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Minderhoud SCS, van Montfoort R, Meijs TA, Korteland SA, Bruse JL, Kardys I, Wentzel JJ, Voskuil M, Hirsch A, Roos-Hesselink JW, van den Bosch AE. Aortic geometry and long-term outcome in patients with a repaired coarctation. Open Heart 2024; 11:e002642. [PMID: 38806222 PMCID: PMC11138275 DOI: 10.1136/openhrt-2024-002642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE This study aims to compare aortic morphology between repaired coarctation patients and controls, and to identify aortic morphological risk factors for hypertension and cardiovascular events (CVEs) in coarctation patients. METHODS Repaired coarctation patients with computed tomography angiography (CTA) or magnetic resonance angiography (MRA) were included, followed-up and compared with sex-matched and age-matched controls. Three-dimensional aortic shape was reconstructed using patients' CTA or MRA, or four-dimensional flow cardiovascular magnetic resonance in controls, and advanced geometrical characteristics were calculated and visualised using statistical shape modelling. In patients, we examined the association of geometrical characteristics with (1) baseline hypertension, using multivariable logistic regression; and (2) cardiovascular events (CVE, composite of aortic complications, coronary artery disease, ventricular arrhythmias, heart failure hospitalisation, stroke, transient ischaemic attacks and cardiovascular death), using multivariable Cox regression. The least absolute shrinkage and selection operator (LASSO) method selected the most informative multivariable model. RESULTS Sixty-five repaired coarctation patients (23 years (IQR 19-38)) were included, of which 44 (68%) patients were hypertensive at baseline. After a median follow-up of 8.7 years (IQR 4.8-15.4), 27 CVEs occurred in 20 patients. Aortic arch dimensions were smaller in patients compared with controls (diameter p<0.001, wall surface area p=0.026, volume p=0.007). Patients had more aortic arch torsion (p<0.001) and a higher curvature (p<0.001). No geometrical characteristics were associated with hypertension. LASSO selected left ventricular mass, male sex, tortuosity and age for the multivariable model. Left ventricular mass (p=0.014) was independently associated with CVE, and aortic tortuosity showed a trend towards significance (p=0.070). CONCLUSION Repaired coarctation patients have a smaller aortic arch and a more tortuous course of the aorta compared with controls. Besides left ventricular mass index, geometrical features might be of importance in long-term risk assessment in coarctation patients.
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Affiliation(s)
- Savine C S Minderhoud
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rick van Montfoort
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Timion A Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan L Bruse
- Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Kolck J, Trippel TD, Philipp K, Gehle P, Geisel D, Beetz NL. Updated 2022 ACC/AHA Guideline Improves Concordance Between TTE and CT in Monitoring Marfan Snydrome and Related Disorders, but Relevant Measurement Differences Remain Frequent. Glob Heart 2024; 23:28. [PMID: 38737456 PMCID: PMC11086607 DOI: 10.5334/gh.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/16/2024] [Indexed: 05/14/2024] Open
Abstract
Background Patients diagnosed with Marfan syndrome or a related syndrome require frequent aorta monitoring using imaging techniques like transthoracic echocardiography (TTE) and computed tomography (CT). Accurate aortic measurement is crucial, as even slight enlargement (>2 mm) often necessitates surgical intervention. The 2022 ACC/AHA guideline for Aortic Disease Diagnosis and Management includes updated imaging recommendations. We aimed to compare these with the 2010 guideline. Methods This retrospective study involved 137 patients with Marfan syndrome or a related disorder, undergoing TTE and ECG-triggered CT. Aortic diameter measurements were taken based on the old 2010 guideline (TTE: inner edge to inner edge, CT: external diameter) and the new 2022 guideline (TTE: leading edge to leading edge, CT: internal diameter). Bland-Altman plots compared measurement differences. Results Using the 2022 guideline significantly reduced differences outside the clinical agreement limit from 49% to 26% for the aortic sinus and from 41% to 29% for the ascending aorta. Mean differences were -0.30 mm for the aortic sinus and +1.12 mm for the ascending aorta using the 2022 guideline, compared to -2.66 mm and +1.21 mm using the 2010 guideline. Conclusion This study demonstrates for the first time that the 2022 ACC/AHA guideline improves concordance between ECG-triggered CT and TTE measurements in Marfan syndrome patients, crucial for preventing life-threatening aortic complications. However, the frequency of differences >2 mm remains high. Clinical Relevance/Application Accurate aortic diameter measurement is vital for patients at risk of fatal aortic complications. While the 2022 guideline enhances concordance between imaging modalities, frequent differences >2 mm persist, potentially impacting decisions on aortic repair. The risk of repeat radiation exposure from ECG-triggered CT, considered the 'gold standard', continues to be justified.
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Affiliation(s)
- Johannes Kolck
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany
- BIH (Berlin Institute of Health), Berlin, Germany
| | - Tobias Daniel Trippel
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Internal Medicine –Cardiology, Charitéplatz 1, 10117 Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Karla Philipp
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Internal Medicine –Cardiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Petra Gehle
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Internal Medicine –Cardiology, Charitéplatz 1, 10117 Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dominik Geisel
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nick Lasse Beetz
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany
- BIH (Berlin Institute of Health), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
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3
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Keuning ZA, Hendriks PM, Duijnhouwer AL, Meccanici F, Siebelink HMJ, van den Hoven AT, Geenen LW, Eindhoven JA, Baggen VJM, Cuypers JAAE, Kauling RM, Roos-Hesselink JW, van den Bosch AE. Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients. CJC Open 2024; 6:1-10. [PMID: 38313345 PMCID: PMC10837668 DOI: 10.1016/j.cjco.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/20/2023] [Indexed: 02/06/2024] Open
Abstract
Background Bicuspid aortic valve (BAV) is a common congenital heart defect. Patients with BAV are at risk for long-term complications such as valve stenosis and regurgitation. This study aimed to investigate sex differences in blood and imaging biomarkers and to describe the long-term prognostic value of blood and echocardiographic biomarkers. Methods Patients were included from 2 prospective observational cohort studies; they underwent venous blood sampling and transthoracic echocardiography including speckle tracking. Analyzed blood biomarkers were red-cell distribution width (RDW), creatinine, C-reactive protein (CRP), troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP), and transforming growth factor-beta (TGF-β). Sex differences were analyzed at baseline. Associations between biomarkers and arrhythmia-free and intervention-free survival were determined by Cox regression, adjusted for age and sex. Results A total of 182 patients with BAV were included: median age 34; interquartile range [IQR]: 23-46 years; 55.5% male. CRP, NT-proBNP, and RDW were higher in women, whereas creatinine, troponin T and TGF-β were higher among men. After a median follow-up time of 6.9 (IQR: 6.5-9.9) years, arrhythmia-free and intervention-free survival was, 81.0% and 73.1%, respectively. NT-proBNP was associated with both arrhythmia-free and intervention-free survival (hazard ratio [HR], 1.94, P = 0.005 and HR, 2.06, P = 0.002, respectively). On echocardiography higher left atrial (LA) size, left ventricular end-diastolic diameter (LVEDD), left ventricular (LV) mass index and E/e' ratio were associated with lower arrhythmia-free survival, whereas higher LA size, LV mass index, aortic valve peak velocity, and aortic regurgitation were associated with lower intervention-free survival. Conclusions Differences were observed in blood biomarkers between men and women with BAV. Besides LV systolic parameters, diastolic LV function and NT-proBNP should have a more prominent role as prognostic markers in clinical care.
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Affiliation(s)
- Zoë A Keuning
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Paul M Hendriks
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Frederike Meccanici
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Allard T van den Hoven
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Laurie W Geenen
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jannet A Eindhoven
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vivan J M Baggen
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- ERN-GUARD-Heart: European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- ERN-GUARD-Heart: European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, The Netherlands
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4
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Tenisch E, Rutz T. The unmet needs for aortic diameter determination in patients with aortopathies. Int J Cardiol 2023; 393:131299. [PMID: 37657669 DOI: 10.1016/j.ijcard.2023.131299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Estelle Tenisch
- Pediatric Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tobias Rutz
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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5
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Vander Linden K, Vanderveken E, Van Hoof L, Maes L, Fehervary H, Dreesen S, Hendrickx A, Verbrugghe P, Rega F, Meuris B, Famaey N. Stiffness matters: Improved failure risk assessment of ascending thoracic aortic aneurysms. JTCVS OPEN 2023; 16:66-83. [PMID: 38204617 PMCID: PMC10775041 DOI: 10.1016/j.xjon.2023.09.008] [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: 05/24/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 01/12/2024]
Abstract
Objectives Rupture and dissection are feared complications of ascending thoracic aortic aneurysms caused by mechanical failure of the wall. The current method of using the aortic diameter to predict the risk of wall failure and to determine the need for surgical resection lacks accuracy. Therefore, this study aims to identify reliable and clinically measurable predictors for aneurysm rupture or dissection by performing a personalized failure risk analysis, including clinical, geometrical, histologic, and mechanical data. Methods The study cohort consisted of 33 patients diagnosed with ascending aortic aneurysms without genetic syndromes. Uniaxial tensile tests until failure were performed to determine the wall strength. Material parameters were fitted against ex vivo planar biaxial data and in vivo pressure-diameter relationships at diastole and systole, which were derived from multiphasic computed tomography (CT) scans. Using the resulting material properties and in vivo data, the maximal in vivo stress at systole was calculated, assuming a thin-walled axisymmetric geometry. The retrospective failure risk was calculated by comparing the peak wall stress at suprasystolic pressure with the wall strength. Results The distensibility coefficient, reflecting aortic compliance and derived from blood pressure measurements and multiphasic CT scans, outperformed predictors solely based on geometrical features in assessing the risk of aneurysm failure. Conclusions In a clinical setting, multiphasic CT scans followed by the calculation of the distensibility coefficient are of added benefit in patient-specific, clinical decision-making. The distensibility derived from the aneurysm volume change has the best predictive power, as it also takes the axial stretch into account.
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Affiliation(s)
| | - Emma Vanderveken
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lauranne Maes
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Heleen Fehervary
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
- FIBEr, KU Leuven Core Facility for Biomechanical Experimentation, Leuven, Belgium
| | - Silke Dreesen
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Amber Hendrickx
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nele Famaey
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
- FIBEr, KU Leuven Core Facility for Biomechanical Experimentation, Leuven, Belgium
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Thijssen CGE, Dekker S, Bons LR, Geenen LW, Gökalp AL, Takkenberg JJM, Mokhles MM, Bekkers JA, Boersma E, Bouwens E, van Kimmenade RRJ, Roos-Hesselink JW. Reply to letter to the editor: "Novel biomarkers associated with thoracic aortic disease". Int J Cardiol 2023; 388:131104. [PMID: 37285923 DOI: 10.1016/j.ijcard.2023.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Carlijn G E Thijssen
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Silvy Dekker
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Lidia R Bons
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Laurie W Geenen
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Arjen L Gökalp
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Elke Bouwens
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands; Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
| | - Roland R J van Kimmenade
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Limongelli G, Monda E, Lioncino M, Di Paolo F, Ferrara F, Vriz O, Calabro P, Bossone E, Pelliccia A. Aortic Root Diameter in Highly-Trained Competitive Athletes: Reference Values According to Sport and Prevalence of Aortic Enlargement. Can J Cardiol 2023; 39:889-897. [PMID: 36803973 DOI: 10.1016/j.cjca.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/25/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Studies exploring the extent of aortic root dilation across the different types of sport are limited. We aimed to define the physiological limits of aortic remodelling in a large population of healthy elite athletes in comparison with nonathletic controls. METHODS A total of 1995 consecutive athletes evaluated at the Institute of Sports Medicine (Rome, Italy) and 515 healthy controls underwent a comprehensive cardiovascular screening. The aortic diameter was measured at the level of the sinuses of Valsalva. The 99th percentile from the mean of the aortic diameter in the control population was used to define an abnormally enlarged aortic root dimension. RESULTS Athletes showed a larger aortic root diameter (30.6 [± 3.3] vs 28.1 [± 3.1] mm, P value < 0.001) than controls. The difference was evident in male and female athletes, regardless of sport- predominant component and level of intensity. The 99th percentile value for aortic root diameter in control male and female subjects was 37 mm and 32 mm, respectively. Based on these values, 50 (4.2%) male and 21 (2.6%) female athletes would have been diagnosed with an enlarged aortic root. However, aortic root diameter of clinical relevance-ie, ≥ 40 mm-was observed in only 17 male athletes (0.85%) and did not exceed > 44 mm. CONCLUSIONS Athletes show a mild, although significant, increased aortic dimension in comparison with healthy controls. The degree of aortic enlargement varies in relation to type of sports and sex. Eventually, only a small minority of athletes exhibited a markedly enlarged aortic diameter (ie, ≥ 40 mm) in a range of clinical relevance.
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Affiliation(s)
- Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational, Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St Bartholomew's Hospital, London, UK.
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational, Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St Bartholomew's Hospital, London, UK
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational, Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | | | - Olga Vriz
- Echocardiography Department, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Paolo Calabro
- Inherited and Rare Cardiovascular Diseases, Department of Translational, Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Eduardo Bossone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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8
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Agdamag AC, Patel P, Duval S, Konety S. Agreement of Proximal Thoracic Aorta Size by Two-Dimensional Transthoracic Echocardiography and Magnetic Resonance Angiography. Am J Cardiol 2023; 193:28-33. [PMID: 36863269 DOI: 10.1016/j.amjcard.2023.01.041] [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: 09/22/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 03/04/2023]
Abstract
There is currently a lack of uniformity in methods of aortic diameter measurements across different imaging modalities. In this study, we sought to evaluate the accuracy of transthoracic echocardiography (TTE) in comparison with magnetic resonance angiography (MRA) for the measurement of proximal thoracic aorta diameters. This is a retrospective analysis of 121 adult patients at our institution who had TTE and electrocardiogram (ECG)-gated MRA performed within 90 days of each other between 2013 and 2020. Measurements were made at the level of sinuses of Valsalva (SoV), sinotubular junction (STJ), and ascending aorta (AA) using leading edge-to-leading edge (LE) convention for TTE and inner-edge-to-inner-edge (IE) convention for MRA. Agreement was assessed using Bland-Altman methods. Intra- and interobserver variability were assessed by intraclass correlation. The average age of patients in the cohort was 62 years, and 69% of patients were male. The prevalence of hypertension, obstructive coronary artery disease, and diabetes was 66%, 20%, and 11%, respectively. The mean aortic diameter by TTE was SoV 3.8 ± 0.5 cm, STJ 3.5 ± 0.4 cm, and AA 4.1 ± 0.6 cm. The TTE-derived measurements were larger than the MRA ones by 0.2 ± 2 mm, 0.8 ± 2 mm, and 0.4 ± 3 mm at the level of SoV, STJ, and AA, respectively, but the differences were not statistically significant. There were no significant differences in the aorta measurements by TTE compared with MRA, when stratified by gender. In conclusion, transthoracic echocardiogram-derived proximal aorta measurements are comparable to MRA measurements. Our study validates current recommendations that TTE is an acceptable modality for screening and serial imaging of the proximal aorta.
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Affiliation(s)
- Arianne Clare Agdamag
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Suma Konety
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
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9
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Meccanici F, de Bruijn JWC, Dommisse JS, Takkenberg JJM, van den Bosch AE, Roos-Hesselink JW. Prevalence and development of aortic dilation and dissection in women with Turner syndrome: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2023; 21:133-144. [PMID: 36688313 DOI: 10.1080/14779072.2023.2172403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Women with Turner syndrome (TS) have an increased risk of aortic disease, reducing life-expectancy. This study aimed to systematically review the prevalence of thoracic aortic dilatation, aortic dimensions and growth, and the incidence of aortic dissection. METHODS A systematic literature search was conducted up to July 2022. Observational studies with an adult TS population were included, and studies including children aged <15 years old or specific TS populations were excluded. RESULTS In total 21 studies were included. The pooled prevalence of ascending aortic dilatation was 23% (95% CI 19-26) at a mean pooled age of 29 years (95% CI 26-32), while the incidence of aortic dissection was 164 per 100.000 patient-years (95% CI 95-284). Three reporting studies showed aortic growth over time to be limited. Risk factors for aortic dilation or dissection were older age, bicuspid aortic valve, aortic coarctation, and hypertension. CONCLUSION In adult TS women, ascending aortic dilatation is common and the hazard of aortic dissection increased compared to the general population, whereas aortic growth is limited. Conventional risk markers do not explain all aortic dissection cases; therefore, new imaging parameters and blood biomarkers are needed to improve prediction, allowing for patient-tailored follow-up and surgical decision-making.
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Affiliation(s)
- F Meccanici
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J W C de Bruijn
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J S Dommisse
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A E van den Bosch
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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10
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Geronzi L, Haigron P, Martinez A, Yan K, Rochette M, Bel-Brunon A, Porterie J, Lin S, Marin-Castrillon DM, Lalande A, Bouchot O, Daniel M, Escrig P, Tomasi J, Valentini PP, Biancolini ME. Assessment of shape-based features ability to predict the ascending aortic aneurysm growth. Front Physiol 2023; 14:1125931. [PMID: 36950300 PMCID: PMC10025384 DOI: 10.3389/fphys.2023.1125931] [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: 12/16/2022] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
The current guidelines for the ascending aortic aneurysm (AsAA) treatment recommend surgery mainly according to the maximum diameter assessment. This criterion has already proven to be often inefficient in identifying patients at high risk of aneurysm growth and rupture. In this study, we propose a method to compute a set of local shape features that, in addition to the maximum diameter D, are intended to improve the classification performances for the ascending aortic aneurysm growth risk assessment. Apart from D, these are the ratio DCR between D and the length of the ascending aorta centerline, the ratio EILR between the length of the external and the internal lines and the tortuosity T. 50 patients with two 3D acquisitions at least 6 months apart were segmented and the growth rate (GR) with the shape features related to the first exam computed. The correlation between them has been investigated. After, the dataset was divided into two classes according to the growth rate value. We used six different classifiers with input data exclusively from the first exam to predict the class to which each patient belonged. A first classification was performed using only D and a second with all the shape features together. The performances have been evaluated by computing accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUROC) and positive (negative) likelihood ratio LHR+ (LHR-). A positive correlation was observed between growth rate and DCR (r = 0.511, p = 1.3e-4) and between GR and EILR (r = 0.472, p = 2.7e-4). Overall, the classifiers based on the four metrics outperformed the same ones based only on D. Among the diameter-based classifiers, k-nearest neighbours (KNN) reported the best accuracy (86%), sensitivity (55.6%), AUROC (0.74), LHR+ (7.62) and LHR- (0.48). Concerning the classifiers based on the four shape features, we obtained the best accuracy (94%), sensitivity (66.7%), specificity (100%), AUROC (0.94), LHR+ (+∞) and LHR- (0.33) with support vector machine (SVM). This demonstrates how automatic shape features detection combined with risk classification criteria could be crucial in planning the follow-up of patients with ascending aortic aneurysm and in predicting the possible dangerous progression of the disease.
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Affiliation(s)
- Leonardo Geronzi
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
- Ansys France, Villeurbanne, France
- *Correspondence: Leonardo Geronzi,
| | - Pascal Haigron
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Antonio Martinez
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
- Ansys France, Villeurbanne, France
| | - Kexin Yan
- Ansys France, Villeurbanne, France
- LaMCoS, Laboratoire de Mécanique des Contacts et des Structures, CNRS UMR5259, INSA Lyon, University of Lyon, Villeurbanne, France
| | | | - Aline Bel-Brunon
- LaMCoS, Laboratoire de Mécanique des Contacts et des Structures, CNRS UMR5259, INSA Lyon, University of Lyon, Villeurbanne, France
| | - Jean Porterie
- Cardiac Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Siyu Lin
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Diana Marcela Marin-Castrillon
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Alain Lalande
- IMVIA Laboratory, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Olivier Bouchot
- Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | - Morgan Daniel
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Pierre Escrig
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Jacques Tomasi
- LTSI–UMR 1099, CHU Rennes, Inserm, University of Rennes, Rennes, France
| | - Pier Paolo Valentini
- Department of Enterprise Engineering “Mario Lucertini”, University of Rome Tor Vergata, Rome, Italy
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11
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Meccanici F, Schotte MH, Snoeren M, Bons LR, van den Hoven AT, Kardys I, Budde RPJ, van den Bosch AE, Duijnhouwer AL, Roos-Hesselink JW. Aortic dilation and growth in women with Turner syndrome. HEART (BRITISH CARDIAC SOCIETY) 2022; 109:102-110. [PMID: 35705330 DOI: 10.1136/heartjnl-2022-320922] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Women with Turner syndrome (TS) are at increased risk of aortic dissection, which is a life-threatening event associated with aortic dilation. Knowledge on the development of aortic dilation over time remains limited. This study aims to describe the prevalence of aortic dilation, to find associated factors and to study aortic growth in women with TS. METHODS In this prospective multicentre cohort study, consecutive adult women with genetically proven TS included between 2014 and 2016 underwent ECG-triggered multiphase CT angiography at baseline and after 3 years. Aortic diameters were measured at seven levels of the thoracic aorta using double oblique reconstruction and indexed for body surface area. Ascending aortic dilation was defined as an aortic size index >20 mm/m2. Aorta-related and cardiovascular events were collected. Statistical analysis included linear and logistic regression and linear mixed effects models. RESULTS The cohort consisted of 89 women with a median age of 34 years (IQR: 24-44). Ascending aortic dilation was found in 38.2% at baseline. At baseline, age (OR: 1.08 (95% CI 1.03 to 1.13), p<0.001), presence of bicuspid aortic valve (BAV) (OR: 7.09 (95% CI 2.22 to 25.9), p=0.002) and systolic blood pressure (OR: 1.06 (95% CI 1.02 to 1.11), p=0.004) were independently associated with ascending aortic dilation. During a median follow-up of 3.0 (2.4-3.6) years (n=77), significant aortic growth was found only at the sinotubular junction (0.20±1.92 mm, p=0.021). No aortic dissection occurred, one patient underwent aortic surgery and one woman died. CONCLUSIONS In women with TS, ascending aortic dilation is common and associated with age, BAV and systolic blood pressure. Aortic diameters were stable during a 3-year follow-up, apart from a significant yet not clinically relevant increase at the sinotubular junction, which may suggest a more benign course of progression than previously reported.
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Affiliation(s)
| | | | - Miranda Snoeren
- Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Lidia R Bons
- Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Isabella Kardys
- Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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12
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Beetz NL, Trippel TD, Philipp K, Maier C, Walter-Rittel T, Shnayien S, Gehle P. Discrepancy of echocardiography and computed tomography in initial assessment and 2-year follow-up for monitoring Marfan syndrome and related disorders. Sci Rep 2022; 12:15333. [PMID: 36097197 PMCID: PMC9468173 DOI: 10.1038/s41598-022-19662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with Marfan syndrome and related disorders are at risk for aortic dissection and aortic rupture and therefore require appropriate monitoring. Computed tomography (CT) and transthoracic echocardiography (TTE) are routinely used for initial diagnosis and follow-up. The purpose of this study is to compare whole-heart CT and TTE aortic measurement for initial work-up, 2-year follow-up, and detection of progressive aortic enlargement. This retrospective study included 95 patients diagnosed with Marfan syndrome or a related disorder. All patients underwent initial work-up including aortic diameter measurement using both electrocardiography-triggered whole-heart CT and TTE. Forty-two of these patients did not undergo aortic repair after initial work-up and were monitored by follow-up imaging within 2 years. Differences between the two methods for measuring aortic diameters were compared using Bland-Altman plots. The acceptable clinical limit of agreement (acLOA) for initial work-up, follow-up, and progression within 2 years was predefined as < ± 2 mm. Bland-Altman analysis revealed a small bias of 0.2 mm with wide limits of agreement (LOA) from + 6.3 to - 5.9 mm for the aortic sinus and a relevant bias of - 1.6 mm with wide LOA from + 5.6 to - 8.9 mm for the ascending aorta. Follow-up imaging yielded a small bias of 0.5 mm with a wide LOA from + 6.7 to - 5.8 mm for the aortic sinus and a relevant bias of 1.1 mm with wide LOA from + 8.1 to - 10.2 mm for the ascending aorta. Progressive aortic enlargement at follow-up was detected in 57% of patients using CT and 40% of patients using TTE. Measurement differences outside the acLOA were most frequently observed for the ascending aorta. Whole-heart CT and TTE measurements show good correlation, but the frequency of measurement differences outside the acLOA is high. TTE systematically overestimates aortic diameters. Therefore, whole-heart CT may be preferred for aortic monitoring of patients with Marfan syndrome and related disorders. TTE remains an indispensable imaging tool that provides additional information not available with CT.
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Affiliation(s)
- Nick Lasse Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Tobias Daniel Trippel
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Karla Philipp
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christoph Maier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Petra Gehle
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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13
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4D Flow MRI in Ascending Aortic Aneurysms: Reproducibility of Hemodynamic Parameters. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
(1) Background: Aorta hemodynamics have been associated with aortic remodeling, but the reproducibility of its assessment has been evaluated marginally in patients with thoracic aortic aneurysm (TAA). The current study evaluated intra- and interobserver reproducibility of 4D flow MRI-derived hemodynamic parameters (normalized flow displacement, flow jet angle, wall shear stress (WSS) magnitude, axial WSS, circumferential WSS, WSS angle, vorticity, helicity, and local normalized helicity (LNH)) in TAA patients; (2) Methods: The thoracic aorta of 20 patients was semi-automatically segmented on 4D flow MRI data in 5 systolic phases by 3 different observers. Each time-dependent segmentation was manually improved and partitioned into six anatomical segments. The hemodynamic parameters were quantified per phase and segment. The coefficient of variation (COV) and intraclass correlation coefficient (ICC) were calculated; (3) Results: A total of 2400 lumen segments were analyzed. The mean aneurysm diameter was 50.8 ± 2.7 mm. The intra- and interobserver analysis demonstrated a good reproducibility (COV = 16–30% and ICC = 0.84–0.94) for normalized flow displacement and jet angle, a very good-to-excellent reproducibility (COV = 3–26% and ICC = 0.87–1.00) for all WSS components, helicity and LNH, and an excellent reproducibility (COV = 3–10% and ICC = 0.96–1.00) for vorticity; (4) Conclusion: 4D flow MRI-derived hemodynamic parameters are reproducible within the thoracic aorta in TAA patients.
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14
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Fleischmann D, Afifi RO, Casanegra AI, Elefteriades JA, Gleason TG, Hanneman K, Roselli EE, Willemink MJ, Fischbein MP. Imaging and Surveillance of Chronic Aortic Dissection: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2022; 15:e000075. [PMID: 35172599 DOI: 10.1161/hci.0000000000000075] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
All patients surviving an acute aortic dissection require continued lifelong surveillance of their diseased aorta. Late complications, driven predominantly by chronic false lumen degeneration and aneurysm formation, often require surgical, endovascular, or hybrid interventions to treat or prevent aortic rupture. Imaging plays a central role in the medical decision-making of patients with chronic aortic dissection. Accurate aortic diameter measurements and rigorous, systematic documentation of diameter changes over time with different imaging equipment and modalities pose a range of practical challenges in these complex patients. Currently, no guidelines or recommendations for imaging surveillance in patients with chronic aortic dissection exist. In this document, we present state-of-the-art imaging and measurement techniques for patients with chronic aortic dissection and clarify the need for standardized measurements and reporting for lifelong surveillance. We also examine the emerging role of imaging and computer simulations to predict aortic false lumen degeneration, remodeling, and biomechanical failure from morphological and hemodynamic features. These insights may improve risk stratification, individualize contemporary treatment options, and potentially aid in the conception of novel treatment strategies in the future.
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15
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Dekker S, Thijssen CGE, Linde DV, Vd Laar IMBH, Saris JJ, van Es ACGM, Doormaal PJV, van Bronswijk P, van Kooten F, Roos-Hesselink JW. Neurovascular abnormalities in patients with Loeys-Dietz syndrome type III. Eur J Med Genet 2022; 65:104424. [PMID: 35031499 DOI: 10.1016/j.ejmg.2022.104424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 11/03/2022]
Abstract
The aim of this article is to describe neurovascular findings in patients with Loeys Dietz syndrome type III and their possible clinical impact. Loeys Dietz syndrome type III, caused by pathogenic SMAD3 variants, is an autosomal dominant syndrome characterized by aneurysms and arterial tortuosity in combination with osteoarthritis. Neurovascular abnormalities have been described in other heritable aortic syndromes, however, reliable data in Loeys Dietz syndrome type III is missing. In our tertiary center, all adult patients with confirmed Loeys Dietz syndrome type III are followed in a standardized aorta outpatient clinic including Computed Tomography Angiography (CTA) of the head and neck region at baseline and (tri) yearly during follow-up. We performed an analysis of the neurovascular imaging findings and clinical follow-up. The primary outcome was a combined endpoint of mortality, dissection, cerebral vascular event and intervention. In addition, tortuosity and vascular growth were assessed. In total 26 patients (mean age 38.4 years, 38.5% males) underwent 102 (mean 3.9 (Schepers et al., 2018; Van Der Linde et al., 2012; van de Laar et al., 2011; van de Laar et al., 2012; Loeys, 2006; van den Hoven et al., 2018; Regalado et al., 2011; Hostetler et al., 2019) per patient) neurovascular Computed Tomography Angiography scans between 2010 and 2021. In 84.6% some form of neurovascular abnormality was found. The abnormalities at baseline were aneurysm (26.9%) dissection flap (7.7%), arterial tortuosity (61.5%), arterial coiling (23.1%) and arterial kinking (3.8%). During follow up (mean 8.85 (Schepers et al., 2018; Van Der Linde et al., 2012; van de Laar et al., 2011; van de Laar et al., 2012; Loeys, 2006; van den Hoven et al., 2018; Regalado et al., 2011; Hostetler et al., 2019; Rodrigues et al., 2009; Bons et al., 2019; Weibel) years) one patient suffered from sudden death and one patient needed a neuro-radiological intervention. No cerebral bleeding or stroke occurred. In conclusion, neurovascular imaging in Loeys Dietz syndrome type III patients revealed abnormalities such as aneurysm, tortuosity, coiling and kinking in the vast majority of patients, but clinical events were rare. Neurovascular screening and follow up is advised in all Loeys Dietz syndrome type III patients.
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Affiliation(s)
- Silvy Dekker
- Department of Congenital Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Denise Vd Linde
- Department of Congenital Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Jasper J Saris
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Paul van Bronswijk
- Department of Congenital Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Fop van Kooten
- Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
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16
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Minderhoud SCS, Roos-Hesselink JW, Chelu RG, Bons LR, van den Hoven AT, Korteland SA, van den Bosch AE, Budde RPJ, Wentzel JJ, Hirsch A. Wall shear stress angle is associated with aortic growth in bicuspid aortic valve patients. Eur Heart J Cardiovasc Imaging 2022; 23:1680-1689. [PMID: 34977931 DOI: 10.1093/ehjci/jeab290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/18/2021] [Indexed: 02/01/2023] Open
Abstract
AIMS Aortic wall shear stress (WSS) distributions in bicuspid aortic valve (BAV) patients have been associated with aortic dilatation, but prospective, longitudinal data are missing. This study assessed differences in aortic WSS distributions between BAV patients and healthy controls and determined the association of WSS with aortic growth in patients. METHODS AND RESULTS Sixty subjects underwent four-dimensional (4D) flow cardiovascular magnetic resonance of the thoracic aorta (32 BAV patients and 28 healthy controls). Peak velocity, pulse wave velocity, aortic distensibility, peak systolic WSS (magnitude, axial, and circumferential), and WSS angle were assessed. WSS angle is defined as the angle between the WSSmagnitude and WSSaxial component. In BAV patients, three-year computed tomography angiography-based aortic volumetric growth was determined in the proximal and entire ascending aorta. WSSaxial was significantly lower in BAV patients compared with controls (0.93 vs. 0.72 Pa, P = 0.047) and WSScircumferential and WSS angle were significantly higher (0.29 vs. 0.64 Pa and 18° vs. 40°, both P < 0.001). Significant volumetric growth of the proximal ascending aorta occurred in BAV patients (from 49.1 to 52.5 cm3, P = 0.003). In multivariable analysis corrected for baseline aortic volume and diastolic blood pressure, WSS angle was the only parameter independently associated with proximal aortic growth (P = 0.031). In the entire ascending aorta, besides the WSS angle, the WSSmagnitude was also independently associated with growth. CONCLUSION Increased WSScircumferential and especially WSS angle are typical in BAV patients. WSS angle was found to predict aortic growth. These findings highlight the potential role of WSS measurements in BAV patients to stratify patients at risk for aortic dilation.
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Affiliation(s)
- Savine C S Minderhoud
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Raluca G Chelu
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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17
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Servato ML, Teixidó-Turá G, Sabate-Rotes A, Galian-Gay L, Gutiérrez L, Valente F, Fernandez-Galera R, Casas G, López-Sainz A, González-Alujas MT, Sao-Aviles A, Ferreira I, Rodríguez-Palomares J, Evangelista A. Are Aortic Root and Ascending Aorta Diameters Measured by the Pediatric versus the Adult American Society of Echocardiography Guidelines Interchangeable? J Clin Med 2021; 10:jcm10225290. [PMID: 34830571 PMCID: PMC8617792 DOI: 10.3390/jcm10225290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. However, there is no uniformity among experts regarding ascending aorta diameter quantification by echocardiography. The aim of this study was to compare maximum aortic root and ascending aorta diameters determined by the diastolic leading edge (DLE) and the systolic inner edge (SIE) conventions in adult and pediatric patients with inherited cardiovascular diseases. Transthoracic echocardiograms were performed in 328 consecutive patients (260 adults and 68 children). Aorta diameters were measured twice at the root and ascending aorta by the DLE convention following the 2015 American Society of Echocardiography (ASE) adult guidelines and the SIE convention following the 2010 ASE pediatric guidelines. Comparison of the diameters measured by the two conventions in the overall population showed a non-significant underestimation of the diameter measured by the SIE convention at root level of 0.28 mm (CI -1.36; 1.93) and at tubular ascending aorta level of 0.17 mm (CI -1.69; 2.03). Intraobserver and interobserver variability were excellent. Maximum aorta diameter measured by the leading edge convention in end-diastole and the inner edge convention in mid-systole had similar values to a mild non-significant underestimation of the inner-to-inner method that permits them to be interchangeable when used in clinical practice.
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Affiliation(s)
- Maria Luz Servato
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Gisela Teixidó-Turá
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Anna Sabate-Rotes
- Department of Pediatric Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain;
| | - Laura Galian-Gay
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Laura Gutiérrez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Filipa Valente
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Ruben Fernandez-Galera
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Guillem Casas
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Angela López-Sainz
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - M. Teresa González-Alujas
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Augusto Sao-Aviles
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Ignacio Ferreira
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Jose Rodríguez-Palomares
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Arturo Evangelista
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
- Teknon Medical Center-Quirón Salud, Heart Institute, 08022 Barcelona, Spain
- Correspondence:
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18
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Beetz NL, Maier C, Shnayien S, Trippel TD, Gehle P, Fehrenbach U, Geisel D. Artificial intelligence-based analysis of body composition in Marfan: skeletal muscle density and psoas muscle index predict aortic enlargement. J Cachexia Sarcopenia Muscle 2021; 12:993-999. [PMID: 34137512 PMCID: PMC8350208 DOI: 10.1002/jcsm.12731] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with Marfan syndrome are at risk for aortic enlargement and are routinely monitored by computed tomography (CT) imaging. The purpose of this study is to analyse body composition using artificial intelligence (AI)-based tissue segmentation in patients with Marfan syndrome in order to identify possible predictors of progressive aortic enlargement. METHODS In this study, the body composition of 25 patients aged ≤50 years with Marfan syndrome and no prior aortic repair was analysed at the third lumbar vertebra (L3) level from a retrospective dataset using an AI-based software tool (Visage Imaging). All patients underwent electrocardiography-triggered CT of the aorta twice within 2 years for suspected progression of aortic disease, suspected dissection, and/or pre-operative evaluation. Progression of aortic enlargement was defined as an increase in diameter at the aortic sinus or the ascending aorta of at least 2 mm. Patients meeting this definition were assigned to the 'progressive aortic enlargement' group (proAE group) and patients with stable diameters to the 'stable aortic enlargement' group (staAE group). Statistical analysis was performed using the Mann-Whitney U test. Two possible body composition predictors of aortic enlargement-skeletal muscle density (SMD) and psoas muscle index (PMI)-were analysed further using multivariant logistic regression analysis. Aortic enlargement was defined as the dependent variant, whereas PMI, SMD, age, sex, body mass index (BMI), beta blocker medication, and time interval between CT scans were defined as independent variants. RESULTS There were 13 patients in the proAE group and 12 patients in the staAE group. AI-based automated analysis of body composition at L3 revealed a significantly increased SMD measured in Hounsfield units (HUs) in patients with aortic enlargement (proAE group: 50.0 ± 8.6 HU vs. staAE group: 39.0 ± 15.0 HU; P = 0.03). PMI also trended towards higher values in the proAE group (proAE group: 6.8 ± 2.3 vs. staAE group: 5.6 ± 1.3; P = 0.19). Multivariate logistic regression revealed significant prediction of aortic enlargement for SMD (P = 0.05) and PMI (P = 0.04). CONCLUSIONS Artificial intelligence-based analysis of body composition at L3 in Marfan patients is feasible and easily available from CT angiography. Analysis of body composition at L3 revealed significantly higher SMD in patients with progressive aortic enlargement. PMI and SMD significantly predicted aortic enlargement in these patients. Using body composition as a predictor of progressive aortic enlargement may contribute information for risk stratification regarding follow-up intervals and the need for aortic repair.
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Affiliation(s)
- Nick Lasse Beetz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Maier
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Seyd Shnayien
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Tobias Daniel Trippel
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Internal Medicine - Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Petra Gehle
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Internal Medicine - Cardiology, Berlin, Germany
| | - Uli Fehrenbach
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
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19
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Boccalini S, Bons LR, van den Hoven AT, van den Bosch AE, Krestin GP, Roos-Hesselink J, Budde RPJ. Bicuspid aortic valve annulus: assessment of geometry and size changes during the cardiac cycle as measured with a standardized method to define the annular plane. Eur Radiol 2021; 31:8116-8129. [PMID: 33895857 PMCID: PMC8523432 DOI: 10.1007/s00330-021-07916-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 12/02/2022]
Abstract
Purpose Bicuspid aortic valve (BAV) is a complex malformation affecting not merely the aortic valve. However, little is known regarding the dynamic physiology of the aortic annulus in these patients and whether it is similar to tricuspid aortic valves (TAV). Determining the BAV annular plane is more challenging than for TAV. Our aim was to present a standardized methodology to determine BAV annulus and investigate its changes in shape and dimensions during the cardiac cycle. Methods BAV patients were prospectively included and underwent an ECG-gated cardiac CTA. The annulus plane was manually identified on reconstructions at 5% intervals of the cardiac cycle with a new standardized method for different BAV types. Based on semi-automatically defined contours, maximum and minimum diameter, area, area-derived diameter, perimeter, asymmetry ratio (AR), and relative area were calculated. Differences of dynamic annular parameters were assessed also per BAV type. Results Of the 55 patients included (38.4 ± 13.3 years; 58% males), 38 had BAV Sievers type 1, 10 type 0, and 7 type 2. The minimum diameter, perimeter, area, and area-derived diameter were significantly higher in systole than in diastole with a relative change of 13.7%, 4.8%, 13.7%, and 7.2% respectively (all p < 0.001). The AR was ≥ 1.1 in all phases, indicating an elliptic shape, with more pronounced flattening in diastole (p < 0.001). Different BAV types showed comparable dynamic changes. Conclusions BAV annulus undergo significant changes in shape during the cardiac cycle with a wider area in systole and a more elliptic conformation in diastole regardless of valve type. Key Points • A refined method for the identification of the annulus plane on CT scans of patients with bicuspid aortic valves, tailored for the specific anatomy of each valve type, is proposed. • The annulus of patients with bicuspid aortic valves undergoes significant changes during the cardiac cycle with a wider area and more circular shape in systole regardless of valve type. • As compared to previously published data, the bicuspid aortic valve annulus has physiological dynamics similar to that encountered in tricuspid valves but with overall larger dimensions. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07916-8.
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Affiliation(s)
- Sara Boccalini
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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20
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Kooijman SS, Duijnhouwer AL, van Kimmenade RRJ, van Dijk APJ, Hink E, de Boer MJ, Timmermans J, Roos-Hesselink JW. Influence of Pregnancy on Aortic Diameter in Women With the Turner Syndrome. Am J Cardiol 2021; 140:122-127. [PMID: 33144162 DOI: 10.1016/j.amjcard.2020.10.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Abstract
Women with Turner syndrome (TS) have high prevalence of cardiovascular anomalies. Literature suggests pregnancy is associated with a higher dissection risk, presumably preceded by aortic dilatation. Whether the aortic diameter truly changes during pregnancy in TS is not well investigated. This study aims to evaluate ascending aortic diameter change during pregnancy and reports on cardiac events during and directly after pregnancy. This tertiary hospital retrospective study investigated all TS women pregnancies (2009 to 2018). Outcome parameters included aortic diameter growth and aortic complications, specifically dissection. Thirty-five pregnancies in 30 TS women, 57% assisted by oocyte donation. Mean age at delivery 32 ± 5 years. In 27 pregnancies of 22 women imaging was available. From over 350 childless TS women a comparison group of 27 was individually matched. The median ascending aortic diameter growth between pre- and postpregnancy imaging was 1.0 mm (IQR -1.0; 2.0), no significant change (p = 0.077). Whether the patient had a bicuspid aortic valve (p = 0.571), monosomy X or mosaic karyotype (p = 0.071) or spontaneous pregnancy or resulting from oocyte donation (p = 0.686) had no significant influence on diameter change. Aortic growth between pregnancy and matched childless group (0.23 vs 0.32 mm/year, p = 0.788) was not significant over 3.3 ± 2 versus 4.4 ± 1 years. During pregnancy or the first 6 months after delivery no aortic complications were observed. In conclusion, this study suggests pregnancy in TS women does not induce faster ascending aortic diameter increase. Also not in presence of a bicuspid aortic valve, monosomy X karyotype, and oocyte donation. No aortic complications occurred. Based on current study pregnancy in TS women seems safe.
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21
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Luan J, Mao L, Zhu Z, Fu W, Zhu T. New indicators for systematic assessment of aortic morphology: a narrative review. J Thorac Dis 2021; 13:372-383. [PMID: 33569218 PMCID: PMC7867839 DOI: 10.21037/jtd-20-2728] [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] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In order to prevent the occurrence of aortic adverse events in ascending thoracic aortic aneurysm patients, preventive surgery is the sole option in case of large aneurysm. Identifying high-risk patients timely and accurately requires effective predictive indicators of aortic adverse events and accurate risk stratification thresholds. Absolute diameter measured after a single imaging examination, which has been used as the predictive indicator for decades, has been proved to be ineffective for risk stratification in moderately dilated aorta. Previously, new indicators combining absolute diameters with personalized parameters have been reported to show better predictive power of aortic adverse events than absolute diameters by correcting the effect of these parameters on the diameters. Meanwhile, combining three-dimensional parameters to formulate risk stratification thresholds not only may characterize the aortic risk morphology more precisely, but also predict aortic adverse events more accurately. These new indicators may provide more systematic assessment methods of patients’ risk, formulate more personalized intervention strategies for ascending thoracic aortic aneurysm patients, and also provide a basis for researchers to develop more accurate and effective risk thresholds. We also highlight that the algorithm obtained by combining multiple indicators may be a better choice compared with single indicator, but this still requires the support of more evidence. Due to the particularity of syndromic aortic disease, whether these new indicators can be used for its risk stratification is still uncertain. Therefore, the scope of this manuscript does not include this kind of disease.
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Affiliation(s)
- Jingyang Luan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Le Mao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziqing Zhu
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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22
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Bons LR, Van Den Hoven AT, Malik M, Van Den Bosch AE, McGhie JS, Duijnhouwer AL, Siebelink HMJ, Hirsch A, Devos DH, Rietzschel E, von der Thüsen JH, van de Laar IMBH, Verhagen JMA, van der Pluijm I, Budde RPJ, Roos-Hesselink JW. Abnormal Aortic Wall Properties in Women with Turner Syndrome. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2020; 8:121-131. [PMID: 33368097 PMCID: PMC7758113 DOI: 10.1055/s-0040-1714384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Turner syndrome (TS) is associated with aortic dilatation and dissection, but the underlying process is unclear. The aim of this study was to investigate the elastic properties and composition of the aortic wall in women with TS.
Methods
In this cross-sectional study, 52 women with TS aged 35 ± 13 years (50% monosomy, 12 with bicuspid aortic valve [BAV] and 4 with coarctation) were investigated using carotid-femoral pulse wave velocity (CF-PWV) by echocardiography and ascending aortic distensibility (AAD) and aortic arch pulse wave velocity (AA-PWV) by magnetic resonance imaging (MRI). As control group, 13 women with BAV without TS and 48 healthy patients were included.
Results
Women with TS showed a higher AA-PWV (β = 1.08, confidence interval [CI]: 0.54–1.62) after correcting for age and comorbidities compared with controls. We found no significant difference in AAD and CF-PWV. In women with TS, the presence of BAV, coarctation of the aorta, or monosomy (45, X) was not associated with aortic stiffness. In addition, aortic tissue samples were investigated with routine and immunohistochemical stains in five additional women with TS who were operated. The tissue showed more compact smooth muscle cell layers with abnormal deposition and structure of elastin and diminished or absent expression of contractile proteins desmin, actin, and caldesmon, as well as the progesterone receptor.
Conclusion
Both aortic arch stiffness measurements on MRI and histomorphological changes point toward an inherent abnormal thoracic aortic wall in women with TS.
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Affiliation(s)
- Lidia R Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Allard T Van Den Hoven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maira Malik
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E Van Den Bosch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacky S McGhie
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Alexander Hirsch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daniel H Devos
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Ernst Rietzschel
- Department of Cardiology, Ghent University Hospital, Gent, Belgium
| | - Jan H von der Thüsen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid M B H van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith M A Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid van der Pluijm
- Department of Vascular Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Molecular Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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23
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Juffermans JF, Westenberg JJM, van den Boogaard PJ, Roest AAW, van Assen HC, van der Palen RLF, Lamb HJ. Reproducibility of Aorta Segmentation on 4D Flow MRI in Healthy Volunteers. J Magn Reson Imaging 2020; 53:1268-1279. [PMID: 33179389 PMCID: PMC7984392 DOI: 10.1002/jmri.27431] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background Hemodynamic aorta parameters can be derived from 4D flow MRI, but this requires lumen segmentation. In both commercially available and research 4D flow MRI software tools, lumen segmentation is mostly (semi‐)automatically performed and subsequently manually improved by an observer. Since the segmentation variability, together with 4D flow MRI data and image processing algorithms, will contribute to the reproducibility of patient‐specific flow properties, the observer's lumen segmentation reproducibility and repeatability needs to be assessed. Purpose To determine the interexamination, interobserver reproducibility, and intraobserver repeatability of aortic lumen segmentation on 4D flow MRI. Study Type Prospective and retrospective. Population A healthy volunteer cohort of 10 subjects who underwent 4D flow MRI twice. Also, a clinical cohort of six subjects who underwent 4D flow MRI once. Field Strength/Sequence 3T; time‐resolved three‐directional and 3D velocity‐encoded sequence (4D flow MRI). Assessment The thoracic aorta was segmented on the 4D flow MRI in five systolic phases. By positioning six planes perpendicular to a segmentation's centerline, the aorta was divided into five segments. The volume, surface area, centerline length, maximal diameter, and curvature radius were determined for each segment. Statistical Tests To assess the reproducibility, the coefficient of variation (COV), Pearson correlation coefficient (r), and intraclass correlation coefficient (ICC) were calculated. Results The interexamination and interobserver reproducibility and intraobserver repeatability were comparable for each parameter. For both cohorts there was very good reproducibility and repeatability for volume, surface area, and centerline length (COV = 10–32%, r = 0.54–0.95 and ICC = 0.65–0.99), excellent reproducibility and repeatability for maximal diameter (COV = 3–11%, r = 0.94–0.99, ICC = 0.94–0.99), and good reproducibility and repeatability for curvature radius (COV = 25–62%, r = 0.73–0.95, ICC = 0.84–0.97). Data Conclusion This study demonstrated no major reproducibility and repeatability limitations for 4D flow MRI aortic lumen segmentation. Level of Evidence 3 Technical Efficacy Stage 2
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Affiliation(s)
- Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Arno A W Roest
- Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roel L F van der Palen
- Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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24
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van den Hoven AT, Yilmazer S, Chelu RG, van Grootel RWJ, Minderhoud SCS, Bons LR, van Berendoncks AM, Duijnhouwer AL, Siebelink HMJ, van den Bosch AE, Budde RPJ, Roos-Hesselink JW, Hirsch A. Left ventricular global longitudinal strain in bicupsid aortic valve patients: head-to-head comparison between computed tomography, 4D flow cardiovascular magnetic resonance and speckle-tracking echocardiography. Int J Cardiovasc Imaging 2020; 36:1771-1780. [PMID: 32451876 PMCID: PMC7438282 DOI: 10.1007/s10554-020-01883-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
Left ventricular global longitudinal strain (LVGLS) analysis is a sensitive measurement of myocardial deformation most often done using speckle-tracking transthoracic echocardiography (TTE). We propose a novel approach to measure LVGLS using feature-tracking software on the magnitude dataset of 4D flow cardiovascular magnetic resonance (CMR) and compare it to dynamic computed tomography (CT) and speckle tracking TTE derived measurements. In this prospective cohort study 59 consecutive adult patients with a bicuspid aortic valve (BAV) were included. The study protocol consisted of TTE, CT, and CMR on the same day. Image analysis was done using dedicated feature-tracking (4D flow CMR and CT) and speckle-tracking (TTE) software, on apical 2-, 3-, and 4-chamber long-axis multiplanar reconstructions (4D flow CMR and CT) or standard apical 2-, 3-, and 4-chamber acquisitions (TTE). CMR and CT GLS analysis was feasible in all patients. Good correlations were observed for GLS measured by CMR (− 21 ± 3%) and CT (− 20 ± 3%) versus TTE (− 20 ± 3%, Pearson’s r: 0.67 and 0.65, p < 0.001). CMR also correlated well with CT (Pearson’s r 0.62, p < 0.001). The inter-observer analysis showed moderate to good reproducibility of GLS measurement by CMR, CT and TTE (Pearsons’s r: 0.51, 0.77, 0.70 respectively; p < 0.05). Additionally, ejection fraction (EF), end-diastolic and end-systolic volume measurements (EDV and ESV) correlated well between all modalities (Pearson’s r > 0.61, p < 0.001). Feature-tracking GLS analysis is feasible using the magnitude images acquired with 4D flow CMR. GLS measurement by CMR correlates well with CT and speckle-tracking 2D TTE. GLS analysis on 4D flow CMR allows for an integrative approach, integrating flow and functional data in a single sequence. Not applicable, observational study.
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Affiliation(s)
- Allard T. van den Hoven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sultan Yilmazer
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Raluca G. Chelu
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roderick W. J. van Grootel
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Savine C. S. Minderhoud
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lidia R. Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - An M. van Berendoncks
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Anthonie L. Duijnhouwer
- Department of Cardiology, Radboud University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hans-Marc J. Siebelink
- Department of Cardiology, Leiden University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E. van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Ricardo P. J. Budde
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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25
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Bons LR, Geenen LW, van den Hoven AT, Dik WA, van den Bosch AE, Duijnhouwer AL, Siebelink HMJ, Budde RPJ, Boersma E, Wessels MW, van de Laar IMBH, DeRuiter MC, Goumans MJ, Loeys BL, Roos-Hesselink JW. Blood biomarkers in patients with bicuspid aortic valve disease. J Cardiol 2020; 76:287-294. [PMID: 32265086 DOI: 10.1016/j.jjcc.2020.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/10/2020] [Accepted: 02/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with a bicuspid aortic valve (BAV) are at risk of developing valve deterioration and aortic dilatation. We aimed to investigate whether blood biomarkers are associated with disease stage in patients with BAV. METHODS Serum levels of high sensitivity C-reactive protein (hsCRP), high sensitivity troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and total transforming growth factor-beta 1 (TGF-ß1) were measured in adult BAV patients with valve dysfunction or aortic pathology. Age-matched general population controls were included for TGFß-1 measurements. Correlation analyses and multivariable linear regression were used to determine the association between (2log-transformed) biomarker levels and aortic valve regurgitation, aortic valve stenosis, aortic dilatation, or left ventricular function. RESULTS hsCRP and hsTnT were measured in the total group of 183 patients (median age 34 years, 25th-75th percentile 23-46), NT-proBNP in 162 patients, and TGF-ß1 beta in 108 patients. Elevated levels of NT-proBNP were found in 20% of the BAV patients, elevated hsTnT in 6%, and elevated hsCRP in 7%. Higher hsTnT levels were independently associated with aortic regurgitation [odds ratio per doubling (OR2log) 1.34, 95% CI 1.01;1.76] and higher NT-proBNP levels with aortic valve maximal velocity (ß2log 0.17, 95%CI 0.07;0.28) and aortic regurgitation (OR2log 1.41, 95%CI 1.11;1.79). Both BAV patients with (9.9 ± 2.7 ng/mL) and without aortic dilatation (10.4 ± 2.9 ng/mL) showed lower TGF-ß1 levels compared to general population controls (n = 85, 11.8 ± 3.2 ng/mL). CONCLUSIONS Higher NT-proBNP and hsTNT levels were associated with aortic valve disease in BAV patients. TGF-ß1 levels were lower in BAV patients than in the general population, and not related to aortic dilatation. Longitudinal data are needed to further investigate the prognostic value of biomarkers in these patients.
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Affiliation(s)
- Lidia R Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laurie W Geenen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem A Dik
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Clinical Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marja W Wessels
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid M B H van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Laboratory for Cardiovascular Cell Biology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bart L Loeys
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Multimodality Assessment of Thoracic Aortic Dimensions: Comparison of Computed Tomography Angiography, Magnetic Resonance Imaging, and Echocardiography Measurements. J Thorac Imaging 2020; 35:399-406. [PMID: 32251236 DOI: 10.1097/rti.0000000000000514] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare thoracic aortic measurements between computed tomography (CT), magnetic resonance imaging (MRI), and transthoracic echocardiography (TTE). MATERIALS AND METHODS A total of 127 patients (mean age: 45±18 y, 49% male) who had undergone CT and MRI evaluation of the thoracic aorta at a single tertiary referral hospital within a 6-month interval between 2007 and 2017 were included in this retrospective study. TTE studies performed within the same 6-month interval were also evaluated. Thoracic aortic measurements were blindly evaluated using multiple techniques and were compared between modalities. RESULTS There was no significant difference in maximum aortic root diameter between CT and MRI when using the inner lumen-to-inner lumen technique (mean difference: 0.2±1.4 mm, P=0.51) or the outer lumen-to-outer lumen technique (mean difference: 0.5±1.4 mm, P=0.07). There were no significant differences between CT and MRI at any other level except for the distal descending aorta (20.2±4.6 vs. 19.8±4.6 mm, P<0.001). However, aortic root measurements by TTE using the leading edge-to-leading edge technique were significantly smaller compared with maximum aortic root diameters using the inner lumen-to-inner lumen and outer lumen-to-outer lumen techniques by both CT (mean difference: 4.9±2.7 mm, P<0.001 and 7.4±2.8 mm, P<0.001, respectively) and MRI (mean difference: 4.8±3.2 mm, P<0.001 and 8.2±3.0 mm, P<0.001, respectively). CONCLUSIONS There is excellent agreement in thoracic aortic measurements between CT and MRI. However, TTE significantly underestimates maximum aortic root diameter compared with CT and MRI. Therefore, caution should be used when interpreting small apparent changes in aortic root diameters between TTE and CT or MRI.
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Bons LR, van den Hoven AT, McGhie JS, van Berendoncks AM, Wiegers-Groeneweg EJA, van Haveren LW, Bowen DJ, van den Bosch AE, Cuypers JAAE, Kauling RM, Budde RPJ, Roos-Hesselink JW. Variability in Echocardiographic Ascending Aortic Diameters due to Image Acquisition by Different Sonographers. J Am Soc Echocardiogr 2019; 33:249-252.e4. [PMID: 31785999 DOI: 10.1016/j.echo.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Jackie S McGhie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - An M van Berendoncks
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | | | - Dan J Bowen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Robert M Kauling
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ricardo P J Budde
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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28
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Zhang M, Wan L, Liu K, Wu W, Li H, Wang Y, Lu B, Wang H. Aortic roots assessment by an automated three-dimensional transesophageal echocardiography: an intra-individual comparison. Int J Cardiovasc Imaging 2019; 35:2029-2036. [PMID: 31297671 DOI: 10.1007/s10554-019-01664-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/03/2019] [Indexed: 01/01/2023]
Abstract
To evaluate the accuracy, reproducibility, and transcatheter heart valve (THV) sizing efficiency of an automated 3-dimensional transesophageal echocardiographic (3D-TEE) post-processing software in the assessments of aortic roots, intra-individually compared with multidetector computed tomography (MDCT). We prospectively studied 67 patients with normal aortic roots. We measured diameters of aortic annulus (AA), sinus of Valsalva (SOV), and sino-tubular junction (STJ) by full-automated and semi-automated methods using 3D-TEE datasets, then compared them to corresponding transthoracic echocardiography and MDCT values. THV sizes were chosen based on echocardiography and MDCT measurements according to recommended criterion. Taking MDCT planimetered diameters as reference, the full-automated (r: 0.4745-0.8792) and semi-automated (r: 0.6647-0.8805) 3D-TEE measurements were linearly correlated (p < 0.0001). The average differences between semi-automated or full-automated measurements and reference were 0.3 mm or 1.3 mm for AA, - 1.9 mm or - 0.5 mm for SOV, and - 0.1 mm or 1.9 mm for STJ, respectively. The intra-class correlation coefficients of semi-automated method were 0.79-0.96 (intra-observer) and 0.75-0.92 (inter-observer). THV sizing by semi-automated measurements using echocardiographic criteria was larger than that by MDCT measurements using MDCT criteria (p < 0.0001) but equivalent (p > 0.05) if both using MDCT standards. The new automated 3D-TEE software allows modeling and quantifying aortic roots with high reproducibility. Measurements by the semi-automated method closely approximate and well correlate with the corresponding MDCT, thus THV sizing by this modeled 3D-TEE measurements should adopt recommended MDCT criteria but not echocardiographic criteria. The full-automated 3D-TEE segmentations are yet immature. (Semi-automated assessMent of Aortic Roots by Three-dimensional transEsophageal echocaRdiography [SMARTER], NCT02724709).
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Affiliation(s)
- Minghui Zhang
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Linyuan Wan
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Kun Liu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Hui Li
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Yuan Wang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Bin Lu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Hao Wang
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China.
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