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Concannon J, Hynes N, McMullen M, Smyth E, Moerman K, McHugh PE, Sultan S, Karmonik C, McGarry JP. A Dual-VENC Four-Dimensional Flow MRI Framework for Analysis of Subject-Specific Heterogeneous Nonlinear Vessel Deformation. J Biomech Eng 2020; 142:114502. [PMID: 33006370 DOI: 10.1115/1.4048649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 07/25/2024]
Abstract
Advancement of subject-specific in silico medicine requires new imaging protocols tailored to specific anatomical features, paired with new constitutive model development based on structure/function relationships. In this study, we develop a new dual-velocity encoding coefficient (VENC) 4D flow MRI protocol that provides unprecedented spatial and temporal resolution of in vivo aortic deformation. All previous dual-VENC 4D flow MRI studies in the literature focus on an isolated segment of the aorta, which fail to capture the full spectrum of aortic heterogeneity that exists along the vessel length. The imaging protocol developed provides high sensitivity to all blood flow velocities throughout the entire cardiac cycle, overcoming the challenge of accurately measuring the highly unsteady nonuniform flow field in the aorta. Cross-sectional area change, volumetric flow rate, and compliance are observed to decrease with distance from the heart, while pulse wave velocity (PWV) is observed to increase. A nonlinear aortic lumen pressure-area relationship is observed throughout the aorta such that a high vessel compliance occurs during diastole, and a low vessel compliance occurs during systole. This suggests that a single value of compliance may not accurately represent vessel behavior during a cardiac cycle in vivo. This high-resolution MRI data provide key information on the spatial variation in nonlinear aortic compliance, which can significantly advance the state-of-the-art of in-silico diagnostic techniques for the human aorta.
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Affiliation(s)
- J Concannon
- Biomedical Engineering, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - N Hynes
- Department of Vascular and Endovascular Surgery, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - M McMullen
- Department of Radiology, Galway Clinic, Doughiska, Galway H91 HHT0, Ireland
| | - E Smyth
- Department of Radiology, Galway Clinic, Doughiska, Galway H91 HHT0, Ireland
| | - K Moerman
- Biomedical Engineering, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - P E McHugh
- Biomedical Engineering, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - S Sultan
- Department of Vascular and Endovascular Surgery, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - C Karmonik
- MRI Core, Houston Methodist Debakey Heart and Vascular Center, Houston, TX 77030
| | - J P McGarry
- Biomedical Engineering, National University of Ireland Galway, Galway H91 TK33, Ireland
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2
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Ghorbani N, Muthurangu V, Khushnood A, Goubergrits L, Nordmeyer S, Fernandes JF, Lee CB, Runte K, Roth S, Schubert S, Kelle S, Berger F, Kuehne T, Kelm M. Impact of valve morphology, hypertension and age on aortic wall properties in patients with coarctation: a two-centre cross-sectional study. BMJ Open 2020; 10:e034853. [PMID: 32213521 PMCID: PMC7170596 DOI: 10.1136/bmjopen-2019-034853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We aimed to investigate the combined effects of arterial hypertension, bicuspid aortic valve disease (BAVD) and age on the distensibility of the ascending and descending aortas in patients with aortic coarctation. DESIGN Cross-sectional study. SETTING The study was conducted at two university medical centres, located in Berlin and London. PARTICIPANTS A total of 121 patients with aortic coarctation (ages 1-71 years) underwent cardiac MRI, echocardiography and blood pressure measurements. OUTCOME MEASURES Cross-sectional diameters of the ascending and descending aortas were assessed to compute aortic area distensibility. Findings were compared with age-specific reference values. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology statement and reporting guidelines. RESULTS Impaired distensibility (below fifth percentile) was seen in 37% of all patients with coarctation in the ascending aorta and in 43% in the descending aorta. BAVD (43%) and arterial hypertension (72%) were present across all ages. In patients >10 years distensibility impairment of the ascending aorta was predominantly associated with BAVD (OR 3.1, 95% CI 1.33 to 7.22, p=0.009). Distensibility impairment of the descending aorta was predominantly associated with arterial hypertension (OR 2.8, 95% CI 1.08 to 7.2, p=0.033) and was most pronounced in patients with uncontrolled hypertension despite antihypertensive treatment. CONCLUSION From early adolescence on, both arterial hypertension and BAVD have a major impact on aortic distensibility. Their specific effects differ in strength and localisation (descending vs ascending aorta). Moreover, adequate blood pressure control is associated with improved distensibility. These findings could contribute to the understanding of cardiovascular complications and the management of patients with aortic coarctation.
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Affiliation(s)
- Niky Ghorbani
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Abbas Khushnood
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Leonid Goubergrits
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Sarah Nordmeyer
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Joao Filipe Fernandes
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Chong-Bin Lee
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - Kilian Runte
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Sophie Roth
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Titus Kuehne
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Marcus Kelm
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- BIH (Berlin Institute of Health), Berlin, Germany
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3
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Concannon J, Dockery P, Black A, Sultan S, Hynes N, McHugh PE, Moerman KM, McGarry JP. Quantification of the regional bioarchitecture in the human aorta. J Anat 2020; 236:142-155. [PMID: 31512228 PMCID: PMC6904601 DOI: 10.1111/joa.13076] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2019] [Indexed: 12/14/2022] Open
Abstract
Regional variance in human aortic bioarchitecture responsible for the elasticity of the vessel is poorly understood. The current study quantifies the elements responsible for aortic compliance, namely, elastin, collagen and smooth muscle cells, using histological and stereological techniques on human tissue with a focus on regional heterogeneity. Using donated cadaveric tissue, a series of samples were excised between the proximal ascending aorta and the distal abdominal aorta, for five cadavers, each of which underwent various staining procedures to enhance specific constituents of the wall. Using polarised light microscopy techniques, the orientation of collagen fibres was studied for each location and each tunical layer of the aorta. Significant transmural and longitudinal heterogeneity in collagen fibre orientations were uncovered throughout the vessel. It is shown that a von Mises mixture model is required accurately to fit the complex collagen fibre distributions that exist along the aorta. Additionally, collagen and smooth muscle cell density was observed to increase with increasing distance from the heart, whereas elastin density decreased. Evidence clearly demonstrates that the aorta is a highly heterogeneous vessel which cannot be simplistically represented by a single compliance value. The quantification and fitting of the regional aortic bioarchitectural data, although not without its limitations, including mean cohort age of 77.6 years, facilitates the development of next-generation finite element models that can potentially simulate the influence of regional aortic composition and microstructure on vessel biomechanics.
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Affiliation(s)
- J. Concannon
- Biomedical EngineeringNational University of Ireland GalwayGalwayIreland
| | - P. Dockery
- Anatomy, School of MedicineNational University of Ireland GalwayGalwayIreland
| | - A. Black
- Anatomy, School of MedicineNational University of Ireland GalwayGalwayIreland
| | - S. Sultan
- Department of Vascular and Endovascular SurgeryNational University of Ireland GalwayGalwayIreland
| | - N. Hynes
- Department of Vascular and Endovascular SurgeryNational University of Ireland GalwayGalwayIreland
| | - P. E. McHugh
- Biomedical EngineeringNational University of Ireland GalwayGalwayIreland
| | - K. M. Moerman
- Biomedical EngineeringNational University of Ireland GalwayGalwayIreland
- Biomechatronics, Media LabMassachusetts Institute of TechnologyCambridgeMAUSA
| | - J. P. McGarry
- Biomedical EngineeringNational University of Ireland GalwayGalwayIreland
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4
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Patient-specific haemodynamic simulations of complex aortic dissections informed by commonly available clinical datasets. Med Eng Phys 2019; 71:45-55. [DOI: 10.1016/j.medengphy.2019.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/22/2019] [Accepted: 06/09/2019] [Indexed: 12/26/2022]
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5
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Cuomo F, Ferruzzi J, Agarwal P, Li C, Zhuang ZW, Humphrey JD, Figueroa CA. Sex-dependent differences in central artery haemodynamics in normal and fibulin-5 deficient mice: implications for ageing. Proc Math Phys Eng Sci 2019; 475:20180076. [PMID: 30760948 PMCID: PMC6364598 DOI: 10.1098/rspa.2018.0076] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022] Open
Abstract
Mouse models provide unique opportunities to study vascular disease, but they demand increased experimental and computational resolution. We describe a workflow for combining in vivo and in vitro biomechanical data to build mouse-specific computational models of the central vasculature including regional variations in biaxial wall stiffness, thickness and perivascular support. These fluid-solid interaction models are informed by micro-computed tomography imaging and in vivo ultrasound and pressure measurements, and include mouse-specific inflow and outflow boundary conditions. Hence, the model can capture three-dimensional unsteady flows and pulse wave characteristics. The utility of this experimental-computational approach is illustrated by comparing central artery biomechanics in adult wild-type and fibulin-5 deficient mice, a model of early vascular ageing. Findings are also examined as a function of sex. Computational results compare well with measurements and data available in the literature and suggest that pulse wave velocity, a spatially integrated measure of arterial stiffness, does not reflect well the presence of regional differences in stiffening, particularly those manifested in male versus female mice. Modelling results are also useful for comparing quantities that are difficult to measure or infer experimentally, including local pulse pressures at the renal arteries and characteristics of the peripheral vascular bed that may differ with disease.
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Affiliation(s)
- Federica Cuomo
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jacopo Ferruzzi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Pradyumn Agarwal
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Chen Li
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Zhen W. Zhuang
- Translational Research Imaging Center, Yale University, New Haven, CT, USA
| | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Vascular Biology and Therapeutics Program, Yale University, New Haven, CT, USA
| | - C. Alberto Figueroa
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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6
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Korneva A, Humphrey JD. Maladaptive aortic remodeling in hypertension associates with dysfunctional smooth muscle contractility. Am J Physiol Heart Circ Physiol 2018; 316:H265-H278. [PMID: 30412437 DOI: 10.1152/ajpheart.00503.2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intramural cells are responsible for establishing, maintaining, and restoring the functional capability and structural integrity of the aortic wall. In response to hypertensive loading, these cells tend to increase wall content via extracellular matrix turnover in an attempt to return wall stress and/or material stiffness toward homeostatic values despite the elevated pressure. Using a common rodent model of induced hypertension, we found marked mouse-to-mouse differences in thoracic aortic remodeling over 2-4 wk of pressure elevation, with mechanoadaptation in some but gross maladaptation in most mice despite the same experimental conditions and overall genetic background. Consistent with our hypothesis, we also found a strong correlation between maladaptive aortic remodeling and a dysfunctional ability of the vessel to vasoconstrict, with maladaptation often evidenced by marked adventitial fibrosis. Remarkably, mouse-to-mouse variability did not correlate with the degree or duration of pressure elevation over the 2- to 4-wk study period. These findings suggest both a need to study together the structure, mechanical properties, and function across layers of the wall when assessing aortic health and a need for caution in using common statistical comparisons across small seemingly well-defined groups that may mask important underlying individual responses, an area of investigation that demands increasing attention as we move toward an era of precision diagnosis and patient care. NEW & NOTEWORTHY There are three primary findings. Marked mouse-to-mouse differences exist in large vessel hypertensive remodeling in an otherwise equivalent cohort of animals. The degree of maladaptation correlates strongly with decreases in smooth muscle contractile capacity. Finally, short-term maladaptive remodeling is independent of the precise degree or duration of the pressure elevation provided that thresholds are exceeded. Therapeutic targets should thus be personalized and focus on both layer-to-layer interactions and early interventions.
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Affiliation(s)
- Arina Korneva
- Department of Biomedical Engineering, Yale University , New Haven, Connecticut
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University , New Haven, Connecticut.,Vascular Biology and Therapeutics Program, Yale School of Medicine , New Haven, Connecticut
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7
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Sinha S, Santoro MM. New models to study vascular mural cell embryonic origin: implications in vascular diseases. Cardiovasc Res 2018; 114:481-491. [PMID: 29385541 DOI: 10.1093/cvr/cvy005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/23/2018] [Indexed: 02/15/2024] Open
Abstract
A key question in vascular biology is how the diversity of origin of vascular mural cells, namely smooth muscle cells (SMCs) and pericytes influences vessel properties, in particular the regional propensity to vascular diseases. This review therefore first describes the role and regulation of mural cells during vascular formation, with a focus on embryonic origin. We then consider the evidence that connects heterogeneities in SMC and pericyte origins with disease. Since this idea has major implications for understanding and modelling human disease, then there is a pressing need for new model systems to investigate mural cell development and the consequences of heterogeneity. Recent advances arising from in vitro strategies for deriving mural cells from human pluripotent stem cells as well as from the zebrafish model will be discussed and the medical relevance of these discoveries will be highlighted.
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Affiliation(s)
- Sanjay Sinha
- Anne McLaren Laboratory, Wellcome Trust and Medical Research Council Cambridge Stem Cell Institute, Forvie Site, University of Cambridge, Robinson Way, Cambridge CB2 0SZ, UK
- Department of Medicine, Addenbrookes Hospital, Box 157, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Massimo Mattia Santoro
- Laboratory of Angiogenesis and Redox Metabolism, Department of Biology, University of Padua, 35131 Padova, Italy
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8
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Itu L, Neumann D, Mihalef V, Meister F, Kramer M, Gulsun M, Kelm M, Kühne T, Sharma P. Non-invasive assessment of patient-specific aortic haemodynamics from four-dimensional flow MRI data. Interface Focus 2017; 8:20170006. [PMID: 29285343 DOI: 10.1098/rsfs.2017.0006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We introduce a parameter estimation framework for automatically and robustly personalizing aortic haemodynamic computations from four-dimensional magnetic resonance imaging data. The framework is based on a reduced-order multiscale fluid-structure interaction blood flow model, and on two calibration procedures. First, Windkessel parameters of the outlet boundary conditions are personalized by solving a system of nonlinear equations. Second, the regional mechanical wall properties of the aorta are personalized by employing a nonlinear least-squares minimization method. The two calibration procedures are run sequentially and iteratively until both procedures have converged. The parameter estimation framework was successfully evaluated on 15 datasets from patients with aortic valve disease. On average, only 1.27 ± 0.96 and 7.07 ± 1.44 iterations were required to personalize the outlet boundary conditions and the regional mechanical wall properties, respectively. Overall, the computational model was in close agreement with the clinical measurements used as objectives (pressures, flow rates, cross-sectional areas), with a maximum error of less than 1%. Given its level of automation, robustness and the short execution time (6.2 ± 1.2 min on a standard hardware configuration), the framework is potentially well suited for a clinical setting.
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Affiliation(s)
- Lucian Itu
- Corporate Technology, Siemens SRL, Brasov, Romania.,Department of Automation and Information Technology, Transilvania University of Brasov, Brasov, Romania
| | - Dominik Neumann
- Medical Imaging Technologies, Siemens Healthcare GmbH, Erlangen, Germany
| | - Viorel Mihalef
- Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ, USA
| | - Felix Meister
- Medical Imaging Technologies, Siemens Healthcare GmbH, Erlangen, Germany
| | - Martin Kramer
- Medical Imaging Technologies, Siemens Healthcare GmbH, Erlangen, Germany
| | - Mehmet Gulsun
- Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ, USA
| | - Marcus Kelm
- Department of Congenital Heart Disease, Unit of Cardiovascular Imaging, German Heart Center, Berlin, Germany
| | - Titus Kühne
- Department of Congenital Heart Disease, Unit of Cardiovascular Imaging, German Heart Center, Berlin, Germany
| | | | - Puneet Sharma
- Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ, USA
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9
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Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation. PLoS One 2017; 12:e0168487. [PMID: 28081162 PMCID: PMC5231370 DOI: 10.1371/journal.pone.0168487] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In aortic coarctation, current guidelines recommend reducing pressure gradients that exceed given thresholds. From a physiological standpoint this should ideally improve the energy expenditure of the heart and thus prevent long term organ damage. OBJECTIVES The aim was to assess the effects of interventional treatment on external and internal heart power (EHP, IHP) in patients with aortic coarctation and to explore the correlation of these parameters to pressure gradients obtained from heart catheterization. METHODS In a collective of 52 patients with aortic coarctation 25 patients received stenting and/or balloon angioplasty, and 20 patients underwent MRI before and after an interventional treatment procedure. EHP and IHP were computed based on catheterization and MRI measurements. Along with the power efficiency these were combined in a cardiac energy profile. RESULTS By intervention, the catheter gradient was significantly reduced from 21.8±9.4 to 6.2±6.1mmHg (p<0.001). IHP was significantly reduced after intervention, from 8.03±5.2 to 4.37±2.13W (p < 0.001). EHP was 1.1±0.3 W before and 1.0±0.3W after intervention, p = 0.044. In patients initially presenting with IHP above 5W intervention resulted in a significant reduction in IHP from 10.99±4.74 W to 4.94±2.45W (p<0.001), and a subsequent increase in power efficiency from 14 to 26% (p = 0.005). No significant changes in IHP, EHP or power efficiency were observed in patients initially presenting with IHP < 5W. CONCLUSION It was demonstrated that interventional treatment of coarctation resulted in a decrease in IHP. Pressure gradients, as the most widespread clinical parameters in coarctation, did not show any correlation to changes in EHP or IHP. This raises the question of whether they should be the main focus in coarctation interventions. Only patients with high IHP of above 5W showed improvement in IHP and power efficiency after the treatment procedure. TRIAL REGISTRATION clinicaltrials.gov NCT02591940.
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10
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Singh C, Wang X, Morsi Y, Wong CS. Importance of stent-graft design for aortic arch aneurysm repair. AIMS BIOENGINEERING 2017. [DOI: 10.3934/bioeng.2017.1.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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11
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Kelm M, Goubergrits L, Fernandes JF, Biocca L, Pongiglione G, Muthurangu V, Khushnood A, Secinaro A, Chinali M, Schubert S, Berger F, Kuehne T. MRI as a tool for non-invasive vascular profiling: a pilot study in patients with aortic coarctation. Expert Rev Med Devices 2016; 13:103-12. [DOI: 10.1586/17434440.2015.1090309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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12
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Humphrey JD, Schwartz MA, Tellides G, Milewicz DM. Role of mechanotransduction in vascular biology: focus on thoracic aortic aneurysms and dissections. Circ Res 2015; 116:1448-61. [PMID: 25858068 PMCID: PMC4420625 DOI: 10.1161/circresaha.114.304936] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thoracic aortic diseases that involve progressive enlargement, acute dissection, or rupture are influenced by the hemodynamic loads and mechanical properties of the wall. We have only limited understanding, however, of the mechanobiological processes that lead to these potentially lethal conditions. Homeostasis requires that intramural cells sense their local chemomechanical environment and establish, maintain, remodel, or repair the extracellular matrix to provide suitable compliance and yet sufficient strength. Proper sensing, in turn, necessitates both receptors that connect the extracellular matrix to intracellular actomyosin filaments and signaling molecules that transmit the related information to the nucleus. Thoracic aortic aneurysms and dissections are associated with poorly controlled hypertension and mutations in genes for extracellular matrix constituents, membrane receptors, contractile proteins, and associated signaling molecules. This grouping of factors suggests that these thoracic diseases result, in part, from dysfunctional mechanosensing and mechanoregulation of the extracellular matrix by the intramural cells, which leads to a compromised structural integrity of the wall. Thus, improved understanding of the mechanobiology of aortic cells could lead to new therapeutic strategies for thoracic aortic aneurysms and dissections.
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MESH Headings
- Aortic Dissection/genetics
- Aortic Dissection/metabolism
- Aortic Dissection/pathology
- Aortic Dissection/physiopathology
- Aortic Dissection/therapy
- Animals
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/pathology
- Aorta, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/genetics
- Aortic Aneurysm, Thoracic/metabolism
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/therapy
- Aortic Rupture/genetics
- Aortic Rupture/metabolism
- Aortic Rupture/pathology
- Aortic Rupture/physiopathology
- Aortic Rupture/therapy
- Biomechanical Phenomena
- Disease Progression
- Extracellular Matrix Proteins/genetics
- Extracellular Matrix Proteins/metabolism
- Genetic Predisposition to Disease
- Hemodynamics
- Humans
- Mechanotransduction, Cellular
- Phenotype
- Stress, Mechanical
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Affiliation(s)
- Jay D Humphrey
- From the Departments of Biomedical Engineering (J.D.H., M.A.S.), Medicine (Cardiology) (M.A.S.), Cell Biology (M.A.S.), and Surgery (G.T.), Yale University, New Haven, CT; and Department of Internal Medicine, University of Texas Health Science Center, Houston (D.M.M.)
| | - Martin A Schwartz
- From the Departments of Biomedical Engineering (J.D.H., M.A.S.), Medicine (Cardiology) (M.A.S.), Cell Biology (M.A.S.), and Surgery (G.T.), Yale University, New Haven, CT; and Department of Internal Medicine, University of Texas Health Science Center, Houston (D.M.M.)
| | - George Tellides
- From the Departments of Biomedical Engineering (J.D.H., M.A.S.), Medicine (Cardiology) (M.A.S.), Cell Biology (M.A.S.), and Surgery (G.T.), Yale University, New Haven, CT; and Department of Internal Medicine, University of Texas Health Science Center, Houston (D.M.M.)
| | - Dianna M Milewicz
- From the Departments of Biomedical Engineering (J.D.H., M.A.S.), Medicine (Cardiology) (M.A.S.), Cell Biology (M.A.S.), and Surgery (G.T.), Yale University, New Haven, CT; and Department of Internal Medicine, University of Texas Health Science Center, Houston (D.M.M.).
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13
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Lombardi KC, Northrup V, McNamara RL, Sugeng L, Weismann CG. Aortic stiffness and left ventricular diastolic function in children following early repair of aortic coarctation. Am J Cardiol 2013; 112:1828-33. [PMID: 24035164 DOI: 10.1016/j.amjcard.2013.07.052] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 11/19/2022]
Abstract
Aortic stiffness and diastolic function are abnormal in adults with repaired coarctation of the aorta (CoA). The goal of this study was to determine the relation between aortic stiffness and left ventricular (LV) diastolic impairment in children who had undergone CoA repair very early in life. This is a retrospective review of echocardiograms in children with isolated repaired CoA (group CoA; n = 24) and healthy matched controls (group Normal; n = 24). We analyzed systolic and LV diastolic functions, proximal and distal ascending aortic stiffness indices (SIs), distensibility, and strain. Age range was 0.3 to 21 (median 9) years. Age at time of CoA repair was 0 to 24 (median 0.5) months. Median time since CoA repair was 6 years. There was no significant difference in blood pressure, LV size, and systolic function between the groups. LV diastolic function was impaired in group CoA compared with group Normal (septal E': CoA 10.3 ± 1.6 cm/s and Normal 13.4 ± 1.9 cm/s, p <0.001). All parameters of proximal and distal ascending aortic elasticities were abnormal in group CoA versus Normal (SI of proximal ascending aorta: CoA 4.9 ± 1.6 and Normal 2.7 ± 0.6, p <0.001). Across all patients, there was a strong correlation between septal E' and proximal ascending aortic SI (r = -0.72, p <0.001). In conclusion, even children who underwent CoA repair at a very young age have abnormal LV diastolic function and aortic elasticity compared with controls and there is a linear relation between the 2. LV diastolic dysfunction in patients with repaired CoA may be due to chronically increased afterload.
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Affiliation(s)
- Kristin C Lombardi
- Division of Pediatric Cardiology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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