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Rubin MJ, Wakinekona NA, Reilly MA, Canales B, Sparapani R, Dyer M, Kibbe MR, Mansukhani NA. Reporting and Analysis of Sex in Vascular Surgery Research. J Vasc Surg 2024:S0741-5214(24)01338-7. [PMID: 38901638 DOI: 10.1016/j.jvs.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/20/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To examine sex in human vascular surgery research by quantifying the inclusion and analysis of sex-based data in high-impact vascular surgery journals. METHODS A bibliographic review of original manuscripts published in the European Journal of Vascular and Endovascular Surgery, Journal of Vascular Surgery, JVS: Venous and Lymphatic Disorders, Journal of Endovascular Therapy, and Annals of Vascular Surgery from January 1, 2018 to December 31, 2020 and January 1, 2023 to December 31, 2023 was conducted. Abstracted data included sex-based data analysis, inclusion of sex as a variable in multivariable analysis, inclusion of sex as an independent variable, and a discussion of sex-based results. RESULTS Of the 3,762 articles that included human, animal, or cell subjects, 249 (6.6%) did not state sex. Of those 249 articles, 183 included human subjects, 55 included animal subjects and 11 utilized cell lines as the subjects. These were removed from analysis as well as the remaining 68 articles with animal subjects. Additionally, 23 researched a sex-specific pathology and were removed from analysis. Of the remaining 3,422 articles included in our study, 42.3% analyzed sex, 46.9% included sex in multivariable analysis, 4.8% included sex as an independent variable, and 26.6% of articles included a discussion of sex. There were no significant differences in all four sex variables between 2018, 2019, and 2020. Between 2018-2020 and 2023, there were significant increases in all four sex variables. Multicenter studies had significantly higher rates of independent analysis of sex over single center studies (7.4% vs 3.3%, p <0.001). There was no significant difference in independent analysis of sex between US-based and non-US-based studies. Only 191 articles (5.6%) had 90% or greater matching of men and women in their study. CONCLUSIONS Equitable inclusion and analysis of sex is rare in vascular surgery research. Less than 5% of articles included an independent analysis of data by sex and few studies included males and females equally. Clinical research is the basis for evidence-based medicine; therefore, it is important to strive for equitable inclusion, analysis, and reporting of data to foster generalizability of clinical research to men and women.
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Affiliation(s)
- Micah J Rubin
- Department of Surgery, Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Nalani A Wakinekona
- Department of Surgery, Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Margaret A Reilly
- Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bethany Canales
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Rodney Sparapani
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Mitchell Dyer
- Department of Surgery, Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Melina R Kibbe
- Department of Surgery and Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA
| | - Neel A Mansukhani
- Department of Surgery, Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI; Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Dong H, Leach JR, Kao E, Zhou A, Chitiboi T, Zhu C, Ballweber M, Jiang F, Lee YJ, Iannuzzi J, Gasper W, Saloner D, Hope MD, Mitsouras D. Measurement of Abdominal Aortic Aneurysm Strain Using MR Deformable Image Registration: Accuracy and Relationship to Recent Aneurysm Progression. Invest Radiol 2024; 59:425-432. [PMID: 37855728 PMCID: PMC11026303 DOI: 10.1097/rli.0000000000001035] [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] [Indexed: 10/20/2023]
Abstract
BACKGROUND Management of asymptomatic abdominal aortic aneurysm (AAA) based on maximum aneurysm diameter and growth rate fails to preempt many ruptures. Assessment of aortic wall biomechanical properties may improve assessment of progression and rupture risk. This study aimed to assess the accuracy of AAA wall strain measured by cine magnetic resonance imaging (MRI) deformable image registration (MR strain) and investigate its relationship with recent AAA progression. METHODS The MR strain accuracy was evaluated in silico against ground truth strain in 54 synthetic MRIs generated from a finite element model simulation of an AAA patient's abdomen for different aortic pulse pressures, tissue motions, signal intensity variations, and image noise. Evaluation included bias with 95% confidence interval (CI) and correlation analysis. Association of MR strain with AAA growth rate was assessed in 25 consecutive patients with >6 months of prior surveillance, for whom cine balanced steady-state free-precession imaging was acquired at the level of the AAA as well as the proximal, normal-caliber aorta. Univariate and multivariate regressions were used to associate growth rate with clinical variables, maximum AAA diameter (D max ), and peak circumferential MR strain through the cardiac cycle. The MR strain interoperator variability was assessed using bias with 95% CI, intraclass correlation coefficient, and coefficient of variation. RESULTS In silico experiments revealed an MR strain bias of 0.48% ± 0.42% and a slope of correlation to ground truth strain of 0.963. In vivo, AAA MR strain (1.2% ± 0.6%) was highly reproducible (bias ± 95% CI, 0.03% ± 0.31%; intraclass correlation coefficient, 97.8%; coefficient of variation, 7.14%) and was lower than in the nonaneurysmal aorta (2.4% ± 1.7%). D max ( β = 0.087) and MR strain ( β = -1.563) were both associated with AAA growth rate. The MR strain remained an independent factor associated with growth rate ( β = -0.904) after controlling for D max . CONCLUSIONS Deformable image registration analysis can accurately measure the circumferential strain of the AAA wall from standard cine MRI and may offer patient-specific insight regarding AAA progression.
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Affiliation(s)
- Huiming Dong
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA (H.D., J.L., E.K., A.Z., C.Z., M.B., Y.J.L., D.S., M.H., D.M.); Vascular Imaging Research Center, San Francisco Veteran Affairs Medical Center, San Francisco, CA (H.D., J.L., E.K., A.Z., C.Z., M.B., D.S., M.H., D.M.); Siemens Healthineers (T.C.); Department of Radiology, University of Washington, Seattle, WA (C.Z.); Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (F.J.); Department of Surgery, University of California, San Francisco, San Francisco, CA (J.I., W. G.); and Department of Vascular Surgery, San Francisco Veteran Affairs Medical Center, San Francisco, CA (J.I., W.G.)
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3
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Olukorode JO, Onwuzo CN, Otabor EO, Nwachukwu NO, Omiko R, Omokore O, Kristilere H, Oladipupo Y, Akin-Adewale R, Kuku O, Ugboke JO, Joseph-Erameh T. Aortic Size Index Versus Aortic Diameter in the Prediction of Rupture in Women With Abdominal Aortic Aneurysm. Cureus 2024; 16:e58673. [PMID: 38774170 PMCID: PMC11106735 DOI: 10.7759/cureus.58673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
Abdominal aortic aneurysms (AAAs) pose significant challenges in clinical management, particularly in female patients, whose unique anatomical and physiological characteristics influence rupture risk. While aortic diameter (AD) has traditionally been the primary metric for predicting rupture, its limitations, especially in women, have spurred exploration into alternative measures such as the aortic size index (ASI). This review examines the anatomy and physiology of AAAs in women, gender-specific challenges in diagnosis and management, and the comparative effectiveness of ASI versus AD in predicting rupture risk. ASI, calculated as AD divided by body surface area (BSA), offers a more nuanced assessment by adjusting for individual body size differences, potentially mitigating gender disparities in rupture rates. Comparative analyses indicate ASI's superiority in predicting adverse aortic events, particularly in women, thereby advocating for its integration into clinical practice to improve patient outcomes. Additionally, emerging techniques such as 3D volumetric measurements and biomechanical assessments show promise in enhancing rupture risk prediction, heralding a shift toward more personalized and effective management strategies for AAA patients.
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Affiliation(s)
- John O Olukorode
- Internal Medicine, Benjamin S. Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, NGA
| | - Chidera N Onwuzo
- Internal Medicine, Benjamin S. Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, NGA
| | - Emmanuel O Otabor
- Internal Medicine, University Hospital Coventry and Warwickshire, Coventry, GBR
| | - Nwachukwu O Nwachukwu
- Internal Medicine, Benjamin S. Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, NGA
| | - Raymond Omiko
- Internal Medicine, Benjamin S. Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, NGA
| | - Olutomiwa Omokore
- Internal Medicine, Benjamin S. Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, NGA
| | - Heritage Kristilere
- Internal Medicine, Benjamin S. Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, NGA
| | | | - Rolake Akin-Adewale
- Internal Medicine, College of Health Sciences, University of Ilorin, Ilorin, NGA
| | - Oluwatosin Kuku
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ogun, NGA
| | - Joshua O Ugboke
- Internal Medicine, College of Medicine, University of Lagos, Lagos, NGA
| | - Thummim Joseph-Erameh
- Internal Medicine, Benjamin S. Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, NGA
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4
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Ren S, Guidoin R, Xu Z, Deng X, Fan Y, Chen Z, Sun A. Narrative Review of Risk Assessment of Abdominal Aortic Aneurysm Rupture Based on Biomechanics-Related Morphology. J Endovasc Ther 2024; 31:178-190. [PMID: 36052406 DOI: 10.1177/15266028221119309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
CLINICAL IMPACT Studies have shown that the biomechanical indicators based on multi-scale models are more effective in accurately assessing the rupture risk of AAA. To meet the need for clinical monitoring and rapid decision making, the typical morphological parameters associated with AAA rupture and their relationships with the mechanical environment have been summarized, which provide a reference for clinical preoperative risk assessment of AAA.
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Affiliation(s)
- Shuqi Ren
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Robert Guidoin
- Department of Surgery, Faculty of Medicine, Université Laval and CHU de Québec Research Centre, Quebec, QC, Canada
| | - Zaipin Xu
- College of Animal Science, Guizhou University, Guiyang, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zengsheng Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Gonring DW, Zottola ZR, Hirad AA, Lakony R, Richards MS, Pitcher G, Stoner MC, Mix DS. Ultrasound elastography to quantify average percent pressure-normalized strain reduction associated with different aortic endografts in 3D-printed hydrogel phantoms. JVS Vasc Sci 2024; 5:100198. [PMID: 38846626 PMCID: PMC11153908 DOI: 10.1016/j.jvssci.2024.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/23/2024] [Indexed: 06/09/2024] Open
Abstract
Objective Strain has become a viable index for evaluating abdominal aortic aneurysm stability after endovascular aneurysm repair (EVAR). In addition, literature has shown that healthy aortic tissue requires a degree of strain to maintain homeostasis. This has led to the hypothesis that too much strain reduction conferred by a high degree of graft oversizing is detrimental to the aneurysm neck in the seal zone of abdominal aortic aneurysms after EVAR. We investigated this in a laboratory experiment by examining the effects that graft oversizing has on the pressure-normalized strain (ε ρ + ¯ /pulse pressure [PP]) reduction using four different infrarenal EVAR endografts and our ultrasound elastography technique. Approximate graft oversizing percentages were 20% (30 mm phantom-graft combinations), 30% (28 mm phantom-graft combinations), and 50% (24 mm phantom-graft combinations). Methods Axisymmetric, 10% by mass polyvinyl alcohol phantoms were connected to a flow simulator. Ultrasound elastography was performed before and after implantation with the four different endografts: (1) 36 mm polyester/stainless steel, (2) 36 mm polyester/electropolished nitinol, (3) 35 mm polytetrafluoroethylene (PTFE)/nitinol, and (4) 36 mm nitinol/polyester/platinum-iridium. Five ultrasound cine loops were taken of each phantom-graft combination. They were analyzed over two different cardiac cycles (end-diastole to end-diastole), yielding a total of 10 maximum mean principal strain (ε ρ + ¯ ) values.ε ρ + ¯ was divided by pulse pressure to yield pressure-normalized strain (ε ρ + ¯ /PP). An analysis of variance was performed for graft comparisons. We calculated the average percentε ρ + ¯ /PP reduction by manufacturer and percent oversizing. These values were used for linear regression analysis. Results Results from one-way analysis of variance showed a significant difference inε ρ + ¯ /PP between the empty phantom condition and all oversizing conditions for all graft manufacturers (F(3, 56) = 106.7 [graft A], 132.7 [graft B], 106.5 [graft C], 105.7 [graft D], P < .0001 for grafts A-D). There was a significant difference when comparing the 50% condition with the 30% and 20% conditions across all manufacturers by post hoc analysis (P < .0001). No significant difference was found when comparing the 20% and 30% oversizing conditions for any of the manufacturers or when comparingε ρ + ¯ /PP values across the manufacturers according to percent oversize. Linear regression demonstrated a significant positive correlation between the percent graft oversize and the all-graft average percentε ρ + ¯ /PP reduction (R 2 = 0.84, P < .0001). Conclusions This brief report suggests that a 10% increase in graft oversizing leads to an approximate 5.9% reduction inε ρ + ¯ /PP on average. Applied clinically, this increase may result in increased stiffness in axisymmetric vessels after EVAR. Further research is needed to determine if this is clinically significant.
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Affiliation(s)
- Dakota W. Gonring
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Adnan A. Hirad
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Ronald Lakony
- Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, NY
| | - Michael S. Richards
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY
| | - Grayson Pitcher
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Michael C. Stoner
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Doran S. Mix
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY
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6
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Derwich W, Schönborn M, Blase C, Wittek A, Oikonomou K, Böckler D, Erhart P. Correlation of four-dimensional ultrasound strain analysis with computed tomography angiography wall stress simulations in abdominal aortic aneurysms. JVS Vasc Sci 2024; 5:100199. [PMID: 38633883 PMCID: PMC11022090 DOI: 10.1016/j.jvssci.2024.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Biomechanical modeling of infrarenal aortic aneurysms seeks to predict ruptures in advance, thereby reducing aneurysm-related deaths. As individual methods focusing on strain and stress analysis lack adequate discretization power, this study aims to explore multifactorial characterization for progressive aneurysmal degeneration. The study's objective is to compare stress- and strain-related parameters in infrarenal aortic aneurysms. Methods Twenty-two patients with abdominal aortic aneurysms (AAAs) (mean maximum diameter, 53.2 ± 7.2 mm) were included in the exploratory study, examined by computed tomography angiography (CTA) and three-dimensional real-time speckle tracking ultrasound (4D-US). The conformity of aneurysm anatomy in 4D-US and CTA was determined with the mean point-to-point distance (MPPD). CTA was employed for each AAA to characterize stress-related indices using the semi-automated A4-clinics RE software. Five segmentations from one 4D-US examination were fused into one averaged model for strain analysis using MATLAB and the Abaqus solver. Results The mean MPPD between the adjacent points of the 4D-US and CTA-derived geometry was 1.8 ± 0.4 mm. The interclass correlation coefficients for all raters and all measurements for the maximum AAA diameter in 2D, 4D ultrasound, and CTA indicate moderate to good reliability (interclass correlation coefficient1 0.69 with 95% confidence interval [CI], 0.49-0.84; P < .001). The peak wall stress (PWS) correlates fairly with the maximum AAA diameter in 2D-US (r = 0.54; P < .01) and 4D-US (r = 0.53; P < .05) and moderately strongly with the maximum exterior AAA diameter (r = 0.63; P < .01). The peak wall rupture risk index shows a strong correlation with the PWS (ρ > 0.9; P < .001) and is influenced by anatomical parameters with equal strength. Isolated observation of the intraluminal thrombus does not provide significant information in the determination of PWS. The maximum AAA diameter in 2D-US shows a fair negative correlation with the mean circumferential, longitudinal and in-plane shear strain (ρ = -0.46; r = -0.45; ρ = -0.47; P < .05 for all). The circumferential strain ratio as an indicator of wall motion heterogeneity increases with the aneurysm diameter (r = 0.47; P < .05). The direct comparison of wall strain and wall stress indices shows no quantitative correlation. Conclusions The strain and stress analyses provide independent biomechanical information of AAAs. At the current stage of development, the two methods are considered complementary and may optimize a more patient-specific rupture risk prediction in the future.
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Affiliation(s)
- Wojciech Derwich
- Vascular and Endovascular Surgery, Department of Cardiac and Vascular Surgery, University Hospital Frankfurt Goethe University, Frankfurt/Main, Germany
| | - Manuel Schönborn
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
| | - Christopher Blase
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
| | - Andreas Wittek
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
| | - Kyriakos Oikonomou
- Vascular and Endovascular Surgery, Department of Cardiac and Vascular Surgery, University Hospital Frankfurt Goethe University, Frankfurt/Main, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Erhart
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
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7
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Zhao TY, Johnson EMI, Elisha G, Halder S, Smith BC, Allen BD, Markl M, Patankar NA. Blood-wall fluttering instability as a physiomarker of the progression of thoracic aortic aneurysms. Nat Biomed Eng 2023; 7:1614-1626. [PMID: 38082182 DOI: 10.1038/s41551-023-01130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/16/2023] [Indexed: 12/20/2023]
Abstract
The diagnosis of aneurysms is informed by empirically tracking their size and growth rate. Here, by analysing the growth of aortic aneurysms from first principles via linear stability analysis of flow through an elastic blood vessel, we show that abnormal aortic dilatation is associated with a transition from stable flow to unstable aortic fluttering. This transition to instability can be described by the critical threshold for a dimensionless number that depends on blood pressure, the size of the aorta, and the shear stress and stiffness of the aortic wall. By analysing data from four-dimensional flow magnetic resonance imaging for 117 patients who had undergone cardiothoracic imaging and for 100 healthy volunteers, we show that the dimensionless number is a physiomarker for the growth of thoracic ascending aortic aneurysms and that it can be used to accurately discriminate abnormal versus natural growth. Further characterization of the transition to blood-wall fluttering instability may aid the understanding of the mechanisms underlying aneurysm progression in patients.
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Affiliation(s)
- Tom Y Zhao
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.
| | - Ethan M I Johnson
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Guy Elisha
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Sourav Halder
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Ben C Smith
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Michael Markl
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Neelesh A Patankar
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.
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8
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Aalbregt E, Rijken L, Nederveen A, van Ooij P, Yeung KK, Jongkind V. Quantitative Magnetic Resonance Imaging to Assess Progression and Rupture Risk of Aortic Aneurysms: A Scoping Review. J Endovasc Ther 2023:15266028231204830. [PMID: 37853734 DOI: 10.1177/15266028231204830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE In current practice, the diameter of an aortic aneurysm is utilized to estimate the rupture risk and decide upon timing of elective repair, although it is known to be imprecise and not patient-specific. Quantitative magnetic resonance imaging (MRI) enables the visualization of several biomarkers that provide information about processes within the aneurysm and may therefore facilitate patient-specific risk stratification. We performed a scoping review of the literature on quantitative MRI techniques to assess aortic aneurysm progression and rupture risk, summarized these findings, and identified knowledge gaps. METHODS Literature concerning primary research was of interest and the medical databases PubMed, Scopus, Embase, and Cochrane were systematically searched. This study used the PRISMA protocol extension for scoping reviews. Articles published between January 2010 and February 2023 involving animals and/or humans were included. Data were extracted by 2 authors using a predefined charting method. RESULTS A total of 1641 articles were identified, of which 21 were included in the scoping review. Quantitative MRI-derived biomarkers were categorized into hemodynamic (8 studies), wall (5 studies) and molecular biomarkers (8 studies). Fifteen studies included patients and/or healthy human subjects. Animal models were investigated in the other 6 studies. A cross-sectional study design was the most common, whereas 5 animal studies had a longitudinal component and 2 studies including patients had a prospective design. A promising hemodynamic biomarker is wall shear stress (WSS), which is estimated based on 4D-flow MRI. Molecular biomarkers enable the assessment of inflammatory and wall deterioration processes. The ADAMTS4-specific molecular magnetic resonance (MR) probe showed potential to predict abdominal aortic aneurysm (AAA) formation and rupture in a murine model. Wall biomarkers assessed using dynamic contrast-enhanced (DCE) MRI showed great potential for assessing AAA progression independent of the maximum diameter. CONCLUSION This scoping review provides an overview of quantitative MRI techniques studied and the biomarkers derived from them to assess aortic aneurysm progression and rupture risk. Longitudinal studies are needed to validate the causal relationships between the identified biomarkers and aneurysm growth, rupture, or repair. In the future, quantitative MRI could play an important role in the personalized risk assessment of aortic aneurysm rupture. CLINICAL IMPACT The currently used maximum aneurysm diameter fails to accurately assess the multifactorial pathology of an aortic aneurysm and precisely predicts rupture in a patient-specific manner. Quantitative magnetic resonance imaging (MRI) enables the detection of various quantitative parameters involved in aneurysm progression and subsequent rupture. This scoping review provides an overview of the studied quantitative MRI techniques, the biomarkers derived from them, and recommendations for future research needed for the implementation of these biomarkers. Ultimately, quantitative MRI could facilitate personalized risk assessment for patients with aortic aneurysms, thereby reducing untimely repairs and improving rupture prevention.
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Affiliation(s)
- Eva Aalbregt
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Lotte Rijken
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Aart Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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9
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Hof A, Guthoff H, Ahdab M, Landerer M, Schäkel J, Niehues J, Schorscher M, Zimmermann O, Winkels H, von Stein P, Geißen S, Baldus S, Adam M, Mollenhauer M, Mehrkens D. Vascular Ultrasound for In Vivo Assessment of Arterial Pathologies in a Murine Model of Atherosclerosis and Aortic Aneurysm. Int J Mol Sci 2023; 24:15261. [PMID: 37894941 PMCID: PMC10607567 DOI: 10.3390/ijms242015261] [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: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Vascular diseases like atherosclerosis and abdominal aortic aneurysm (AAA) are common pathologies in the western world, promoting various potentially fatal conditions. Here, we evaluate high-resolution (HR) ultrasound in mouse models of atherosclerosis and AAA as a useful tool for noninvasive monitoring of early vascular changes in vivo. We used Apolipoprotein E-deficient (ApoE-/-) mice as an atherosclerosis model and induced AAA development by the implementation of Angiotensin II-releasing osmotic minipumps. HR ultrasound of the carotid artery or the abdominal aorta was performed to monitor vascular remodeling in vivo. Images were analyzed by speckle tracking algorithms and correlated to histological analyses and subsequent automated collagen quantification. Consistent changes were observed via ultrasound in both models: Global radial strain (GRS) was notably reduced in the AAA model (23.8 ± 2.8% vs. 12.5 ± 2.5%, p = 0.01) and in the atherosclerotic mice (20.6 ± 1.3% vs. 15.8 ± 0.9%, p = 0.02). In mice with AAA, vessel distensibility was significantly reduced, whereas intima-media thickness was increased in atherosclerotic mice. The area and collagen content of the tunica media were increased in diseased arteries of both models as measured by automated image analysis of Picrosirius Red-stained aortic sections. Correlation analysis revealed a strong correlation of multiple parameters, predicting early vascular damage in HR ultrasound and histological examinations. In conclusion, our findings underscore the potential of HR ultrasound in effectively tracing early alterations in arterial wall properties in murine models of atherosclerosis and AAA.
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Affiliation(s)
- Alexander Hof
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Henning Guthoff
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Maysam Ahdab
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
| | - Max Landerer
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
| | - Jasper Schäkel
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Jana Niehues
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
| | - Maximilian Schorscher
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Oscar Zimmermann
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Holger Winkels
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Philipp von Stein
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
| | - Simon Geißen
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Stephan Baldus
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Matti Adam
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Martin Mollenhauer
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
| | - Dennis Mehrkens
- Department for Experimental Cardiology, Faculty of Medicine, University of Cologne, Clinic III for Internal Medicine, University Hospital Cologne, 50937 Cologne, Germany; (A.H.); (M.A.); (M.L.); (J.S.); (J.N.); (M.S.); (O.Z.); (H.W.); (P.v.S.); (S.G.); (S.B.); (M.A.); (M.M.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, 50937 Cologne, Germany
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10
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Hegner A, Wittek A, Derwich W, Huß A, Gámez AJ, Blase C. Using averaged models from 4D ultrasound strain imaging allows to significantly differentiate local wall strains in calcified regions of abdominal aortic aneurysms. Biomech Model Mechanobiol 2023; 22:1709-1727. [PMID: 37405538 PMCID: PMC10511614 DOI: 10.1007/s10237-023-01738-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
Abdominal aortic aneurysms are a degenerative disease of the aorta associated with high mortality. To date, in vivo information to characterize the individual elastic properties of the aneurysm wall in terms of rupture risk is lacking. We have used time-resolved 3D ultrasound strain imaging to calculate spatially resolved in-plane strain distributions characterized by mean and local maximum strains, as well as indices of local variations in strains. Likewise, we here present a method to generate averaged models from multiple segmentations. Strains were then calculated for single segmentations and averaged models. After registration with aneurysm geometries based on CT-A imaging, local strains were divided into two groups with and without calcifications and compared. Geometry comparison from both imaging modalities showed good agreement with a root mean squared error of 1.22 ± 0.15 mm and Hausdorff Distance of 5.45 ± 1.56 mm (mean ± sd, respectively). Using averaged models, circumferential strains in areas with calcifications were 23.2 ± 11.7% (mean ± sd) smaller and significantly distinguishable at the 5% level from areas without calcifications. For single segmentations, this was possible only in 50% of cases. The areas without calcifications showed greater heterogeneity, larger maximum strains, and smaller strain ratios when computed by use of the averaged models. Using these averaged models, reliable conclusions can be made about the local elastic properties of individual aneurysm (and long-term observations of their change), rather than just group comparisons. This is an important prerequisite for clinical application and provides qualitatively new information about the change of an abdominal aortic aneurysm in the course of disease progression compared to the diameter criterion.
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Affiliation(s)
- Achim Hegner
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Andreas Wittek
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, Frankfurt am Main, Germany
| | - Armin Huß
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Antonio J. Gámez
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Christopher Blase
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Cell and Vascular Mechanics, Goethe University, Frankfurt am Main, Germany
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11
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Hegner A, Cebull HL, Gámez AJ, Blase C, Goergen CJ, Wittek A. Biomechanical characterization of tissue types in murine dissecting aneurysms based on histology and 4D ultrasound-derived strain. Biomech Model Mechanobiol 2023; 22:1773-1788. [PMID: 37707685 PMCID: PMC10511389 DOI: 10.1007/s10237-023-01759-6] [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: 01/31/2023] [Accepted: 07/26/2023] [Indexed: 09/15/2023]
Abstract
Abdominal aortic aneurysm disease is the local enlargement of the aorta, typically in the infrarenal section, causing up to 200,000 deaths/year. In vivo information to characterize the individual elastic properties of the aneurysm wall in terms of rupture risk is lacking. We used a method that combines 4D ultrasound and direct deformation estimation to compute in vivo 3D Green-Lagrange strain in murine angiotensin II-induced dissecting aortic aneurysms, a commonly used mouse model. After euthanasia, histological staining of cross-sectional sections along the aorta was performed in areas where in vivo strains had previously been measured. The histological sections were segmented into intact and fragmented elastin, thrombus with and without red blood cells, and outer vessel wall including the adventitia. Meshes were then created from the individual contours based on the histological segmentations. The isolated contours of the outer wall and lumen from both imaging modalities were registered individually using a coherent point drift algorithm. 2D finite element models were generated from the meshes, and the displacements from the registration were used as displacement boundaries of the lumen and wall contours. Based on the resulting deformed contours, the strains recorded were grouped according to segmented tissue regions. Strains were highest in areas containing intact elastin without thrombus attachment. Strains in areas with intact elastin and thrombus attachment, as well as areas with disrupted elastin, were significantly lower. Strains in thrombus regions with red blood cells were significantly higher compared to thrombus regions without. We then compared this analysis to statistical distribution indices and found that the results of each aligned, elucidating the relationship between vessel strain and structural changes. This work demonstrates the possibility of advancing in vivo assessments to a microstructural level ultimately improving patient outcomes.
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Affiliation(s)
- Achim Hegner
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Hannah L. Cebull
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, USA
| | - Antonio J. Gámez
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Christopher Blase
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Cell and Vascular Mechanics, Goethe University, Frankfurt am Main, Germany
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, USA
| | - Andreas Wittek
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
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12
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Margaretha Nievergeld AH, Maas EJ, de Ruijter J, Cornelia Fonken JH, Henricus Maria van Sambeek MR, Paulus Lopata RG. Automatic Segmentation and Mechanical Characterisation of the Intraluminal Thrombus and Arterial Wall of Abdominal Aortic Aneurysms Using Time Resolved 3D Ultrasound Images. Eur J Vasc Endovasc Surg 2023; 66:418-427. [PMID: 36963747 DOI: 10.1016/j.ejvs.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/19/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE This study proposed a method for semi-automatic segmentation of abdominal aortic aneurysms (AAAs) and their intraluminal thrombus (ILT), based on time resolved 3D ultrasound (US), and validated results with computed tomography (CT). Mechanical properties of both wall and ILT were determined, and possible correlations with ILT size and blood pressure were investigated. METHODS A semi-automatic segmentation algorithm was developed combining a star-Kalman approach with a 3D snake algorithm. The segmented geometries of both lumen and inner vessel wall were validated with both manual US based segmentations and CT based segmentations. Finally, the lumen and vessel wall distensibility and ILT compressibility were estimated and correlated with ILT size and blood pressure. RESULTS For the vessel wall and lumen, the median Similarity Index (SI) was 92% (IQR 90, 94%) and 83% (IQR 75, 87%), respectively. The distensibility of the vessel wall could be determined in 37 of 40 cases and had a median value of 0.28 10-5 Pa-1 (IQR 0.18, 0.51 ×10-5). The median systolic to diastolic volume change of the ILT was determined successfully in 21 of 40 patients, and was -0.57% (IQR -1.1, 1.2%). The vessel and lumen distensibility showed a strong correlation with the systolic pressure (p < .010), rather than with the diastolic pressure. Lumen distensibility was strongly correlated with ILT thickness (p = .023). The performance of the semi-automatic segmentation algorithm was shown to be as good as the manual segmentations and highly dependent on the visibility of the ILT (limited contrast in seven patients and clutter in nine patients). CONCLUSION This study has shown promising results for mechanical characterisation of the vessel, and ILT, including a correlation between distensibility, ILT size, and blood pressure. For future work, the inclusion rate needs to be increased by improving the image contrast with novel US techniques.
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Affiliation(s)
- Arjet Helena Margaretha Nievergeld
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Esther Jorien Maas
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Joerik de Ruijter
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Judith Helena Cornelia Fonken
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Marcus Rodolph Henricus Maria van Sambeek
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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13
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Zottola ZR, Kong DS, Medhekar AN, Frye LE, Hao SB, Gonring DW, Hirad AA, Stoner MC, Richards MS, Mix DS. Intermediate pressure-normalized principal wall strain values are associated with increased abdominal aortic aneurysmal growth rates. Front Cardiovasc Med 2023; 10:1232844. [PMID: 37719977 PMCID: PMC10501562 DOI: 10.3389/fcvm.2023.1232844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Current abdominal aortic aneurysm (AAA) assessment relies on analysis of AAA diameter and growth rate. However, evidence demonstrates that AAA pathology varies among patients and morphometric analysis alone is insufficient to precisely predict individual rupture risk. Biomechanical parameters, such as pressure-normalized AAA principal wall strain (ε ρ + ¯ /PP, %/mmHg), can provide useful information for AAA assessment. Therefore, this study utilized a previously validated ultrasound elastography (USE) technique to correlate ε ρ + ¯ /PP with the current AAA assessment methods of maximal diameter and growth rate. Methods Our USE algorithm utilizes a finite element mesh, overlaid a 2D cross-sectional view of the user-defined AAA wall, at the location of maximum diameter, to track two-dimensional, frame-to-frame displacements over a full cardiac cycle, using a custom image registration algorithm to produce ε ρ + ¯ /PP. This metric was compared between patients with healthy aortas and AAAs (≥3 cm) and compared between small and large AAAs (≥5 cm). AAAs were then separated into terciles based on ε ρ + ¯ /PP values to further assess differences in our metric across maximal diameter and prospective growth rate. Non-parametric tests of hypotheses were used to assess statistical significance as appropriate. Results USE analysis was conducted on 129 patients, 16 healthy aortas and 113 AAAs, of which 86 were classified as small AAAs and 27 as large. Non-aneurysmal aortas showed higher ε ρ + ¯ /PP compared to AAAs (0.044 ± 0.015 vs. 0.034 ± 0.017%/mmHg, p = 0.01) indicating AAA walls to be stiffer. Small and large AAAs showed no difference in ε ρ + ¯ /PP. When divided into terciles based on ε ρ + ¯ /PP cutoffs of 0.0251 and 0.038%/mmHg, there was no difference in AAA diameter. There was a statistically significant difference in prospective growth rate between the intermediate tercile and the outer two terciles (1.46 ± 2.48 vs. 3.59 ± 3.83 vs. 1.78 ± 1.64 mm/yr, p = 0.014). Discussion There was no correlation between AAA diameter and ε ρ + ¯ /PP, indicating biomechanical markers of AAA pathology are likely independent of diameter. AAAs in the intermediate tercile of ε ρ + ¯ /PP values were found to have nearly double the growth rates than the highest or lowest tercile, indicating an intermediate range of ε ρ + ¯ /PP values for which patients are at risk for increased AAA expansion, likely necessitating more frequent imaging follow-up.
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Affiliation(s)
- Zachary R. Zottola
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Daniel S. Kong
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Ankit N. Medhekar
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Lauren E. Frye
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Scarlett B. Hao
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Dakota W. Gonring
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Adnan A. Hirad
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael C. Stoner
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael S. Richards
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Doran S. Mix
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
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14
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Wang X, Carpenter HJ, Ghayesh MH, Kotousov A, Zander AC, Amabili M, Psaltis PJ. A review on the biomechanical behaviour of the aorta. J Mech Behav Biomed Mater 2023; 144:105922. [PMID: 37320894 DOI: 10.1016/j.jmbbm.2023.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/14/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
Large aortic aneurysm and acute and chronic aortic dissection are pathologies of the aorta requiring surgery. Recent advances in medical intervention have improved patient outcomes; however, a clear understanding of the mechanisms leading to aortic failure and, hence, a better understanding of failure risk, is still missing. Biomechanical analysis of the aorta could provide insights into the development and progression of aortic abnormalities, giving clinicians a powerful tool in risk stratification. The complexity of the aortic system presents significant challenges for a biomechanical study and requires various approaches to analyse the aorta. To address this, here we present a holistic review of the biomechanical studies of the aorta by categorising articles into four broad approaches, namely theoretical, in vivo, experimental and combined investigations. Experimental studies that focus on identifying mechanical properties of the aortic tissue are also included. By reviewing the literature and discussing drawbacks, limitations and future challenges in each area, we hope to present a more complete picture of the state-of-the-art of aortic biomechanics to stimulate research on critical topics. Combining experimental modalities and computational approaches could lead to more comprehensive results in risk prediction for the aortic system.
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Affiliation(s)
- Xiaochen Wang
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Harry J Carpenter
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Mergen H Ghayesh
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Andrei Kotousov
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Anthony C Zander
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Marco Amabili
- Department of Mechanical Engineering, McGill University, Montreal H3A 0C3, Canada
| | - Peter J Psaltis
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia 5000, Australia; Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia
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15
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Bracco MI, Broda M, Lorenzen US, Florkow MC, Somphone O, Avril S, Biancolini ME, Rouet L. Fast strain mapping in abdominal aortic aneurysm wall reveals heterogeneous patterns. Front Physiol 2023; 14:1163204. [PMID: 37362444 PMCID: PMC10285457 DOI: 10.3389/fphys.2023.1163204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
Abdominal aortic aneurysm patients are regularly monitored to assess aneurysm development and risk of rupture. A preventive surgical procedure is recommended when the maximum aortic antero-posterior diameter, periodically assessed on two-dimensional abdominal ultrasound scans, reaches 5.5 mm. Although the maximum diameter criterion has limited ability to predict aneurysm rupture, no clinically relevant tool that could complement the current guidelines has emerged so far. In vivo cyclic strains in the aneurysm wall are related to the wall response to blood pressure pulse, and therefore, they can be linked to wall mechanical properties, which in turn contribute to determining the risk of rupture. This work aimed to enable biomechanical estimations in the aneurysm wall by providing a fast and semi-automatic method to post-process dynamic clinical ultrasound sequences and by mapping the cross-sectional strains on the B-mode image. Specifically, the Sparse Demons algorithm was employed to track the wall motion throughout multiple cardiac cycles. Then, the cyclic strains were mapped by means of radial basis function interpolation and differentiation. We applied our method to two-dimensional sequences from eight patients. The automatic part of the analysis took under 1.5 min per cardiac cycle. The tracking method was validated against simulated ultrasound sequences, and a maximum root mean square error of 0.22 mm was found. The strain was calculated both with our method and with the established finite-element method, and a very good agreement was found, with mean differences of one order of magnitude smaller than the image spatial resolution. Most patients exhibited a strain pattern that suggests interaction with the spine. To conclude, our method is a promising tool for investigating abdominal aortic aneurysm wall biomechanics as it can provide a fast and accurate measurement of the cyclic wall strains from clinical ultrasound sequences.
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Affiliation(s)
- Marta Irene Bracco
- Mines Saint-Étienne, University Jean Monnet, INSERM, Sainbiose, Saint-Étienne, France
- Philips Research Paris, Suresnes, France
| | - Magdalena Broda
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Stephane Avril
- Mines Saint-Étienne, University Jean Monnet, INSERM, Sainbiose, Saint-Étienne, France
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16
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Pirruccello JP, Rämö JT, Choi SH, Chaffin MD, Kany S, Nekoui M, Chou EL, Jurgens SJ, Friedman SF, Juric D, Stone JR, Batra P, Ng K, Philippakis AA, Lindsay ME, Ellinor PT. The Genetic Determinants of Aortic Distention. J Am Coll Cardiol 2023; 81:1320-1335. [PMID: 37019578 DOI: 10.1016/j.jacc.2023.01.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/09/2023] [Accepted: 01/27/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND As the largest conduit vessel, the aorta is responsible for the conversion of phasic systolic inflow from ventricular ejection into more continuous peripheral blood delivery. Systolic distention and diastolic recoil conserve energy and are enabled by the specialized composition of the aortic extracellular matrix. Aortic distensibility decreases with age and vascular disease. OBJECTIVES In this study, we sought to discover epidemiologic correlates and genetic determinants of aortic distensibility and strain. METHODS We trained a deep learning model to quantify thoracic aortic area throughout the cardiac cycle from cardiac magnetic resonance images and calculated aortic distensibility and strain in 42,342 UK Biobank participants. RESULTS Descending aortic distensibility was inversely associated with future incidence of cardiovascular diseases, such as stroke (HR: 0.59 per SD; P = 0.00031). The heritabilities of aortic distensibility and strain were 22% to 25% and 30% to 33%, respectively. Common variant analyses identified 12 and 26 loci for ascending and 11 and 21 loci for descending aortic distensibility and strain, respectively. Of the newly identified loci, 22 were not significantly associated with thoracic aortic diameter. Nearby genes were involved in elastogenesis and atherosclerosis. Aortic strain and distensibility polygenic scores had modest effect sizes for predicting cardiovascular outcomes (delaying or accelerating disease onset by 2%-18% per SD change in scores) and remained statistically significant predictors after accounting for aortic diameter polygenic scores. CONCLUSIONS Genetic determinants of aortic function influence risk for stroke and coronary artery disease and may lead to novel targets for medical intervention.
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Affiliation(s)
- James P Pirruccello
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA; Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA; Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
| | - Joel T Rämö
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Mark D Chaffin
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Shinwan Kany
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mahan Nekoui
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth L Chou
- Smidt Heart Institute, Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sean J Jurgens
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Samuel F Friedman
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Dejan Juric
- Harvard Medical School, Boston, Massachusetts, USA; Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James R Stone
- Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Kenney Ng
- IBM Research, Cambridge, Massachusetts, USA
| | - Anthony A Philippakis
- Eric and Wendy Schmidt Center, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Mark E Lindsay
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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17
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Lee MHY, Li B, Feridooni T, Li PY, Shakespeare A, Samarasinghe Y, Cuen-Ojeda C, Verma R, Kishibe T, Al-Omran M. Racial and ethnic differences in presentation severity and postoperative outcomes in vascular surgery. J Vasc Surg 2023; 77:1274-1288.e14. [PMID: 36202287 DOI: 10.1016/j.jvs.2022.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We assessed the effect of race and ethnicity on presentation severity and postoperative outcomes in those with abdominal aortic aneurysms (AAAs), carotid artery stenosis (CAS), peripheral arterial disease (PAD), and type B aortic dissection (TBAD). METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception until December 2020. Two reviewers independently selected randomized controlled trials and observational studies reporting race and/or ethnicity and presentation severity and/or postoperative outcomes for adult patients who had undergone major vascular procedures. They independently extracted the study data and assessed the risk of bias using the Newcastle-Ottawa scale. The meta-analysis used random effects models to derive the odds ratios (ORs) and risk ratios (RRs) and their corresponding 95% confidence intervals (CIs). The primary outcome was presentation severity stratified by the proportion of patients with advanced disease, including ruptured vs nonruptured AAA, symptomatic vs asymptomatic CAS, chronic limb-threatening ischemia vs claudication, and complicated vs uncomplicated TBAD. The secondary outcomes included postoperative all-cause mortality and disease-specific outcomes. RESULTS A total of 81 studies met the inclusion criteria. Black (OR, 4.18; 95% CI, 1.31-13.26), Hispanic (OR, 2.01; 95% CI, 1.85-2.19), and Indigenous (OR, 1.97; 95% CI, 1.39-2.80) patients were more likely to present with ruptured AAAs than were White patients. Black and Hispanic patients had had higher symptomatic CAS (Black: OR, 1.20; 95% CI, 1.04-1.38; Hispanic: OR, 1.32; 95% CI, 1.20-1.45) and chronic limb-threatening ischemia (Black: OR, 1.67; 95% CI, 1.14-2.43; Hispanic: OR, 1.73; 95% CI 1.13-2.65) presentation rates. No study had evaluated the effect of race or ethnicity on complicated TBAD. All-cause mortality was higher for Black (RR, 1.23; 95% CI, 1.01-1.51), Hispanic (RR, 1.90; 95% CI, 1.57-2.31), and Indigenous (RR, 1.24; 95% CI, 1.12-1.37) patients after AAA repair. Postoperatively, Black (RR, 1.54; 95% CI, 1.19-2.00) and Hispanic (RR, 1.54; 95% CI, 1.31-1.81) patients were associated with stroke/transient ischemic attack after carotid revascularization and lower extremity amputation (RR, 1.90; 95% CI, 1.76-2.06; and RR, 1.69; 95% CI, 1.48-1.94, respectively). CONCLUSIONS Certain visible minorities were associated with higher morbidity and mortality across various vascular surgery presentations. Further research to understand the underpinnings is required.
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Affiliation(s)
- Michael Ho-Yan Lee
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ben Li
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Tiam Feridooni
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Pei Ye Li
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Audrey Shakespeare
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Yasith Samarasinghe
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cesar Cuen-Ojeda
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Raj Verma
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Teruko Kishibe
- Health Sciences Library, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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18
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Derwich W, Keller T, Filmann N, Schmitz-Rixen T, Blasé C, Oikonomou K, Wittek A. Changes in Aortic Diameter and Wall Strain in Progressing Abdominal Aortic Aneurysms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36794590 DOI: 10.1002/jum.16193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/15/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The analysis of wall strain opens new perspectives in the prediction of abdominal aortic aneurysm (AAA) rupture. This study investigates the capability of four-dimensional ultrasound (4D US) to detect and characterize changes in wall strain in the same patients during follow-up observations. METHODS Eighteen patients were examined by 64 4D US scans during a median follow-up period of 24.5 months. After performing the 4D US and manual aneurysm segmentation, kinematic analysis was performed using a customized interface and evaluation of the mean and peak circumferential strain, as well as spatial heterogeneity. RESULTS All aneurysms showed a continuous diameter growth with a mean rate of 4% per year (P < .001). The mean circumferential strain (MCS) tends to increase from a median 0.89% by 10.49% per year in follow-up independent of the aneurysm diameter (P = .063). The subgroup analysis reveals a cohort with increasing MCS and decreasing spatial heterogeneity, as well as a cohort with nonincreasing MCS and increasing spatial heterogeneity (P < .05). CONCLUSIONS The 4D US is able to register the strain changes in AAA follow-up. The MCS tends to increase during the observation time in the entire cohort, but the changes were independent of the maximum aneurysm diameter. The kinematic parameters allow the entire AAA cohort to differentiate into two subgroups and provide additional information about the pathologic behavior of the aneurysm wall.
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Affiliation(s)
- Wojciech Derwich
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt Goethe University, Frankfurt am Main, Germany
| | - Tobias Keller
- Department of General, Visceral and Oncological Surgery, Klinikum Wetzlar, Wetzlar, Germany
| | - Natalie Filmann
- Institute for Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | | | - Christopher Blasé
- Personalised Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt Goethe University, Frankfurt am Main, Germany
| | - Andreas Wittek
- Personalised Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
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19
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Sjoerdsma M, Verstraeten SCFPM, Maas EJ, van de Vosse FN, van Sambeek MRHM, Lopata RGP. Spatiotemporal Registration of 3-D Multi-perspective Ultrasound Images of Abdominal Aortic Aneurysms. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:318-332. [PMID: 36441033 DOI: 10.1016/j.ultrasmedbio.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Methods for patient-specific abdominal aortic aneurysm (AAA) progression monitoring and rupture risk assessment are widely investigated. Three-dimensional ultrasound can visualize the AAA's complex geometry and displacement fields. However, ultrasound has a limited field of view and low frame rate (i.e., 3-8 Hz). This article describes an approach to enhance the temporal resolution and the field of view. First, the frame rate was increased for each data set by sequencing multiple blood pulse cycles into one cycle. The sequencing method uses the original frame rate and the estimated pulse wave rate obtained from AAA distension curves. Second, the temporal registration was applied to multi-perspective acquisitions of the same AAA. Third, the field of view was increased through spatial registration and fusion using an image feature-based phase-only correlation method and a wavelet transform, respectively. Temporal sequencing was fully correct in aortic phantoms and was successful in 51 of 62 AAA patients, yielding a factor 5 frame rate increase. Spatial registration of proximal and distal ultrasound acquisitions was successful in 32 of 37 different AAA patients, based on the comparison between the fused ultrasound and computed tomography segmentation (95th percentile Haussdorf distances and similarity indices of 4.2 ± 1.7 mm and 0.92 ± 0.02 mm, respectively). Furthermore, the field of view was enlarged by 9%-49%.
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Affiliation(s)
- Marloes Sjoerdsma
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Sabine C F P M Verstraeten
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Esther J Maas
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans N van de Vosse
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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20
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A systematic review summarizing local vascular characteristics of aneurysm wall to predict for progression and rupture risk of abdominal aortic aneurysms. J Vasc Surg 2023; 77:288-298.e2. [PMID: 35843510 DOI: 10.1016/j.jvs.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/06/2022] [Accepted: 07/07/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE At present, the rupture risk prediction of abdominal aortic aneurysms (AAAs) and, hence, the clinical decision making regarding the need for surgery, is determined by the AAA diameter and growth rate. However, these measures provide limited predictive information. In the present study, we have summarized the measures of local vascular characteristics of the aneurysm wall that, independently of AAA size, could predict for AAA progression and rupture. METHODS We systematically searched PubMed and Web of Science up to September 13, 2021 to identify relevant studies investigating the relationship between local vascular characteristics of the aneurysm wall and AAA growth or rupture in humans. A quality assessment was performed using the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool. All included studies were divided by four types of measures of arterial wall characteristics: metabolism, calcification, intraluminal thrombus, and compliance. RESULTS A total of 20 studies were included. Metabolism of the aneurysm wall, especially when measured by ultra-small superparamagnetic iron oxide uptake, and calcification were significantly related to AAA growth. A higher intraluminal thrombus volume and thickness had correlated positively with the AAA growth in one study but in another study had correlated negatively. AAA compliance demonstrated no correlation with AAA growth and rupture. The aneurysmal wall characteristics showed no association with AAA rupture. However, the metabolism, measured via ultra-small superparamagnetic iron oxide uptake, but none of the other measures, showed a trend toward a relationship with AAA rupture, although the difference was not statistically significant. CONCLUSIONS The current measures of aortic wall characteristics have the potential to predict for AAA growth, especially the measures of metabolism and calcification. Evidence regarding AAA rupture is scarce, and, although more work is needed, aortic wall metabolism could potentially be related to AAA rupture. This highlights the role of aortic wall characteristics in the progression of AAA but also has the potential to improve the prediction of AAA growth and rupture.
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21
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Boyd AJ. Biomechanical rupture risk prediction with abdominal aortic aneurysm growth. JVS Vasc Sci 2022; 3:364. [PMID: 36643687 PMCID: PMC9834427 DOI: 10.1016/j.jvssci.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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22
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Dong H, Raterman B, White RD, Starr J, Vaccaro P, Haurani M, Go M, Eisner M, Brock G, Kolipaka A. MR Elastography of Abdominal Aortic Aneurysms: Relationship to Aneurysm Events. Radiology 2022; 304:721-729. [PMID: 35638926 PMCID: PMC9434816 DOI: 10.1148/radiol.212323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/26/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
Abstract
Background Abdominal aortic aneurysm (AAA) diameter remains the standard clinical parameter to predict growth and rupture. Studies suggest that using solely AAA diameter for risk stratification is insufficient. Purpose To evaluate the use of aortic MR elastography (MRE)-derived AAA stiffness and stiffness ratio at baseline to identify the potential for future aneurysm rupture or need for surgical repair. Materials and Methods Between August 2013 and March 2019, 72 participants with AAA and 56 healthy participants were enrolled in this prospective study. MRE examinations were performed to estimate AAA stiffness and the stiffness ratio between AAA and its adjacent remote normal aorta. Two Cox proportional hazards models were used to assess AAA stiffness and stiffness ratio for predicting aneurysmal events (subsequent repair, rupture, or diameter >5.0 cm). Log-rank tests were performed to determine a critical stiffness ratio suggesting high-risk AAAs. Baseline AAA stiffness and stiffness ratio were studied using Wilcoxon rank-sum tests between participants with and without aneurysmal events. Spearman correlation was used to investigate the relationship between stiffness and other potential imaging markers. Results Seventy-two participants with AAA (mean age, 71 years ± 9 [SD]; 56 men and 16 women) and 56 healthy participants (mean age, 42 years ± 16; 27 men and 29 women) were evaluated. In healthy participants, aortic stiffness positively correlated with age (ρ = 0.44; P < .001). AAA stiffness (event group [n = 21], 50.3 kPa ± 26.5 [SD]; no-event group [n = 21], 86.9 kPa ± 52.6; P = .01) and the stiffness ratio (event group, 0.7 ± 0.4; no-event group, 2.0 ± 1.4; P < .001) were lower in the event group than the no-event group at a mean follow-up of 449 days. AAA stiffness did not correlate with diameter in the event group (ρ = -0.06; P = .68) or the no-event group (ρ = -0.13; P = .32). AAA stiffness was inversely correlated with intraluminal thrombus area (ρ = -0.50; P = .01). Conclusion Lower abdominal aortic aneurysm stiffness and stiffness ratio measured with use of MR elastography was associated with aneurysmal events at a 15-month follow-up. © RSNA, 2022 See also the editorial by Sakuma in this issue.
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Affiliation(s)
- Huiming Dong
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Brian Raterman
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Richard D. White
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Jean Starr
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Patrick Vaccaro
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Mounir Haurani
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Michael Go
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Mariah Eisner
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Guy Brock
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
| | - Arunark Kolipaka
- From the Department of Radiology (H.D., B.R., R.D.W., A.K.), Department of Internal Medicine, Division of Cardiovascular Medicine (R.D.W., A.K.), Department of Surgery (J.S., P.V., M.H., M.G.), and Department of Biomedical Informatics and Center for Biostatistics (M.E., G.B.), College of Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, 4th Floor, Columbus, OH 43210; Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio (H.D., A.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.D.W.)
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23
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Zottola ZR, Gonring DW, Wang ML, Hirad AA, Richards MS, Stoner MC, Mix DS. Changes in Intra-operative Aortic Strain as Detected by Ultrasound Elastography in Patients Following Abdominal Endovascular Aneurysm Repair. J Vasc Surg Cases Innov Tech 2022; 8:762-769. [DOI: 10.1016/j.jvscit.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/17/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022] Open
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24
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Aneurysm geometry analyzed by the novel three-dimensional tomographic ultrasound relates to abdominal aortic aneurysm growth. Ann Vasc Surg 2022; 87:469-477. [DOI: 10.1016/j.avsg.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022]
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25
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Numerical investigation of abdominal aortic aneurysm hemodynamics using the reduced unified continuum formulation for vascular fluid-structure interaction. FORCES IN MECHANICS 2022. [DOI: 10.1016/j.finmec.2022.100089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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26
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Ning H, Liu X, Ma C, Yang J, Li T. The Evaluation of Longitudinal Strain of Large and Small Abdominal Aortic Aneurysm by Two-Dimensional Speckle-Tracking Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1085-1093. [PMID: 34296470 DOI: 10.1002/jum.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/21/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA) is a dangerous and lethal vascular disease. Non-invasive two-dimensional speckle-tracking imaging (2D STI) plays an important role in assessing aortic biomechanical properties. Our study aimed to evaluate the alterations of biomechanical characteristics using 2D STI in 91 AAA patients with different size. METHODS Aneurysm strain, elastic modulus, stiffness index β, and aortic distensibility determined by M-Mode ultrasound (US), and longitudinal strain (LS) derived from 2D STI were compared in 40 large AAA patients (diameter ≥ 55 mm) and 51 small AAA patients (diameter < 55 mm). RESULTS Compared with small AAA group, anterior wall longitudinal strain (ALS) and posterior wall longitudinal strain (PLS) were significantly decreased in large AAA group (all P < .05) and not affected by age, symptom, hypertension, and thrombus. Meanwhile, ALS and PLS correlated negatively with maximal aneurysm diameters (r = -0.628 and -0.469, respectively, all P < .001). And only ALS was associated with M-Mode US parameters (all P < .05). Based on receiver operating characteristic (ROC) analysis, ALS and PLS had strong diagnostic values for large AAA with the area under the curve (AUC) of 0.82 and 0.72, and cut-off points of 1.71 and 1.64% with a sensitivity of 78 and 72%, and a specificity of 75 and 70%, respectively. CONCLUSIONS LS measured by 2D STI could evaluate the biomechanical properties of aneurysm wall with different size, and add additional diagnostic value in distinguishing between small and large AAA.
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Affiliation(s)
- Hongxia Ning
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaozheng Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
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Sauceda A. A contemporary review of non-invasive methods in diagnosing abdominal aortic aneurysms. J Ultrason 2021; 21:e332-e339. [PMID: 34970445 PMCID: PMC8678647 DOI: 10.15557/jou.2021.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Currently, the impact of abdominal aortic aneurysm may be changing despite the aging population, but may be ambiguous given the decline in smoking, the use of screening methods, and integration of non-surgical treatment. Objective: This review aimed to assess the most common currently used non-invasive methods to identify abdominal aortic aneurysm, namely ultrasound and computed tomography. Methods: PRISMA guidelines were utilized to retrieve original articles from the past five years. All retrospective and prospective studies/trials were included, but limited to US and CT abdominal aortic aneurysm diagnostic imaging methods. Qualitative assessment of study quality is described. Results: Three of the six studies reported abdominal aortic aneurysm screening data. The estimated prevalence of abdominal aortic aneurysm for the three studies ranged from 4.5% to 6.2%. CT had slightly higher sensitivity and US had higher specificity for abdominal aortic aneurysm diagnosis. Two of the described studies assessed technical issues and problems with contemporary imaging of abdominal aortic aneurysm. The final article described measuring abdominal aortic aneurysm function of aortic distensibility and its pulse wave velocity for a comprehensive assessment of the abdominal aortic aneurysm via standard CT imaging. Conclusions: Both US and CT are useful diagnostic imaging modalities for abdominal aortic aneurysm, but remain with unique pitfalls and propensity for errors, notwithstanding patient-related errors. Technical issues in imaging with both ultrasound and CT are not straightforward. The potential value of an integrated CT protocol with CT-US fusion and/or assessment of aortic function rather than solely aortic anatomy may further diminish diagnostic complexities.
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Affiliation(s)
- Ana Sauceda
- Allied Health, University of Oklahoma HSC, United States
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Chiu P, Lee HP, Dalal AR, Koyano T, Nguyen M, Connolly AJ, Chaudhuri O, Fischbein MP. Relative strain is a novel predictor of aneurysmal degeneration of the thoracic aorta: An ex vivo mechanical study. JVS Vasc Sci 2021; 2:235-246. [PMID: 34806052 PMCID: PMC8585654 DOI: 10.1016/j.jvssci.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/28/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Current guidelines for prophylactic replacement of the thoracic aorta, primarily based on size alone, may not be adequate in identifying patients at risk for either progression of disease or aortic catastrophe. We undertook the current study to determine whether the mechanical properties of the aorta might be able to predict aneurysmal dilatation of the aorta using a clinical database and benchtop mechanical testing of human aortic tissue. METHODS Using over 400 samples from 31 patients, mechanical properties were studied in (a) normal aorta and then (b) between normal and diseased aorta using linear mixed-effects models. A machine learning technique was used to predict aortic growth rate over time using mechanical properties and baseline clinical characteristics. RESULTS Healthy aortic tissue under in vivo loading conditions, after accounting for aortic segment location, had lower longitudinal elastic modulus compared with circumferential elastic modulus: -166.8 kPa (95% confidence interval [CI]: -210.8 to -122.7, P < .001). Fracture toughness was also lower in the longitudinal vs circumferential direction: -201.2 J/m3 (95% CI: -272.9 to -129.5, P < .001). Finally, relative strain was lower in the longitudinal direction compared with the circumferential direction: -0.01 (95% CI: -0.02 to -0.004, P = .002). Patients with diseased aorta, after accounting for segment location and sample direction, had decreased toughness compared with normal aorta, -431.7 J/m3 (95% CI: -628.6 to -234.8, P < .001), and increased relative strain, 0.09 (95% CI: 0.04 to 0.14, P = .003). CONCLUSIONS Increasing relative strain was identified as a novel independent predictor of aneurysmal degeneration. Noninvasive measurement of relative strain may aid in the identification and monitoring of patients at risk for aneurysmal degeneration. (JVS-Vascular Science 2021;2:1-12.). CLINICAL RELEVANCE Aortic aneurysm surveillance and prophylactic surgical recommendations are based on computed tomographic angiogram aortic dimensions and growth rate measurements. However, aortic catastrophes may occur at small sizes, confounding current risk stratification models. Herein, we report that increasing aortic relative strain, that is, greater distensibility, is associated with growth over time, thus potentially identifying patients at risk for dissection/rupture.
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Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Hong-Pyo Lee
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Alex R. Dalal
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Tiffany Koyano
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Marie Nguyen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Andrew J. Connolly
- Department of Pathology, University of California San Francisco, San Francisco, Calif
| | - Ovijit Chaudhuri
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Michael P. Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
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Lorenzen US, Eiberg JP, Hultgren R, Wanhainen A, Langenskiöld M, Sillesen HH, Bredahl KK. The Short-term Predictive Value of Vessel Wall Stiffness on Abdominal Aortic Aneurysm Growth. Ann Vasc Surg 2021; 77:187-194. [PMID: 34437978 DOI: 10.1016/j.avsg.2021.05.051] [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: 02/19/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) surveillance programs are currently based solely on AAA diameter. The diameter criterion alone, however, seems inadequate as small AAAs comprise 5-10 % of ruptured AAAs as well as some large AAAs never rupture. Aneurysm wall stiffness has been suggested to predict rupture and growth; this study aimed to investigate the prognostic value of AAA vessel wall stiffness for growth on prospectively collected data. METHODS Analysis was based on data from a randomised, placebo-controlled, multicentre trial investigating mast-cell-inhibitors to halt aneurysm growth (the AORTA trial). Systolic and diastolic AAA diameter was determined in 326 patients using electrocardiogram-gated ultrasound (US). Stiffness was calculated at baseline and after 1 year. RESULTS Maximum AAA diameter increased from 44.1 mm to 46.5 mm during the study period. Aneurysm growth after 1 year was not predicted by baseline stiffness (-0.003 mm/U; 95 % CI: -0.007 to 0.001 mm/U; P = 0.15). Throughout the study period, stiffness remained unchanged (8.3 U; 95 % CI: -2.5 to 19.1 U; P = 0.13) and without significant correlation to aneurysm growth (R: 0.053; P = 0.38). CONCLUSIONS Following a rigorous US protocol, this study could not confirm AAA vessel wall stiffness as a predictor of aneurysm growth in a 1-year follow-up design. The need for new and subtle methods to complement diameter for improved AAA risk assessment is warranted.
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Affiliation(s)
| | - Jonas P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
| | - Marcus Langenskiöld
- Department of Molecular and Clinical Medicine, University of Gothenurg, Sweden
| | - Henrik H Sillesen
- Department of Vascular Surgery, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim K Bredahl
- Department of Vascular Surgery, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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30
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Nannini G, Caimi A, Palumbo MC, Saitta S, Girardi LN, Gaudino M, Roman MJ, Weinsaft JW, Redaelli A. Aortic hemodynamics assessment prior and after valve sparing reconstruction: A patient-specific 4D flow-based FSI model. Comput Biol Med 2021; 135:104581. [PMID: 34174756 DOI: 10.1016/j.compbiomed.2021.104581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Valve-sparing root replacement (VSRR) of the ascending aorta is a life-saving procedure for the treatment of aortic aneurysms, but patients remain at risk for post-operative events involving the downstream native aorta, the mechanism for which is uncertain. It is possible that proximal graft replacement of the ascending aorta induces hemodynamics alterations in the descending aorta, which could trigger adverse events. Herein, we present a fluid-structure interaction (FSI) protocol, based on patient-specific geometry and boundary conditions, to assess impact of proximal aortic grafts on downstream aortic hemodynamics and distensibility. METHODS Cardiac magnetic resonance (CMR), including MRA, cine-CMR and 4D flow sequences, was performed prior and after VSRR on one subject. Central blood pressure was non-invasively acquired at the time of the CMR: data were used to reconstruct the pre- and post-VSRR model and derive patient-specific boundary conditions for the FSI and a computational fluid dynamic (CFD) analysis with the same settings. Results were validated comparing the predicted velocity field against 4D flow dataset, over four landmarks along the aorta, and the predicted distensibility against the cine-CMR derived value. RESULTS Instantaneous velocity magnitudes extracted from 4D flow and FSI were similar (p > 0.05), while CFD-predicted velocity was significantly higher (p < 0.001), especially in the descending aorta of the pre-VSRR model (vmax was 73 cm/s, 76 cm/s and 99 cm/s, respectively). As measured in cine-CMR, FSI predicted an increase in descending aorta distensibility after grafting (i.e., 4.02 to 5.79 10-3 mmHg-1). In the descending aorta, the post-VSRR model showed increased velocity, aortic distensibility, stress and strain and wall shear stress. CONCLUSIONS Our Results indicate that i) the distensibility of the wall cannot be neglected, and hence the FSI method is necessary to obtain reliable results; ii) graft implantation induces alterations in the hemodynamics and biomechanics along the thoracic aorta, that may trigger adverse vessel remodeling.
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Affiliation(s)
- Guido Nannini
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy.
| | - Alessandro Caimi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Maria Chiara Palumbo
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Simone Saitta
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mary J Roman
- Department of Medicine (Cardiology), Weill Cornell College, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Cardiology), Weill Cornell College, New York, NY, USA
| | - Alberto Redaelli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
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31
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Petterson N, Sjoerdsma M, van Sambeek M, van de Vosse F, Lopata R. Mechanical characterization of abdominal aortas using multi-perspective ultrasound imaging. J Mech Behav Biomed Mater 2021; 119:104509. [PMID: 33865067 DOI: 10.1016/j.jmbbm.2021.104509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/13/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
Mechanical characterization of abdominal aortic aneurysms using personalized biomechanical models is being widely investigated as an alternative criterion to assess risk of rupture. These methods rely on accurate wall motion detection and appropriate model boundary conditions. In this study, multi-perspective ultrasound is combined with finite element models to perform mechanical characterization of abdominal aortas in volunteers. Multi-perspective biplane radio frequency ultrasound recordings were made under seven angles (-45° to 45°) in one phantom set-up and eight volunteers, which were merged using automatic image registration. 2-D displacement fields were estimated in the seven longitudinal ultrasound views, creating a sparse, high resolution 3-D map of the wall motion at relatively high frame rates (20-27 Hz). The displacements were used to personalize the subject-specific finite element model of which the geometry of the aorta, spine, and surrounding tissue were determined from a single 3-D ultrasound acquisition. Automatic registration of the multi-perspective images was successful in six out of eight cases with an average error of 5.4° compared to the ground truth. Displacements of the aortic wall were measured and cyclic strain of the aortic diameter was found ranging from 4.2% to 8.6%. The subject-specific mesh and inverse FE analysis was performed yielding shear moduli estimates for the wall between 104 and 215 kPa. Comparative results from a single-perspective workflow revealed very low aortic wall motion signal, which resulted in relatively high modulus estimates, between 230 and 754 kPa. Multi-perspective biplane ultrasound imaging was used to personalize finite element models of the abdominal aorta and its surroundings, and performing mechanical characterization of the aortic shear modulus. The method was found to be a more robust method compared to a single-perspective 3-D ultrasound approach. Future research will focus on investigating the use of multiple 3-D ultrasound acquisitions, the feasibility of free-hand scanning, the creation of a full 3-D automatic registration process, and with that, enable a clinical continuation of this study.
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Affiliation(s)
- Niels Petterson
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - Marloes Sjoerdsma
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands.
| | - Marc van Sambeek
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - Frans van de Vosse
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - Richard Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
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In Vivo Aortic Magnetic Resonance Elastography in Abdominal Aortic Aneurysm: A Validation in an Animal Model. Invest Radiol 2021; 55:463-472. [PMID: 32520516 DOI: 10.1097/rli.0000000000000660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Using maximum diameter of an abdominal aortic aneurysm (AAA) alone for management can lead to delayed interventions or unnecessary urgent repairs. Abdominal aortic aneurysm stiffness plays an important role in its expansion and rupture. In vivo aortic magnetic resonance elastography (MRE) was developed to spatially measure AAA stiffness in previous pilot studies and has not been thoroughly validated and evaluated for its potential clinical value. This study aims to evaluate noninvasive in vivo aortic MRE-derived stiffness in an AAA porcine model and investigate the relationships between MRE-derived AAA stiffness and (1) histopathology, (2) uniaxial tensile test, and (3) burst testing for assessing MRE's potential in evaluating AAA rupture risk. MATERIALS AND METHODS Abdominal aortic aneurysm was induced in 31 Yorkshire pigs (n = 226 stiffness measurements). Animals were randomly divided into 3 cohorts: 2-week, 4-week, and 4-week-burst. Aortic MRE was sequentially performed. Histopathologic analyses were performed to quantify elastin, collagen, and mineral densities. Uniaxial tensile test and burst testing were conducted to measure peak stress and burst pressure for assessing the ultimate wall strength. RESULTS Magnetic resonance elastography-derived AAA stiffness was significantly higher than the normal aorta. Significant reduction in elastin and collagen densities as well as increased mineralization was observed in AAAs. Uniaxial tensile test and burst testing revealed reduced ultimate wall strength. Magnetic resonance elastography-derived aortic stiffness correlated to elastin density (ρ = -0.68; P < 0.0001; n = 60) and mineralization (ρ = 0.59; P < 0.0001; n = 60). Inverse correlations were observed between aortic stiffness and peak stress (ρ = -0.32; P = 0.0495; n = 38) as well as burst pressure (ρ = -0.55; P = 0.0116; n = 20). CONCLUSIONS Noninvasive in vivo aortic MRE successfully detected aortic wall stiffening, confirming the extracellular matrix remodeling observed in the histopathologic analyses. These mural changes diminished wall strength. Inverse correlation between MRE-derived aortic stiffness and aortic wall strength suggests that MRE-derived stiffness can be a potential biomarker for clinically assessing AAA wall status and rupture potential.
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de Hoop H, Petterson NJ, van de Vosse FN, van Sambeek MRHM, Schwab HM, Lopata RGP. Multiperspective Ultrasound Strain Imaging of the Abdominal Aorta. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3714-3724. [PMID: 32746118 DOI: 10.1109/tmi.2020.3003430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Current decision-making for clinical intervention of abdominal aortic aneurysms (AAAs) is based on the maximum diameter of the aortic wall, but this does not provide patient-specific information on rupture risk. Ultrasound (US) imaging can assess both geometry and deformation of the aortic wall. However, low lateral contrast and resolution are currently limiting the precision of both geometry and local strain estimates. To tackle these drawbacks, a multiperspective scanning mode was developed on a dual transducer US system to perform strain imaging at high frame rates. Experimental imaging was performed on porcine aortas embedded in a phantom of the abdomen, pressurized in a mock circulation loop. US images were acquired with three acquisition schemes: Multiperspective ultrafast imaging, single perspective ultrafast imaging, and conventional line-by-line scanning. Image registration was performed by automatic detection of the transducer surfaces. Multiperspective images and axial displacements were compounded for improved segmentation and tracking of the aortic wall, respectively. Performance was compared in terms of image quality, motion tracking, and strain estimation. Multiperspective compound displacement estimation reduced the mean motion tracking error over one cardiac cycle by a factor 10 compared to conventional scanning. Resolution increased in radial and circumferential strain images, and circumferential signal-to-noise ratio (SNRe) increased by 10 dB. Radial SNRe is high in wall regions moving towards the transducer. In other regions, radial strain estimates remain cumbersome for the frequency used. In conclusion, multiperspective US imaging was demonstrated to improve motion tracking and circumferential strain estimation of porcine aortas in an experimental set-up.
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34
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Risk Factors and Mouse Models of Abdominal Aortic Aneurysm Rupture. Int J Mol Sci 2020; 21:ijms21197250. [PMID: 33008131 PMCID: PMC7583758 DOI: 10.3390/ijms21197250] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) rupture is an important cause of death in older adults. In clinical practice, the most established predictor of AAA rupture is maximum AAA diameter. Aortic diameter is commonly used to assess AAA severity in mouse models studies. AAA rupture occurs when the stress (force per unit area) on the aneurysm wall exceeds wall strength. Previous research suggests that aortic wall structure and strength, biomechanical forces on the aorta and cellular and proteolytic composition of the AAA wall influence the risk of AAA rupture. Mouse models offer an opportunity to study the association of these factors with AAA rupture in a way not currently possible in patients. Such studies could provide data to support the use of novel surrogate markers of AAA rupture in patients. In this review, the currently available mouse models of AAA and their relevance to the study of AAA rupture are discussed. The review highlights the limitations of mouse models and suggests novel approaches that could be incorporated in future experimental AAA studies to generate clinically relevant results.
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35
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Mantella LE, Chan W, Bisleri G, Hassan SMA, Liblik K, Benbarkat H, Rival DE, Johri AM. The use of ultrasound to assess aortic biomechanics: Implications for aneurysm and dissection. Echocardiography 2020; 37:1844-1850. [PMID: 32931051 DOI: 10.1111/echo.14856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/08/2020] [Accepted: 08/21/2020] [Indexed: 12/30/2022] Open
Abstract
Arterial stiffening, which occurs when conduit arteries thicken and lose elasticity, has been associated with cardiovascular disease and increased risk for future cardiovascular events. Specifically, aortic stiffening plays a large role in the pathogenesis of vascular diseases, such as aneurysm formation and dissection. Current parameters used to assess risk of aortic rupture include absolute diameter and growth rate. However, these properties lack the reliability required to accurately risk-stratify patients. As with any elastic conduit, it is important to assess the biomechanical properties of the aorta in order to assess cardiovascular risk and prevent disease progression. There are several invasive and noninvasive methods by which stiffness of the large arteries can be assessed. Of particular interest are ultrasound-based methods, such as tissue Doppler imaging and speckle-tracking echocardiography, due to their noninvasive and feasible nature. In this review, we summarize studies demonstrating utility of noninvasive ultrasound imaging methods for measuring aortic biomechanics for the assessment and management of aortic aneurysms.
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Affiliation(s)
- Laura E Mantella
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Winnie Chan
- Department of Medicine, Kingston General Hospital, Kingston, ON, Canada
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Kingston General Hospital, Kingston, ON, Canada
| | - Syed M Ali Hassan
- Division of Cardiac Surgery, Kingston General Hospital, Kingston, ON, Canada
| | - Kiera Liblik
- Department of Medicine, Kingston General Hospital, Kingston, ON, Canada
| | - Hanane Benbarkat
- Department of Medicine, Kingston General Hospital, Kingston, ON, Canada
| | - David E Rival
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Amer M Johri
- Department of Medicine, Kingston General Hospital, Kingston, ON, Canada
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Doyle BJ, Bappoo N, Syed MB, Forsythe RO, Powell JT, Conlisk N, Hoskins PR, McBride OM, Shah AS, Norman PE, Newby DE. Biomechanical Assessment Predicts Aneurysm Related Events in Patients with Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2020; 60:365-373. [DOI: 10.1016/j.ejvs.2020.02.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 01/09/2023]
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Reproducibility assessment of ultrasound-based aortic stiffness quantification and verification using Bi-axial tensile testing. J Mech Behav Biomed Mater 2020; 103:103571. [DOI: 10.1016/j.jmbbm.2019.103571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 09/10/2019] [Accepted: 11/29/2019] [Indexed: 01/04/2023]
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Jalalahmadi G, Helguera M, Mix DS, Hodis S, Richards MS, Stoner MC, Linte CA. (PEAK) WALL STRESS AS AN INDICATOR OF ABDOMINAL AORTIC ANEURYSM SEVERITY. PROCEEDINGS. IEEE WESTERN NEW YORK IMAGE AND SIGNAL PROCESSING WORKSHOP 2019; 2018. [PMID: 31342015 DOI: 10.1109/wnyipw.2018.8576453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abdominal aortic aneurysms, which consist of dilatations of the infra-renal aorta by at least 1.5 times of its normal diameter, are becoming a leading cause of death worldwide. Rupture often occurs unexpectedly, before a repair procedure is conducted. The AAA maximum diameter has been used as a clinical criterion to monitor AAA severity. However, assessment of AAA rupture risk requires knowledge of wall stress and wall strength at the potential rupture location. We conducted a study on 37 patient specific CT datasets to investigate the benefits of using peak wall stress instead of Dmax for AAA rupture severity. Correlation between PWS and 24 geometric indices and biomechanical factors was studied where eleven of them showed a statistically significant correlation with PWS. A Finite Element Analysis Rupture Index was used to conclude that the use of D max as a single predictor of AAA behavior and severity may be insufficient based on our patient population with a Dmax smaller than the 5.5 cm, clinically recommended repair threshold.
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Affiliation(s)
- Golnaz Jalalahmadi
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, USA
| | - María Helguera
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, USA.,Instituto Tecnológico José Mario Molina Pasquel y Henríquez - Unidad Lagos de Moreno, Jalisco, México
| | - Doran S Mix
- Biomedical Engineering Department, Rochester Institute of Technology, Rochester, USA.,Department of Surgery, Division of Vascular Surgery, University of Rochester Medical Center, Rochester, USA
| | - Simona Hodis
- Department of Mathematics, Texas A&M University-Kingsville, Kingsville, TX, USA
| | - Michael S Richards
- Biomedical Engineering Department, Rochester Institute of Technology, Rochester, USA.,Department of Surgery, Division of Vascular Surgery, University of Rochester Medical Center, Rochester, USA
| | - Michael C Stoner
- Department of Surgery, Division of Vascular Surgery, University of Rochester Medical Center, Rochester, USA
| | - Cristian A Linte
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, USA.,Biomedical Engineering Department, Rochester Institute of Technology, Rochester, USA
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Wang Y, Li H, Guo Y, Lee WN. Bidirectional Ultrasound Elastographic Imaging Framework for Non-invasive Assessment of the Non-linear Behavior of a Physiologically Pressurized Artery. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1184-1196. [PMID: 30876671 DOI: 10.1016/j.ultrasmedbio.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
Studies of non-destructive bidirectional ultrasound assessment of non-linear mechanical behavior of the artery are scarce in the literature. We hereby propose derivation of a strain-shear modulus relationship as a new graphical diagnostic index using an ultrasound elastographic imaging framework, which encompasses our in-house bidirectional vascular guided wave imaging (VGWI) and ultrasound strain imaging (USI). This framework is used to assess arterial non-linearity in two orthogonal (i.e., longitudinal and circumferential) directions in the absence of non-invasive pressure measurement. Bidirectional VGWI estimates longitudinal (μL) and transverse (μT) shear moduli, whereas USI estimates radial strain (ɛr). Vessel-mimicking phantoms (with and without longitudinal pre-stretch) and in vitro porcine aortas under static and/or dynamic physiologic intraluminal pressure loads were examined. ɛr was found to be a suitable alternative to intraluminal pressure for representation of cyclic loading on the artery wall. Results revealed that μT values of all samples examined increased non-linearly with εr magnitude and more drastically than μL, whereas μL values of only the pre-stretched phantoms and aortas increased with ɛr magnitude. As a new graphical representation of arterial non-linearity and function, strain-shear modulus loops derived by the proposed framework over two consecutive dynamic loading cycles differentiated sample pre-conditions and corroborated direction-dependent non-linear mechanical behaviors of the aorta with high estimation repeatability.
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Affiliation(s)
- Yahua Wang
- Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong
| | - He Li
- Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong
| | - Yuexin Guo
- Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong
| | - Wei-Ning Lee
- Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong; Medical Engineering Programme, University of Hong Kong, Hong Kong.
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Singh A, Horsfield MA, Bekele S, Greenwood JP, Dawson DK, Berry C, Hogrefe K, Kelly DJ, Houston JG, Guntur Ramkumar P, Uddin A, Suzuki T, McCann GP. Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves. Eur Radiol 2018; 29:2340-2349. [PMID: 30488106 PMCID: PMC6443917 DOI: 10.1007/s00330-018-5775-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/03/2018] [Accepted: 09/19/2018] [Indexed: 11/17/2022]
Abstract
Objectives To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS). Methods MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm2/m2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated. Results The AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area. Conclusions In patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role. Key Points • Both cellular abnormalities secondary to genetic differences and abnormal flow patterns have been implicated in the pathophysiology of aortic dilatation and increased vascular complications associated with bicuspid aortic valves (BAV). • We demonstrate an increased ascending aortic size in patients with BAV and moderate to severe AS compared to TAV and controls, but no difference in aortic stiffness parameters, therefore suggesting a dissociation between dilatation and stiffness. • Sub-group analysis showed greater aortic size but lower stiffness parameters in those with BAV type-II AS compared to BAV type-I. Electronic supplementary material The online version of this article (10.1007/s00330-018-5775-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK.
| | | | - Soliana Bekele
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular & Metabolic Medicine, Leeds University, Leeds, LS2 9JT, UK
| | - Dana K Dawson
- Cardiovascular Medicine Research Unit, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Kai Hogrefe
- Cardiology Department, Kettering General Hospital Foundation Trust, Rothwell Rd, Kettering, NN16 8UZ, UK
| | - Damian J Kelly
- Cardiology Department, Royal Derby Hospital, Uttoxeter Rd, Derby, DE22 3NE, UK
| | - John G Houston
- Division of Molecular & Clinical Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Prasad Guntur Ramkumar
- Division of Molecular & Clinical Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular & Metabolic Medicine, Leeds University, Leeds, LS2 9JT, UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby road, Leicester, LE3 9QP, UK
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Campobasso R, Condemi F, Viallon M, Croisille P, Campisi S, Avril S. Evaluation of Peak Wall Stress in an Ascending Thoracic Aortic Aneurysm Using FSI Simulations: Effects of Aortic Stiffness and Peripheral Resistance. Cardiovasc Eng Technol 2018; 9:707-722. [DOI: 10.1007/s13239-018-00385-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/08/2018] [Indexed: 12/25/2022]
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42
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Leemans EL, Willems TP, Slump CH, van der Laan MJ, Zeebregts CJ. Additional value of biomechanical indices based on CTa for rupture risk assessment of abdominal aortic aneurysms. PLoS One 2018; 13:e0202672. [PMID: 30133522 PMCID: PMC6105024 DOI: 10.1371/journal.pone.0202672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Biomechanics for rupture risk prediction in abdominal aortic aneurysms (AAA) are gaining popularity. However, their clinical applicability is still doubtful as there is lack of standardization. This study evaluates the added value of biomechanical indices in rupture risk assessment. METHODS This study included 175 asymptomatic, 11 sAAA and 45 ruptured aneurysms. 3D-geometries were reconstructed using computer tomography angiographies. Subsequently, finite element models were made to calculate peak wall stress (PWS), peak wall rupture index (PWRI) and the rupture risk equivalent diameter (RRED). The indices were determined with a dedicated software to facilitate standardization. RESULTS SAAAs showed a trend towards higher PWS, PWRI and RRED compared to asymptomatic AAAs, but PWS (22.0±5.8 vs. 33.4±15.8 N/cm2), PWRI (0.52±0.2 vs. 1.01±0.64), and RRED (65±60 vs. 98±51 mm) were significantly (p = 0.001) higher in ruptured. However, after diameter-matching no significant differences were seen. The ROC-curves for the maximum diameter and all biomechanical indices were similar but it slightly increased when diameter and biomechanical indices were combined. CONCLUSIONS This study showed no added value for biomechanical indices in AAA rupture risk assessment. Additionally, the difficulty of such an assessment increases. However, as symptomatic aneurysms show a trend towards higher biomechanical indices with similar diameters the indices may provide information about aneurysm growth and development.
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Affiliation(s)
- Eva L. Leemans
- Departments of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Departments of Biomechanical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Robotics and Mechatronics, MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Tineke P. Willems
- Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cornelis H. Slump
- Department of Robotics and Mechatronics, MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Maarten J. van der Laan
- Departments of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J. Zeebregts
- Departments of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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43
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Groeneveld ME, Meekel JP, Rubinstein SM, Merkestein LR, Tangelder GJ, Wisselink W, Truijers M, Yeung KK. Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture. J Am Heart Assoc 2018; 7:JAHA.117.007791. [PMID: 29960996 PMCID: PMC6064909 DOI: 10.1161/jaha.117.007791] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The natural course of abdominal aortic aneurysms (AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture. METHODS AND RESULTS Potential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty-two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S-elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta-analysis was conducted because of clinical and methodological heterogeneity. CONCLUSIONS We identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.
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Affiliation(s)
- Menno E Groeneveld
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Jorn P Meekel
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Sidney M Rubinstein
- Department of Health Sciences and Amsterdam Public Health research institute, VU University, Amsterdam, The Netherlands
| | - Lisanne R Merkestein
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Geert Jan Tangelder
- Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Maarten Truijers
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands .,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
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44
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Yao L, Folsom AR, Alonso A, Lutsey PL, Pankow JS, Guan W, Cheng S, Lederle FA, Tang W. Association of carotid atherosclerosis and stiffness with abdominal aortic aneurysm: The atherosclerosis risk in communities (ARIC) study. Atherosclerosis 2018; 270:110-116. [PMID: 29407878 PMCID: PMC5844275 DOI: 10.1016/j.atherosclerosis.2018.01.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/20/2018] [Accepted: 01/24/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Individuals with atherosclerosis and stiffness often have increased abdominal aortic diameters, but prospective evidence linking them to the risk of abdominal aortic aneurysm (AAA) is limited. METHODS We prospectively examined the relationship of carotid atherosclerosis and stiffness with future risk of AAA in ARIC. At Visits 1 (1987-89) or 2 (1990-1992), we assessed carotid atherosclerosis (represented by greater carotid intima-media thickness [cIMT] or presence of atherosclerotic plaque) and lower carotid distensibility (reflected by a higher carotid Beta Index). We identified incident, clinical AAAs during follow-up through 2011 using hospital discharge codes, Medicare outpatient diagnoses, or death certificates. RESULTS Participants' mean age at baseline was 54.2 years (SD 5.8), 45% were male and 73% white. During a median of 22.5 years of follow-up, 542 clinical AAAs were ascertained. After multivariable adjustment, the presence of carotid atherosclerotic plaque at baseline was associated with 1.31 (95% CI: 1.10-1.57; p = 0.003) times higher risk of clinical AAA. Greater cIMT and Beta Index were also associated with clinical AAA with a dose-response across quartiles (p trend for both: 0.006; hazard ratios [95% CI] for the highest vs. lowest quartiles: 1.55 [1.13-2.11] and 1.68 [1.16-2.43], respectively). The associations of cIMT and Beta Index with AAA were independent of each other. CONCLUSIONS This prospective population-based study found that indices of greater carotid atherosclerosis and lower carotid distensibility are markers of increased AAA risk.
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Affiliation(s)
- Lu Yao
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Susan Cheng
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank A Lederle
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Weihong Tang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
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45
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Jalalahmadi G, Helguera M, Mix DS, Linte CA. Toward modeling the effects of regional material properties on the wall stress distribution of abdominal aortic aneurysms. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10578. [PMID: 31213733 DOI: 10.1117/12.2294558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The overall geometry and different biomechanical parameters of an abdominal aortic aneurysm (AAA), contribute to its severity and risk of rupture, therefore they could be used to track its progression. Previous and ongoing research efforts have resorted to using uniform material properties to model the behavior of AAA. However, it has been recently illustrated that different regions of the AAA wall exhibit different behavior due to the effect of the biological activities in the metalloproteinase matrix that makes up the wall at the aneurysm site. In this work, we introduce a non-invasive patient-specific regional material property model to help us better understand and investigate the AAA wall stress distribution, peak wall stress (PWS) severity, and potential rupture risk. Our results indicate that the PWS and the overall wall stress distribution predicted using the proposed regional material property model, are higher than those predicted using the traditional homogeneous, hyper-elastic model (p <1.43E-07). Our results also show that to investigate AAA, the overall geometry, presence of intra-luminal thrombus (ILT), and loading condition in a patient specific manner may be critical for capturing the biomechanical complexity of AAAs.
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Affiliation(s)
- Golnaz Jalalahmadi
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, USA
| | - María Helguera
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, USA.,Instituto Tecnológico José Mario Molina Pasquel y Henríquez - Unidad Lagos de Moreno, Jalisco, México
| | - Doran S Mix
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, USA.,Department of Surgery, Division of Vascular Surgery, University of Rochester Medical Center, Rochester, USA
| | - Cristian A Linte
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, USA.,Biomedical Engineering Department, Rochester Institute of Technology, Rochester, USA
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46
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A non-invasive methodology for ATAA rupture risk estimation. J Biomech 2018; 66:119-126. [DOI: 10.1016/j.jbiomech.2017.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/13/2017] [Accepted: 11/09/2017] [Indexed: 01/05/2023]
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47
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Auricchio F, Ferrara A, Lanzarone E, Morganti S, Totaro P. A Regression Method Based on Noninvasive Clinical Data to Predict the Mechanical Behavior of Ascending Aorta Aneurysmal Tissue. IEEE Trans Biomed Eng 2017; 64:2607-2617. [DOI: 10.1109/tbme.2016.2645762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Mix DS, Yang L, Johnson CC, Couper N, Zarras B, Arabadjis I, Trakimas LE, Stoner MC, Day SW, Richards MS. Detecting Regional Stiffness Changes in Aortic Aneurysmal Geometries Using Pressure-Normalized Strain. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2372-2394. [PMID: 28728780 PMCID: PMC5562537 DOI: 10.1016/j.ultrasmedbio.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 04/26/2017] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
Transabdominal ultrasound elasticity imaging could improve the assessment of rupture risk for abdominal aortic aneurysms by providing information on the mechanical properties and stress or strain states of vessel walls. We implemented a non-rigid image registration method to visualize the pressure-normalized strain within vascular tissues and adapted it to measure total strain over an entire cardiac cycle. We validated the algorithm's performance with both simulated ultrasound images with known principal strains and anatomically accurate heterogeneous polyvinyl alcohol cryogel vessel phantoms. Patient images of abdominal aortic aneurysm were also used to illustrate the clinical feasibility of our imaging algorithm and the potential value of pressure-normalized strain as a clinical metric. Our results indicated that pressure-normalized strain could be used to identify spatial variations in vessel tissue stiffness. The results of this investigation were sufficiently encouraging to warrant a clinical study measuring abdominal aortic pressure-normalized strain in a patient population with aneurysmal disease.
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Affiliation(s)
- Doran S Mix
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, New York, USA.
| | - Ling Yang
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Camille C Johnson
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, New York, USA
| | - Nathan Couper
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Ben Zarras
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Isaac Arabadjis
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, New York, USA
| | - Lauren E Trakimas
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael C Stoner
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Steven W Day
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, New York, USA
| | - Michael S Richards
- Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, New York, USA
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49
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Di Salvo G, Bulbul Z, Pergola V, Issa Z, Siblini G, Muhanna N, Galzerano D, Fadel B, Al Joufan M, Al Fayyadh M, Al Halees Z. Gothic aortic arch and cardiac mechanics in young patients after arterial switch operation for d-transposition of the great arteries. Int J Cardiol 2017; 241:163-167. [DOI: 10.1016/j.ijcard.2017.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 12/18/2022]
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50
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Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair. Circulation 2017; 136:787-797. [PMID: 28720724 PMCID: PMC5571881 DOI: 10.1161/circulationaha.117.028433] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/17/2017] [Indexed: 12/31/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation on magnetic resonance imaging (MRI). In patients with abdominal aortic aneurysm, we assessed whether USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes. Methods In a prospective multicenter open-label cohort study, 342 patients with abdominal aortic aneurysm (diameter ≥40 mm) were classified by the presence of USPIO enhancement and were monitored with serial ultrasound and clinical follow-up for ≥2 years. The primary end point was the composite of aneurysm rupture or repair. Results Participants (85% male, 73.1±7.2 years) had a baseline aneurysm diameter of 49.6±7.7 mm, and USPIO enhancement was identified in 146 (42.7%) participants, absent in 191 (55.8%), and indeterminant in 5 (1.5%). During follow-up (1005±280 days), 17 (5.0%) abdominal aortic aneurysm ruptures, 126 (36.8%) abdominal aortic aneurysm repairs, and 48 (14.0%) deaths occurred. Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1±2.5 versus 2.5±2.4 mm/year, P=0.0424), although this was not independent of current smoking habit (P=0.1993). Patients with USPIO enhancement had higher rates of aneurysm rupture or repair (47.3% versus 35.6%; 95% confidence intervals, 1.1–22.2; P=0.0308). This finding was similar for each component of rupture (6.8% versus 3.7%, P=0.1857) or repair (41.8% versus 32.5%, P=0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair (P=0.0275), all-cause mortality (P=0.0635), and aneurysm-related mortality (P=0.0590). Baseline abdominal aortic aneurysm diameter (P<0.0001) and current smoking habit (P=0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic, 0.7935–0.7936). Conclusions USPIO-enhanced MRI is a novel approach to the identification of aortic wall cellular inflammation in patients with abdominal aortic aneurysms and predicts the rate of aneurysm growth and clinical outcome. However, it does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors. Clinical Trial Registration: URL: http://www.isrctn.com. Unique identifier: ISRCTN76413758.
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