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Spetko N, Rong J, Larson MG, Haidar M, Raber I, Peters K, Benjamin EJ, O'Donnell CJ, Manning WJ, Vasan RS, Mitchell GF, Tsao CW. Cross-Sectional Relationships of Proximal Aortic Stiffness and Left Ventricular Diastolic Function in Adults in the Community. J Am Heart Assoc 2022; 11:e027230. [PMID: 36533620 PMCID: PMC9798804 DOI: 10.1161/jaha.122.027230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Stiffness of the proximal aorta may play a critical role in adverse left ventricular (LV)-vascular interactions and associated LV diastolic dysfunction. In a community-based sample, we sought to determine the association between proximal aortic stiffness measured by cardiovascular magnetic resonance (CMR) and several clinical measures of LV diastolic mechanics. Methods and Results Framingham Heart Study Offspring adults (n=1502 participants, mean 67±9 years, 54% women) with available 1.5T CMR and transthoracic echocardiographic measures were included. Measures included proximal descending aortic strain and aortic arch pulse wave velocity by CMR (2002-2006) and diastolic function (mitral Doppler E and A wave velocity, E wave area, and LV tissue Doppler e' velocity) by echocardiography (2005-2008). Multivariable linear regression analysis was used to relate CMR aortic stiffness measures to measures of echocardiographic LV diastolic function. All continuous variables were standardized. In multivariable-adjusted regression analyses, aortic strain was inversely associated with E wave deceleration time (estimated β=-0.10±0.032, P=0.001), whereas aortic arch pulse wave velocity was inversely associated with E/A ratio (estimated β=-0.094±0.027, P=0.0006), E wave area (estimated β=-0.070±0.027, P=0.010), and e' (estimated β=-0.061±0.027, P=0.022), all indicating associations of higher aortic stiffness by CMR with less favorable LV diastolic function. Compared with men, women had a larger inverse relationship between pulse wave velocity and E/A ratio (interaction β=-0.085±0.031, P=0.0064). There was no significant effect modification by age or a U-shaped (quadratic) relation between aortic stiffness and LV diastolic function measures. Conclusions Higher proximal aortic stiffness is associated with less favorable LV diastolic function. Future studies may clarify temporal relations of aortic stiffness with varying patterns and progression of LV diastolic dysfunction.
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Affiliation(s)
- Nicholas Spetko
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Jian Rong
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA
| | - Martin G. Larson
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Department of Mathematics and StatisticsBoston UniversityBostonMA
| | | | - Inbar Raber
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Kevin Peters
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Emelia J. Benjamin
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Sections of Preventive Medicine and Epidemiology and Cardiology, Department of MedicineBoston University School of Medicine, Department of Epidemiology, Boston University School of Public HealthBostonMA
| | - Christopher J. O'Donnell
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, and Division of Cardiovascular Medicine, Brigham and Women’s HospitalHarvard Medical SchoolWest RoxburyMA
| | - Warren J. Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA,Department of Radiology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Ramachandran S. Vasan
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Sections of Preventive Medicine and Epidemiology and Cardiology, Department of MedicineBoston University School of Medicine, Department of Epidemiology, Boston University School of Public HealthBostonMA
| | | | - Connie W. Tsao
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
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Chongthammakun V, Pan AY, Earing MG, Damluji AA, Goot BH, Cava JR, Gerardin JF. The association between cardiac magnetic resonance-derived aortic stiffness parameters and aortic dilation in young adults with bicuspid aortic valve: With and without coarctation of aorta. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 20:100194. [PMID: 38560418 PMCID: PMC10978397 DOI: 10.1016/j.ahjo.2022.100194] [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: 01/10/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 04/04/2024]
Abstract
Background Bicuspid aortic valve (BAV) is associated with progressive aortic dilation. Studies in aortopathies have shown a correlation between increased aortic stiffness and aortic dilation. We aimed to evaluate aortic stiffness measures as predictors of progressive aortic dilation by cardiac magnetic resonance (CMR) in BAV patients. Methods This is a retrospective study of 49 patients with BAV (median age 21.1 years at first CMR visit) with ≥2 CMR at the Wisconsin Adult Congenital Heart Disease Program (WAtCH). Circumferential aortic strain, distensibility, and β-stiffness index were obtained from CMR-derived aortic root cine imaging, and aortic dimensions were measured at aortic root and ascending aorta. A linear mixed-model and logistic regression were used to identify important predictors of progressive aortic dilation. Results Over a median of 3.8 years follow-up, the annual growth rates of aortic root and ascending aorta dimensions were 0.25 and 0.16 mm/year, respectively. Aortic strain and distensibility decreased while β-stiffness index increased with age. Aortic root strain and distensibility were associated with progressive dilation of the ascending aorta. Baseline aortic root diameter was an independent predictor of >1 mm/year growth rate of the aortic root (adjusted OR 1.34, 95 % CI 1.03-1.74, p = 0.028). Most patients (61 %) had coexisting coarctation of aorta. Despite the higher prevalence of hypertension in patients with aortic coarctation, hypertension or coarctation had no effect on baseline aorta dimensions, stiffness, or progressive aortic dilation. Conclusion Some CMR-derived aortic stiffness parameters correlated with progressive aortic dilation in BAV and should be further investigated in larger and older BAV cohorts.
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Affiliation(s)
- Vasutakarn Chongthammakun
- Adult Congenital Heart Disease Program, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States of America
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Amy Y. Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Michael G. Earing
- Sections of Cardiology and Pediatric Cardiology, University of Chicago, Chicago, IL, United States of America
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA, United States of America
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Benjamin H. Goot
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Joseph R. Cava
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jennifer F. Gerardin
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
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Jones PA, Wilson JS. The Potential for Quantifying Regional Distributions of Radial and Shear Strain in the Thoracic and Abdominal Aortic Wall Using Spiral Cine DENSE Magnetic Resonance Imaging. J Biomech Eng 2021; 143:1097183. [PMID: 33537707 DOI: 10.1115/1.4050029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Indexed: 11/08/2022]
Abstract
Aortic displacement encoding with stimulated echoes (DENSE) magnetic resonance imaging (MRI) was recently developed to assess heterogeneities in aortic wall circumferential strain (CS). However, previous studies neglected potential radial and shear strain (RSS) distributions. Herein, we present an improved aortic DENSE MRI postprocessing method to assess the feasibility of quantifying all components of the two-dimensional (2D) strain tensor. 32 previously acquired 2D DENSE scans from three distinct aortic locations were re-analyzed. Contrasting previous studies, displacements of the inner and outer aortic wall layers were processed separately to preserve RSS. Differences in regional strain between the new and old postprocessing methods were evaluated, along with interobserver, intraobserver, and interscan repeatability for all strain components. The new postprocessing method revealed an overall mean absolute difference in regional CS of 0.01 ± 0.01 compared to the prior method, with minimal impact on CS repeatability. Mean absolute magnitudes of regional RSS increased significantly compared to changes in CS (radial 0.04 ± 0.05, p < 0.001; shear 0.04 ± 0.04, p = 0.02). Most repeatability metrics for RSS were significantly worse than for CS. The unique distributions of RSS for each axial location associated well with local periaortic structures and mean aortic displacement. The new postprocessing method captures heterogeneous distributions of nonzero RSS which may provide new information for improving clinical diagnostics and computational modeling of heterogeneous aortic wall mechanics. However, future studies are required to improve the repeatability of RSS and assess the influence of partial volume effects.
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Affiliation(s)
- Patrick A Jones
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23220
| | - John S Wilson
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23220; Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219
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Rong LQ, Palumbo MC, Rahouma M, Lopes AJ, Devereux RB, Kim J, Girardi LN, Gaudino M, Weinsaft JW. Descending aortic strain quantification by intra-operative transesophageal echocardiography: Multimodality validation via cardiovascular magnetic resonance. Echocardiography 2020; 37:1820-1827. [PMID: 32909633 DOI: 10.1111/echo.14851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Whereas cardiac magnetic resonance (CMR) imaging provides high temporal resolution imaging of aortic distensibility (strain), transesophageal echocardiography (TEE) is widely used for intra-operative aortic imaging and provides a clinical alternative for aortic assessment. We tested intra-operative global circumferential aortic strain (GCS) measured on TEE in relation to the reference of CMR-derived strain among patients undergoing surgical graft repair of ascending aortic aneurysms. METHODS CMR (3T) was prospectively performed in patients scheduled for aortic repair. TEE was performed intra-operatively; images were co-localized with MRI. GCS on CMR and TEE was quantified independently, blinded to results of the other modality. RESULTS 25 patients (54 ± 10 year-old, 88% male) were studied, inclusive of 13 genetically mediated and 12 degenerative aneurysms: CMR and TEE were performed within 12 ± 9 days. Pulse pressure (PP)-adjusted descending aortic TEE-derived GCS strongly correlated with cine-CMR-derived GCS (r = .75, P = .002) though absolute GCS and PP-adjusted values were slightly lower (5.40 ± 1.11 vs 6.49 ± 1.43% and 11.55 ± 3.04 vs 13.99 ± 4.53%, respectively). Similarly, TEE yielded slightly lower end-diastolic area (EDA [5.1 ± 1.7 cm2 vs 5.8 ± 1.3 cm2 , P = .004]) and end-systolic area (ESA [6.1 ± 1.9 cm2 vs 6.5 ± 1.7 cm2 , P = .10]), with significant correlations between the two modalities (r = .73, .76, P < .05 for all). CONCLUSIONS This exploratory study supports feasibility of TEE for assessing aortic GCS in a surgical at-risk population, as well as magnitude of agreement between intra-operative TEE and preoperative CMR. We found that there is a significant correlation between GCS and EDA and ESA aortic areas, but that TEE-derived parameters underestimated CMR values by a small but significant amount.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Maria C Palumbo
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Mohammed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Alexandra J Lopes
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Richard B Devereux
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Jiwon Kim
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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