1
|
Shlimon K, Lindenberger M, De Basso R, Cinthio M, Bjarnegård N. Increased diameter and stiffness of elastic but not muscular arteries in men with abdominal aortic aneurysm. J Appl Physiol (1985) 2024; 136:1410-1417. [PMID: 38660725 DOI: 10.1152/japplphysiol.00875.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024] Open
Abstract
It has been proposed that formation of abdominal aortic aneurysm (AAA) is part of a systemic arterial dilatative disease. However, arteries in the upper extremities are scarcely studied and it remains unclear whether both muscular and elastic arteries are affected by the proposed systemic arterial dilatation. The aim of this study was to investigate the diameter and stiffness of muscular and elastic arteries in arterial branches originating from the aortic arch. Twenty-six men with AAA (69 ± 4 yr) and 57 men without AAA (70 ± 5 yr) were included in the study. Ultrasound was used to examine the distal and proximal brachial artery, axillary artery, and common carotid artery (CCA), and measurement of diameter and diameter change was performed with wall-tracking software. Blood pressure measurements were used to calculate local arterial wall stiffness indices. The AAA cohort presented larger arterial diameters in the CCA and axillary artery after adjustment for body surface area (P = 0.002, respectively), whereas the brachial artery diameters were unchanged. Indices of increased stiffness in CCA (e.g., lower distensibility, P = 0.003) were seen in subjects with AAA after adjustments for body mass index and mean arterial blood pressure. This study supports the theory of a systemic arterial dilating diathesis in peripheral elastic, but not in muscular, arteries. Peripheral elastic arteries also exhibited increased stiffness, in analogy with findings in the aorta in AAA.NEW & NOTEWORTHY We present data partially supporting the notion of abdominal aortic aneurysm being a systemic vascular disease with focal manifestation in the abdominal aorta, from two well-defined groups recruited from a regional screening program. We show that elastic arteries distal from the aorta exhibit vascular alterations without aneurysmal formation in subjects with AAA compared with controls while muscular arteries seem unaffected.
Collapse
Affiliation(s)
- Kristian Shlimon
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Lindenberger
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Rachel De Basso
- Department of Natural Sciences and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Magnus Cinthio
- Department of Electrical Measurements, Lund University, Lund, Sweden
| | - Niclas Bjarnegård
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
2
|
Sjöstrand S, Widerström A, Svensson I, Segers P, Erlöv T, Ahlgren ÅR, Cinthio M. The impact of geometry, intramural friction, and pressure on the antegrade longitudinal motion of the arterial wall: A phantom and finite element study. Physiol Rep 2023; 11:e15746. [PMID: 37332094 PMCID: PMC10277212 DOI: 10.14814/phy2.15746] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023] Open
Abstract
Longitudinal motion of the carotid arterial wall, as measured with ultrasound, has shown promise as an indicator of vascular health. The underlying mechanisms are however not fully understood. We have found, in in vivo studies, that blood pressure has a strong relation to the antegrade longitudinal displacement in early systole. Further, we have identified that a tapered geometry and the intramural friction in-between two parts of a vessel wall influence the longitudinal displacement. We therefore studied the interaction between pressure, vessel geometry and intramural friction, tapered and straight ultrasound phantoms in a paralleled hydraulic bench study and corresponding numerical models. Profound antegrade longitudinal motion was induced in the innermost part of both tapered phantoms and the numerical models, but to a lesser extent when intramural friction was increased in the simulations. Strong correlations (R = 0.82-0.96; p < 1e-3; k = 9.3-14 μm/mmHg) between longitudinal displacement and pulse pressure were found in six of seven regions of interest in tapered phantoms. The motion of the straight phantom and the corresponding numerical model was smaller, on average zero or close to zero. This study demonstrates that tapering of the lumen, low intramural friction, and pressure might be important conducive features to the antegrade longitudinal motion of the arterial wall in vivo.
Collapse
Affiliation(s)
- Sandra Sjöstrand
- Department of Biomedical Engineering, Faculty of EngineeringLund UniversityLundSweden
- IBiTech‐bioMMedaGhent UniversityGhentBelgium
| | - Alice Widerström
- Department of Biomedical Engineering, Faculty of EngineeringLund UniversityLundSweden
- IBiTech‐bioMMedaGhent UniversityGhentBelgium
| | - Ingrid Svensson
- Department of Biomedical Engineering, Faculty of EngineeringLund UniversityLundSweden
| | | | - Tobias Erlöv
- Department of Biomedical Engineering, Faculty of EngineeringLund UniversityLundSweden
| | - Åsa Rydén Ahlgren
- Department of Translational MedicineLund UniversityLundSweden
- Department of Medical Imaging and Physiology, Skåne University HospitalLund UniversityMalmöSweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, Faculty of EngineeringLund UniversityLundSweden
| |
Collapse
|
3
|
Ahlgren ÅR, Erlöv T, Cinthio M. Response of the carotid artery longitudinal motion to submaximal physical activity in healthy humans-Marked changes already at low workload. Physiol Rep 2023; 11:e15580. [PMID: 36702558 PMCID: PMC9879728 DOI: 10.14814/phy2.15580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/18/2023] Open
Abstract
The longitudinal motion of the arterial wall, that is, the displacement of the arterial wall along the artery, parallel to blood flow, is still largely unexplored. The magnitude and nature of putative changes in longitudinal motion of the arterial wall in response to physical activity in humans remain unknown. The aim of this study was therefore to study the longitudinal motion of the carotid artery wall during physical activity in healthy humans. Using in-house developed non-invasive ultrasonic methods, the longitudinal motion of the intima-media complex and the diameter changes of the right common carotid artery (CCA) in 40 healthy volunteers (20 volunteers aged 22-35 years; 20 volunteers aged 55-68 years) were assessed at rest and during submaximal supine bicycle exercise. In a subset of the subjects (n = 18) also intramural shear strain were analyzed. The longitudinal motion of the intima-media complex underwent marked changes in response to physical activity, already at low workload; with most evident a marked increase of the first antegrade displacement (p < 0.001) in early systole. Likewise, the corresponding shear strain also increased significantly (p = 0.004). The increase in longitudinal motion showed significant correlation to increase in blood pressure, but not to blood flow velocity or wall shear stress. In conclusion, physical activity markedly influences the longitudinal motion of the carotid artery wall in healthy humans already at low load. A possible "cushioning" function as well as possible implications for the function of the vasa vasorum, endothelium, and smooth muscle cells and extracellular matrix of the media, are discussed.
Collapse
Affiliation(s)
- Åsa Rydén Ahlgren
- Department of Translational MedicineLund UniversityLundSweden
- Department of Medical Imaging and Physiology, Skåne University HospitalLund UniversityMalmöSweden
| | - Tobias Erlöv
- Department of Biomedical EngineeringLund UniversityLundSweden
| | - Magnus Cinthio
- Department of Biomedical EngineeringLund UniversityLundSweden
| |
Collapse
|
4
|
Granéli C, Erlöv T, Mitev RM, Kasselaki I, Hagelsteen K, Gisselsson D, Jansson T, Cinthio M, Stenström P. Ultra high frequency ultrasonography to distinguish ganglionic from aganglionic bowel wall in Hirschsprung disease: A first report. J Pediatr Surg 2021; 56:2281-2285. [PMID: 33676743 DOI: 10.1016/j.jpedsurg.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND/PURPOSE In Hirschsprung disease (HD) surgery, confirming ganglionic bowel is essential. A faster diagnostic method than the current frozen biopsy is desirable. This study investigated whether aganglionic and ganglionic intestinal wall can be distinguished from each other by ultra high frequency ultrasound (UHF ultrasound). METHODS In an HD center during 2019, intestinal walls of recto-sigmoid specimens from HD patients were examined ex vivo with a 70 MHz UHF ultrasound transducer. Data from four sites were described. Histopathologic analysis was compared to the ultrasonography outcome at each site. Each patient's specimen served as its own control. RESULTS 11 resected recto-sigmoid specimens (median 20 cm long [range 6.5-33]) with transition zones of 5 cm (2-11 cm) were taken from children aged 22 days (13-48) weighing 3668 g (3500-5508); 44 key sites were analyzed. There was full concordance for 42/44 (95%) key sites and 10 of 11 (91%) specimens. The specimen with discordance of two key sites contained a segment of aganglionosis (3 cm) and a transition zone (1 cm): the site discordance was limited to the transition zone ends. CONCLUSIONS This first report on UHF ultrasound in recto-sigmoid HD shows promising results in identifying aganglionosis, transition zones and ganglionic bowel. Further in vivo studies are required.
Collapse
Affiliation(s)
- Christina Granéli
- Department of Pediatric Surgery, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Tobias Erlöv
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, Lund, Sweden
| | - Rodrigo Munoz Mitev
- Department of Clinical Genetics and Oncology-Pathology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Ioanna Kasselaki
- Department of Clinical Genetics and Oncology-Pathology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Kristine Hagelsteen
- Department of Pediatric Surgery, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - David Gisselsson
- Department of Clinical Genetics and Oncology-Pathology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Tomas Jansson
- Department of Clinical Sciences Lund/Biomedical Engineering, Lund University, Lund, Sweden; Clinical Engineering Skåne, Digitalisering IT/MT, Region Skåne, Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, The Faculty of Engineering, Lund University, Lund, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital Lund, Lund University, Lund, Sweden.
| |
Collapse
|
5
|
Zhu Y, Cinthio M, Erlöv T, Bjarnegård N, Ahlgren ÅR. Comparison of the multi-phasic longitudinal displacement of the left and right common carotid artery in healthy humans. Clin Physiol Funct Imaging 2021; 41:342-354. [PMID: 33763958 DOI: 10.1111/cpf.12701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/16/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND During the cardiac cycle, there is a multi-phasic bidirectional longitudinal movement (LMov) of the intima-media complex of large arteries, i.e. along the arteries. On the left side the common carotid artery (CCA) arises directly from the aortic arc, whereas on the right side the CCA originate from the innominate artery. AIM The aim of this study was to compare LMov of the left and right CCA of healthy subjects to investigate whether the difference in anatomy is of importance for LMov. MATERIAL AND METHODS The CCA's of 93 healthy subjects were investigated using in-house developed ultrasound methods. RESULTS Although the basic pattern were the same in the majority of subjects, several phases of LMov were significantly larger on the left side (the first retrograde phase, p = 0.0006; the second antegrade, "returning" phase, p < 0.00001; and the rapid retrograde phase of movement at the end of the cardiac cycle, p < 0.000001). In contrast, no significant side-difference in the amplitude of the first antegrade movement was seen. The maximal (peak-to-peak) LMov was significantly larger on the left side (p = 0.002). DISCUSSION AND CONCLUSION The side-differences found in LMov may be related to the difference in anatomy, including possible difference in distance to the heart and especially the presence of an extra bifurcation on the right side. Our data provide an important base for the further study of the relation between LMov and cardiovascular risk factors and atherosclerosis.
Collapse
Affiliation(s)
- Yuxiang Zhu
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.,Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Magnus Cinthio
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Tobias Erlöv
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Niclas Bjarnegård
- Department of Diagnostics and Specialist Medicine, Faculty of Health, Medicine and Caring Sciences, University of Linköping, Linköping, Sweden
| | - Åsa Rydén Ahlgren
- Department of Translational Medicine, Lund University, Lund, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| |
Collapse
|
6
|
Cinthio M, Albinsson J, Erlöv T, Bjarnegård N, Länne T, Ahlgren ÅR. Longitudinal Movement of the Common Carotid Artery Wall: New Information on Cardiovascular Aging. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2283-2295. [PMID: 30077411 DOI: 10.1016/j.ultrasmedbio.2018.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
Putative changes in the multiphasic pattern of longitudinal movement of the common carotid artery wall in the normal aging process are unknown. The aim of this study was to explore the phases, and resulting patterns, of the longitudinal movement of the intima-media complex of the human common carotid artery with respect to age and gender. One hundred thirty-five healthy non-smoking patients of different ages were investigated using in-house-developed ultrasound methods. The patterns of longitudinal movement seen in middle-aged and older patients were markedly different from those commonly seen in young patients, including the appearance of two additional phases of motion and, thus, new complex patterns. The displacement and maximum velocity of one of the phases, occurring at the time of aortic valve closure, increased quadratically with age in both men and women.
Collapse
Affiliation(s)
- Magnus Cinthio
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.
| | - John Albinsson
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Tobias Erlöv
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Niclas Bjarnegård
- Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
| | - Toste Länne
- Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
| | - Åsa Rydén Ahlgren
- Department of Translational Medicine, Lund University, Lund, Sweden; Lund University, Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
7
|
Robust estimation of carotid artery wall motion using the elasticity-based state-space approach. Med Image Anal 2017; 37:1-21. [DOI: 10.1016/j.media.2017.01.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 12/31/2022]
|
8
|
Sjostrand S, Widerstrom A, Ahlgren AR, Cinthio M. Design and Fabrication of a Conceptual Arterial Ultrasound Phantom Capable of Exhibiting Longitudinal Wall Movement. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:11-18. [PMID: 27529873 DOI: 10.1109/tuffc.2016.2597246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The longitudinal movement of the arterial wall of large human arteries has shown promise to be an independent indicator of vascular health. Despite growing interest in this movement, its nature, causes, and implications are not fully understood, and existing phantoms have failed to show a pure longitudinal movement that is not secondary to the distension. An often overlooked aspect of the arterial wall is the interaction between the different layers. The longitudinal movement of the innermost layers, the intima and media, can be several hundred micrometers in the direction of flow during early systole. This is markedly larger than that of the adventitia, indicating that sliding occurs between the two layers. This feature was incorporated into a phantom by casting it in two parts. The molds were developed in-house using mainly a 3-D printer, a versatile and easy production method. Additionally, the phantom contains a tapered region. Using the phantom, we were able to demonstrate a pure longitudinal movement; when it was subjected to a pulsatile pressure, the wall displaced 220 [Formula: see text] (SD 40) radially and 560 [Formula: see text] (SD 74) longitudinally distal to the tapering. The motion followed the pressure variations. This paper serves as a guide for phantom production, explaining each step of the process.
Collapse
|