortunato
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa
| | - Lauren V Huckaby
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Leonid V Emerel
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Virginia Schlosser
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa
| | - Fan Yang
- Department of Statistics, University of Pittsburgh School of Public Health, Pittsburgh, Pa
| | - Julie A Phillippi
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa
| | - David A Vorp
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa; Department of Chemical and Petroleum Engineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Asheville Heart, Asheville, NC
| | - Spandan Maiti
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Department of Chemical and Petroleum Engineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa
| | - Thomas G Gleason
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pa; Asheville Heart, Asheville, NC.
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Yuan X, Kan X, Li J, Yan Y, Mirsadraee S, Mittal T, Shah A, Saunders D, Xu XY, Nienaber CA. Four-dimensional analysis of aortic root motion in normal population using retrospective multiphase computed tomography. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae007. [PMID: 39045205 PMCID: PMC11195731 DOI: 10.1093/ehjimp/qyae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/30/2024] [Indexed: 07/25/2024]
Abstract
Aims Aortic root motion is suspected to contribute to proximal aortic dissection. While motion of the aorta in four dimensions can be traced with real-time imaging, displacement and rotation in quantitative terms remain unknown. The hypothesis was to show feasibility of quantification of three-dimensional aortic root motion from dynamic CT imaging. Methods and results Dynamic CT images of 40 patients for coronary assessment were acquired using a dynamic protocol. Scans were ECG-triggered and segmented in 10 time-stepped phases (0-90%) per cardiac cycle. With identification of the sinotubular junction (STJ), a patient-specific co-ordinate system was created with the z-axis (out-of-plane) parallel to longitudinal direction. The left and right coronary ostia were traced at each time-step to quantify downward motion in reference to the STJ plane, motion within the STJ plane (in-plane), and the degree of rotation. Enrolled individuals had an age of 65 ± 12, and 14 were male (35%). The out-of-plane motion was recorded with the largest displacement of 10.26 ± 2.20 and 8.67 ± 1.69 mm referenced by left and right coronary ostia, respectively. The mean downward movement of aortic root was 9.13 ± 1.86 mm. The largest in-plane motion was recorded at 9.17 ± 2.33 mm and 6.51 ± 1.75 mm referenced by left and right coronary ostia, respectively. The largest STJ in-plane motion was 7.37 ± 1.96 mm, and rotation of the aortic root was 11.8 ± 4.60°. Conclusion In vivo spatial and temporal displacement of the aortic root can be identified and quantified from multiphase ECG-gated contrast-enhanced CT images. Knowledge of normal 4D motion of the aortic root may help understand its biomechanical impact in patients with aortopathy and pre- and post-surgical or transcatheter aortic valve replacement.
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Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, School of Medicine, Imperial College London, Exhibition Road, London SW7 2BX, UK
| | - Xiaoxin Kan
- Center for Vascular Surgery and Wound Care, Jinshan Hospital, Fudan University, Shanghai, China
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Jianpeng Li
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yang Yan
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Saeed Mirsadraee
- National Heart and Lung Institute, School of Medicine, Imperial College London, Exhibition Road, London SW7 2BX, UK
- Department of Radiology, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Tarun Mittal
- National Heart and Lung Institute, School of Medicine, Imperial College London, Exhibition Road, London SW7 2BX, UK
- Department of Radiology, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Andrew Shah
- Department of Radiology, East and North Hertfordshire NHS Foundation Trust, Middlesex, UK
| | - Debbie Saunders
- Department of Radiology, East and North Hertfordshire NHS Foundation Trust, Middlesex, UK
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, School of Medicine, Imperial College London, Exhibition Road, London SW7 2BX, UK
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Vitarelli A, Capotosto L, Miraldi F, Mukred K, Francone M, Galea N, Mangieri E, Tanzilli G, Viceconte N, Mancone M, Nguyen BL, Smaldone C, Al-Kindy S. Biventricular interaction and aortic function in adult patients with repaired tetralogy of Fallot: a two-dimensional-three-dimensional speckle-tracking echocardiographic study. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae015. [PMID: 39045204 PMCID: PMC11195699 DOI: 10.1093/ehjimp/qyae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/20/2024] [Indexed: 07/25/2024]
Abstract
Aims In patients late after correction of tetralogy of Fallot (TOF), the combined effects of pre-operative hypertrophy and hypoxia, ventricular interdependence, acquired post-operative lesions such as pulmonary or aortic regurgitation, and congenital vasculopathy may result in impaired right ventricular (RV) and left ventricular (LV) function. The aim of the present study was to investigate the interventricular interactions in repaired TOF (rTOF) and the impact of aortic function on biventricular performance using two-dimensional (2D-STE) and three-dimensional speckle-tracking echocardiography (3D-STE). Methods and results Twenty-five adult patients with rTOF and 25 age- and gender-matched healthy controls were studied. LV and RV volumes were determined by 3D-STE and cardiac magnetic resonance. LV and RV longitudinal strains (LVLS and RVLS) and LV and RV area strains (LVAS and RVAS) and LV twist/rotation were calculated by 3D-STE. Ascending aorta circumferential strain (AAo-CS) was obtained using 2D-STE. LV 3D-STE parameters were decreased in rTOF patients compared with controls even in patients with normal ejection fraction. AAo-CS was decreased (6.7 ± 1.9 vs. 10.1 ± 2.6, P = 0.003) in rTOF patients compared with controls even in the presence of normal aortic dimensions and correlated with AAo diameter (r = -0.69, P = 0.0001), LV twist (r = 0.54, P = 0.004), LVAS (r = -0.56, P = 0.003), and RVLS (r = -0.39, P = 0.036). LVAS and AAo-CS were associated with disease severity (peak oxygen consumption and arrhythmia occurrence). Significant improvement in global χ 2 value was noted with RV 3D-STE parameters + LVAS + AAo-CS compared with RV dysfunction alone for detecting exercise capacity impairment (from 77.1 to 84.4 to 91.2, P = 0.003). Conclusion Speckle-tracking echocardiography revealed subtle LV and AAo dysfunction in adults with rTOF. A correlation was observed between LV and RV strain changes and between AAo strain impairment and LV/RV dysfunction. LV and AAo changes had an incremental value in evaluating disease severity.
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Affiliation(s)
- Antonio Vitarelli
- Cardiodiagnostica CS, Via Lima 35, Rome 00198, Italy
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Lidia Capotosto
- Cardiodiagnostica CS, Via Lima 35, Rome 00198, Italy
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Fabio Miraldi
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Khaled Mukred
- University Teaching Hospital, Department of Cardiology and Medicine, Dhamar, Yemen
| | - Marco Francone
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Nicola Galea
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Enrico Mangieri
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Gaetano Tanzilli
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Nicola Viceconte
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Massimo Mancone
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Bich Lien Nguyen
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
| | - Costantino Smaldone
- Department of Cardiology and Cardiac Surgery, San Carlo Hospital, Potenza, Italy
| | - Sulaiman Al-Kindy
- Department of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy
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Endothelial dysfunction in Marfan syndrome mice is restored by resveratrol. Sci Rep 2022; 12:22504. [PMID: 36577770 PMCID: PMC9797556 DOI: 10.1038/s41598-022-26662-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
Patients with Marfan syndrome (MFS) develop thoracic aortic aneurysms as the aorta presents excessive elastin breaks, fibrosis, and vascular smooth muscle cell (vSMC) death due to mutations in the FBN1 gene. Despite elaborate vSMC to aortic endothelial cell (EC) signaling, the contribution of ECs to the development of aortic pathology remains largely unresolved. The aim of this study is to investigate the EC properties in Fbn1C1041G/+ MFS mice. Using en face immunofluorescence confocal microscopy, we showed that EC alignment with blood flow was reduced, EC roundness was increased, individual EC surface area was larger, and EC junctional linearity was decreased in aortae of Fbn1C1041G/+ MFS mice. This modified EC phenotype was most prominent in the ascending aorta and occurred before aortic dilatation. To reverse EC morphology, we performed treatment with resveratrol. This restored EC blood flow alignment, junctional linearity, phospho-eNOS expression, and improved the structural integrity of the internal elastic lamina of Fbn1C1041G/+ mice. In conclusion, these experiments identify the involvement of ECs and underlying internal elastic lamina in MFS aortic pathology, which could act as potential target for future MFS pharmacotherapies.
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Fibrillin-1 Gene Polymorphisms (rs145233125, rs11070646, rs201170905) Are Associated With the Susceptibility and Clinical Prognosis of DeBakey Type III Aortic Dissection in Chinese Han Population. J Cardiovasc Pharmacol 2022; 80:118-124. [PMID: 35500095 DOI: 10.1097/fjc.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT We aim to investigate whether genetic variants of the Fibrillin-1 (FBN1) gene were associated with DeBakey type III aortic dissection (AD) and its clinical prognosis in Chinese Han population. Three single-nucleotide polymorphisms (SNPs) (rs145233125, rs11070646, rs201170905) in FBN1 were analyzed in patients with DeBakey type III AD (159) and healthy subjects (216). Gene-environment interactions were evaluated to use generalized multifactor dimensionality reduction. Haplotype analysis of the 3 SNPs in the FBN1 gene was performed by Haploview software. Patients were followed up for average 4 years. G carriers of rs11070646 and rs201170905 in FBN1 have an increased risk of DeBakey type III AD. The interaction of FBN1 and environmental factors facilitated to the increased risk of DeBakey type III AD (cross-validation consistency = 10/10, P = 0.001). One of the most common haplotypes revealed an increased risk of DeBakey type III AD (CGG, P = 0.009). Recessive models of rs145233125 CC genotype ( P < 0.05) and rs201170905 GG genotype ( P < 0.001) were associated with an increased risk of death and recurrent chest pain of DeBakey type III AD. In conclusions, FBN1 gene polymorphisms contribute to DeBakey type III AD susceptibility. The interactions of gene and environment are related with the risk of DeBakey type III AD. C carriers of rs145233125 and G carriers of rs201170905 may be the adverse prognostic indicators of death and recurrent chest pain in DeBakey type III AD.
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Bracamonte JH, Saunders SK, Wilson JS, Truong UT, Soares JS. Patient-Specific Inverse Modeling of In Vivo Cardiovascular Mechanics with Medical Image-Derived Kinematics as Input Data: Concepts, Methods, and Applications. APPLIED SCIENCES-BASEL 2022; 12:3954. [PMID: 36911244 PMCID: PMC10004130 DOI: 10.3390/app12083954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inverse modeling approaches in cardiovascular medicine are a collection of methodologies that can provide non-invasive patient-specific estimations of tissue properties, mechanical loads, and other mechanics-based risk factors using medical imaging as inputs. Its incorporation into clinical practice has the potential to improve diagnosis and treatment planning with low associated risks and costs. These methods have become available for medical applications mainly due to the continuing development of image-based kinematic techniques, the maturity of the associated theories describing cardiovascular function, and recent progress in computer science, modeling, and simulation engineering. Inverse method applications are multidisciplinary, requiring tailored solutions to the available clinical data, pathology of interest, and available computational resources. Herein, we review biomechanical modeling and simulation principles, methods of solving inverse problems, and techniques for image-based kinematic analysis. In the final section, the major advances in inverse modeling of human cardiovascular mechanics since its early development in the early 2000s are reviewed with emphasis on method-specific descriptions, results, and conclusions. We draw selected studies on healthy and diseased hearts, aortas, and pulmonary arteries achieved through the incorporation of tissue mechanics, hemodynamics, and fluid-structure interaction methods paired with patient-specific data acquired with medical imaging in inverse modeling approaches.
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Affiliation(s)
- Johane H. Bracamonte
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Sarah K. Saunders
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - John S. Wilson
- Department of Biomedical Engineering and Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Uyen T. Truong
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Joao S. Soares
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
- Correspondence:
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Is physical activity a future therapy for patients with Marfan syndrome? Orphanet J Rare Dis 2022; 17:46. [PMID: 35144638 PMCID: PMC8832740 DOI: 10.1186/s13023-022-02198-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/30/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The international recommendations tend to avoid physical activity (PA) for patients with Marfan syndrome (MFS). However, exceptions have recently been made in the most recent recommendations for these patients, suggesting benefits from doing PA at low intensity only. Furthermore, there is no evidence that moderate aerobic or weight training can worsen the disease symptoms and increase mortality of MFS patients. The present review sums up the work carried out in the field of PA and MFS. The review aims to (1) identify the different types of exercise testing and training protocols and (2) discuss the feasibility and potentially beneficial nature of PA as an innovative way to manage MFS patients.
Methods The scientific literature was reviewed using the following words: Marfan syndrome, training, physical activity, evaluation, weight training, arterial disease, aneurysms, lung damage, aortic dissection, rupture. A total of 345 studies were prospected and 43 studies were included. Conclusions A limited number of studies were done in humans, however one demonstrated the feasibility of the management of MFS patients with PA. There were potential beneficial effects of PA on arterial structures, but this review also showed deleterious effects when PA was conducted at high intensities, corresponding to 75–85% of the maximal oxygen uptake. However, these effects have only been reported in animal studies.
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Rocha WEM, Oliveira MFRA, Soares JD, L'Armée VMFS, Martins MPG, Rocha AM, Feitosa ADM, Lima RC, Oliveira PPM, Silveira-Filho LM, Coelho-Filho OR, Matos-Souza JR, Petrucci O, Sposito AC, Nadruz W. Left Ventricular Concentric Geometric Patterns Are Associated With Worse Prognosis Among Patients With Type-A Aortic Dissection. J Am Heart Assoc 2021; 10:e018273. [PMID: 33599150 PMCID: PMC8174278 DOI: 10.1161/jaha.120.018273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background This study compared left ventricular (LV) characteristics between patients with type‐A and type‐B aortic dissection (AD) and evaluated the ability of LV remodeling phenotypes (hypertrophy, concentricity, or geometric patterns) to predict mortality in both AD types. Methods and Results We evaluated 236 patients with type A and 120 patients with type B who had echocardiograms within 60 days before or after AD diagnosis (median [25th, 75th percentiles] time difference between echocardiogram and AD diagnosis=1 [0, 6] days) from 3 centers. Patients were stratified according to LV phenotypes, and early (90‐day) and late (1‐year) mortality after AD diagnosis were assessed. In adjusted logistic regression analysis, patients with type A had higher and lower odds of concentric and eccentric hypertrophy (odds ratio [OR], 2.56; 95% CI, 1.50–4.36; P<0.001; and OR, 0.55; 95% CI, 0.31–0.97; P=0.039, respectively) than those with type B. Results of multivariable Cox‐regression analysis showed that LV remodeling phenotypes were not related to mortality in patients with type B. By contrast, LV concentricity was associated with greater early and late mortality (hazard ratio [HR], 2.22; 95% CI, 1.24–3.96; P=0.007 and HR, 2.06; 95% CI, 1.20–3.54; P=0.009, respectively) in type A. In further analysis considering normal LV geometry as reference, LV concentric remodeling and concentric hypertrophy were associated with early mortality (HR, 7.78; 95% CI, 2.35–25.78; P<0.001 and HR, 4.38; 95% CI, 1.47–13.11; P=0.008, respectively), whereas concentric remodeling was associated with late mortality (HR, 5.40; 95% CI, 1.91–15.26; P<0.001) among patients with type A. Assessment of LV geometric patterns and concentricity provided incremental prognostic value in predicting early and late mortality beyond clinical variables in patients with type A based on net reclassification improvement and integrated discrimination improvement. Conclusions LV geometric patterns derived from LV concentricity were associated with greater mortality among patients with type A and may be markers of adverse prognosis in this population.
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Affiliation(s)
- Walter E M Rocha
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Matheus F R A Oliveira
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Julia D Soares
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Victor M F S L'Armée
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Mayara P G Martins
- Department of Cardiology Pontifical Catholic University of Campinas Campinas SP Brazil
| | - Aloísio M Rocha
- Department of Cardiology Pontifical Catholic University of Campinas Campinas SP Brazil
| | - Audes D M Feitosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil.,Laboratory of Immunopathology Keizo Asami Federal University of Pernambuco Recife PE Brazil
| | - Ricardo C Lima
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Pedro P M Oliveira
- Department of Surgery School of Medical Sciences State University of Campinas São Paulo Brazil
| | | | - Otavio R Coelho-Filho
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - José R Matos-Souza
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Orlando Petrucci
- Department of Surgery School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Andrei C Sposito
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Wilson Nadruz
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
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Balint B, Federspiel JM, Schwab T, Ehrlich T, Ramsthaler F, Schäfers HJ. Aortic Regurgitation Is Associated With Ascending Aortic Remodeling in the Nondilated Aorta. Arterioscler Thromb Vasc Biol 2021; 41:1179-1190. [PMID: 33441026 DOI: 10.1161/atvbaha.120.315739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The probability of aortic complications in patients with bicuspid aortic valve is higher in association with aortic regurgitation (AR) compared with aortic stenosis (AS) or normally functioning valves. The objective of this study was to determine whether this is related to the specific characteristics of aneurysmatic dilatation that includes AR or whether AR itself has a negative impact on the aortic wall, independent of aneurysmatic dilatation. Approach and Results: Nondilated aortic specimens were harvested intraoperatively from individuals with tricuspid aortic valves and either AS (n=10) or AR (n=16). For controls, nondilated aortas were harvested during autopsies from individuals with tricuspid aortic valves and no evidence of aortic valve disease (n=10). Histological and immunohistochemical analyses revealed that compared with control aortas, overall medial degeneration was more severe in AR-aortas (P=0.005) but not AS-aortas (P=0.23). This pathological remodeling included mucoid extracellular matrix accumulation (P=0.005), elastin loss (P=0.003), elastin fragmentation (P=0.008), and decreased expression of fibrillin (P=0.003) and collagen (P=0.008). Furthermore, eNOS (endothelial nitric oxide synthase) expression was decreased in the intima (P=0.0008) and in vasa vasorum (P=0.004) of AR-aortas but not AS-aortas (all P>0.05). Likewise, subendothelial apoptosis was increased in AR-aortas (P=0.03) but not AS-aortas (P=0.50). CONCLUSIONS AR has a negative effect on the nondilated ascending aortic wall. Accordingly, our results support the need for more detailed studies of the aortic wall in relation to aortic valve disease and may ultimately lead to more aggressive clinical monitoring and/or surgical criteria for patients with relevant AR. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Brittany Balint
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Jan M Federspiel
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Tanja Schwab
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Tristan Ehrlich
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Frank Ramsthaler
- Institute of Forensic Medicine (F.R.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
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11
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Plonek T, Rylski B, Nawrocki P, Beyersdorf F, Jasinski M, Kuliczkowski W. Systolic stretching of the ascending aorta. Arch Med Sci 2021; 17:25-30. [PMID: 33488852 PMCID: PMC7811307 DOI: 10.5114/aoms.2019.82997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Longitudinal stretching of the aorta due to systolic heart motion contributes to the stress in the wall of the ascending aorta. The objective of this study was to assess longitudinal systolic stretching of the aorta and its correlation with the diameters of the ascending aorta and the aortic root. MATERIAL AND METHODS Aortographies of 122 patients were analyzed. The longitudinal systolic stretching of the aorta caused by the contraction of the heart during systole and the maximum dimensions of the aortic root and ascending aorta were measured in all patients. RESULTS The maximum dimension of the aortic root was on average 34.9 ±4.5 mm and the mean diameter of the ascending aorta was 33.9 ±5.4 mm. The systolic aortic stretching negatively correlated with age (r = -0.49, p < 0.001) and the diameter of the tubular ascending aorta (r = -0.44, p < 0.001). There was no significant correlation between the stretching and the dimension of the aortic root (r = -0.11, p = 0.239). There was a statistically significant (p < 0.001) difference in the longitudinal aortic stretching values between patients with a normal aortic valve (10.6 ±3.1 mm) and an aortic valve pathology (8.0 ±3.2 mm in all patients with an aortic valve pathology; 7.5 ±4.3 mm in isolated aortic stenosis, 8.5 ±2.9 mm in the case of isolated insufficiency, 8.2 ±2.8 mm for valves that were both stenotic and insufficient). CONCLUSIONS Systolic aortic stretching negatively correlates with the diameter of the tubular ascending aorta and the age of the patients, and does not correlate with the diameter of the aortic root. It is lower in patients with an aortic valve pathology.
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Affiliation(s)
- Tomasz Plonek
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Rylski
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pawel Nawrocki
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Friedhelm Beyersdorf
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
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12
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Bracamonte JH, Wilson JS, Soares JS. Assessing Patient-Specific Mechanical Properties of Aortic Wall and Peri-Aortic Structures From In Vivo DENSE Magnetic Resonance Imaging Using an Inverse Finite Element Method and Elastic Foundation Boundary Conditions. J Biomech Eng 2020; 142:121011. [PMID: 32632452 DOI: 10.1115/1.4047721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Indexed: 11/08/2022]
Abstract
The establishment of in vivo, noninvasive patient-specific, and regionally resolved techniques to quantify aortic properties is key to improving clinical risk assessment and scientific understanding of vascular growth and remodeling. A promising and novel technique to reach this goal is an inverse finite element method (FEM) approach that utilizes magnetic resonance imaging (MRI)-derived displacement fields from displacement encoding with stimulated echoes (DENSE). Previous studies using DENSE MRI suggested that the infrarenal abdominal aorta (IAA) deforms heterogeneously during the cardiac cycle. We hypothesize that this heterogeneity is driven in healthy aortas by regional adventitial tethering and interaction with perivascular tissues, which can be modeled with elastic foundation boundary conditions (EFBCs) using a collection of radially oriented springs with varying stiffness with circumferential distribution. Nine healthy IAAs were modeled using previously acquired patient-specific imaging and displacement fields from steady-state free procession (SSFP) and DENSE MRI, followed by assessment of aortic wall properties and heterogeneous EFBC parameters using inverse FEM. In contrast to traction-free boundary condition, prescription of EFBC reduced the nodal displacement error by 60% and reproduced the DENSE-derived heterogeneous strain distribution. Estimated aortic wall properties were in reasonable agreement with previously reported experimental biaxial testing data. The distribution of normalized EFBC stiffness was consistent among all patients and spatially correlated to standard peri-aortic anatomical features, suggesting that EFBC could be generalized for human adults with normal anatomy. This approach is computationally inexpensive, making it ideal for clinical research and future incorporation into cardiovascular fluid-structure analyses.
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Affiliation(s)
- Johane H Bracamonte
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, Richmond, VA 23284
| | - John S Wilson
- Department of Biomedical Engineering and Pauley Heart Center, Virginia Commonwealth University, 601 West Main Street, Richmond, VA 23284
| | - Joao S Soares
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, Richmond, VA 23284
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13
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Demolder A, von Kodolitsch Y, Muiño-Mosquera L, De Backer J. Myocardial Function, Heart Failure and Arrhythmia in Marfan Syndrome: A Systematic Literature Review. Diagnostics (Basel) 2020; 10:E751. [PMID: 32992882 PMCID: PMC7599866 DOI: 10.3390/diagnostics10100751] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Abstract
Marfan syndrome (MFS) is a heritable systemic connective tissue disease with important cardiovascular involvement, including aortic root dilatation and mitral valve prolapse. Life expectancy in patients with MFS is mainly determined by cardiovascular complications, among which aortic dissection or rupture are most dreaded. In recent years, heart failure and ventricular arrhythmia have drawn attention as extra-aortic cardiovascular manifestations and as additional reported causes of death. Imaging studies have provided data supporting a primary myocardial impairment in the absence of valvular disease or cardiovascular surgery, while studies using ambulatory ECG have demonstrated an increased susceptibility to ventricular arrhythmia. In this paper, current literature was reviewed in order to provide insights in characteristics, pathophysiology and evolution of myocardial function, heart failure and ventricular arrhythmia in MFS.
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Affiliation(s)
- Anthony Demolder
- Centre for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; (L.M.-M.); (J.D.B.)
| | | | - Laura Muiño-Mosquera
- Centre for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; (L.M.-M.); (J.D.B.)
- Department of Paediatrics, Division of Paediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Julie De Backer
- Centre for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; (L.M.-M.); (J.D.B.)
- Department of Cardiology, Ghent University Hospital, 9000 Ghent, Belgium
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14
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Mantella LE, Chan W, Bisleri G, Hassan SMA, Liblik K, Benbarkat H, Rival DE, Johri AM. The use of ultrasound to assess aortic biomechanics: Implications for aneurysm and dissection. Echocardiography 2020; 37:1844-1850. [PMID: 32931051 DOI: 10.1111/echo.14856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/08/2020] [Accepted: 08/21/2020] [Indexed: 12/30/2022] Open
Abstract
Arterial stiffening, which occurs when conduit arteries thicken and lose elasticity, has been associated with cardiovascular disease and increased risk for future cardiovascular events. Specifically, aortic stiffening plays a large role in the pathogenesis of vascular diseases, such as aneurysm formation and dissection. Current parameters used to assess risk of aortic rupture include absolute diameter and growth rate. However, these properties lack the reliability required to accurately risk-stratify patients. As with any elastic conduit, it is important to assess the biomechanical properties of the aorta in order to assess cardiovascular risk and prevent disease progression. There are several invasive and noninvasive methods by which stiffness of the large arteries can be assessed. Of particular interest are ultrasound-based methods, such as tissue Doppler imaging and speckle-tracking echocardiography, due to their noninvasive and feasible nature. In this review, we summarize studies demonstrating utility of noninvasive ultrasound imaging methods for measuring aortic biomechanics for the assessment and management of aortic aneurysms.
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Affiliation(s)
- Laura E Mantella
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Winnie Chan
- Department of Medicine, Kingston General Hospital, Kingston, ON, Canada
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Kingston General Hospital, Kingston, ON, Canada
| | - Syed M Ali Hassan
- Division of Cardiac Surgery, Kingston General Hospital, Kingston, ON, Canada
| | - Kiera Liblik
- Department of Medicine, Kingston General Hospital, Kingston, ON, Canada
| | - Hanane Benbarkat
- Department of Medicine, Kingston General Hospital, Kingston, ON, Canada
| | - David E Rival
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Amer M Johri
- Department of Medicine, Kingston General Hospital, Kingston, ON, Canada
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15
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Deplano V, Boufi M, Gariboldi V, Loundou AD, D'Journo XB, Cautela J, Djemli A, Alimi YS. Mechanical characterisation of human ascending aorta dissection. J Biomech 2019; 94:138-146. [PMID: 31400813 DOI: 10.1016/j.jbiomech.2019.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/10/2019] [Accepted: 07/22/2019] [Indexed: 01/03/2023]
Abstract
Mechanical characteristics of both the healthy ascending aorta and acute type A aortic dissection were investigated using in vitro biaxial tensile tests, in vivo measurements via transoesophageal echocardiography and histological characterisations. This combination of analysis at tissular, structural and microstructural levels highlighted the following: (i) a linear mechanical response for the dissected intimomedial flap and, conversely, nonlinear behaviour for both healthy and dissected ascending aorta; all showed anisotropy; (ii) a stiffer mechanical response in the longitudinal than in the circumferential direction for the healthy ascending aorta, consistent with the histological quantification of collagen and elastin fibre density; (iii) a link between dissection and ascending aorta stiffening, as revealed by biaxial tensile tests. This result was corroborated by in vivo measurements with stiffness index, β, and Peterson modulus, Ep, higher for patients with dissection than for control patients. It was consistent with histological analysis on dissected samples showing elastin fibre dislocations, reduced elastin density and increased collagen density. To our knowledge, this is the first study to report biaxial tensile tests on the dissected intimomedial flap and in vivo stiffness measurements of acute type A dissection in humans.
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Affiliation(s)
- Valérie Deplano
- Aix Marseille Univ, CNRS, IRPHE, Ecole Centrale Marseille, Marseille, France.
| | - Mourad Boufi
- Aix Marseille Univ, APHM, IFSTTAR, LBA, North Hospital, Department of Vascular Surgery, Marseille, France; Aix Marseille Univ, CNRS, IRPHE, Ecole Centrale Marseille, Marseille, France
| | - Vlad Gariboldi
- Aix Marseille Univ, APHM, Timone Hospital, Department of Cardiac Surgery, Marseille, France
| | - Anderson D Loundou
- Aix Marseille Univ, SPMC EA3279, Department of Public Health, Marseille, France
| | - Xavier Benoit D'Journo
- Aix Marseille Univ, APHM, North Hospital, Department of Thoracic Surgery, Marseille, France
| | - Jennifer Cautela
- Aix Marseille Univ, APHM, North Hospital, Department of Cardiology, Marseille, France
| | - Amina Djemli
- Aix Marseille Univ, APHM, North Hospital, Department of Pathology, Marseille, France
| | - Yves S Alimi
- Aix Marseille Univ, APHM, IFSTTAR, LBA, North Hospital, Department of Vascular Surgery, Marseille, France
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16
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Salvi P, Furlanis G, Grillo A, Pini A, Salvi L, Marelli S, Rovina M, Moretti F, Gaetano R, Pintassilgo I, Faini A, Fabris B, Carretta R, Parati G. Unreliable Estimation of Aortic Pulse Wave Velocity Provided by the Mobil-O-Graph Algorithm-Based System in Marfan Syndrome. J Am Heart Assoc 2019; 8:e04028. [PMID: 31020905 PMCID: PMC6512139 DOI: 10.1161/jaha.118.011440] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/19/2019] [Indexed: 12/29/2022]
Abstract
Background Several devices have been proposed to assess arterial stiffness in clinical daily use over the past few years, by estimating aortic pulse wave velocity (PWV) from a single measurement of brachial oscillometric blood pressure, using patented algorithms. It is uncertain if these systems are able to provide additional elements, beyond the contribution carried by age and blood pressure levels, in the definition of early vascular damage expressed by the stiffening of the arterial wall. Methods and Results The aim of our study was to compare the estimated algorithm-based PWV values, provided by the Mobil-O-Graph system, with the standard noninvasive assessment of aortic PWV in patients with Marfan syndrome (ie, in subjects characterized by premature aortic stiffening and low blood pressure values). Aortic stiffness was simultaneously evaluated by carotid-femoral PWV with a validated arterial tonometer and estimated with an arm cuff-based ambulatory blood pressure monitoring Mobil-O-Graph device on 103 patients with Marfan syndrome (50 men; mean± SD age, 38±15 years). Aortic PWV, estimated by the Mobil-O-Graph, was significantly ( P<0.0001) lower (mean± SD, 6.1±1.3 m/s) than carotid-femoral PWV provided by arterial tonometry (mean± SD , 8.8±3.1 m/s). The average of differences between PWV values provided by the 2 methods (±1.96×SD) was -2.7±5.7 m/s. Conclusions The Mobil-O-Graph provides PWV values related to an ideal subject for a given age and blood pressure, but it is not able to evaluate early vascular aging expressed by high PWV in the individual patient. This is well shown in patients with Marfan syndrome.
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Affiliation(s)
- Paolo Salvi
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSMilanItaly
| | - Giulia Furlanis
- Department of MedicalSurgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Andrea Grillo
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
| | - Alessandro Pini
- Department of CardiologyAzienda Socio Sanitaria Territoriale Fatebenefratelli SaccoRare Disease Center “Marfan Clinic”MilanItaly
| | - Lucia Salvi
- Department of Internal Medicine and TherapeuticsFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Susan Marelli
- Department of CardiologyAzienda Socio Sanitaria Territoriale Fatebenefratelli SaccoRare Disease Center “Marfan Clinic”MilanItaly
| | - Matteo Rovina
- Department of MedicalSurgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Francesco Moretti
- Department of Molecular MedicineFondazione IRCCS Policlinico San MatteoUniversity of PaviaItaly
| | | | | | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSMilanItaly
| | - Bruno Fabris
- Department of MedicalSurgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Renzo Carretta
- Department of MedicalSurgical and Health SciencesUniversity of TriesteTriesteItaly
- Institute of Biomedicine and Molecular Immunology “A. Monroy,”National Research Council of Italy (CNR)PalermoItaly
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
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17
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Emerel L, Thunes J, Kickliter T, Billaud M, Phillippi JA, Vorp DA, Maiti S, Gleason TG. Predissection-derived geometric and distensibility indices reveal increased peak longitudinal stress and stiffness in patients sustaining acute type A aortic dissection: Implications for predicting dissection. J Thorac Cardiovasc Surg 2018; 158:355-363. [PMID: 30551966 DOI: 10.1016/j.jtcvs.2018.10.116] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/17/2018] [Accepted: 10/26/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess ascending aortic distensibility and build geometry and distensibility-based patient-specific stress distribution maps in patients sustaining type A aortic dissection (TAAD) using predissection noninvasive imaging. METHODS Review of charts from patients undergoing surgical repair of TAAD (n = 351) led to the selection of a subset population (n = 7) with 2 or more predissection computed tomography angiography scans and echocardiograms at least 1 year before dissection. Ascending aortic wall biomechanical properties (aortic strain, distensibility, and stiffness) were compared with age- and size-matched nondissected nonaneurysmal controls. Patient-specific aortic strain served as an input in aortic geometry-based simulated 3-dimensional reconstructions to generate longitudinal and circumferential wall stress maps. Inspection of perioperative dissection scans and intraoperative visual examination confirmed primary tear locations. RESULTS Predissection echocardiography revealed ascending aortas of patients sustaining TAAD to exhibit decreased aortic wall strain (14.50 ± 1.13% vs 8.49 ± 1.08%; P < .01), decreased distensibility (4.26 ± 0.44 vs 2.39 ± 0.33 10-6 cm2·dyne-1; P < .01), increased stiffness (3.84 ± 0.24 vs 7.48 ± 1.05; P < .001), and increased longitudinal wall stress (246 ± 22 vs 172 ± 37 kPa; P < .01). There was no significant difference in circumferential wall stress. Predissection computed tomography angiography models revealed overlap between regions of increased longitudinal wall stress and primary tear sites. CONCLUSIONS Using predissection imaging, we identified increased stiffness and longitudinal wall stress in ascending aortas of patients with dissection. Patient-specific imaging-derived biomechanical property maps like these may be instrumental toward designing better prediction models of aortic dissection potential.
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Affiliation(s)
- Leonid Emerel
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - James Thunes
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa
| | - Trevor Kickliter
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa
| | - Marie Billaud
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Julie A Phillippi
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pa; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, Pa
| | - David A Vorp
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pa; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, Pa; Department of Chemical & Petroleum Engineering, University of Pittsburgh, Pittsburgh, Pa
| | - Spandan Maiti
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa
| | - Thomas G Gleason
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pa; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, Pa; Center for Thoracic Aortic Disease, University of Pittsburgh, Pittsburgh, Pa.
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18
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Faganello G, Cioffi G, Rossini M, Ognibeni F, Giollo A, Fisicaro M, Russo G, Di Nora C, Doimo S, Tarantini L, Mazzone C, Cherubini A, D'Agata Mottolesi B, Pandullo C, Di Lenarda A, Sinagra G, Viapiana O. Are aortic coarctation and rheumatoid arthritis different models of aortic stiffness? Data from an echocardiographic study. Cardiovasc Ultrasound 2018; 16:9. [PMID: 29940971 PMCID: PMC6019794 DOI: 10.1186/s12947-018-0126-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/23/2018] [Indexed: 01/20/2023] Open
Abstract
Background Patients who underwent a successful repair of the aortic coarctation (CoA) show high risk for cardiovascular (CV) events. Mechanical and structural abnormalities in the ascending aorta (Ao) might have a role in the prognosis of CoA patients. We analyzed the elastic properties of Ao measured as aortic stiffness index (AoSI) in CoA patients in the long-term period and we compared AoSI with a cohort of 38 patients with rheumatoid arthritis (RA) and 38 non-RA matched controls. Methods Data from 19 CoA patients were analyzed 28 ± 13 years after surgery. Abnormally high AoSI was diagnosed if AoSI > 6.07% (95th percentile of the AoSI detected in our reference healthy population). AoSI was assessed at the level of the aortic root by two-dimensional guided M-mode evaluation. Results CoA patients showed more than two-fold higher AoSI compared to RA and controls (9.8 ± 12.6 vs 4.8 ± 2.5% and 3.1 ± 2.0%, respectively; all p < 0.05 and in 5 of 19 patients with CoA (26%) AoSI was exceptionally high. The 5 patients with abnormally high AoSI were older with higher BP, LV mass and prevalence of LV diastolic dysfunction. Multiple linear regression analysis revealed that AoSI was independently related to the presence of LV hypertrophy and higher LV relative wall thickness. Conclusions CoA patients have higher AoSI levels than RA patients and non-RA matched controls. AoSI levels are abnormally high in a small sub-group of CoA patients who show a very high-risk clinical profile for adverse CV events.
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Affiliation(s)
- Giorgio Faganello
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy.
| | - Giovanni Cioffi
- Department of Cardiology, Villa Bianca Hospital, Trento, Italy
| | - Maurizio Rossini
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Federica Ognibeni
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Giollo
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Maurizio Fisicaro
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy
| | - Giulia Russo
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy
| | - Concetta Di Nora
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy
| | - Sara Doimo
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy
| | - Luigi Tarantini
- Department of cardiology, Ospedale Civile S. Martino, Belluno, Italy
| | - Carmine Mazzone
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy
| | - Antonella Cherubini
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy
| | | | - Claudio Pandullo
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy
| | - Andrea Di Lenarda
- Cardiovascular Centre, Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, via Slataper n°9, 34134, Trieste, Italy
| | - Gianfranco Sinagra
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Ombretta Viapiana
- Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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19
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Abstract
OBJECTIVE Marfan syndrome (MFS) is an autosomal dominant genetic disorder characterized by aortic root dilation and dissection and an abnormal fibrillin-1 synthesis. In this observational study, we evaluated aortic stiffness in MFS and its association with ascending aorta diameters and fibrillin-1 genotype. METHODS A total of 116 Marfan adult patients without history of cardiovascular surgery, and 144 age, sex, blood pressure and heart rate matched controls were enrolled. All patients underwent arterial stiffness evaluation through carotid-femoral pulse wave velocity (PWV) and central blood pressure waveform analysis (PulsePen tonometer). Fibrillin-1 mutations were classified based on the effect on the protein, into 'dominant negative' and 'haploinsufficient' mutations. RESULTS PWV and central pulse pressure were significantly higher in MFS patients than in controls [respectively 7.31 (6.81-7.44) vs. 6.69 (6.52-6.86) m/s, P = 0.0008; 41.3 (39.1-43.5) vs. 34.0 (32.7-35.3) mmHg, P < 0.0001], with a higher age-related increase of PWV in MFS (β 0.062 vs. 0.036). Pressure amplification was significantly reduced in MFS [18.2 (15.9-20.5) vs. 33.4 (31.6-35.2)%, P < 0.0001]. Central pressure profile was altered even in MFS patients without aortic dilatation. Multiple linear regression models showed that PWV independently predicted aortic diameters at the sinuses of Valsalva (ß = 0.243, P = 0.002) and at the sinotubular junction (ß = 0.186, P = 0.048). PWV was higher in 'dominant negative' than 'haploinsufficient' fibrillin-1 mutations [7.37 (7.04-7.70) vs. 6.60 (5.97-7.23) m/s, P = 0.035], although this difference was not significant after adjustment. CONCLUSION Aortic stiffness is increased in MFS, independently from fibrillin-1 genotype and is associated with diameters of ascending aorta. Alterations in central hemodynamics are present even when aortic diameter is within normal limits. Our findings suggest an accelerated arterial aging in MFS.
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Plonek T, Zak M, Rylski B, Berezowski M, Czerny M, Beyersdorf F, Jasinski M, Filipiak J. Wall stress correlates with intimal entry tear localization in Type A aortic dissection†. Interact Cardiovasc Thorac Surg 2018; 27:797-801. [DOI: 10.1093/icvts/ivy158] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/10/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Tomasz Plonek
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Malgorzata Zak
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Mikolaj Berezowski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jaroslaw Filipiak
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
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21
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Jiang WJ, Ren WH, Liu XJ, Liu Y, Wu FJ, Sun LZ, Lan F, Du J, Zhang HJ. Disruption of mechanical stress in extracellular matrix is related to Stanford type A aortic dissection through down-regulation of Yes-associated protein. Aging (Albany NY) 2017; 8:1923-1939. [PMID: 27608489 PMCID: PMC5076445 DOI: 10.18632/aging.101033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/06/2016] [Indexed: 01/19/2023]
Abstract
In this study, we assessed whether the down-regulation of Yes-associated protein (YAP) is involved in the pathogenesis of extracellular matrix (ECM) mechanical stress-induced Stanford type A aortic dissection (STAAD). Human aortic samples were obtained from heart transplantation donors as normal controls and from STAAD patients undergoing surgical replacement of the ascending aorta. Decreased maximum aortic wall velocity, ECM disorders, increased VSMC apoptosis, and YAP down-regulation were identified in STAAD samples. In a mouse model of STAAD, YAP was down-regulated over time during the development of ECM damage, and increased VSMC apoptosis was also observed. YAP knockdown induced VSMC apoptosis under static conditions in vitro, and the change in mechanical stress induced YAP down-regulation and VSMC apoptosis. This study provides evidence that YAP down-regulation caused by the disruption of mechanical stress is associated with the development of STAAD via the induction of apoptosis in aortic VSMCs. As STAAD is among the most elusive and life-threatening vascular diseases, better understanding of the molecular pathogenesis of STAAD is critical to improve clinical outcome.
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Affiliation(s)
- Wen-Jian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 10029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China.,The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing 10029, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing 10029, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China, 10029
| | - Wei-Hong Ren
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China
| | - Xu-Jie Liu
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China
| | - Yan Liu
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China
| | - Fu-Jian Wu
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China
| | - Li-Zhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China.,The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing 10029, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing 10029, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China, 10029
| | - Feng Lan
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China
| | - Jie Du
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China
| | - Hong-Jia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 10029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 10029, China.,Beijing Laboratory for Cardiovascular Precision Medicine, Beijing 10029, China.,The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing 10029, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing 10029, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China, 10029
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22
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Abstract
Echocardiography is the primary modality for imaging the aorta for the diagnosis and serial evaluation of pathological conditions. In this article, we review the methodology for optimal echocardiographic imaging of the various segments of the aorta and discuss abnormalities of the aorta including stenosis, dilation including aortopathy and sinus of Valsalva aneurysms, and fistulous communications involving the ascending aorta including aortoventricular tunnel and ruptured sinus of Valsalva aneurysm. We review novel echocardiographic measurements of aortic functional properties of the aorta such as elasticity and stiffness, and review the literature on the potential additive value of such measurements for structural assessment alone. Finally, we discuss the limitations of echocardiography in the precise and optimal imaging of the aorta.
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23
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Nowak-Machen M. The role of transesophageal echocardiography in aortic surgery. Best Pract Res Clin Anaesthesiol 2016; 30:317-29. [DOI: 10.1016/j.bpa.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 12/12/2022]
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24
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Whitlock MC, Hundley WG. Noninvasive Imaging of Flow and Vascular Function in Disease of the Aorta. JACC Cardiovasc Imaging 2016; 8:1094-1106. [PMID: 26381770 DOI: 10.1016/j.jcmg.2015.08.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 02/06/2023]
Abstract
With advancements in technology and a better understanding of human cardiovascular physiology, research as well as clinical care can go beyond dimensional anatomy offered by traditional imaging and investigate aortic functional properties and the impact disease has on this function. Linking the knowledge of the histopathological changes with the alterations in aortic function observed on noninvasive imaging results in a better understanding of disease pathophysiology. Translating this to clinical medicine, these noninvasive imaging assessments of aortic function are proving to be able to diagnose disease, better predict risk, and assess response to therapies. This review is designed to summarize the various hemodynamic measures that can characterize the aorta, the various noninvasive techniques, and applications for various disease states.
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Affiliation(s)
- Matthew C Whitlock
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Gregory Hundley
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Radiological Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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25
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Hillebrand M, Nouri G, Hametner B, Parragh S, Köster J, Mortensen K, Schwarz A, von Kodolitsch Y, Wassertheurer S. Ambulatory (24 h) blood pressure and arterial stiffness measurement in Marfan syndrome patients: a case control feasibility and pilot study. BMC Cardiovasc Disord 2016; 16:81. [PMID: 27151044 PMCID: PMC4858860 DOI: 10.1186/s12872-016-0263-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/29/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The aim of this work is the investigation of measures of ambulatory brachial and aortic blood pressure and indices of arterial stiffness and aortic wave reflection in Marfan patients. METHODS A case-control study was conducted including patients with diagnosed Marfan syndrome following Ghent2 nosology and healthy controls matched for sex, age and daytime brachial systolic blood pressure. For each subject a 24 h ambulatory blood pressure and 24 h pulse wave analysis measurement was performed. RESULTS All parameters showed a circadian pattern whereby pressure dipping was more pronounced in Marfan patients. During daytime only Marfan patients with aortic root surgery showed increased pulse wave velocity. In contrast, various nighttime measurements, wave reflection determinants and circadian patterns showed a significant difference. CONCLUSIONS The findings of our study provide evidence that ambulatory measurement of arterial stiffness parameters is feasible and that these determinants are significantly different in Marfan syndrome patients compared to controls in particular at nighttime. Further investigation is therefore indicated.
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Affiliation(s)
- Matthias Hillebrand
- Universitäres Herzzentrum Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ghazaleh Nouri
- Universitäres Herzzentrum Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Bernhard Hametner
- AIT Austrian Institute of Technology, Donau-City Str. 1, 1220, Vienna, Austria
| | - Stephanie Parragh
- AIT Austrian Institute of Technology, Donau-City Str. 1, 1220, Vienna, Austria
| | - Jelena Köster
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik II, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Kai Mortensen
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik II, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Achim Schwarz
- IEM GmbH, Cockerillstr. 69, 52222, Stolberg, Germany
| | - Yskert von Kodolitsch
- Universitäres Herzzentrum Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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26
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Lee JJ, Galatioto J, Rao S, Ramirez F, Costa KD. Losartan Attenuates Degradation of Aorta and Lung Tissue Micromechanics in a Mouse Model of Severe Marfan Syndrome. Ann Biomed Eng 2016; 44:2994-3006. [PMID: 27090893 DOI: 10.1007/s10439-016-1616-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/07/2016] [Indexed: 01/24/2023]
Abstract
Marfan syndrome (MFS) is an autosomal dominant disease of the connective tissue due to mutations in the fibrillin-1 gene (FBN1). This study aimed at characterizing microelastic properties of the ascending aortic wall and lung parenchyma tissues from wild type (WT) and age-matched Fbn1 hypomorphic mice (Fbn1(mgR/mgR) mice) to identify tissue-specific biomechanical effects of aging and disease in MFS. Atomic force microscopy was used to indent lung parenchyma and aortic wall tissues, using Hybrid Eshelby Decomposition analysis to extract layer-specific properties of the intima and media. The intima stiffened with age and was not different between WT and Fbn1(mgR/mgR) tissues, whereas the media layer of MFS aortas showed progressive structural and mechanical degradation with a modulus that was 50% softer than WT by 3.5 months of age. Similarly, MFS mice displayed progressive structural and mechanical deterioration of lung tissue, which was over 85% softer than WT by 3.5 months of age. Chronic treatment with the angiotensin type I receptor antagonist, losartan, attenuated the aorta and lung tissue degradation, resulting in structural and mechanical properties not significantly different from age-matched WT controls. By revealing micromechanical softening of elastin-rich aorta and lung tissues with disease progression in fibrillin-1 deficient mice, our findings support the use of losartan as a prophylactic treatment that may abrogate the life-threatening symptoms of MFS.
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Affiliation(s)
- Jia-Jye Lee
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.,Department of Biomedical Engineering, The City College of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - Josephine Galatioto
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Satish Rao
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Francesco Ramirez
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Kevin D Costa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
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27
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Tae HJ, Petrashevskaya N, Marshall S, Krawczyk M, Talan M. Cardiac remodeling in the mouse model of Marfan syndrome develops into two distinctive phenotypes. Am J Physiol Heart Circ Physiol 2015; 310:H290-9. [PMID: 26566724 DOI: 10.1152/ajpheart.00354.2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/01/2015] [Indexed: 12/21/2022]
Abstract
Marfan syndrome (MFS) is a systemic disorder of connective tissue caused by mutations in fibrillin-1. Cardiac dysfunction in MFS has not been characterized halting the development of therapies of cardiac complication in MFS. We aimed to study the age-dependent cardiac remodeling in the mouse model of MFS FbnC1039G+/- mouse [Marfan heterozygous (HT) mouse] and its association with valvular regurgitation. Marfan HT mice of 2-4 mo demonstrated a mild hypertrophic cardiac remodeling with predominant decline of diastolic function and increased transforming growth factor-β canonical (p-SMAD2/3) and noncanonical (p-ERK1/2 and p-p38 MAPK) signaling and upregulation of hypertrophic markers natriuretic peptides atrium natriuretic peptide and brain natriuretic peptide. Among older HT mice (6-14 mo), cardiac remodeling was associated with two distinct phenotypes, manifesting either dilated or constricted left ventricular chamber. Dilatation of left ventricular chamber was accompanied by biochemical evidence of greater mechanical stress, including elevated ERK1/2 and p38 MAPK phosphorylation and higher brain natriuretic peptide expression. The aortic valve regurgitation was registered in 20% of the constricted group and 60% of the dilated group, whereas mitral insufficiency was observed in 40% of the constricted group and 100% of the dilated group. Cardiac dysfunction was not associated with the increase of interstitial fibrosis and nonmyocyte proliferation. In the mouse model fibrillin-1, haploinsufficiency results in the early onset of nonfibrotic hypertrophic cardiac remodeling and dysfunction, independently from valvular abnormalities. MFS heart is vulnerable to stress-induced cardiac dilatation in the face of valvular regurgitation, and stress-activated MAPK signals represent a potential target for cardiac management in MFS.
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Affiliation(s)
- Hyun-Jin Tae
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Natalia Petrashevskaya
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Shannon Marshall
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Melissa Krawczyk
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Mark Talan
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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28
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Singh SD, Xu XY, Pepper JR, Treasure T, Mohiaddin RH. Biomechanical properties of the Marfan's aortic root and ascending aorta before and after personalised external aortic root support surgery. Med Eng Phys 2015; 37:759-66. [PMID: 26054807 DOI: 10.1016/j.medengphy.2015.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 02/16/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022]
Abstract
Marfan syndrome is an inherited systemic connective tissue disease which may lead to aortic root disease causing dilatation, dissection and rupture of the aorta. The standard treatment is a major operation involving either an artificial valve and aorta or a complex valve repair. More recently, a personalised external aortic root support (PEARS) has been used to strengthen the aorta at an earlier stage of the disease avoiding risk of both rupture and major surgery. The aim of this study was to compare the stress and strain fields of the Marfan aortic root and ascending aorta before and after insertion of PEARS in order to understand its biomechanical implications. Finite element (FE) models were developed using patient-specific aortic geometries reconstructed from pre and post-PEARS magnetic resonance images in three Marfan patients. For the post-PEARS model, two scenarios were investigated-a bilayer model where PEARS and the aortic wall were treated as separate layers, and a single-layer model where PEARS was incorporated into the aortic wall. The wall and PEARS materials were assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall corresponding to the patients' pulse pressure was applied. Results from our FE models with patient-specific geometries show that peak aortic stresses and displacements before PEARS were located at the sinuses of Valsalva but following PEARS surgery, these peak values were shifted to the aortic arch, particularly at the interface between the supported and unsupported aorta. Further studies are required to assess the statistical significance of these findings and how PEARS compares with the standard treatment.
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Affiliation(s)
- S D Singh
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - X Y Xu
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
| | - J R Pepper
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
| | - T Treasure
- Clinical Operational Research, Department of Mathematics, University College London, 4 Taviton Street, London WC1H 0BT, UK
| | - R H Mohiaddin
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College London, London SW7 2AZ, UK
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29
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Bhatt AB, Buck JS, Zuflacht JP, Milian J, Kadivar S, Gauvreau K, Singh MN, Creager MA. Distinct effects of losartan and atenolol on vascular stiffness in Marfan syndrome. Vasc Med 2015; 20:317-25. [PMID: 25795452 DOI: 10.1177/1358863x15569868] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We conducted a randomized, double-blind trial of losartan (100 mg QD) versus atenolol (50 mg QD) for 6 months in adults with Marfan syndrome. Carotid-femoral pulse wave velocity (PWV), central augmentation index (AIx), aortic diameter and left ventricular (LV) function were assessed with arterial tonometry and echocardiography. Thirty-four subjects (18 female; median age 35 years, IQR 27, 45) were randomized. Central systolic and diastolic blood pressure decreased comparably with atenolol and losartan (p = 0.64 and 0.31, respectively); heart rate decreased with atenolol (p = 0.02), but not with losartan. PWV decreased in patients treated with atenolol (-1.15 ± 1.68 m/s; p = 0.01), but not in those treated with losartan (-0.22 ± 0.59 m/s; p = 0.15; between-group difference p = 0.04). In contrast, AIx decreased in the losartan group (-9.6 ± 8.6%; p < 0.001) but not in the atenolol group (0.9 ± 6.2%, p = 0.57; between-group difference p < 0.001). There was no significant change in aortic diameters or LV ejection fraction in either treatment group. In adults with Marfan syndrome, 6 months of treatment with atenolol improves PWV, whereas losartan reduces the AIx. By improving vascular stiffness via distinct mechanisms of action, there is physiologic value to considering the use of both medications in individuals with Marfan syndrome.
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Affiliation(s)
- Ami B Bhatt
- Brigham and Women's Hospital, Boston, MA, USA Massachusetts General Hospital, Boston, MA, USA Children's Hospital of Boston, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Kimberlee Gauvreau
- Children's Hospital of Boston, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Michael N Singh
- Brigham and Women's Hospital, Boston, MA, USA Children's Hospital of Boston, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Mark A Creager
- Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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30
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Rabkin SW, Chan KK, Chow B, Janusz MT. Pulse wave velocity involving proximal portions of the aorta correlates with the degree of aortic dilatation at the sinuses of valsalva in ascending thoracic aortic aneurysms. Ann Vasc Dis 2015; 7:404-9. [PMID: 25593626 DOI: 10.3400/avd.oa.14-00063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/06/2014] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the relationship between arterial stiffness measured in different aortic segments and the presence and extent of ascending thoracic aortic aneurysm (ATAA). METHODS Patients at a Thoracic Aortic Diseases clinic at a University teaching hospital were compared to patients attending a Cardiology outpatient Clinic at the same institution. A non-invasive measure of vascular stiffness was performed using pulse wave velocity (PWV) measurement of several vascular segments-carotid-femoral pulse wave velocity (cfPWV), heart-femoral pulse wave velocity (hfPWV) and brachial-ankle pulse wave velocity (baPWV). Aortic dimensions were measured on echocardiogram. RESULTS Patients with ATAA (N = 32) were 66 years and the same age as those without ATAA (N = 46). There was no significant difference between those with or without aortic aneurysm with respect to cfPWV, hfPWV or baPWV. In ATAA, there was a significant (p <0.05) inverse correlation between aortic diameter at the sinuses of Valsalva and cfPWV, as well as hfPWV, but not with baPWV. This relationship was not evident in persons without ATAA. CONCLUSION Reduced aortic stiffness (increased compliance), assessed by cfPWV or hfPWV, correlates with larger aortic size of ATAA at the level of the sinuses of Valsalva but not at the ascending aorta, suggesting cfPWV may be a useful method to assess the size of ATAA at the level of the sinuses of Valsalva. Overall aortic stiffness assessed by PWV did not differentiate persons with or without an ATAA, in individuals who do not have a genetic or inheritable cause of their ATAA.
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Affiliation(s)
- Simon W Rabkin
- Department of Medicine, University of British Columbia , Vancouver, Canada
| | - Kenneth K Chan
- Department of Medicine, University of British Columbia , Vancouver, Canada
| | - Bryan Chow
- Department of Medicine, University of British Columbia , Vancouver, Canada
| | - Michael T Janusz
- Department of Surgery, University of British Columbia , Vancouver, Canada
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31
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Lu Q, Liu H. Correlation of Ascending Aorta Elasticity and the Severity of Coronary Artery Stenosis in Hypertensive Patients with Coronary Heart Disease Assessed by M-Mode and Tissue Doppler Echocardiography. Cell Biochem Biophys 2014; 71:785-8. [DOI: 10.1007/s12013-014-0263-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Querzoli G, Fortini S, Espa S, Costantini M, Sorgini F. Fluid dynamics of aortic root dilation in Marfan syndrome. J Biomech 2014; 47:3120-8. [DOI: 10.1016/j.jbiomech.2014.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/09/2014] [Accepted: 06/18/2014] [Indexed: 12/20/2022]
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33
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Aortic stiffness is increased in patients with premature coronary artery disease: A tissue Doppler imaging study. J Cardiol 2014; 63:223-9. [DOI: 10.1016/j.jjcc.2013.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/01/2013] [Accepted: 08/14/2013] [Indexed: 11/22/2022]
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34
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Vizzardi E, Trichaki E, Bonadei I, Sciatti E, Salghetti F, Raddino R, Metra M. Elastic Aortic Properties in Patients with X Syndrome. Heart Lung Circ 2014; 23:114-8. [DOI: 10.1016/j.hlc.2013.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/15/2013] [Accepted: 07/18/2013] [Indexed: 12/01/2022]
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35
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Tan CNH, Fraser AG. Perioperative transesophageal echocardiography for aortic dissection. Can J Anaesth 2014; 61:362-78. [PMID: 24477464 DOI: 10.1007/s12630-014-0113-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/14/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Aortic dissection is an infrequent but serious condition that often requires immediate operative intervention. We explore recent developments in the classification of aortic dissection and perioperative transesophageal echocardiography that assist with quantifying the severity of disease and facilitate its management. PRINCIPAL FINDINGS We describe the pivotal role of echocardiography in relation to key surgical considerations such as cannulation, aortic root surgery, perfusion in the aortic arch vessels, stenting in hybrid arch repair, and timing of preventative surgery. CONCLUSION Developments in the classification of aortic dissection have improved our perspective and understanding of the key presenting features that affect mortality. Improvements in patient outcome may be achieved in part by appropriately timed echocardiography-guided surgery.
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Affiliation(s)
- Christine N H Tan
- Department of Anaesthesia, Critical Care and Pain Management, B3, University Hospital of Wales, Cardiff, CF 14 4XW, UK,
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Santavy P. Multidisciplinary approach to a Marfan syndrome patient with emphasis on cardiovascular complications. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157:1-4. [PMID: 23567654 DOI: 10.5507/bp.2013.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/22/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Marfan syndrome (MFS) is the most common inherited disorder of connective tissue affecting multiple organ systems. The most life-threatening and life-shortening complication is aortic dissection. Without surgery, life expectancy of MFS patients is reduced to approximately 32 years. Early identification and appropriate multidisciplinary medical cooperation is essential. CONCLUSION Proper follow up, therapy and timely surgical repair lead to an almost normal lifespan in affected individuals.
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Affiliation(s)
- Petr Santavy
- Department of Cardiac Surgery, University Hospital Olomouc, Czech Republic.
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Impaired vascular contractility and aortic wall degeneration in fibulin-4 deficient mice: effect of angiotensin II type 1 (AT1) receptor blockade. PLoS One 2011; 6:e23411. [PMID: 21858106 PMCID: PMC3153486 DOI: 10.1371/journal.pone.0023411] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 07/16/2011] [Indexed: 01/19/2023] Open
Abstract
Medial degeneration is a key feature of aneurysm disease and aortic dissection. In a murine aneurysm model we investigated the structural and functional characteristics of aortic wall degeneration in adult fibulin-4 deficient mice and the potential therapeutic role of the angiotensin (Ang) II type 1 (AT1) receptor antagonist losartan in preventing aortic media degeneration. Adult mice with 2-fold (heterozygous Fibulin-4+/R) and 4-fold (homozygous Fibulin-4R/R) reduced expression of fibulin-4 displayed the histological features of cystic media degeneration as found in patients with aneurysm or dissection, including elastin fiber fragmentation, loss of smooth muscle cells, and deposition of ground substance in the extracellular matrix of the aortic media. The aortic contractile capacity, determined by isometric force measurements, was diminished, and was associated with dysregulation of contractile genes as shown by aortic transcriptome analysis. These structural and functional alterations were accompanied by upregulation of TGF-β signaling in aortas from fibulin-4 deficient mice, as identified by genome-scaled network analysis as well as by immunohistochemical staining for phosphorylated Smad2, an intracellular mediator of TGF-β. Tissue levels of Ang II, a regulator of TGF-β signaling, were increased. Prenatal treatment with the AT1 receptor antagonist losartan, which blunts TGF-β signaling, prevented elastic fiber fragmentation in the aortic media of newborn Fibulin-4R/R mice. Postnatal losartan treatment reduced haemodynamic stress and improved lifespan of homozygous knockdown fibulin-4 animals, but did not affect aortic vessel wall structure. In conclusion, the AT1 receptor blocker losartan can prevent aortic media degeneration in a non-Marfan syndrome aneurysm mouse model. In established aortic aneurysms, losartan does not affect aortic architecture, but does improve survival. These findings may extend the potential therapeutic application of inhibitors of the renin-angiotensin system to the preventive treatment of aneurysm disease.
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Aortic stiffness: current understanding and future directions. J Am Coll Cardiol 2011; 57:1511-22. [PMID: 21453829 DOI: 10.1016/j.jacc.2010.12.017] [Citation(s) in RCA: 633] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 12/06/2010] [Accepted: 12/08/2010] [Indexed: 01/06/2023]
Abstract
The aorta stiffens with aging, a process that is accelerated by arterial hypertension. Decreased arterial compliance is one of the earliest detectable manifestations of adverse structural and functional changes within the vessel wall. The use of different imaging techniques optimized for assessment of vascular elasticity and quantification of luminal and vessel wall parameters allows for a comprehensive and detailed view of the vascular system. In addition, several studies have also documented the prognostic importance of arterial stiffness (AS) in various populations as an independent predictor of cardiovascular morbidity and all-cause mortality. Measurement of AS by applanation tonometry with pulse-wave velocity has been the gold-standard method and is well-validated in large populations as a strong predictor of adverse cardiovascular outcomes. Because aortic stiffness depends on the prevailing blood pressure, effective antihypertensive treatment is expected to reduce it in proportion to the blood pressure reduction. Nevertheless, drugs lowering blood pressure might differ in their effects on structure and function of the arterial walls. This review paper not only will discuss the current understanding and clinical significance of AS but also will review the effects of various pharmacological and nonpharmacological interventions that can be used to preserve the favorable profile of a more compliant and less stiff aorta.
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Molecular simulations predict novel collagen conformations during cross-link loading. Matrix Biol 2011; 30:356-60. [PMID: 21620686 DOI: 10.1016/j.matbio.2011.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/28/2011] [Accepted: 03/31/2011] [Indexed: 11/24/2022]
Abstract
Collagen cross-linking mechanically strengthens tissues during development and aging, but there is limited data describing how force transmitted across cross-links affects molecular conformation. We used Steered Molecular Dynamics (SMD) to model perpendicular force through a side chain. Results predicted that collagen peptides have negligible bending resistance and that mechanical force causes helix disruption below covalent bond failure strength, suggesting alternative molecular conformations precede cross-link rupture and macroscopic damage during mechanical loading.
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Mariko B, Pezet M, Escoubet B, Bouillot S, Andrieu JP, Starcher B, Quaglino D, Jacob MP, Huber P, Ramirez F, Faury G. Fibrillin-1 genetic deficiency leads to pathological ageing of arteries in mice. J Pathol 2011; 224:33-44. [PMID: 21432852 DOI: 10.1002/path.2840] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 11/11/2010] [Accepted: 12/06/2010] [Indexed: 02/02/2023]
Abstract
Fibrillin-1, the major component of extracellular microfibrils that associate with insoluble elastin in elastic fibres, is mainly synthesized during development and postnatal growth and is believed to guide elastogenesis. Mutations in the fibrillin-1 gene cause Marfan syndrome, a multisystem disorder characterized by aortic aneurysms and dissections. The recent finding that early deficiency of elastin modifies vascular ageing has raised the possibility that fibrillin-1 deficiency could also contribute to late-onset pathology of vascular remodelling. To address this question, we examined cardiovascular function in 3-week-old, 6-month-old, and 24-month-old mice that are heterozygous for a hypomorphic structural mutation of fibrillin-1 (Fbn1{+/mgΔ} mice). Our results indicate that Fbn1{+/mgΔ} mice, particularly those that are 24 months old, are slightly more hypotensive than wild-type littermates. Additionally, aneurysm and aortic insufficiency were more frequently observed in ageing Fbn1{+/mgΔ}$ mice than in the wild-type counterparts. We also noted substantial fragmentation and decreased number of elastic lamellae in the aortic wall of Fbn1{+/mgΔ} mice, which were correlated with an increase in aortic stiffness, a decrease in vasoreactivity, altered expression of elastic fibre-related genes, including fibrillin-1 and elastin, and a decrease in the relative ratio between tissue elastin and collagen. Collectively, our findings suggest that the heterozygous mgΔ mutation accelerates some aspects of vascular ageing and eventually leads to aortic manifestations resembling those of Marfan syndrome. Importantly, our data also indicate that vascular abnormalities in Fbn1{+/mgΔ} mice are opposite to those induced by elastin haploinsufficiency during ageing that affect blood pressure, vascular dimensions, and number of elastic lamellae.
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Kiotsekoglou A, Moggridge JC, Saha SK, Kapetanakis V, Govindan M, Alpendurada F, Mullen MJ, Camm J, Sutherland GR, Bijnens BH, Child AH. Assessment of Aortic Stiffness in Marfan Syndrome Using Two-Dimensional and Doppler Echocardiography. Echocardiography 2011; 28:29-37. [DOI: 10.1111/j.1540-8175.2010.01241.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yang WI, Shim CY, Cho IJ, Chang HJ, Choi D, Jang Y, Chung N, Cho SY, Ha JW. Dyssynchronous Systolic Expansion of Carotid Artery in Patients with Marfan Syndrome. J Am Soc Echocardiogr 2010; 23:1310-6. [DOI: 10.1016/j.echo.2010.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 11/16/2022]
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Vitarelli A, Capotosto L. Role of echocardiography in the assessment and management of adult congenital heart disease in pregnancy. Int J Cardiovasc Imaging 2010; 27:843-57. [PMID: 21082254 DOI: 10.1007/s10554-010-9750-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/08/2010] [Indexed: 01/10/2023]
Abstract
Congenital heart disease represent a large proportion of heart disease in pregnancy. With the exception of patients with Eisenmenger's syndrome, pulmonary vascular obstructive disease, and Marfan's syndrome with aortopathy, maternal death during pregnancy is rare in women with CHD but morbidity occurs such as heart failure, arrhythmias, and stroke. Echocardiography represents a milestone in diagnosis, understanding of pathophysiology, assessment of disease severity and patient monitoring in pregnant women with unoperated and post-operative congenital heart disease.
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Affiliation(s)
- Antonio Vitarelli
- Echocardiology Unit, Cardiac Department, Sapienza University, Via Lima 35, 00198, Rome, Italy.
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Petrini J, Yousry M, Rickenlund A, Liska J, Hamsten A, Eriksson P, Franco-Cereceda A, Caidahl K, Eriksson MJ. The Feasibility of Velocity Vector Imaging by Transesophageal Echocardiography for Assessment of Elastic Properties of the Descending Aorta in Aortic Valve Disease. J Am Soc Echocardiogr 2010; 23:985-92. [DOI: 10.1016/j.echo.2010.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Indexed: 10/19/2022]
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Abstract
Arterial stiffness describes the rigidity of the arterial wall. Its significance owes to its relationship with the pulsatile afterload presented to the left ventricle and its implications on ventricular-arterial coupling. In adults, the contention that arterial stiffness as a marker and risk factor for cardiovascular morbidity and mortality is gaining support. Noninvasive methods have increasingly been adopted in both the research and clinical arena to determine local, segmental, and systemic arterial stiffness in the young. With adoption of these noninvasive techniques for use in children and adolescents, the phenomenon and significance of arterial stiffening in the young is beginning to be unveiled. The list of childhood factors and conditions found to be associated with arterial stiffening has expanded rapidly over the last decade; these include traditional cardiovascular risk factors, prenatal growth restriction, vasculitides, vasculopathies associated with various syndromes, congenital heart disease, and several systemic diseases. The findings of arterial stiffening have functional implications on energetic efficiency, structure, and function of the left ventricle. Early identification of arterial dysfunction in childhood may provide a window for early intervention, although longitudinal studies are required to determine whether improvement of arterial function in normal and at-risk paediatric populations will be translated into clinical benefits.
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Affiliation(s)
- Yiu-Fai Cheung
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Syyong HT, Chung AWY, Yang HHC, van Breemen C. Dysfunction of endothelial and smooth muscle cells in small arteries of a mouse model of Marfan syndrome. Br J Pharmacol 2009; 158:1597-608. [PMID: 19814726 DOI: 10.1111/j.1476-5381.2009.00439.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Marfan syndrome, a connective tissue disorder caused by mutations in FBN1 encoding fibrillin-1, results in life-threatening complications in the aorta, but little is known about its effects in resistance vasculature. EXPERIMENTAL APPROACH Second-order mesenteric arteries from mice at 3, 6 and 10 months of age (n= 30) heterozygous for the Fbn1 allele encoding a cysteine substitution (Fbn1(C1039G/+)) were compared with those from age-matched control littermates. KEY RESULTS Stress-strain curves indicated that arterial stiffness was increased at 6 and 10 months of age in Marfan vessels. Isometric force measurement revealed that contraction in response to potassium (60 mM)-induced membrane depolarization was decreased by at least 28% in Marfan vessels at all ages, while phenylephrine (3 microM)-induced contraction was reduced by at least 40% from 6 months. Acetylcholine-induced relaxation in Marfan vessels was reduced to 70% and 45% of control values, respectively, at 6 and 10 months. Sensitivity to sodium nitroprusside was reduced at 6 months (pEC(50)= 5.64 +/- 0.11, control pEC(50)= 7.34 +/- 0.04) and 10 months (pEC(50)= 5.99 +/- 0.07, control pEC(50)= 6.99 +/- 0.14). Pretreatment with N(omega)-Nitro-L-arginine methyl ester (200 microM) had no effect on acetylcholine-induced relaxation in Marfan vessels, but reduced vasorelaxation in control vessels to 57% of control values. Addition of indomethacin (10 microM) and catalase (1000 U.mL(-1)) further inhibited vasorelaxation in Marfan vessels to a greater degree compared with control vessels. CONCLUSIONS AND IMPLICATIONS Pathogenesis of Marfan syndrome in resistance-sized arteries increases stiffness and impairs vasomotor function.
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Affiliation(s)
- H T Syyong
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
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Augmentation index relates to progression of aortic disease in adults with Marfan syndrome. Am J Hypertens 2009; 22:971-9. [PMID: 19574960 DOI: 10.1038/ajh.2009.115] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Noninvasive applanation tonometry (APT) is useful to assess aortic stiffness and pulse wave reflection. Moreover, APT can predict outcome in many conditions such as arterial hypertension. In this study, we test whether APT measurements relate to progression of aortic disease in Marfan syndrome (MFS). METHODS We performed APT in 50 consecutive, medically treated adults with MFS (19 men and 31 women aged 32 +/- 13 years), who had not undergone previous cardiovascular surgery. During 22 +/- 16 months of follow-up, 26 of these patients developed progression of aortic disease, which we defined as progression of aortic root diameters >or=5 mm/annum (18 individuals), aortic surgery >or=3 months after APT (seven individuals), or onset of acute aortic dissection any time after APT (one individual). RESULTS Univariate Cox regression analysis suggested an association of aortic disease progression with age (P = 0.001), total cholesterol levels (P = 0.04), aortic root diameter (P = 0.007), descending aorta diameter (P = 0.01), aortic root ratio (P = 0.02), and augmentation index (AIx@HR75; P < 0.006). Multivariate Cox regression analysis confirmed an independent impact on aortic disease progression exclusively for baseline aortic root diameters (hazard ratio = 1.347; 95% confidence interval (CI) 1.104-1.643; P = 0.003) and AIx@HR75 (hazard ratio = 1.246; 95% CI 1.029-1.508; P = 0.02). In addition, Kaplan-Meier survival curve analysis illustrated significantly lower rates of aortic root disease progression both with lower AIx@HR75 (P = 0.025) and with lower pulse wave velocity (PWV) values (P = 0.027). CONCLUSIONS We provide evidence that APT parameters relate to aortic disease progression in medically treated patients with MFS. We believe that APT has a potential to improve risk stratification in the clinical management of MFS patients.
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Zhao F, Zhang H, Wahle A, Thomas MT, Stolpen AH, Scholz TD, Sonka M. Congenital aortic disease: 4D magnetic resonance segmentation and quantitative analysis. Med Image Anal 2009; 13:483-93. [PMID: 19303351 DOI: 10.1016/j.media.2009.02.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Revised: 02/06/2009] [Accepted: 02/09/2009] [Indexed: 11/30/2022]
Abstract
Automated and accurate segmentation of the aorta in 4D (3D+time) cardiovascular magnetic resonance (MR) image data is important for early detection of congenital aortic disease leading to aortic aneurysms and dissections. A computer-aided diagnosis (CAD) method is reported that allows one to objectively identify subjects with connective tissue disorders from 16-phase 4D aortic MR images. Starting with a step of multi-view image registration, our automated segmentation method combines level-set and optimal surface segmentation algorithms in a single optimization process so that the final aortic surfaces in all 16 cardiac phases are determined. The resulting aortic lumen surface is registered with an aortic model followed by calculation of modal indices of aortic shape and motion. The modal indices reflect the differences of any individual aortic shape and motion from an average aortic behavior. A Support Vector Machine (SVM) classifier is used for the discrimination between normal and connective tissue disorder subjects. 4D MR image data sets acquired from 104 normal volunteers and connective tissue disorder patients MR datasets were used for development and performance evaluation of our method. The automated 4D segmentation resulted in accurate aortic surfaces in all 16 cardiac phases, covering the aorta from the aortic annulus to the diaphragm, yielding subvoxel accuracy with signed surface positioning errors of -0.07+/-1.16 voxel (-0.10+/-2.05mm). The computer-aided diagnosis method distinguished between normal and connective tissue disorder subjects with a classification correctness of 90.4%.
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Affiliation(s)
- Fei Zhao
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA 52242, USA
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Vitarelli A, Conde Y, Cimino E, D'Orazio S, Stellato S, Battaglia D, Padella V, Caranci F, Continanza G, Dettori O, Capotosto L. Assessment of Ascending Aorta Distensibility After Successful Coarctation Repair by Strain Doppler Echocardiography. J Am Soc Echocardiogr 2008; 21:729-36. [DOI: 10.1016/j.echo.2007.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Indexed: 10/22/2022]
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