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Rosnel C, Sivera R, Cervi E, Danton M, Schievano S, Capelli C, Aggarwal A. Are aortic biomechanical properties early markers of dilatation in patients with Marfan syndrome? A systematic review and meta-analysis. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01881-z. [PMID: 39073692 DOI: 10.1007/s10237-024-01881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
Although tissue stiffness is known to play an important role in aortic dilatation, the current guidelines for offering preventative surgery in patients with Marfan syndrome rely solely on the aortic diameter. In this systematic review and meta-analysis, we analyze and compare literature on in vivo aortic stiffness measures in Marfan patients. Our aim is to assess the potential of these measurements as early indicators of aortic dilatation. Following the PRISMA guidelines, we collected literature on diameter and three in vivo stiffness measures: Pulse wave velocity (PWV), β -stiffness index (SI) and distensibility, at five different aortic locations in patients with Marfan syndrome. Results were reviewed and compared against each other. For meta-analysis, an augmented dataset was created by combining data from the literature. Regression with respect to age and statistical comparisons were performed. Thirty articles reporting data from 1925 patients with Marfan and 836 patients without Marfan were reviewed. PWV was found to be higher in Marfan, but only in dilated aortas. Distensibility was found to be lower even in non-dilated aortas, and its decrease was associated with higher chances of developing aortic dilatation. β -SI was higher in Marfan patients and was positively correlated with the rate of aortic dilatation, emphasizing its role as a valuable indicator. In our meta-analysis, all stiffness measures showed a significant variation with age. Distensibility and β -stiffness index were different in Marfan patients at all locations, and the difference was more pronounced after accounting for age-related variation. From the literature, β -SI and distensibility emerge as the best predictors of future aortic dilatation. Our meta-analysis quantifies age-related changes in aortic stiffness and highlights the importance of accounting for age in comparing these measurements. Missing diameter values in the literature limited our analysis. Further investigation of criteria combining stiffness and diameter is recommended to better assist clinical decisions for prophylactic surgery.
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Affiliation(s)
- Claire Rosnel
- Glasgow Computational Engineering Centre, James Watt School of Engineering, University of Glasgow, Glasgow, Scotland, UK
| | - Raphael Sivera
- Institute of Cardiovascular Science, University College London, London, England, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, England, UK
| | - Mark Danton
- Department of Paediatric Cardiac Services, Royal Hospital for Children, Glasgow, Scotland, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, England, UK
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, England, UK
| | - Ankush Aggarwal
- Glasgow Computational Engineering Centre, James Watt School of Engineering, University of Glasgow, Glasgow, Scotland, UK.
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2
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Weismann CG, Hlebowicz J, Åkesson A, Liuba P, Hanseus K. Comprehensive Characterization of Arterial and Cardiac Function in Marfan Syndrome-Can Biomarkers Help Improve Outcome? Front Physiol 2022; 13:873373. [PMID: 35547588 PMCID: PMC9081671 DOI: 10.3389/fphys.2022.873373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Marfan Syndrome (MFS) has been associated with increased aortic stiffness and left ventricular dysfunction. The latter may be due to the underlying genotype and/or secondary to aortic stiffening (vascular-ventricular interaction). The aim of this study was to characterize arterial and cardiac function in MFS using a multimodal approach. Methods: Prospective observational study of MFS patients and healthy controls. Methods included echocardiography, ascending aortic distensibility, common carotid intima media thickness [cIMT], parameters of wave reflection, carotid-femoral pulse wave velocity [cfPWV]), reactive hyperemia index [RHI], and biomarker analysis (Olink, CVII panel). Results: We included 20 patients with MFS and 67 controls. Ascending aortic distensibility, cIMT and RHI were decreased, while all parameters of arterial wave reflection, stiffness and BNP levels were increased in the MFS group. Both systolic and diastolic function were impaired relative to controls. Within the MFS group, no significant correlation between arterial and cardiac function was identified. However, cfPWV correlated significantly with indexed left ventricular mass and volume in MFS. Bran natriuretic peptide (BNP) was the only biomarker significantly elevated in MFS following correction for age and sex. Conclusions: MFS patients have generally increased aortic stiffness, endothelial dysfunction and BNP levels while cIMT is decreased, supporting that the mechanism of general stiffening is different from acquired vascular disease. CfPWV is associated with cardiac size, blood pressure and BNP in MFS patients. These may be early markers of disease progression that are suitable for monitoring pharmacological treatment effects in MFS patients.
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Affiliation(s)
- Constance G Weismann
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Pediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.,Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Ludwig-Maximilian University Hospital, Munich, Germany
| | - Joanna Hlebowicz
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anna Åkesson
- Clinical Studies Sweden - Froum South, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Pediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Katarina Hanseus
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Pediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
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3
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Oller J, Gabandé-Rodríguez E, Ruiz-Rodríguez MJ, Desdín-Micó G, Aranda JF, Rodrigues-Diez R, Ballesteros-Martínez C, Blanco EM, Roldan-Montero R, Acuña P, Forteza Gil A, Martín-López CE, Nistal JF, Lino Cardenas CL, Lindsay ME, Martín-Ventura JL, Briones AM, Miguel Redondo J, Mittelbrunn M. Extracellular Tuning of Mitochondrial Respiration Leads to Aortic Aneurysm. Circulation 2021; 143:2091-2109. [PMID: 33709773 PMCID: PMC8140666 DOI: 10.1161/circulationaha.120.051171] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/26/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Marfan syndrome (MFS) is an autosomal dominant disorder of the connective tissue caused by mutations in the FBN1 (fibrillin-1) gene encoding a large glycoprotein in the extracellular matrix called fibrillin-1. The major complication of this connective disorder is the risk to develop thoracic aortic aneurysm. To date, no effective pharmacologic therapies have been identified for the management of thoracic aortic disease and the only options capable of preventing aneurysm rupture are endovascular repair or open surgery. Here, we have studied the role of mitochondrial dysfunction in the progression of thoracic aortic aneurysm and mitochondrial boosting strategies as a potential treatment to managing aortic aneurysms. METHODS Combining transcriptomics and metabolic analysis of aortas from an MFS mouse model (Fbn1c1039g/+) and MFS patients, we have identified mitochondrial dysfunction alongside with mtDNA depletion as a new hallmark of aortic aneurysm disease in MFS. To demonstrate the importance of mitochondrial decline in the development of aneurysms, we generated a conditional mouse model with mitochondrial dysfunction specifically in vascular smooth muscle cells (VSMC) by conditional depleting Tfam (mitochondrial transcription factor A; Myh11-CreERT2Tfamflox/flox mice). We used a mouse model of MFS to test for drugs that can revert aortic disease by enhancing Tfam levels and mitochondrial respiration. RESULTS The main canonical pathways highlighted in the transcriptomic analysis in aortas from Fbn1c1039g/+ mice were those related to metabolic function, such as mitochondrial dysfunction. Mitochondrial complexes, whose transcription depends on Tfam and mitochondrial DNA content, were reduced in aortas from young Fbn1c1039g/+ mice. In vitro experiments in Fbn1-silenced VSMCs presented increased lactate production and decreased oxygen consumption. Similar results were found in MFS patients. VSMCs seeded in matrices produced by Fbn1-deficient VSMCs undergo mitochondrial dysfunction. Conditional Tfam-deficient VSMC mice lose their contractile capacity, showed aortic aneurysms, and died prematurely. Restoring mitochondrial metabolism with the NAD precursor nicotinamide riboside rapidly reverses aortic aneurysm in Fbn1c1039g/+ mice. CONCLUSIONS Mitochondrial function of VSMCs is controlled by the extracellular matrix and drives the development of aortic aneurysm in Marfan syndrome. Targeting vascular metabolism is a new available therapeutic strategy for managing aortic aneurysms associated with genetic disorders.
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Affiliation(s)
- Jorge Oller
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
- Instituto de Investigación Sanitaria del Hospital 12 de Octubre (i+12), Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., M.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain (J.O., R.R-D., R.R-M., A.M.B., J.M.R.)
| | - Enrique Gabandé-Rodríguez
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
- Instituto de Investigación Sanitaria del Hospital 12 de Octubre (i+12), Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., M.M.)
| | | | - Gabriela Desdín-Micó
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
- Instituto de Investigación Sanitaria del Hospital 12 de Octubre (i+12), Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., M.M.)
| | - Juan Francisco Aranda
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
- Instituto de Investigación Sanitaria del Hospital 12 de Octubre (i+12), Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., M.M.)
| | - Raquel Rodrigues-Diez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain (J.O., R.R-D., R.R-M., A.M.B., J.M.R.)
- Departamento de Farmacología, Universidad Autónoma de Madrid, Instituto de Investigación Hospital La Paz, Spain (R.R-D., C.B-M., A.M.B.)
| | - Constanza Ballesteros-Martínez
- Departamento de Farmacología, Universidad Autónoma de Madrid, Instituto de Investigación Hospital La Paz, Spain (R.R-D., C.B-M., A.M.B.)
| | - Eva María Blanco
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
- Instituto de Investigación Sanitaria del Hospital 12 de Octubre (i+12), Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., M.M.)
| | - Raquel Roldan-Montero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain (J.O., R.R-D., R.R-M., A.M.B., J.M.R.)
- Instituto de Investigación Sanitaria-Fundación Jimenez Diaz, Madrid, Spain (R.R-M. J.L.M-V.)
- Hospital Universitario Puerta de Hierro, Madrid, Spain. (R.R-M., J.L.M-V.)
| | - Pedro Acuña
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
| | - Alberto Forteza Gil
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
- Instituto de Investigación Sanitaria del Hospital 12 de Octubre (i+12), Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., M.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain (J.O., R.R-D., R.R-M., A.M.B., J.M.R.)
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (M.J.R-R., J.M.R.)
- Departamento de Farmacología, Universidad Autónoma de Madrid, Instituto de Investigación Hospital La Paz, Spain (R.R-D., C.B-M., A.M.B.)
- Instituto de Investigación Sanitaria-Fundación Jimenez Diaz, Madrid, Spain (R.R-M. J.L.M-V.)
- Hospital Universitario Puerta de Hierro, Madrid, Spain. (R.R-M., J.L.M-V.)
- Cardiovascular Surgery, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain. (J.F.N.)
- Massachusetts General Hospital Thoracic Aortic Center, Boston (C.L.L.C., M.E.L.)
| | - Carlos E. Martín-López
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
- Instituto de Investigación Sanitaria del Hospital 12 de Octubre (i+12), Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., M.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain (J.O., R.R-D., R.R-M., A.M.B., J.M.R.)
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (M.J.R-R., J.M.R.)
- Departamento de Farmacología, Universidad Autónoma de Madrid, Instituto de Investigación Hospital La Paz, Spain (R.R-D., C.B-M., A.M.B.)
- Instituto de Investigación Sanitaria-Fundación Jimenez Diaz, Madrid, Spain (R.R-M. J.L.M-V.)
- Hospital Universitario Puerta de Hierro, Madrid, Spain. (R.R-M., J.L.M-V.)
- Cardiovascular Surgery, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain. (J.F.N.)
- Massachusetts General Hospital Thoracic Aortic Center, Boston (C.L.L.C., M.E.L.)
| | - J. Francisco Nistal
- Cardiovascular Surgery, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain. (J.F.N.)
| | | | - Mark Evan Lindsay
- Massachusetts General Hospital Thoracic Aortic Center, Boston (C.L.L.C., M.E.L.)
| | - José Luís Martín-Ventura
- Instituto de Investigación Sanitaria-Fundación Jimenez Diaz, Madrid, Spain (R.R-M. J.L.M-V.)
- Hospital Universitario Puerta de Hierro, Madrid, Spain. (R.R-M., J.L.M-V.)
| | - Ana M. Briones
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain (J.O., R.R-D., R.R-M., A.M.B., J.M.R.)
- Departamento de Farmacología, Universidad Autónoma de Madrid, Instituto de Investigación Hospital La Paz, Spain (R.R-D., C.B-M., A.M.B.)
| | - Juan Miguel Redondo
- Instituto de Investigación Sanitaria del Hospital 12 de Octubre (i+12), Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., M.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain (J.O., R.R-D., R.R-M., A.M.B., J.M.R.)
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (M.J.R-R., J.M.R.)
| | - María Mittelbrunn
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas Universidad Autónoma de Madrid, Spain (J.O., E.G-R., G.D-M., J.F.A., E.M.B., P.A., M.M.)
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4
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Cui JZ, Harris KC, Raedschelders K, Hollander Z, Potts JE, De Souza A, Kiess M, McManus BM, Bernatchez P, Raffin LA, Paine H, van Breemen C, Sandor GGS, Esfandiarei M. Aortic Dimensions, Biophysical Properties, and Plasma Biomarkers in Children and Adults with Marfan or Loeys-Dietz Syndrome. CJC Open 2020; 3:585-594. [PMID: 34027363 PMCID: PMC8134910 DOI: 10.1016/j.cjco.2020.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background Aortic dilation, stiffening, and dissection are common and potentially lethal complications of Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS), which involve abnormal transforming growth factor beta (TGF-β) signalling. The relation of aortic dimensions, stiffness, and biomarker levels is unknown. The objective of this study was to measure aortic dimensions, stiffness, TGF-β and matrix metalloproteinase (MMP) levels, and endothelial function in patients with MFS, and to compare TGF-β levels in patients with MFS receiving different therapeutic regimens. Methods This was a cohort study of 40 MFS and 4 LDS patients and 87 control participants. Aortic dimension and stiffness indexes, including pulse wave velocity (PWV), were measured using echocardiography and Doppler. Total and free TGF-β and MMP blood levels were measured using Quantikine (R&D Systems, Inc, Minneapolis, MN) and Quanterix (Billerica, MA) kits. Endothelial function was measured using brachial artery flow-mediated dilation. Results PWV was increased in patients with MFS. There were increased MMP-2 levels in those with MFS but no increase in free or total TGF-β or MMP-9 levels compared with control participants. There was no difference in TGF-β levels between MFS patients receiving no medications, angiotensin receptor blockers, and β-blockers. PWV correlated most strongly with age. Endothelial function showed premature gradual decline in patients with MFS. Conclusions Despite the increased PWV, monitoring aortic stiffness or TGF-β levels would not be helpful in patients with MFS. TGF-β levels were not increased and the increased MMP-2 levels suggest consideration of a different therapeutic target.
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Affiliation(s)
- Jason Z Cui
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Kevin C Harris
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Koen Raedschelders
- Advanced Clinical Biosystems Research Institute at Smidt Heart Institute, Los Angeles, California, USA
| | - Zsuzsanna Hollander
- UBC James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Astrid De Souza
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marla Kiess
- Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Bruce M McManus
- UBC James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascal Bernatchez
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart and Lung Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie A Raffin
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heidi Paine
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelis van Breemen
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mitra Esfandiarei
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
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5
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Salvi L, Alfonsi J, Grillo A, Pini A, Soranna D, Zambon A, Pacini D, Di Bartolomeo R, Salvi P, Parati G. Postoperative and mid-term hemodynamic changes after replacement of the ascending aorta. J Thorac Cardiovasc Surg 2020; 163:1283-1292. [PMID: 32624310 DOI: 10.1016/j.jtcvs.2020.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate aortic distensibility and pulse waveform patterns associated with the ascending aortic aneurysm, and to analyze the postoperative and mid-term hemodynamic changes induced by prosthetic replacement of the ascending aorta. METHODS Central blood pressure waves were recorded at the carotid artery level by means of a validated transcutaneous arterial tonometer in 30 patients undergoing prosthetic replacement of ascending aortic aneurysm and in 30 control patients. Measurements were obtained the day before surgery and 5 to 7 days and 16 to 20 months after surgery. RESULTS The ascending aortic aneurysm was associated with a less steep slope of early systolic phase of the pressure curve (pulsus tardus) compared with a control group (0.54 ± 0.18 mm Hg/ms vs 0.69 ± 0.26 mm Hg/ms; P = .011). Replacing the ascending aorta with a noncompliant vascular prosthesis steepened the pulse pressure slope during the early systolic phase in the postoperative period (0.77 ± .29 mm Hg/ms), providing values comparable with those of the control group in the mid-term (0.67 ± .20 mm Hg/ms). No change in aortic stiffness was found either postoperatively or in the mid-term after ascending aorta surgical replacement (carotid-femoral pulse wave velocity: preoperative, 9.0 ± 2.6 m/s; postoperative, 9.0 ± 2.9 m/s; mid-term postoperative, 9.3 ± 2.8 m/s). CONCLUSIONS This study does not confirm the assumption that substitution of the viscoelastic ascending aorta with a rigid prosthesis can cause serious hemodynamic alterations downstream, because we did not observe a worsening of global aortic distensibility after insertion of a rigid prosthetic aorta. The ascending aortic aneurysm is associated with a pulsus tardus.
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Affiliation(s)
- Lucia Salvi
- Foundation IRCCS Polyclinic San Matteo, University of Pavia, Pavia, Italy
| | - Jacopo Alfonsi
- Department of Cardiovascular Surgery, S Orsola Hospital, University of Bologna, Bologna, Italy
| | - Andrea Grillo
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Pini
- Vascular Cardiogenetic Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Davide Soranna
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit, Milan, Italy
| | - Antonella Zambon
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit, Milan, Italy; Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Davide Pacini
- Department of Cardiovascular Surgery, S Orsola Hospital, University of Bologna, Bologna, Italy
| | - Roberto Di Bartolomeo
- Department of Cardiovascular Surgery, S Orsola Hospital, University of Bologna, Bologna, Italy
| | - Paolo Salvi
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit, Milan, Italy.
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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6
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Salvi P, Furlanis G, Grillo A, Pini A, Salvi L, Marelli S, Rovina M, Moretti F, Gaetano R, Pintassilgo I, Faini A, Fabris B, Carretta R, Parati G. Unreliable Estimation of Aortic Pulse Wave Velocity Provided by the Mobil-O-Graph Algorithm-Based System in Marfan Syndrome. J Am Heart Assoc 2019; 8:e04028. [PMID: 31020905 PMCID: PMC6512139 DOI: 10.1161/jaha.118.011440] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/19/2019] [Indexed: 12/29/2022]
Abstract
Background Several devices have been proposed to assess arterial stiffness in clinical daily use over the past few years, by estimating aortic pulse wave velocity (PWV) from a single measurement of brachial oscillometric blood pressure, using patented algorithms. It is uncertain if these systems are able to provide additional elements, beyond the contribution carried by age and blood pressure levels, in the definition of early vascular damage expressed by the stiffening of the arterial wall. Methods and Results The aim of our study was to compare the estimated algorithm-based PWV values, provided by the Mobil-O-Graph system, with the standard noninvasive assessment of aortic PWV in patients with Marfan syndrome (ie, in subjects characterized by premature aortic stiffening and low blood pressure values). Aortic stiffness was simultaneously evaluated by carotid-femoral PWV with a validated arterial tonometer and estimated with an arm cuff-based ambulatory blood pressure monitoring Mobil-O-Graph device on 103 patients with Marfan syndrome (50 men; mean± SD age, 38±15 years). Aortic PWV, estimated by the Mobil-O-Graph, was significantly ( P<0.0001) lower (mean± SD, 6.1±1.3 m/s) than carotid-femoral PWV provided by arterial tonometry (mean± SD , 8.8±3.1 m/s). The average of differences between PWV values provided by the 2 methods (±1.96×SD) was -2.7±5.7 m/s. Conclusions The Mobil-O-Graph provides PWV values related to an ideal subject for a given age and blood pressure, but it is not able to evaluate early vascular aging expressed by high PWV in the individual patient. This is well shown in patients with Marfan syndrome.
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Affiliation(s)
- Paolo Salvi
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSMilanItaly
| | - Giulia Furlanis
- Department of MedicalSurgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Andrea Grillo
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
| | - Alessandro Pini
- Department of CardiologyAzienda Socio Sanitaria Territoriale Fatebenefratelli SaccoRare Disease Center “Marfan Clinic”MilanItaly
| | - Lucia Salvi
- Department of Internal Medicine and TherapeuticsFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Susan Marelli
- Department of CardiologyAzienda Socio Sanitaria Territoriale Fatebenefratelli SaccoRare Disease Center “Marfan Clinic”MilanItaly
| | - Matteo Rovina
- Department of MedicalSurgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Francesco Moretti
- Department of Molecular MedicineFondazione IRCCS Policlinico San MatteoUniversity of PaviaItaly
| | | | | | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSMilanItaly
| | - Bruno Fabris
- Department of MedicalSurgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Renzo Carretta
- Department of MedicalSurgical and Health SciencesUniversity of TriesteTriesteItaly
- Institute of Biomedicine and Molecular Immunology “A. Monroy,”National Research Council of Italy (CNR)PalermoItaly
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
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7
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Cui JZ, Lee L, Sheng X, Chu F, Gibson CP, Aydinian T, Walker DC, Sandor GGS, Bernatchez P, Tibbits GF, van Breemen C, Esfandiarei M. In vivo characterization of doxycycline-mediated protection of aortic function and structure in a mouse model of Marfan syndrome-associated aortic aneurysm. Sci Rep 2019; 9:2071. [PMID: 30765726 PMCID: PMC6376062 DOI: 10.1038/s41598-018-38235-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
Aortic aneurysm is the most life-threatening complication in Marfan syndrome (MFS) patients. Doxycycline, a nonselective matrix metalloproteinases inhibitor, was reported to improve the contractile function and elastic fiber structure and organization in a Marfan mouse aorta using ex vivo small chamber myography. In this study, we assessed the hypothesis that a long-term treatment with doxycycline would reduce aortic root growth, improve aortic wall elasticity as measured by pulse wave velocity, and improve the ultrastructure of elastic fiber in the mouse model of MFS. In our study, longitudinal measurements of aortic root diameters using high-resolution ultrasound imaging display significantly decreased aortic root diameters and lower pulse wave velocity in doxycycline-treated Marfan mice starting at 6 months as compared to their non-treated MFS counterparts. In addition, at the ultrastructural level, our data show that long-term doxycycline treatment corrects the irregularities of elastic fibers within the aortic wall of Marfan mice to the levels similar to those observed in control subjects. Our findings underscore the key role of matrix metalloproteinases during the progression of aortic aneurysm, and provide new insights into the potential therapeutic value of doxycycline in blocking MFS-associated aortic aneurysm.
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Affiliation(s)
- Jason Z Cui
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Ling Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Xiaoye Sheng
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Fanny Chu
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine P Gibson
- Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - Taline Aydinian
- Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - David C Walker
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Pascal Bernatchez
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Glen F Tibbits
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Cornelis van Breemen
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Mitra Esfandiarei
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada. .,Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA.
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8
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Khan S, Fakhouri F, Majeed W, Kolipaka A. Cardiovascular magnetic resonance elastography: A review. NMR IN BIOMEDICINE 2018; 31:e3853. [PMID: 29193358 PMCID: PMC5975119 DOI: 10.1002/nbm.3853] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 09/29/2017] [Indexed: 05/19/2023]
Abstract
Cardiovascular diseases are the leading cause of death worldwide. These cardiovascular diseases are associated with mechanical changes in the myocardium and aorta. It is known that stiffness is altered in many diseases, including the spectrum of ischemia, diastolic dysfunction, hypertension and hypertrophic cardiomyopathy. In addition, the stiffness of the aortic wall is altered in multiple diseases, including hypertension, coronary artery disease and aortic aneurysm formation. For example, in diastolic dysfunction in which the ejection fraction is preserved, stiffness can potentially be an important biomarker. Similarly, in aortic aneurysms, stiffness can provide valuable information with regard to rupture potential. A number of studies have addressed invasive and non-invasive approaches to test and measure the mechanical properties of the myocardium and aorta. One of the non-invasive approaches is magnetic resonance elastography (MRE). MRE is a phase-contrast magnetic resonance imaging technique that measures tissue stiffness non-invasively. This review article highlights the technical details and application of MRE in the quantification of myocardial and aortic stiffness in different disease states.
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Affiliation(s)
- Saad Khan
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Faisal Fakhouri
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
| | - Waqas Majeed
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Arunark Kolipaka
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
- Department of Internal Medicine-Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
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9
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. Doppler Echocardiography Assessment of Aortic Stiffness in Female Adolescents with Anorexia Nervosa. J Am Soc Echocardiogr 2018; 31:784-790. [PMID: 29559196 DOI: 10.1016/j.echo.2018.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with abnormalities in biomarkers of cardiovascular risk. Arterial stiffness, as measured by pulse-wave velocity (PWV), is also a risk factor for cardiovascular disease. The aims of this study were to determine the stiffness of the aorta in female adolescents with AN and to determine if either the severity or the type of AN was associated with PWV. METHODS This was a retrospective case-control study. Adolescent patients with a clinical diagnosis of AN were included. Aortic diameter and pulse-wave transit time over a portion of the thoracic aorta were measured using Doppler echocardiography, and PWV was calculated. RESULTS There were 94 female patients with AN and 60 adolescent female control subjects. There was no significant difference in age between patients with AN and control subjects (15.5 ± 1.7 vs 15.1 ± 2.6 years, P = .220). Body mass index (16.0 ± 2.4 vs 19.7 ± 2.7 kg/m2, P < .001) and body mass index percentile (9.4 ± 15.6 vs 45.5 ± 26.2, P < .001) were significantly lower for patients with AN than control subjects. PWV (443 ± 106 vs 383 ± 77 cm/sec, P < .001) was significantly higher in patients with AN than control subjects. Similar differences from control subjects were found in patients with AN with both lower and higher body mass index percentiles and also in patients with AN with the restrictive or the binge-purge subtype. CONCLUSIONS Female adolescents with AN have increased aortic stiffness compared with control subjects. This study suggests that patients with AN may be at increased risk for future cardiovascular disease. Future studies are required to determine the reversibility of these changes with weight restoration.
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Affiliation(s)
- Carolina A Escudero
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine, British Columbia Children's Hospital and Provincial Specialized Eating Disorders Program, Vancouver, British Columbia, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Gerald J Mugford
- Memorial University of Newfoundland, Faculty of Medicine and Discipline of Psychiatry, St. John's, Newfoundland, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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10
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Lee L, Cui JZ, Cua M, Esfandiarei M, Sheng X, Chui WA, Xu MH, Sarunic MV, Beg MF, van Breemen C, Sandor GGS, Tibbits GF. Aortic and Cardiac Structure and Function Using High-Resolution Echocardiography and Optical Coherence Tomography in a Mouse Model of Marfan Syndrome. PLoS One 2016; 11:e0164778. [PMID: 27824871 PMCID: PMC5100915 DOI: 10.1371/journal.pone.0164778] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 10/02/2016] [Indexed: 12/23/2022] Open
Abstract
Marfan syndrome (MFS) is an autosomal-dominant disorder of connective tissue caused by mutations in the fibrillin-1 (FBN1) gene. Mortality is often due to aortic dissection and rupture. We investigated the structural and functional properties of the heart and aorta in a [Fbn1C1039G/+] MFS mouse using high-resolution ultrasound (echo) and optical coherence tomography (OCT). Echo was performed on 6- and 12-month old wild type (WT) and MFS mice (n = 8). In vivo pulse wave velocity (PWV), aortic root diameter, ejection fraction, stroke volume, left ventricular (LV) wall thickness, LV mass and mitral valve early and atrial velocities (E/A) ratio were measured by high resolution echocardiography. OCT was performed on 12-month old WT and MFS fixed mouse hearts to measure ventricular volume and mass. The PWV was significantly increased in 6-mo MFS vs. WT (366.6 ± 19.9 vs. 205.2 ± 18.1 cm/s; p = 0.003) and 12-mo MFS vs. WT (459.5 ± 42.3 vs. 205.3 ± 30.3 cm/s; p< 0.0001). PWV increased with age in MFS mice only. We also found a significantly enlarged aortic root and decreased E/A ratio in MFS mice compared with WT for both age groups. The [Fbn1C1039G/+] mouse model of MFS replicates many of the anomalies of Marfan patients including significant aortic dilation, central aortic stiffness, LV systolic and diastolic dysfunction. This is the first demonstration of the direct measurement in vivo of pulse wave velocity non-invasively in the aortic arch of MFS mice, a robust measure of aortic stiffness and a critical clinical parameter for the assessment of pathology in the Marfan syndrome.
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Affiliation(s)
- Ling Lee
- Child and Family Research Institute, Department of Cardiovascular Sciences, Vancouver, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Jason Z. Cui
- Child and Family Research Institute, Department of Cardiovascular Sciences, Vancouver, BC, Canada
- Division of Cardiology, Department of Pediatrics, UBC, Vancouver, BC, Canada
| | - Michelle Cua
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Mitra Esfandiarei
- Child and Family Research Institute, Department of Cardiovascular Sciences, Vancouver, BC, Canada
- Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Xiaoye Sheng
- Child and Family Research Institute, Department of Cardiovascular Sciences, Vancouver, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Winsey Audrey Chui
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Michael Haoying Xu
- Child and Family Research Institute, Department of Cardiovascular Sciences, Vancouver, BC, Canada
| | - Marinko V. Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Mirza Faisal Beg
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Cornelius van Breemen
- Child and Family Research Institute, Department of Cardiovascular Sciences, Vancouver, BC, Canada
- Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - George G. S. Sandor
- Child and Family Research Institute, Department of Cardiovascular Sciences, Vancouver, BC, Canada
- Division of Cardiology, Department of Pediatrics, UBC, Vancouver, BC, Canada
| | - Glen F. Tibbits
- Child and Family Research Institute, Department of Cardiovascular Sciences, Vancouver, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- * E-mail:
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11
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Echocardiographic Assessment of Aortic Pulse-Wave Velocity: Validation against Invasive Pressure Measurements. J Am Soc Echocardiogr 2016; 29:1109-1116. [DOI: 10.1016/j.echo.2016.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 12/16/2022]
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12
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Akazawa Y, Motoki N, Tada A, Yamazaki S, Hachiya A, Matsuzaki S, Kamiya M, Nakamura T, Kosho T, Inaba Y. Decreased Aortic Elasticity in Children With Marfan Syndrome or Loeys-Dietz Syndrome. Circ J 2016; 80:2369-2375. [DOI: 10.1253/circj.cj-16-0739] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yohei Akazawa
- Department of Pediatrics, Shinshu University School of Medicine
| | - Noriko Motoki
- Department of Pediatrics, Shinshu University School of Medicine
| | - Akira Tada
- Department of Pediatrics, Shinshu University School of Medicine
| | - Shoko Yamazaki
- Department of Pediatrics, Shinshu University School of Medicine
| | - Akira Hachiya
- Department of Pediatrics, Shinshu University School of Medicine
| | | | - Motoko Kamiya
- Department of Pediatrics, Shinshu University School of Medicine
- Department of Medical Genetics, Shinshu University School of Medicine
| | - Tomohiko Nakamura
- Division of Neonatology, Shinshu University School of Medicine
- Division of Neonatology, Nagano Children’s Hospital
| | - Tomoki Kosho
- Department of Medical Genetics, Shinshu University School of Medicine
| | - Yuji Inaba
- Department of Pediatrics, Shinshu University School of Medicine
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13
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Kenyhercz WE, Raterman B, Illapani VSP, Dowell J, Mo X, White RD, Kolipaka A. Quantification of aortic stiffness using magnetic resonance elastography: Measurement reproducibility, pulse wave velocity comparison, changes over cardiac cycle, and relationship with age. Magn Reson Med 2015; 75:1920-6. [PMID: 26096227 DOI: 10.1002/mrm.25719] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess MR elastography (MRE)-derived aortic shear stiffness (μMRE ) measurements for: 1) reproducibility, 2) comparison to pulse wave velocity, 3) changes over the cardiac cycle, and 4) relationship with age. METHODS Cardiac-gated aortic MRE was performed on 20 healthy volunteers (aged 20-73 years). For assessing reproducibility of stiffness measurements, scans were repeated per volunteer. MRE wave images were analyzed to obtain stiffness of the abdominal aorta across the cardiac cycle, and comparisons were made with subject age. RESULTS Analysis of concordance correlation coefficient between scans 1 and 2 showed that rc = 0.86 (95% confidence interval, 0.77, 0.94) with P < 0.0001. Significantly higher μMRE was observed for all volunteers during end-systole when compared to end-diastole (P < 0.0001). μMRE increased with age; end-systolic stiffness demonstrated a relatively stronger correlation with age (r = 0.62, P = 0.003) when compared to end-diastolic stiffness (r = 0.51, P = 0.023); and the slopes of end-systole and end-diastole were found to be significantly different (P = 0.011). [Formula: see text] at end-systole and end-diastole correlated linearly with pulse wave velocity, with an r = 0.54 (P = 0.013) and r = 0.58 (P = 0.008), respectively. CONCLUSION The results of this study indicate that MRE-derived aortic shear stiffness measurements are robust (reproducible and comparable to similar techniques). Mean μMRE was higher during end-systole when compared to end-diastole. μMRE was found to increase with age and showed a stronger correlation with end-systolic stiffness than with end-diastolic stiffness.
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Affiliation(s)
- William E Kenyhercz
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Brian Raterman
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Venkata Sita Priyanka Illapani
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Joshua Dowell
- Department of Internal Medicine, Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Xiaokui Mo
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Richard D White
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Department of Internal Medicine, Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Arunark Kolipaka
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Department of Internal Medicine, Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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14
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Myers KA, Leung MT, Terri Potts M, Potts JE, Sandor GG. Noninvasive Assessment of Vascular Function and Hydraulic Power and Efficiency in Pediatric Fontan Patients. J Am Soc Echocardiogr 2013; 26:1221-1227. [DOI: 10.1016/j.echo.2013.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Indexed: 10/26/2022]
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15
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Alghamdi M, De Souza AM, White CT, Potts MT, Warady BA, Furth SL, Kimball TR, Potts JE, Sandor GGS. Echo-Doppler assessment of the biophysical properties of the aorta in children with chronic kidney disease. Pediatr Cardiol 2013; 34:1218-25. [PMID: 23381174 DOI: 10.1007/s00246-013-0632-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/02/2013] [Indexed: 01/21/2023]
Abstract
Chronic kidney disease (CKD) is known to cause increased arterial stiffness, which is an important independent risk factor for adverse cardiovascular events. The purpose of this study was to assess the vascular properties of the aorta (AO) in a group of children with CKD using a noninvasive echocardiography (echo)-Doppler method. We studied 24 children with stages 2 through 5 CKD and 48 age-matched controls. Detailed echocardiographic assessment and echo-Doppler pulse wave velocity (PWV) was performed. Indices of arterial stiffness, including characteristic (Zc) and input (Zi) impedances, elastic pressure-strain modulus (Ep), and arterial wall stiffness index, were calculated. CKD patients underwent full nephrology assessment, and an iohexol glomerular filtration rate was performed, which allowed for accurate assignment of the CKD stage. CKD patients had greater median systolic blood pressure (114 vs. 110 mmHg; p < 0.04) and pulse pressure (51 vs. 40 mmHg; p < 0.001) compared with controls. PWV was similar between groups (358 vs. 344 cm s(-1); p = 0.759), whereas Zi (182 vs. 131 dyne s cm(-5); p < 0.001), Zc (146 vs. 138 dyne s cm(-5); p = 0.05), and Ep (280 vs. 230 mmHg; p < 0.02) were significantly greater in CKD than in controls. Although load-dependent measures of arterial stiffness were greater in non-dialysis dependent CKD patients, PWV was not increased compared with controls. This suggests that the increased arterial stiffness may not be permanent in these pediatric patients with kidney disease.
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Affiliation(s)
- Mohammed Alghamdi
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
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16
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Dormand H, Mohiaddin RH. Cardiovascular magnetic resonance in Marfan syndrome. J Cardiovasc Magn Reson 2013; 15:33. [PMID: 23587220 PMCID: PMC3651373 DOI: 10.1186/1532-429x-15-33] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/15/2013] [Indexed: 12/20/2022] Open
Abstract
This review provides an overview of Marfan syndrome with an emphasis on cardiovascular complications and cardiovascular imaging. Both pre- and post-operative imaging is addressed with an explanation of surgical management. All relevant imaging modalities are discussed with a particular focus on cardiovascular MR.
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Affiliation(s)
- Helen Dormand
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Raad H Mohiaddin
- Royal Brompton Hospital and National Heart & Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
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17
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van der Linde D, van de Laar IMBH, Bertoli-Avella AM, Oldenburg RA, Bekkers JA, Mattace-Raso FUS, van den Meiracker AH, Moelker A, van Kooten F, Frohn-Mulder IME, Timmermans J, Moltzer E, Cobben JM, van Laer L, Loeys B, De Backer J, Coucke PJ, De Paepe A, Hilhorst-Hofstee Y, Wessels MW, Roos-Hesselink JW. Aggressive cardiovascular phenotype of aneurysms-osteoarthritis syndrome caused by pathogenic SMAD3 variants. J Am Coll Cardiol 2012; 60:397-403. [PMID: 22633655 DOI: 10.1016/j.jacc.2011.12.052] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/05/2011] [Accepted: 12/18/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was describe the cardiovascular phenotype of the aneurysms-osteoarthritis syndrome (AOS) and to provide clinical recommendations. BACKGROUND AOS, caused by pathogenic SMAD3 variants, is a recently described autosomal dominant syndrome characterized by aneurysms and arterial tortuosity in combination with osteoarthritis. METHODS AOS patients in participating centers underwent extensive cardiovascular evaluation, including imaging, arterial stiffness measurements, and biochemical studies. RESULTS We included 44 AOS patients from 7 families with pathogenic SMAD3 variants (mean age: 42 ± 17 years). In 71%, an aortic root aneurysm was found. In 33%, aneurysms in other arteries in the thorax and abdomen were diagnosed, and in 48%, arterial tortuosity was diagnosed. In 16 patients, cerebrovascular imaging was performed, and cerebrovascular abnormalities were detected in 56% of them. Fifteen deaths occurred at a mean age of 54 ± 15 years. The main cause of death was aortic dissection (9 of 15; 60%), which occurred at mildly increased aortic diameters (range: 40 to 63 mm). Furthermore, cardiac abnormalities were diagnosed, such as congenital heart defects (6%), mitral valve abnormalities (51%), left ventricular hypertrophy (19%), and atrial fibrillation (22%). N-terminal brain natriuretic peptide (NT-proBNP) was significantly higher in AOS patients compared with matched controls (p < 0.001). Aortic pulse wave velocity was high-normal (9.2 ± 2.2 m/s), indicating increased aortic stiffness, which strongly correlated with NT-proBNP (r = 0.731, p = 0.005). CONCLUSIONS AOS predisposes patients to aggressive and widespread cardiovascular disease and is associated with high mortality. Dissections can occur at relatively mildly increased aortic diameters; therefore, early elective repair of the ascending aorta should be considered. Moreover, cerebrovascular abnormalities were encountered in most patients.
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18
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Dogdu O, Kaya MG, Yarlioglues M, Dogan A, Ardic I, Elcik D, Kalay N, Kaynar L, Kurnaz F, Eryol NK. Impaired Aortic Elastic Properties in Patients with Chronic Graft-versus-Host Disease. Echocardiography 2011; 28:1011-8. [DOI: 10.1111/j.1540-8175.2011.01475.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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19
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