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Lo SCY, McCullough JWS, Xue X, Coveney PV. Uncertainty quantification of the impact of peripheral arterial disease on abdominal aortic aneurysms in blood flow simulations. J R Soc Interface 2024; 21:20230656. [PMID: 38593843 PMCID: PMC11003782 DOI: 10.1098/rsif.2023.0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Peripheral arterial disease (PAD) and abdominal aortic aneurysms (AAAs) often coexist and pose significant risks of mortality, yet their mutual interactions remain largely unexplored. Here, we introduce a fluid mechanics model designed to simulate the haemodynamic impact of PAD on AAA-associated risk factors. Our focus lies on quantifying the uncertainty inherent in controlling the flow rates within PAD-affected vessels and predicting AAA risk factors derived from wall shear stress. We perform a sensitivity analysis on nine critical model parameters through simulations of three-dimensional blood flow within a comprehensive arterial geometry. Our results show effective control of the flow rates using two-element Windkessel models, although specific outlets need attention. Quantities of interest like endothelial cell activation potential (ECAP) and relative residence time are instructive for identifying high-risk regions, with ECAP showing greater reliability and adaptability. Our analysis reveals that the uncertainty in the quantities of interest is 187% of that of the input parameters. Notably, parameters governing the amplitude and frequency of the inlet velocity exert the strongest influence on the risk factors' variability and warrant precise determination. This study forms the foundation for patient-specific simulations involving PAD and AAAs which should ultimately improve patient outcomes and reduce associated mortality rates.
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Affiliation(s)
- Sharp C. Y. Lo
- Centre for Computational Science, University College London, London, UK
| | | | - Xiao Xue
- Centre for Computational Science, University College London, London, UK
| | - Peter V. Coveney
- Centre for Computational Science, University College London, London, UK
- Advanced Research Computing Centre, University College London, London, UK
- Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
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2
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Marino M, Sauty B, Vairo G. Unraveling the complexity of vascular tone regulation: a multiscale computational approach to integrating chemo-mechano-biological pathways with cardiovascular biomechanics. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01826-6. [PMID: 38507180 DOI: 10.1007/s10237-024-01826-6] [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: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 03/22/2024]
Abstract
Vascular tone regulation is a crucial aspect of cardiovascular physiology, with significant implications for overall cardiovascular health. However, the precise physiological mechanisms governing smooth muscle cell contraction and relaxation remain uncertain. The complexity of vascular tone regulation stems from its multiscale and multifactorial nature, involving global hemodynamics, local flow conditions, tissue mechanics, and biochemical pathways. Bridging this knowledge gap and translating it into clinical practice presents a challenge. In this paper, a computational model is presented to integrate chemo-mechano-biological pathways with cardiovascular biomechanics, aiming to unravel the intricacies of vascular tone regulation. The computational framework combines an algebraic description of global hemodynamics with detailed finite element analyses at the scale of vascular segments for describing their passive and active mechanical response, as well as the molecular transport problem linked with chemo-biological pathways triggered by wall shear stresses. Their coupling is accounted for by considering a two-way interaction. Specifically, the focus is on the role of nitric oxide-related molecular pathways, which play a critical role in modulating smooth muscle contraction and relaxation to maintain vascular tone. The computational framework is employed to examine the interplay between localized alterations in the biomechanical response of a specific vessel segment-such as those induced by calcifications or endothelial dysfunction-and the broader global hemodynamic conditions-both under basal and altered states. The proposed approach aims to advance our understanding of vascular tone regulation and its impact on cardiovascular health. By incorporating chemo-mechano-biological mechanisms into in silico models, this study allows us to investigate cardiovascular responses to multifactorial stimuli and incorporate the role of adaptive homeostasis in computational biomechanics frameworks.
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Affiliation(s)
- Michele Marino
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy.
| | - Bastien Sauty
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 SAINBIOSE, F-42023, Saint-Etienne, France
| | - Giuseppe Vairo
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy
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3
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Totaro P, Morganti S, Auricchio F, Pelenghi S. Aortic wall thickness in dilated ascending aorta: Comparison between tricuspid and bicuspid aortic valve. Arch Cardiovasc Dis 2023; 116:498-505. [PMID: 37770332 DOI: 10.1016/j.acvd.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is frequently associated with dilatation of the thoracic aorta. Peculiar anatomical, histological and mechanical changes of the aortic wall in BAV aortopathy have been hypothesized to suggest an increased risk of acute aortic complications in patients with BAV. AIM In this study we tried to clarify any differences in the adaptability of the aortic wall to the mechanism of dilatation between patients with BAV and those with TAV. METHODS In total, 354 samples were taken from 71 patients undergoing elective aortic surgery and divided into two groups: BAV group (n=16; 101 samples); and TAV group (n=55; 253 samples). Aortic wall thickness was measured with a dedicated caliper. The relationship between aortic wall thickness and aortic dilatation and demographic variables was evaluated cumulatively and comparatively (BAV versus TAV). In patients with more than three samples available, intrapatient variability was also studied. Finally, potential risk factors for severely reduced aortic wall thickness were also assessed. RESULTS Analysis of preoperative characteristics revealed significant differences in patient age (54±16years for BAV and 66±11years for TAV; P=0.0011), with no differences in variables related to aortic dilatation (including phenotype). Cumulative aortic wall thickness was significantly thinner in the anterior than in the posterior wall. In the comparative analysis, aortic wall thickness was significantly thinner in patients with BAV in both the anterior and posterior regions. Furthermore, in patients with BAV, dilatation>51mm was a significant predictor of severely reduced aortic wall thickness. CONCLUSIONS In our experience, patients with BAV aortopathy reached the cut-off for the surgical indication at an early age. Careful monitoring in patients with BAV is mandatory when aortic dilatation has reached 51mm, as it is related to significant anatomical changes.
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MESH Headings
- Humans
- Middle Aged
- Male
- Bicuspid Aortic Valve Disease/diagnostic imaging
- Bicuspid Aortic Valve Disease/surgery
- Bicuspid Aortic Valve Disease/physiopathology
- Female
- Aortic Valve/abnormalities
- Aortic Valve/diagnostic imaging
- Aortic Valve/surgery
- Aortic Valve/pathology
- Aortic Valve/physiopathology
- Aged
- Adult
- Risk Factors
- Dilatation, Pathologic
- Heart Valve Diseases/diagnostic imaging
- Heart Valve Diseases/surgery
- Heart Valve Diseases/physiopathology
- Heart Valve Diseases/pathology
- Heart Valve Diseases/complications
- Tricuspid Valve/diagnostic imaging
- Tricuspid Valve/physiopathology
- Tricuspid Valve/abnormalities
- Tricuspid Valve/pathology
- Tricuspid Valve/surgery
- Retrospective Studies
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/surgery
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/pathology
- Aorta, Thoracic/surgery
- Aorta, Thoracic/physiopathology
- Aorta, Thoracic/abnormalities
- Aortic Valve Disease/diagnostic imaging
- Aortic Valve Disease/surgery
- Aortic Valve Disease/physiopathology
- Aortic Valve Disease/pathology
- Aortic Aneurysm/diagnostic imaging
- Aortic Aneurysm/pathology
- Aortic Aneurysm/surgery
- Aortic Aneurysm/etiology
- Aortic Aneurysm/physiopathology
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Affiliation(s)
- Pasquale Totaro
- Division of Cardiac Surgery, IRCCS Foundation Hospital "San Matteo", Piazzale Golgi 1, 27100 Pavia, Italy.
| | - Simone Morganti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Foundation Hospital "San Matteo", Piazzale Golgi 1, 27100 Pavia, Italy
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4
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Sundström E, Tretter JT. Impact of Variation in Commissural Angle between Fused Leaflets in the Functionally Bicuspid Aortic Valve on Hemodynamics and Tissue Biomechanics. Bioengineering (Basel) 2023; 10:1219. [PMID: 37892949 PMCID: PMC10604894 DOI: 10.3390/bioengineering10101219] [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: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
In subjects with functionally bicuspid aortic valves (BAVs) with fusion between the coronary leaflets, there is a natural variation of the commissural angle. What is not fully understood is how this variation influences the hemodynamics and tissue biomechanics. These variables may influence valvar durability and function, both in the native valve and following repair, and influence ongoing aortic dilation. A 3D aortic valvar model was reconstructed from a patient with a normal trileaflet aortic valve using cardiac magnetic resonance (CMR) imaging. Fluid-structure interaction (FSI) simulations were used to compare the effects of the varying commissural angles between the non-coronary with its adjacent coronary leaflet. The results showed that the BAV with very asymmetric commissures (120∘ degree commissural angle) reduces the aortic opening area during peak systole and with a jet that impacts on the right posterior wall proximally of the ascending aorta, giving rise to elevated wall shear stress. This manifests in a shear layer with a retrograde flow and strong swirling towards the fused leaflet side. In contrast, a more symmetrical commissural angle (180∘ degree commissural angle) reduces the jet impact on the posterior wall and leads to a linear decrease in stress and strain levels in the non-fused non-coronary leaflet. These findings highlight the importance of considering the commissural angle in the progression of aortic valvar stenosis, the regional distribution of stresses and strain levels experienced by the leaflets which may predispose to valvar deterioration, and progression in thoracic aortic dilation in patients with functionally bicuspid aortic valves. Understanding the hemodynamics and biomechanics of the functionally bicuspid aortic valve and its variation in structure may provide insight into predicting the risk of aortic valve dysfunction and thoracic aortic dilation, which could inform clinical decision making and potentially lead to improved aortic valvar surgical outcomes.
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Affiliation(s)
- Elias Sundström
- Department of Engineering Mechanics, Flow Research Center, KTH Royal Institute of Technology, Teknikringen 8, 100 44 Stockholm, Sweden
| | - Justin T. Tretter
- Congenital Valve Procedural Planning Center, Department of Pediatric Cardiology and Division of Pediatric Cardiac Surgery, Cleveland Clinic Children’s, and The Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
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5
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Kesävuori R, Kaseva T, Salli E, Raivio P, Savolainen S, Kangasniemi M. Deep learning-aided extraction of outer aortic surface from CT angiography scans of patients with Stanford type B aortic dissection. Eur Radiol Exp 2023; 7:35. [PMID: 37380806 DOI: 10.1186/s41747-023-00342-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/01/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Guidelines recommend that aortic dimension measurements in aortic dissection should include the aortic wall. This study aimed to evaluate two-dimensional (2D)- and three-dimensional (3D)-based deep learning approaches for extraction of outer aortic surface in computed tomography angiography (CTA) scans of Stanford type B aortic dissection (TBAD) patients and assess the speed of different whole aorta (WA) segmentation approaches. METHODS A total of 240 patients diagnosed with TBAD between January 2007 and December 2019 were retrospectively reviewed for this study; 206 CTA scans from 206 patients with acute, subacute, or chronic TBAD acquired with various scanners in multiple different hospital units were included. Ground truth (GT) WAs for 80 scans were segmented by a radiologist using an open-source software. The remaining 126 GT WAs were generated via semi-automatic segmentation process in which an ensemble of 3D convolutional neural networks (CNNs) aided the radiologist. Using 136 scans for training, 30 for validation, and 40 for testing, 2D and 3D CNNs were trained to automatically segment WA. Main evaluation metrics for outer surface extraction and segmentation accuracy were normalized surface Dice (NSD) and Dice coefficient score (DCS), respectively. RESULTS 2D CNN outperformed 3D CNN in NSD score (0.92 versus 0.90, p = 0.009), and both CNNs had equal DCS (0.96 versus 0.96, p = 0.110). Manual and semi-automatic segmentation times of one CTA scan were approximately 1 and 0.5 h, respectively. CONCLUSIONS Both CNNs segmented WA with high DCS, but based on NSD, better accuracy may be required before clinical application. CNN-based semi-automatic segmentation methods can expedite the generation of GTs. RELEVANCE STATEMENT Deep learning can speeds up the creation of ground truth segmentations. CNNs can extract the outer aortic surface in patients with type B aortic dissection. KEY POINTS • 2D and 3D convolutional neural networks (CNNs) can extract the outer aortic surface accurately. • Equal Dice coefficient score (0.96) was reached with 2D and 3D CNNs. • Deep learning can expedite the creation of ground truth segmentations.
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Affiliation(s)
- Risto Kesävuori
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland.
| | - Tuomas Kaseva
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland
| | - Eero Salli
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland
| | - Peter Raivio
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sauli Savolainen
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Marko Kangasniemi
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland
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6
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Longtine AG, Venkatasubramanian R, Zigler MC, Lindquist AJ, Mahoney SA, Greenberg NT, VanDongen NS, Ludwig KR, Moreau KL, Seals DR, Clayton ZS. Female C57BL/6N mice are a viable model of aortic aging in women. Am J Physiol Heart Circ Physiol 2023; 324:H893-H904. [PMID: 37115626 PMCID: PMC10202480 DOI: 10.1152/ajpheart.00120.2023] [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: 02/28/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
The aorta stiffens with aging in both men and women, which predicts cardiovascular mortality. Aortic wall structural and extracellular matrix (ECM) remodeling, induced in part by chronic low-grade inflammation, contribute to aortic stiffening. Male mice are an established model of aortic aging. However, there is little information regarding whether female mice are an appropriate model of aortic aging in women, which we aimed to elucidate in the present study. We assessed two strains of mice and found that in C57BL/6N mice, in vivo aortic stiffness (pulse wave velocity, PWV) was higher with aging in both sexes, whereas in B6D2F1 mice, PWV was higher in old versus young male mice, but not in old versus young female mice. Because the age-related stiffening that occurs in men and women was reflected in male and female C57BL/6N mice, we examined the mechanisms of stiffening in this strain. In both sexes, aortic modulus of elasticity (pin myography) was lower in old mice, occurred in conjunction with and was related to higher plasma levels of the elastin-degrading enzyme matrix metalloproteinase-9 (MMP-9), and was accompanied by higher numbers of aortic elastin breaks and higher abundance of adventitial collagen-1. Plasma levels of the inflammatory cytokines interferon-γ, interleukin 6, and monocyte chemoattractant protein-1 were higher in both sexes of old mice. In conclusion, female C57BL/6N mice exhibit aortic stiffening, reduced modulus of elasticity and structural/ECM remodeling, and associated increases in MMP-9 and systemic inflammation with aging, and thus are an appropriate model of aortic aging in women.NEW & NOTEWORTHY Our study demonstrates that with aging, female C57BL/6N mice exhibit higher in vivo aortic stiffness, reduced modulus of elasticity, aortic wall structural and extracellular matrix remodeling, and elevations in systemic inflammation. These changes are largely reflective of those that occur with aging in women. Thus, female C57BL/6N mice are a viable model of human aortic aging and the utility of these animals should be considered in future biomedical investigations.
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Affiliation(s)
- Abigail G Longtine
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | | | - Melanie C Zigler
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Alexandra J Lindquist
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Nathan T Greenberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Nicholas S VanDongen
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Katelyn R Ludwig
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kerrie L Moreau
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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7
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Bianchini E, Lønnebakken MT, Wohlfahrt P, Piskin S, Terentes‐Printzios D, Alastruey J, Guala A. Magnetic Resonance Imaging and Computed Tomography for the Noninvasive Assessment of Arterial Aging: A Review by the VascAgeNet COST Action. J Am Heart Assoc 2023; 12:e027414. [PMID: 37183857 PMCID: PMC10227315 DOI: 10.1161/jaha.122.027414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Magnetic resonance imaging and computed tomography allow the characterization of arterial state and function with high confidence and thus play a key role in the understanding of arterial aging and its translation into the clinic. Decades of research into the development of innovative imaging sequences and image analysis techniques have led to the identification of a large number of potential biomarkers, some bringing improvement in basic science, others in clinical practice. Nonetheless, the complexity of some of these biomarkers and the image analysis techniques required for their computation hamper their widespread use. In this narrative review, current biomarkers related to aging of the aorta, their founding principles, the sequence, and postprocessing required, and their predictive values for cardiovascular events are summarized. For each biomarker a summary of reference values and reproducibility studies and limitations is provided. The present review, developed in the COST Action VascAgeNet, aims to guide clinicians and technical researchers in the critical understanding of the possibilities offered by these advanced imaging modalities for studying the state and function of the aorta, and their possible clinically relevant relationships with aging.
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Affiliation(s)
| | - Mai Tone Lønnebakken
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
| | - Peter Wohlfahrt
- Department of Preventive CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
- Centre for Cardiovascular PreventionCharles University Medical School I and Thomayer HospitalPragueCzech Republic
- Department of Medicine IICharles University in Prague, First Faculty of MedicinePragueCzech Republic
| | - Senol Piskin
- Department of Mechanical Engineering, Faculty of Engineering and Natural SciencesIstinye UniversityIstanbulTurkey
- Modeling, Simulation and Extended Reality LaboratoryIstinye UniversityIstanbulTurkey
| | - Dimitrios Terentes‐Printzios
- First Department of Cardiology, Hippokration Hospital, Athens Medical SchoolNational and Kapodistrian University of AthensGreece
| | - Jordi Alastruey
- School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca (VHIR)BarcelonaSpain
- CIBER‐CV, Instituto de Salud Carlos IIIMadridSpain
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8
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Beketova TV. Non-infectious diseases of the aorta and large arteries. TERAPEVT ARKH 2022; 94:695-703. [DOI: 10.26442/00403660.2022.05.201500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022]
Abstract
This article describes the various forms of inflammatory lesions of the aorta and large arteries, including chronic periaortitis, as well as the diagnostic methods are considered. Large vessel vasculitis represent the most common entities, however, there is also an association with other rheumatological or inflammatory diseases, drug-induced or paraneoplastic entities. Instrumental imaging modalities play an important role in the diagnosis.
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9
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Lee BC, Kang VJW, Pan CT, Huang JZ, Lin YL, Chang YY, Tsai CH, Chou CH, Chen ZW, Liao CW, Chiu YW, Wu VC, Hung CS, Chang CC, Lin YH. KCNJ5 Somatic Mutation Is Associated With Higher Aortic Wall Thickness and Less Calcification in Patients With Aldosterone-Producing Adenoma. Front Endocrinol (Lausanne) 2022; 13:830130. [PMID: 35311227 PMCID: PMC8924484 DOI: 10.3389/fendo.2022.830130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Primary aldosteronism (PA) is the most common type of secondary hypertension, and it is associated with a higher rate of cardiovascular complications. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma (APA), however their influence on vascular remodeling and injury is still unclear. The aim of this study was to investigate the association between KCNJ5 somatic mutation status and vascular status. METHODS We enrolled 179 APA patients who had undergone adrenalectomy from a prospectively maintained database, of whom 99 had KCNJ5 somatic mutations. Preoperative clinical, biochemical and imaging data of abdominal CT, including abdominal aortic calcification (AAC) score, aortic diameter and wall thickness at levels of superior (SMA) and inferior (IMA) mesenteric arteries were analyzed. RESULTS After propensity score matching for age, sex, body mass index, triglycerides and low-density lipoprotein, there were 48 patients in each KCNJ5 (+) and KCNJ5 (-) group. Mutation carriers had a lower AAC score (217.3 ± 562.2 vs. 605.6 ± 1359.1, P=0.018), higher aortic wall thickness (SMA level: 2.2 ± 0.6 mm vs. 1.8 ± 0.6 mm, P=0.006; IMA level: 2.4 ± 0.6 mm vs. 1.8 ± 0.7 mm, P<0.001) than non-carriers. In multivariate analysis, KCNJ5 mutations were independently associated with AAC score (P=0.014) and aortic wall thickness (SMA level: P<0.001; IMA level: P=0.004). After adrenalectomy, mutation carriers had less aortic wall thickness progression than non-carriers (Δthickness SMA: -0.1 ± 0.8 mm vs. 0.9 ± 0.6 mm, P=0.024; IMA: -0.1 ± 0.6 mm vs. 0.8 ± 0.7 mm, P=0.04). CONCLUSION KCNJ5 mutation carriers had less calcification burden of the aorta, thickened aortic wall, and less wall thickness progression than non-carriers.
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Affiliation(s)
- Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Departments of Medical Imaging, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Victor Jing-Wei Kang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ting Pan
- Departments of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Jia-Zheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Li Lin
- Department of Business Administration and Graduate School of Service Management, Chihlee University of Technology, New Taipei City, Taiwan
| | - Yi-Yao Chang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Hsuan Tsai
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Zheng-Wei Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan
| | - Yu-Wei Chiu
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Chin-Chen Chang,
| | - Yen-Hung Lin
- Department of Business Administration and Graduate School of Service Management, Chihlee University of Technology, New Taipei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
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10
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Wilson JS, Islam M, Oshinski JN. In Vitro Validation of Regional Circumferential Strain Assessment in a Phantom Aortic Model Using Cine Displacement Encoding With Stimulated Echoes MRI. J Magn Reson Imaging 2021; 55:1773-1784. [PMID: 34704637 DOI: 10.1002/jmri.27972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A novel application of cine Displacement ENcoding with Stimulated Echoes Magnetic Resonance Imaging (DENSE MRI) has recently been described to assess regional heterogeneities in circumferential strain around the aortic wall in vivo; however, validation is first required for successful clinical translation. PURPOSE To validate the quantification of regional circumferential strain around the wall of an aortic phantom using DENSE MRI. STUDY TYPE In vitro phantom study. POPULATION Three polyvinyl alcohol aortic phantoms with eight axially oriented nitinol wires embedded evenly around the walls. FIELD STRENGTH/SEQUENCE 3 T; gradient-echo aortic DENSE MRI with spiral cine readout, gradient-echo phase-contrast MRI (PCMR) with Cartesian cine readout. ASSESSMENT Phantoms were connected to a pulsatile flow loop and peak DENSE-derived regional circumferential Green strains at 16 equally spaced sectors around the wall were assessed according to previously published algorithms. "True" regional circumferential strains were calculated by manually tracking displacements of the nitinol wires by two independent observers. Normalized circumferential strains (NCS) were calculated by dividing regional strains by the mean strain. Finally, DENSE-derived regional strain was corrected by multiplying regional DENSE NCS by the mean strain calculated from the diameter change on the PCMR. STATISTICAL TESTS One-sample t-test, Paired-sample t-test, and analysis of variance with Bonferroni correction, coefficient of variation (CoV), Bland-Altman analysis; P < 0.05 was considered statistically significant. RESULTS Aortic DENSE MRI significantly overestimated circumferential strain compared to the wire-tracking method (mean difference and SD 0.030 ± 0.014, CoV 0.31). However, NCS demonstrated good agreement between DENSE and wire-tracking data (mean difference 0.000 ± 0.172, CoV 0.15). After correcting the DENSE-derived regional strain, the mean difference in regional circumferential strain between DENSE and wire-tracking was significantly reduced to 0.006 ± 0.008, and the CoV was reduced to 0.18. DATA CONCLUSION For aortic phantoms with mild spatial heterogeneity in circumferential strain, the previously published aortic DENSE MRI technique successfully assessed the regional NCS distribution but overestimated the mean strain. This overestimation is correctable by computing a more accurate mean circumferential strain using a separate cine scan. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- John S Wilson
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Muhammad Islam
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - John N Oshinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
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11
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Zeng W, Caudillo A, Mukherjee S, Lee SH, Panzer MB. Development and multi-level validation of a computational model to predict traumatic aortic injury. Comput Biol Med 2021; 136:104700. [PMID: 34352453 DOI: 10.1016/j.compbiomed.2021.104700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Traumatic aortic injury (TAI) is one of the leading causes of fatalities in blunt impact. However, there is no consensus on the injury mechanism of TAI in traffic accidents, mainly due to the complexity of occurrence scenarios and limited real-world crash data relevant to TAI. In this study, a computational model of the aorta with nonlinear mechanical characteristics and accurate morphology was developed and integrated within a thorax finite element model that included all major anatomical structures. To maximize the model's capability for predicting TAI, a multi-level process was presented to validate the model comprehensively. At the component level, the in vitro aortic pressurization testing was simulated to mimic the aortic burst pressure. Then, a sled test of a truncated cadaver was modeled to evaluate aorta response under posterior acceleration. The frontal chest pendulum impact was utilized to validate the performance of the aorta within full body model under direct chest compression. A parametric study was implemented to determine an injury tolerance for the aorta under these different loading conditions. The simulated peak pressure before aortic rupture was within the range of the experimental burst pressure. For the sled test, the simulated chest deflection and cross-sectional pressure of the aorta were correlated with the experimental measurement. No aorta injury was observed in simulated results of both sled test and chest pendulum impact, which matched the experimental findings. The present model will be a useful tool for understanding the TAI mechanisms, evaluating injury tolerance, and developing prevention strategies for aortic injuries.
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Affiliation(s)
- Wei Zeng
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA.
| | - Adrian Caudillo
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Sayak Mukherjee
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Sang-Hyun Lee
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Matthew B Panzer
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA.
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12
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Omae T, Song Y, Yoshioka T, Tani T, Yoshida A. Effect of insulin treatment on pulsatility ratio and resistance index of the retinal artery in patients with type 2 diabetes. PLoS One 2021; 16:e0254980. [PMID: 34283877 PMCID: PMC8291657 DOI: 10.1371/journal.pone.0254980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/07/2021] [Indexed: 11/29/2022] Open
Abstract
This study aimed to evaluate whether long-term insulin treatment is associated with abnormalities in retinal circulation in type 2 diabetic patients. We evaluated 19 eyes of nondiabetic individuals and 68 eyes of type 2 diabetic patients. The eyes of diabetic patients were classified into two groups according to the presence or absence of long-term insulin therapy. We used a Doppler optical coherence tomography flowmeter to measure diameter, velocity, and blood flow in the major temporal retinal artery. The pulsatility ratio (PR) and resistance index (RI), indices of vascular rigidity, were calculated from the blood velocity profile. PR and RI were significantly elevated in type 2 diabetic patients compared with nondiabetic subjects (P < 0.05). In type 2 diabetes patients, PR and RI were significantly higher in patients receiving long-term insulin treatment than in those without (P < 0.01). There was a significant difference in velocity (P < 0.05), but not diameter and blood flow, between nondiabetic subjects and type 2 diabetes patients. No significant difference in diameter, velocity, or blood flow was observed between the groups with and without long-term insulin treatment. Long-term insulin treatment can affect PR and RI, which might be associated with vascular rigidity of the retinal artery in patients with type 2 diabetes.
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Affiliation(s)
- Tsuneaki Omae
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
- * E-mail:
| | - Youngseok Song
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Takafumi Yoshioka
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Tomofumi Tani
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
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13
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Shchetynska-Marinova T, Amendt K, Sadick M, Keese M, Sigl M. Aortitis - An Interdisciplinary Challenge. In Vivo 2021; 35:41-52. [PMID: 33402448 DOI: 10.21873/invivo.12230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
The term 'aortitis' comprises a heterogeneous spectrum of diseases, with varied etiology and clinical presentations, whose common characteristic is the inflammation of the aortic wall. Since aortitis can mimic almost all common cardiovascular disorders, its clinical recognition remains a challenge. Some cases of aortitis remain undetected for a long time and may be diagnosed after severe life-threatening complications have already arisen. The diagnosis of aortitis is based on the presence of homogeneous circumferential thickening of the aortic wall detected on aortic imaging, or typical histological features in combination with clinical findings and laboratory parameters. Management of aortitis is usually conservative (immunosuppressive drugs in noninfectious aortitis; antimicrobial drugs in infectious). However, if vascular complications such as aortic aneurysm, rupture, or steno-occlusive events appear, aortic surgery or endovascular therapy may be required. This review article summarizes the current knowledge regarding the etiology, clinical presentation, diagnosis, and treatment of inflammatory diseases of the aorta to promote better clinical management of these entities.
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Affiliation(s)
- Tetyana Shchetynska-Marinova
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Klaus Amendt
- Vascular Center Oberrhein, Internal Medicine I, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Keese
- Department of Vascular Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Sigl
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;
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14
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On the impact of vessel wall stiffness on quantitative flow dynamics in a synthetic model of the thoracic aorta. Sci Rep 2021; 11:6703. [PMID: 33758315 PMCID: PMC7988183 DOI: 10.1038/s41598-021-86174-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Aortic wall stiffening is a predictive marker for morbidity in hypertensive patients. Arterial pulse wave velocity (PWV) correlates with the level of stiffness and can be derived using non-invasive 4D-flow magnetic resonance imaging (MRI). The objectives of this study were twofold: to develop subject-specific thoracic aorta models embedded into an MRI-compatible flow circuit operating under controlled physiological conditions; and to evaluate how a range of aortic wall stiffness impacts 4D-flow-based quantification of hemodynamics, particularly PWV. Three aorta models were 3D-printed using a novel photopolymer material at two compliant and one nearly rigid stiffnesses and characterized via tensile testing. Luminal pressure and 4D-flow MRI data were acquired for each model and cross-sectional net flow, peak velocities, and PWV were measured. In addition, the confounding effect of temporal resolution on all metrics was evaluated. Stiffer models resulted in increased systolic pressures (112, 116, and 133 mmHg), variations in velocity patterns, and increased peak velocities, peak flow rate, and PWV (5.8–7.3 m/s). Lower temporal resolution (20 ms down to 62.5 ms per image frame) impacted estimates of peak velocity and PWV (7.31 down to 4.77 m/s). Using compliant aorta models is essential to produce realistic flow dynamics and conditions that recapitulated in vivo hemodynamics.
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15
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Hardikar A, Harle R, Marwick TH. Aortic Thickness: A Forgotten Paradigm in Risk Stratification of Aortic Disease. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2020; 8:132-140. [PMID: 33368098 PMCID: PMC7758112 DOI: 10.1055/s-0040-1715609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed at risk-stratifying aortic dilatation using aortic wall thickness (AWT) and comparing methods of AWT assessment. METHODS Demographic, epidemiological, and perioperative data on 72 consecutive aortic surgeries (age = 62 years[standard deviation (SD) = 12] years) performed by a single surgeon were collected from hospital database. Aortic thickness was measured on computed tomography scans, as well as intraoperatively in four quadrants, at the level of aortic sinuses, as well as midascending aorta, using calipers. Aortic wall stress was calculated using standard mathematical formulae. RESULTS The ascending aorta was 48.2 (SD = 8) mm and the mean thickness at ascending aorta level was 1.9 (SD = 0.3) mm. There was congruence between imaging and intraoperative measurements of thickness, as well as between the radiologist and surgeon. Preoperatively, 16 patients had multiple imaging studies showing an average rate of growth of 1.2 mm per year without significant difference in thickness. The wider the aorta, the thinner was the lateral or convex wall. Aortic stenosis (p = 0.01), lateral to medial wall thickness ratio (p = 0.04), and history of hypertension (p = 0.00), all had protective effect on aortic root stress. The ascending aortic stress was directly affected by age (p = 0.03) and inversely related to lateral to medial wall thickness ratio (p = 0.03). CONCLUSION Aortic thickness can be measured preoperatively and easily confirmed intraoperatively. Risk stratification based on both aortic thickness and diameter (stress calculations) would better predict acute aortic events in dilated aortas and define aortic resection criteria more objectively.
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Affiliation(s)
- Ashutosh Hardikar
- Menzies Institute for Medical Research, University of Tasmania, Australia.,Department of Cardiothoracic Surgery, Royal Hobart Hospital, Hobart, Australia
| | - Robin Harle
- Department of Radiology, Royal Hobart Hospital, Hobart, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
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16
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Bäumler K, Vedula V, Sailer AM, Seo J, Chiu P, Mistelbauer G, Chan FP, Fischbein MP, Marsden AL, Fleischmann D. Fluid-structure interaction simulations of patient-specific aortic dissection. Biomech Model Mechanobiol 2020; 19:1607-1628. [PMID: 31993829 DOI: 10.1007/s10237-020-01294-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/14/2020] [Indexed: 12/01/2022]
Abstract
Credible computational fluid dynamic (CFD) simulations of aortic dissection are challenging, because the defining parallel flow channels-the true and the false lumen-are separated from each other by a more or less mobile dissection membrane, which is made up of a delaminated portion of the elastic aortic wall. We present a comprehensive numerical framework for CFD simulations of aortic dissection, which captures the complex interplay between physiologic deformation, flow, pressures, and time-averaged wall shear stress (TAWSS) in a patient-specific model. Our numerical model includes (1) two-way fluid-structure interaction (FSI) to describe the dynamic deformation of the vessel wall and dissection flap; (2) prestress and (3) external tissue support of the structural domain to avoid unphysiologic dilation of the aortic wall and stretching of the dissection flap; (4) tethering of the aorta by intercostal and lumbar arteries to restrict translatory motion of the aorta; and a (5) independently defined elastic modulus for the dissection flap and the outer vessel wall to account for their different material properties. The patient-specific aortic geometry is derived from computed tomography angiography (CTA). Three-dimensional phase contrast magnetic resonance imaging (4D flow MRI) and the patient's blood pressure are used to inform physiologically realistic, patient-specific boundary conditions. Our simulations closely capture the cyclical deformation of the dissection membrane, with flow simulations in good agreement with 4D flow MRI. We demonstrate that decreasing flap stiffness from [Formula: see text] to [Formula: see text] kPa (a) increases the displacement of the dissection flap from 1.4 to 13.4 mm, (b) decreases the surface area of TAWSS by a factor of 2.3, (c) decreases the mean pressure difference between true lumen and false lumen by a factor of 0.63, and (d) decreases the true lumen flow rate by up to 20% in the abdominal aorta. We conclude that the mobility of the dissection flap substantially influences local hemodynamics and therefore needs to be accounted for in patient-specific simulations of aortic dissection. Further research to accurately measure flap stiffness and its local variations could help advance future CFD applications.
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Affiliation(s)
- Kathrin Bäumler
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA.
| | - Vijay Vedula
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
| | - Anna M Sailer
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Jongmin Seo
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, 94305, USA
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, 94305, USA
| | - Gabriel Mistelbauer
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Frandics P Chan
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, 94305, USA
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Dominik Fleischmann
- 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University, Stanford, CA, 94305, USA
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17
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Sundström E, Jonnagiri R, Gutmark-Little I, Gutmark E, Critser P, Taylor MD, Tretter JT. Effects of Normal Variation in the Rotational Position of the Aortic Root on Hemodynamics and Tissue Biomechanics of the Thoracic Aorta. Cardiovasc Eng Technol 2019; 11:47-58. [PMID: 31701357 DOI: 10.1007/s13239-019-00441-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/30/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Variation in the rotational position of the aortic root relative to the left ventricle is present in normal trileaflet aortic valves. Its impact on the resulting fluid mechanics of blood flow in the thoracic aorta and structural mechanics in the aortic wall are unknown. We aimed to determine the regional hemodynamic and biomechanical differences in different rotational positions of the normal aortic root (clockwise, central, and counterclockwise positions). METHOD Cardiac magnetic resonance imaging (CMR) data was acquired from a normal pediatric patient. These were used for reconstruction of the aortic valve and thoracic aorta 3D model. Fluid-structure interaction (FSI) simulations were employed to study the influence of the root rotation with a central position as compared to observed extreme variations. Patient-specific phase-encoding CMR data were used to assess the validity of computed blood flow. The 3D FSI model was coupled with Windkessel boundary conditions that were tuned for physiological pressures. A grid velocity function was adopted for the valve motion during the systolic period. RESULTS The largest wall shear stress level is detected in the clockwise positioned aortic root at the sinutubular junction. Two counter-rotating vortex cores are formed within the aortic root of both the central and extreme root configurations, however, in the clockwise root the vortex system becomes more symmetric. This also coincides with more entrainment of the valve jet and more turbulence production along the shear layer. CONCLUSION A clockwise rotational position of the aortic root imparts an increased wall shear stress at the sinutubular junction and proximal ascending aorta in comparison to other root rotation positions. This may pose increased risk for dilation of the sinutubular junction and ascending aorta in the patient with a clockwise positioned aortic root compared to other normal positional configurations.
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Affiliation(s)
- Elias Sundström
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, 45267, USA.
| | - Raghuvir Jonnagiri
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Iris Gutmark-Little
- Division of Endocrine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Ephraim Gutmark
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, 45267, USA.,Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Paul Critser
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Michael D Taylor
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, 45267, USA
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18
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Msoka TF, Van Guilder GP, van Furth M, Smulders Y, Meek SJ, Bartlett JA, Vissoci JRN, van Agtmael MA. The effect of HIV infection, antiretroviral therapy on carotid intima-media thickness: A systematic review and meta-analysis. Life Sci 2019; 235:116851. [PMID: 31499070 PMCID: PMC10496646 DOI: 10.1016/j.lfs.2019.116851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 01/09/2023]
Abstract
AIMS We performed a systematic review and meta-analysis on the effect of HIV infection and antiretroviral therapy (ART) on carotid intima-media thickness (cIMT) to elucidate the role of HIV infection and ART. Also, an analysis on the role of ethnicity and gender on cIMT in HIV-infected populations was performed. MAIN METHODS We searched the PubMed, Web of Science, the WHO websites and International AIDS Society for published observational studies were conducted by two independent reviewers for studies comparing HIV-infected antiretroviral-experienced patients and/or inexperienced with healthy controls on cIMT. The primary outcome was the standardized mean difference (SMD) of cIMT. FINDINGS Twenty studies (five cohort, 15 cross-sectional, and two both cohort and cross-sectional studies) were identified comprising 7948 subjects (4656 HIV-infected; 3292 controls). In cohort studies, the standardized mean 1-year change in cIMT between HIV-infected patients and uninfected controls was not significantly different (0.16 mm/yr; 95% CI, -0.16, 0.49; p = 0.326). In 17 cross-sectional studies, the SMD in cIMT was significantly higher in HIV-infected than uninfected persons (0.27 mm; 95% CI, 0.04, 0.49; p = 0.027). HIV-infected patients on ART exhibited significantly higher SMD in cIMT compared to those not on ART (0.75 mm; 95% CI, 0.30, 1.19; p = 0.001). No confounding effect of gender and ethnicity could be established using meta-regression p > 0.05. SIGNIFICANCE HIV infection itself and ART appear to influence the progression of cIMT and hence may be risk factors for cardiovascular events. No firm conclusions could be drawn on the effect of ethnic/race and gender differences on cIMT in HIV-infected populations.
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Affiliation(s)
- Titus F Msoka
- Kilimanjaro Christian Medical Centre, Department of Internal Medicine, Moshi, Tanzania.
| | - Gary P Van Guilder
- Department of Health and Nutritional Sciences, South Dakota State University, USA
| | | | - Yvo Smulders
- VUmc Hospital Amsterdam, Department Infectiology, Netherlands
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19
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Groenendyk JW, Shukla P, Dey AK, Elnabawi YA, Aksentijevich M, Choi H, Genovese LD, Harrington CL, Natarajan B, Goyal A, Reddy AS, Rodante J, Kabbany MT, Sadek A, Al Najafi M, Playford MP, Joshi AA, Ahlman MA, Gelfand JM, Bluemke DA, Mehta NN. Association of aortic vascular uptake of 18FDG by PET/CT and aortic wall thickness by MRI in psoriasis: a prospective observational study. Eur J Nucl Med Mol Imaging 2019; 46:2488-2495. [PMID: 31385013 DOI: 10.1007/s00259-019-04454-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/18/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The contribution of inflammation to the incidence of cardiovascular disease (CVD) has been increasingly recognized in recent years. We investigated the relationship of aortic vascular uptake of 18F-FDG by PET/CT and aortic wall thickness (AWT) by MRI in psoriasis, a chronic inflammatory disease with increased incidence of CVD. One hundred sixty-five patients with plaque psoriasis participated in an ongoing longitudinal cohort study. Subclinical atherosclerosis was assessed as aortic uptake of 18F-FDG by PET/CT reported as target-to-background ratio (TBR) and AWT by MRI reported as maximal thickness. RESULTS Patients with psoriasis were middle aged, predominantly male, and had mild CV risk by traditional risk factors. Psoriasis severity as measured by PASI score was a notable determinant of AWT (ρ = 0.20, p = 0.01). Moreover, aortic vascular uptake of 18F-FDG associated with AWT by MRI at baseline in unadjusted analysis (β = 0.27 p = 0.001) and following adjustment for traditional cardiovascular risk factors, waist-to-hip ratio, and statin use (β = 0.21 p = 0.01). Finally, following 1 year of psoriasis treatment, a decrease in aortic vascular uptake of 18F-FDG was associated with a reduction in AWT in fully adjusted models (β = 0.33, p = 0.02). CONCLUSION In conclusion, we demonstrate that psoriasis severity and aortic vascular uptake of 18F-FDG in the aorta were associated with AWT. Following treatment of psoriasis, a decrease in aortic vascular uptake of 18F-FDG was associated with a reduction in AWT at 1 year. These findings suggest that aortic vascular uptake of 18F-FDG is associated with early evidence of vascular disease assessed by aortic wall thickness. Prospective studies in larger populations including other inflammatory diseases are warranted.
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Affiliation(s)
- Jacob W Groenendyk
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Parag Shukla
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Youssef A Elnabawi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Milena Aksentijevich
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Harry Choi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Leonard D Genovese
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Charlotte L Harrington
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Balaji Natarajan
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Aditya Goyal
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Aarthi S Reddy
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Justin Rodante
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Mohammad Tarek Kabbany
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Ahmed Sadek
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Mina Al Najafi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Aditya A Joshi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA
| | - Mark A Ahlman
- National Institutes of Health Clinical Center, 10 Center Drive, Clinical Research Center, Bethesda, MD, 20892, USA
| | - Joel M Gelfand
- University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA.
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20
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Nguyen DM, Wagenhäuser MU, Mehrkens D, Adam M, Tsao PS, Ramasubramanian AK. An Automated Algorithm to Quantify Collagen Distribution in Aortic Wall. J Histochem Cytochem 2018; 67:267-274. [PMID: 30452870 DOI: 10.1369/0022155418814231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Arterial diseases including abdominal aortic aneurysm and atherosclerosis are biomechanical diseases characterized by significant changes in the structure and strength of the vessel wall. It is now established that local variations in fibrillar collagen and elastin matrix turnover is critical to arterial stiffening and progression of the disease. The collagen content in the aortic wall has nominally been quantified by biochemical assays and immunohistochemical analysis as the total amount because of the difficulty in separating the media and adventitia. In this work, we have developed an algorithm for automatic quantification of layer-specific collagen content from bright-field and polarized microscopic images of histological sections of mouse aorta stained with Picrosirius red (PSR) stain. The images were processed sequentially including separation of layers, erosion, segregation of regions, binarization, and quantification of pixel intensities to obtain collagen content in the media and adventitia separately. We observed that the automated algorithm rapidly and accurately quantified collagen content from a wide range of image quality compared with manual measurements particularly when the medial and adventitial layers overlap. Together, our algorithm will be of significant impact in the rapid, reliable, and accurate analyses of collagen distribution in histological sections of connective tissues.
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Affiliation(s)
- Dustin M Nguyen
- Department of Chemical and Materials Engineering, San José State University, San José, CA
| | - Markus U Wagenhäuser
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA.,VA Palo Alto Health Care System, Palo Alto, CA
| | - Dennis Mehrkens
- Department of Cardiovascular Medicine, University Heart Center and Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiovascular Medicine, University Heart Center and Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Philip S Tsao
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA.,VA Palo Alto Health Care System, Palo Alto, CA
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21
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Cecelja M, Jiang B, Keehn L, Hussain T, Silva Vieira M, Phinikaridou A, Greil G, Spector TD, Chowienczyk P. Arterial stiffening is a heritable trait associated with arterial dilation but not wall thickening: a longitudinal study in the twins UK cohort. Eur Heart J 2018; 39:2282-2288. [PMID: 29590330 PMCID: PMC6012080 DOI: 10.1093/eurheartj/ehy165] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/15/2017] [Accepted: 03/07/2018] [Indexed: 01/19/2023] Open
Abstract
Aims Vascular ageing is characterized by arterial stiffening, dilation, and arterial wall thickening. We investigated the extent to which these changes are related and their heritability during 5 year follow-up in the Twins UK cohort. Methods and results Carotid-femoral pulse wave velocity (PWVcf), carotid diameter, carotid distensibility, and carotid intima-media thickness (IMT) were measured in 762 female twins (mean age 57.9 ± 8.6 years) at two time-points over an average follow-up of 4.9 ± 1.5 years. Magnetic resonance imaging (MRI) was performed in a sub-sample of 38 women to measure aortic pulse wave velocity (PWVaorta), diameter, and wall thickness. Heritability of changes in arterial wall properties was estimated using structural equation modelling. Annual increases in PWVcf, carotid diameter, distensibility, and IMT were 0.139 m/s, 0.028 mm, -0.4 kPa-1, and 0.011 mm per year, respectively. In regression analysis, predictors of progression in PWVcf included age, mean arterial pressure (MAP), and heart rate (HR) at baseline, and progression in MAP, HR, and body mass index (BMI). Predictors of progression in IMT included progression in MAP, BMI, and triglyceride levels. Progression of PWV and distensibility correlated with progression in carotid diameter but not with IMT. Heritability of progression of PWVcf, diameter, and IMT was 55%, 21%, and 8%, respectively. In a sub-sample of women that underwent MRI, aortic wall thickness increased by 0.19 mm/year, but aortic wall thickening was not correlated with an increase in lumen diameter or PWVaorta. Conclusion Arterial stiffening, as measured by PWVcf, and dilation are heritable but independent of arterial wall thickening. Genetic and cardiovascular risk factors contribute differently to progression of PWV and IMT.
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Affiliation(s)
- Marina Cecelja
- Department of Clinical Pharmacology, King’s College London British Heart Foundation Centre, St Thomas’ Hospital, Lambeth Palace Road, London, UK
| | - Benyu Jiang
- Department of Clinical Pharmacology, King’s College London British Heart Foundation Centre, St Thomas’ Hospital, Lambeth Palace Road, London, UK
| | - Louise Keehn
- Department of Clinical Pharmacology, King’s College London British Heart Foundation Centre, St Thomas’ Hospital, Lambeth Palace Road, London, UK
| | - Tarique Hussain
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Drive B3.09, Dallas, TX, USA
| | - Miguel Silva Vieira
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, London, UK
| | - Alkystis Phinikaridou
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, London, UK
| | - Gerald Greil
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Drive B3.09, Dallas, TX, USA
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, Lambeth Palace Road, London, UK
| | - Phil Chowienczyk
- Department of Clinical Pharmacology, King’s College London British Heart Foundation Centre, St Thomas’ Hospital, Lambeth Palace Road, London, UK
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22
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Feasibility of a 3D Printed Patient-Specific Model System to Determine Hemodynamic Energy Delivery During Extracorporeal Circulation. ASAIO J 2018; 64:309-317. [DOI: 10.1097/mat.0000000000000638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Shavik SM, Jiang Z, Baek S, Lee LC. High Spatial Resolution Multi-Organ Finite Element Modeling of Ventricular-Arterial Coupling. Front Physiol 2018; 9:119. [PMID: 29551977 PMCID: PMC5841309 DOI: 10.3389/fphys.2018.00119] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
While it has long been recognized that bi-directional interaction between the heart and the vasculature plays a critical role in the proper functioning of the cardiovascular system, a comprehensive study of this interaction has largely been hampered by a lack of modeling framework capable of simultaneously accommodating high-resolution models of the heart and vasculature. Here, we address this issue and present a computational modeling framework that couples finite element (FE) models of the left ventricle (LV) and aorta to elucidate ventricular-arterial coupling in the systemic circulation. We show in a baseline simulation that the framework predictions of (1) LV pressure-volume loop, (2) aorta pressure-diameter relationship, (3) pressure-waveforms of the aorta, LV, and left atrium (LA) over the cardiac cycle are consistent with the physiological measurements found in healthy human. To develop insights of ventricular-arterial interactions, the framework was then used to simulate how alterations in the geometrical or, material parameter(s) of the aorta affect the LV and vice versa. We show that changing the geometry and microstructure of the aorta model in the framework led to changes in the functional behaviors of both LV and aorta that are consistent with experimental observations. On the other hand, changing contractility and passive stiffness of the LV model in the framework also produced changes in both the LV and aorta functional behaviors that are consistent with physiology principles.
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Affiliation(s)
- Sheikh Mohammad Shavik
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Zhenxiang Jiang
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Seungik Baek
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
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24
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Baldo MP, Cunha RS, Ribeiro ALP, Lotufo PA, Chor D, Barreto SM, Bensenor IM, Pereira AC, Mill JG. Racial Differences in Arterial Stiffness are Mainly Determined by Blood Pressure Levels: Results From the ELSA-Brasil Study. J Am Heart Assoc 2017. [PMID: 28637779 PMCID: PMC5669170 DOI: 10.1161/jaha.117.005477] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Black people have a higher risk of developing hypertension and presenting higher vascular stiffening. Our aim was to investigate whether the association between race and aortic stiffness could be explained by differences in the primary risk factors. Methods and Results We analyzed data from 11 472 adults (mean age, 51.9±8.9; 53.8% female) self‐reported as white (n=6173), brown (n=3364), or black (n=1935). Their carotid‐to‐femoral pulse wave velocity (cf‐PWV) as well as clinical and anthropometric parameters were measured. cf‐PWV was higher in blacks than in whites or browns (men: white, 9.63±1.81; brown, 9.63±1.88; black, 9.98±1.99; women: white, 8.84±1.64; brown, 9.02±1.68; black, 9.34±1.91; P<0.05). However, this difference disappeared after adjustments for age, mean arterial pressure, heart rate, waist circumference, fasting glucose, and glomerular filtration rate (men: white, 9.68±1.54; brown, 9.68±1.50; black, 9.73±1.52; women: white, 8.93±1.32; brown, 8.98±1.29; black, 9.02±1.32; P>0.05). The association between race and arterial stiffness was significant for brown and black women in the highest cf‐PWV quartile, even after controlling for covariates. There were no differences in the age‐related increase in cf‐PWV among the racial groups after adjustment, confirming the strong effect of age and mean arterial pressure on cf‐PWV revealed by the multiple linear regression. Conclusions Racial differences in cf‐PWV were mainly attributed to differences in mean arterial pressure and age, although they cannot fully explain the association between race and cf‐PWV in women in the highest cf‐PWV values. This suggests that therapeutic approaches to overcome the effects of aging on the vascular system should focus on blood pressure control, especially in the black population.
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Affiliation(s)
- Marcelo P Baldo
- Department of Pathophysiology, Montes Claros State University, Montes Claros, MG, Brazil
| | - Roberto S Cunha
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Antônio L P Ribeiro
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | - Dora Chor
- Escola Nacional de Saúde Pública Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandhi M Barreto
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | | | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
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25
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Treitl KM, Maurus S, Sommer NN, Kooijman-Kurfuerst H, Coppenrath E, Treitl M, Czihal M, Hoffmann U, Dechant C, Schulze-Koops H, Saam T. 3D-black-blood 3T-MRI for the diagnosis of thoracic large vessel vasculitis: A feasibility study. Eur Radiol 2016; 27:2119-2128. [PMID: 27510630 DOI: 10.1007/s00330-016-4525-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the feasibility of T1w-3D black-blood turbo spin echo (TSE) sequence with variable flip angles for the diagnosis of thoracic large vessel vasculitis (LVV). METHODS Thirty-five patients with LVV, diagnosed according to the current standard of reference, and 35 controls were imaged at 3.0T using 1.2 × 1.3 × 2.0 mm3 fat-suppressed, T1w-3D, modified Volumetric Isotropic TSE Acquisition (mVISTA) pre- and post-contrast. Applying a navigator and peripheral pulse unit triggering (PPU), the total scan time was 10-12 min. Thoracic aorta and subclavian and pulmonary arteries were evaluated for image quality (IQ), flow artefact intensity, diagnostic confidence, concentric wall thickening and contrast enhancement (CWT, CCE) using a 4-point scale. RESULTS IQ was good in all examinations (3.25 ± 0.72) and good to excellent in 342 of 408 evaluated segments (83.8 %), while 84.1 % showed no or minor flow artefacts. The interobserver reproducibility for the identification of CCE and CWT was 0.969 and 0.971 (p < 0.001) with an average diagnostic confidence of 3.47 ± 0.64. CCE and CWT were strongly correlated (Cohen's k = 0.87; P < 0.001) and significantly more frequent in the LVV-group (52.8 % vs. 1.0 %; 59.8 % vs. 2.4 %; P < 0.001). CONCLUSIONS Navigated fat-suppressed T1w-3D black-blood MRI with PPU-triggering allows diagnosis of thoracic LVV. KEY POINTS • Cross-sectional imaging is frequently applied in the diagnosis of LVV. • Navigated, PPU-triggered, T1w-3D mVISTA pre- and post contrast takes 10-12 min. • In this prospective, single-centre study, T1w-3D mVISTA accurately depicted large thoracic vessels. • T1w-3D mVISTA visualized CWT/CCW as correlates of mural inflammation in LVV. • T1w-3D mVISTA might be an alternative diagnostic tool without ionizing radiation.
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Affiliation(s)
- Karla Maria Treitl
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany. .,German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany.
| | - Stefan Maurus
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Nora Narvina Sommer
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | | | - Eva Coppenrath
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Marcus Treitl
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Michael Czihal
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Claudia Dechant
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Tobias Saam
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany.,German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany
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26
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Effects of age, blood pressure and antihypertensive treatments on retinal arterioles remodeling assessed by adaptive optics. J Hypertens 2016; 34:1115-22. [DOI: 10.1097/hjh.0000000000000894] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Saey V, Ploeg M, Delesalle C, van Loon G, Gröne A, Ducatelle R, Duchateau L, Chiers K. Morphometric Properties of the Thoracic Aorta of Warmblood and Friesian Horses with and without Aortic Rupture. J Comp Pathol 2016; 154:225-30. [PMID: 26987511 DOI: 10.1016/j.jcpa.2016.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 12/11/2022]
Abstract
Rupture of the aorta is much more common in Friesians compared with other breeds of horse. Rupture always occurs adjacent to the scar of the ligamentum arteriosum. Previous histological examination of ruptured aortic walls suggested the presence of an underlying connective tissue disorder. Therefore, the aim of the present study was to compare the structural characteristics of the tunica media of the mid-thoracic aorta, distant to the lesion, in warmblood and Friesian horses with and without thoracic aortic rupture. In unaffected Friesian horses, the thickness of the tunica media, as well as the percentage area comprised of collagen type I, were significantly higher compared with the warmblood horses, supporting the hypothesis of a primary collagen disorder in the Friesian horse breed. However, in the tunica media of the affected Friesian horses there was no significant wall thickening. Moreover, the percentage area comprised of elastin was significantly lower, while the percentage area comprised of smooth muscle was higher, compared with unaffected Friesian and warmblood horses. These lesions are suggestive of an additional mild elastin deficiency with compensatory smooth muscle cell hypertrophy in affected Friesians.
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Affiliation(s)
- V Saey
- Laboratory of Veterinary Pathology, Department of Pathology, Bacteriology and Poultry Diseases, Ghent University, Merelbeke, Belgium.
| | - M Ploeg
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - C Delesalle
- Department of Comparative Physiology and Biometrics, Belgium
| | - G van Loon
- Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
| | - A Gröne
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - R Ducatelle
- Laboratory of Veterinary Pathology, Department of Pathology, Bacteriology and Poultry Diseases, Ghent University, Merelbeke, Belgium
| | - L Duchateau
- Department of Comparative Physiology and Biometrics, Belgium
| | - K Chiers
- Laboratory of Veterinary Pathology, Department of Pathology, Bacteriology and Poultry Diseases, Ghent University, Merelbeke, Belgium
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28
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Slobodin G, Nakhleh A, Rimar D, Wolfson V, Rosner I, Odeh M. Increased aortic wall thickness for the diagnosis of aortitis: a computed tomography-based study. Int J Rheum Dis 2015; 19:82-6. [DOI: 10.1111/1756-185x.12742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gleb Slobodin
- Department of Internal Medicine A; Bnai Zion Medical Center; Haifa Israel
- Ruth & Bruce Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - Afif Nakhleh
- Department of Internal Medicine A; Bnai Zion Medical Center; Haifa Israel
| | - Doron Rimar
- Ruth & Bruce Rappaport Faculty of Medicine; Technion; Haifa Israel
- Rheumatology Unit; Bnai Zion Medical Center; Haifa Israel
| | - Vladimir Wolfson
- Interventional Radiology Unit; Bnai Zion Medical Center; Haifa Israel
| | - Itzhak Rosner
- Ruth & Bruce Rappaport Faculty of Medicine; Technion; Haifa Israel
- Rheumatology Unit; Bnai Zion Medical Center; Haifa Israel
| | - Majed Odeh
- Department of Internal Medicine A; Bnai Zion Medical Center; Haifa Israel
- Ruth & Bruce Rappaport Faculty of Medicine; Technion; Haifa Israel
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29
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Liu CY, Chen D, Bluemke DA, Wu CO, Teixido-Tura G, Chugh A, Vasu S, Lima JAC, Hundley WG. Evolution of aortic wall thickness and stiffness with atherosclerosis: long-term follow up from the multi-ethnic study of atherosclerosis. Hypertension 2015; 65:1015-9. [PMID: 25776078 DOI: 10.1161/hypertensionaha.114.05080] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/24/2015] [Indexed: 11/16/2022]
Abstract
The study was performed to determine age, sex, and time-dependent changes in aortic wall thickness (AWT) and to evaluate cross-sectional associations between AWT and arterial stiffness in older adults. Three hundred seventy-one longitudinal and 426 cross-sectional measurements of AWT from cardiovascular magnetic resonance imaging studies conducted within the Multi-Ethnic Study of Atherosclerosis were analyzed at 2 points in time, in 2000 to 2002 and then again from follow-up examinations in 2010 to 2012. Aortic wall thickness was determined from a double inversion recovery black-blood fast spin-echo sequence, and aortic stiffness was measured from a phase-contrast cine gradient echo sequence. The thickness of the midthoracic descending aortic wall was measured and correlated to distensibility of the ascending aorta and aortic pulse wave velocity. The average rate of AWT change was 0.032 mm/y. The increase in AWT was greater for those aged 45 to 54 years relative to individuals older than 55 years (P trend<0.001). Ascending aortic distensibility was lower (P<0.001) and pulse wave velocity was higher (P=0.012) for hypertensive subjects. After adjustment for traditional risk factors, distensibility of the ascending aorta was significantly related to AWT in participants without hypertension. Hypertension was associated with increased aortic stiffness independent of aortic wall thickness.
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Affiliation(s)
- Chia-Ying Liu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Doris Chen
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - David A Bluemke
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Colin O Wu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Gisela Teixido-Tura
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Atul Chugh
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - Sujethra Vasu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - João A C Lima
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.)
| | - W Gregory Hundley
- From the Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD (C.-Y.L., D.A.B.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (D.C., D.A.B., J.A.C.L.); Office of Biostatistics Research, National Heart, Lung, and Blood Institutes (NHLBI), Bethesda, MD (C.O.W.); Department of Cardiology, Hospital General Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain (G.T.-T.); Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (A.C.); and Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC (S.V., W.G.H.).
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Lorbeer R, Schneider T, Quadrat A, Kühn JP, Dörr M, Völzke H, Lieb W, Hegenscheid K, Mensel B. Cardiovascular risk factors and thoracic aortic wall thickness in a general population. J Vasc Interv Radiol 2015; 26:635-41. [PMID: 25704225 DOI: 10.1016/j.jvir.2014.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/10/2014] [Accepted: 12/14/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the association of cardiovascular risk factors with wall thickness of the ascending and descending thoracic aorta in the general population. MATERIALS AND METHODS The study included 1,176 individuals (523 women) 21-83 years old from the Study of Health in Pomerania without history of stroke or myocardial infarction. Aortic wall thickness (AWT) was determined by cine magnetic resonance imaging. The associations of AWT with the cardiovascular risk factors male sex, age, smoking, body mass index (BMI), systolic and diastolic blood pressure, hemoglobin A1c, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were assessed by multivariable linear regression models, and interaction effects were tested. RESULTS Male sex (β = .086, P < .001), age (β = .006, P < .001), and BMI (β = .013, P < .001) were positively associated with the AWT of the ascending aorta. Male sex (β = .105, P < .001), age (β = .006, P < .001), current smoker (β = .044, P = .010), BMI (β = .013, P < .001), and HDL-C (β = .057, P = .008) revealed a positive association with AWT of the descending aorta. LDL-C (β = -.024, P = .009; β = -.018, P = .010) was inversely associated with the AWT of the ascending and descending aorta, respectively. Triglyceride levels (β = .024, P = .027; β = .018, P = .024) showed a positive association with the AWT of the ascending and descending aorta, respectively, in men, but not in women. CONCLUSIONS Established cardiovascular risk factors, including male sex, older age, smoking, high BMI, and high triglyceride levels, were associated with increasing thoracic AWT of the ascending and descending aorta. High HDL-C and low LDL-C levels were correlated with AWT.
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Affiliation(s)
- Roberto Lorbeer
- Institute for Community Medicine, Section SHIP-KEF, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany.
| | - Tobias Schneider
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - Alexander Quadrat
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - Jens-Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, Section SHIP-KEF, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian Albrechts University, Kiel, Germany
| | - Katrin Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
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GRAYSON PETERC. Lumpers and Splitters: Ongoing Issues in the Classification of Large Vessel Vasculitis. J Rheumatol 2015; 42:149-51. [DOI: 10.3899/jrheum.141376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mensel B, Quadrat A, Schneider T, Kühn JP, Dörr M, Völzke H, Lieb W, Hegenscheid K, Lorbeer R. MRI-based determination of reference values of thoracic aortic wall thickness in a general population. Eur Radiol 2014; 24:2038-44. [PMID: 24816934 DOI: 10.1007/s00330-014-3188-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/13/2014] [Accepted: 04/14/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To provide age- and sex-specific reference values for MRI-derived wall thickness of the ascending and descending aorta in the general population. MATERIALS AND METHODS Data of 753 subjects (311 females) aged 21-81 years were analysed. MRI was used to determine the aortic wall thickness (AWT). Equations for reference value calculation according to age were established for females and males. RESULTS Median wall thickness of the ascending aorta was 1.46 mm (5th-95th range: 1.15-1.88 mm) for females and 1.56 mm (1.22-1.99 mm) for males. Median wall thickness of the descending aorta was 1.26 mm (0.97-1.58 mm) in females and 1.36 mm (1.04-1.75 mm) in males. While median and 5th and 95th percentiles for the ascending and descending aorta increased with age in both sexes, the association between age and median AWT was stronger in males than in females for both the ascending and descending aorta. CONCLUSIONS Reference values for the ascending and descending AWT are provided. In a healthy sample from the general population, the wall of the ascending aorta is thicker than the wall of the descending aorta, and both walls are thicker in males than females. The increase in wall thickness with age is greater in males. KEY POINTS Ascending aortic wall thickness is greater than descending aortic wall thickness. Ascending and descending aortic wall thickness is greater in males. Thoracic aortic wall thickness increases with age in both sexes. The age-related increase in aortic wall thickness is stronger in males.
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Affiliation(s)
- Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany,
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Yan H, Ranadive SM, Heffernan KS, Lane AD, Kappus RM, Cook MD, Wu PT, Sun P, Harvey IS, Woods JA, Wilund KR, Fernhall B. Hemodynamic and arterial stiffness differences between African-Americans and Caucasians after maximal exercise. Am J Physiol Heart Circ Physiol 2014; 306:H60-8. [PMID: 24186094 PMCID: PMC3920155 DOI: 10.1152/ajpheart.00710.2013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/27/2013] [Indexed: 01/21/2023]
Abstract
African-American (AA) men have higher arterial stiffness and augmentation index (AIx) than Caucasian-American (CA) men. Women have greater age-associated increases in arterial stiffness and AIx than men. This study examined racial and sex differences in arterial stiffness and central hemodynamics at rest and after an acute bout of maximal exercise in young healthy individuals. One hundred young, healthy individuals (28 AA men, 24 AA women, 25 CA men, and 23 CA women) underwent measurements of aortic blood pressure (BP) and arterial stiffness at rest and 15 and 30 min after an acute bout of graded maximal aerobic exercise. Aortic BP and AIx were derived from radial artery applanation tonometry. Aortic stiffness (carotid-femoral) was measured via pulse wave velocity. Aortic stiffness was increased in AA subjects but not in CA subjects (P < 0.05) after an acute bout of maximal cycling exercise, after controlling for body mass index. Aortic BP decreased after exercise in CA subjects but not in AA subjects (P < 0.05). Women exhibited greater reductions in AIx after maximal aerobic exercise compared with men (P < 0.05). In conclusion, race and sex impact vascular and central hemodynamic responses to exercise. Young AA and CA subjects exhibited differential responses in central stiffness and central BP after acute maximal exercise. Premenopausal women had greater augmented pressure at rest and after maximal aerobic exercise than men. Future research is needed to examine the potential mechanisms.
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Affiliation(s)
- Huimin Yan
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois
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Shang EK, Nathan DP, Woo EY, Fairman RM, Wang GJ, Gorman RC, Gorman JH, Jackson BM. Local wall thickness in finite element models improves prediction of abdominal aortic aneurysm growth. J Vasc Surg 2013; 61:217-23. [PMID: 24095043 DOI: 10.1016/j.jvs.2013.08.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/14/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Growing evidence suggests that peak wall stress (PWS) derived from finite element analysis (FEA) of abdominal aortic aneurysms (AAAs) predicts clinical outcomes better than diameter alone. Prior models assume uniform wall thickness (UWT). We hypothesize that the inclusion of locally variable wall thickness (VWT) into FEA of AAAs will improve its ability to predict clinical outcomes. METHODS Patients with AAAs (n = 26) undergoing radiologic surveillance were identified. Custom MATLAB algorithms generated UWT and VWT aortic geometries from computed tomography angiography images, which were subsequently loaded with systolic blood pressure using FEA. PWS and aneurysm expansion (as a proxy for rupture risk and the need for repair) were examined. RESULTS The average radiologic follow-up time was 22.0 ± 13.6 months and the average aneurysm expansion rate was 2.8 ± 1.7 mm/y. PWS in VWT models significantly differed from PWS in UWT models (238 ± 68 vs 212 ± 73 kPa; P = .025). In our sample, initial aortic diameter was not found to be correlated with aneurysm expansion (r = 0.26; P = .19). A stronger correlation was found between aneurysm expansion and PWS derived from VWT models compared with PWS from UWT models (r = 0.86 vs r = 0.58; P = .032 by Fisher r to Z transformation). CONCLUSIONS The inclusion of locally VWT significantly improved the correlation between PWS and aneurysm expansion. Aortic wall thickness should be incorporated into future FEA models to accurately predict clinical outcomes.
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Affiliation(s)
- Eric K Shang
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Derek P Nathan
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Edward Y Woo
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, Pa
| | - Ronald M Fairman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, Pa
| | - Grace J Wang
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, Pa
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Joseph H Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Benjamin M Jackson
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, Pa.
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Rosero EB, Kho KA, Joshi GP, Giesecke M, Schaffer JI. Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease. Obstet Gynecol 2013; 122:778-786. [PMID: 24084534 PMCID: PMC4361072 DOI: 10.1097/aog.0b013e3182a4ee4d] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy. METHODS Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. RESULTS Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P=.002). In a propensity-matched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80% compared with 8.85%, relative risk 0.99, 95% confidence interval [CI] 0.89-1.09, P=.910). There was a lower incidence of blood transfusions in robotic cases (2.1% compared with 3.1%; P<.001), but patients undergoing robotic hysterectomy were more likely to experience postoperative pneumonia (relative risk 2.2, 95% CI 1.24-3.78, P=.005). The median cost of hospital care was $9,788 (interquartile range $7,105-12,780) for robotic hysterectomy and $7,299 (interquartile range $5,650-9,583) for laparoscopic hysterectomy (P<.001). Hospital costs were on average $2,489 (95% CI $2,313-2,664) higher for patients undergoing robotic hysterectomy. CONCLUSION The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more. LEVEL OF EVIDENCE : II.
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Affiliation(s)
- Eric B Rosero
- Departments of Anesthesiology and Pain Management and Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
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Mensel B, Kühn JP, Schneider T, Quadrat A, Hegenscheid K. Mean thoracic aortic wall thickness determination by cine MRI with steady-state free precession: validation with dark blood imaging. Acad Radiol 2013; 20:1004-8. [PMID: 23830606 DOI: 10.1016/j.acra.2013.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/14/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the validity and reliability of measuring mean aortic wall thickness (MAWT) of the ascending and descending aorta using cine steady-state free precession (SSFP) imaging compared to dark blood (DB) imaging. MATERIALS AND METHODS DB and SSFP images of the thoracic aorta acquired at 1.5 T in 50 volunteers (26 women, 24 men; mean age: 50.2 ± 13.1 years) were used. MAWT was calculated on DB and SSFP images for the ascending and descending aorta at the level of the right pulmonary artery by two independent observers. Validity was assessed using Bland-Altman analysis, Passing-Bablok regression, and Spearman correlation. Reliability was assessed using Bland-Altman analysis and intraclass coefficients (ICCs). RESULTS The mean MAWT of the ascending aorta on DB and SSFP images was 1.89 ± 0.21 mm and 1.87 ± 0.20 mm. The measurements for the descending aorta were 1.60 ± 0.22 and 1.63 ± 0.20 mm, respectively. Comparison of DB and SSFP measurements revealed a mean bias of 1.3% (95% limits of agreement (LOA): -7.9, 10.5%) for the ascending and of -2.1% (LOA: -10.5, 6.3%) for the descending aorta. The corresponding regression equation was y = 0.042 + 0.960 × (r = 0.91; P < .0001) and y = 0.118 + 0.939 × (r = 0.95; P < .0001), respectively. Intra- and interobserver variability showed a mean bias of less than 2.0% and LOA of less than ±15.0%. ICCs were greater than or equal to 0.85. CONCLUSIONS MAWT determination in the ascending and descending aorta using cine SSFP sequences is highly valid and reliable compared to DB imaging.
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Maroules CD, Rosero E, Ayers C, Peshock RM, Khera A. Abdominal aortic atherosclerosis at MR imaging is associated with cardiovascular events: the Dallas heart study. Radiology 2013; 269:84-91. [PMID: 23781118 DOI: 10.1148/radiol.13122707] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the value of two abdominal aortic atherosclerosis measurements at magnetic resonance (MR) imaging for predicting future cardiovascular events. MATERIALS AND METHODS This study was approved by the institutional review board and complied with HIPAA regulations. The study consisted of 2122 participants from the multiethnic, population-based Dallas Heart Study who underwent abdominal aortic MR imaging at 1.5 T. Aortic atherosclerosis was measured by quantifying mean aortic wall thickness (MAWT) and aortic plaque burden. Participants were monitored for cardiovascular death, nonfatal cardiac events, and nonfatal extracardiac vascular events over a mean period of 7.8 years ± 1.5 (standard deviation [SD]). Cox proportional hazards regression was used to assess independent associations of aortic atherosclerosis and cardiovascular events. RESULTS Increasing MAWT was positively associated with male sex (odds ratio, 3.66; P < .0001), current smoking (odds ratio, 2.53; P < .0001), 10-year increase in age (odds ratio, 2.24; P < .0001), and hypertension (odds ratio, 1.66; P = .0001). A total of 143 participants (6.7%) experienced a cardiovascular event. MAWT conferred an increased risk for composite events (hazard ratio, 1.28 per 1 SD; P = .001). Aortic plaque was not associated with increased risk for composite events. Increasing MAWT and aortic plaque burden both conferred an increased risk for nonfatal extracardiac events (hazard ratio of 1.52 per 1 SD [P < .001] and hazard ratio of 1.46 per 1 SD [P = .03], respectively). CONCLUSION MR imaging measures of aortic atherosclerosis are predictive of future adverse cardiovascular events.
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Affiliation(s)
- Christopher D Maroules
- Departments of Radiology, Anesthesiology, Clinical Sciences, and Internal Medicine, Division of Cardiology and the Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
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Time-dependent alterations in rat macrovessels with type 1 diabetes. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:278620. [PMID: 22315586 PMCID: PMC3270547 DOI: 10.1155/2012/278620] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 10/03/2011] [Accepted: 10/07/2011] [Indexed: 11/17/2022]
Abstract
Vascular complications are associated with the progressive severity of diabetes, resulting in significant morbidity and mortality. This study quantifies functional vascular parameters and macrovascular structure in a rat model of type 1 diabetes. While there was no difference in the systemic arterial elastance (Ea) with 50 days of diabetes, changes were noted in the aorta and femoral artery including increased tunica media extracellular matrix content, decreased width of both the media and individual smooth muscle cell layers, and increased incidence of damaged mitochondria. Extracellular matrix proteins and elastin levels were significantly greater in the aorta of diabetic animals. These differences correlated with diminished matrix metalloprotease activity in the aorta of the diabetic animals. In conclusion, diabetes significantly altered the structure and ultrastructure of the aorta and femoral artery before systemic changes in arterial elastance could be detected.
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Chen LQ, Rohatgi A, Ayers CR, Das SR, Khera A, Berry JD, McGuire DK, de Lemos JA. Race-specific associations of myeloperoxidase with atherosclerosis in a population-based sample: the Dallas Heart Study. Atherosclerosis 2011; 219:833-8. [PMID: 21917261 DOI: 10.1016/j.atherosclerosis.2011.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/13/2011] [Accepted: 08/15/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Myeloperoxidase (MPO) is a leukocyte-derived enzyme that appears to be directly involved in atherosclerosis development. We evaluated the association of circulating MPO with coronary and aortic atherosclerosis in a large, multiethnic population. METHODS AND RESULTS Plasma levels of MPO were measured in 3294 subjects participating in the Dallas Heart Study, a probability-based population sample. Coronary artery calcification (CAC) was measured by EBCT, and abdominal aorta plaque prevalence (AP) and burden (APB), as well as abdominal aorta wall thickness (AWT) were determined by MRI. Associations between MPO and atherosclerosis phenotypes were assessed in multivariable analyses adjusting for traditional atherosclerosis risk factors. MPO levels in the 4th compared with 1st quartile independently associated with prevalent AP (OR 1.41, 95% CI 1.08-1.84), APB (beta coefficient 0.23, p = 0.02), and AWT (beta coefficient 0.04, p = 0.03), but not with prevalent CAC (OR 0.84, 95% CI 0.61-1.17). MPO remained associated with aortic atherosclerosis phenotypes but not coronary calcification after adjustment for other inflammatory biomarkers. A significant interaction was observed between race/ethnicity, MPO and AP (p(interaction) = 0.038), such that MPO levels in the 4th vs 1st quartile associated with prevalent AP in African Americans, (OR 1.81, 95% CI 1.23-2.65) but not in White or Hispanic participants (OR 0.99, 95% CI 0.68-1.44). CONCLUSION Higher levels of MPO associated with aortic but not coronary atherosclerosis, with significant associations limited to African American participants. These findings suggest that MPO might be a novel risk factor contributing to racial disparities in peripheral vascular disease.
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Affiliation(s)
- Lu Q Chen
- The Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, United States
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