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Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, Bura-Rivière A, De Backer J, Deglise S, Della Corte A, Heiss C, Kałużna-Oleksy M, Kurpas D, McEniery CM, Mirault T, Pasquet AA, Pitcher A, Schaubroeck HAI, Schlager O, Sirnes PA, Sprynger MG, Stabile E, Steinbach F, Thielmann M, van Kimmenade RRJ, Venermo M, Rodriguez-Palomares JF. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024; 45:3538-3700. [PMID: 39210722 DOI: 10.1093/eurheartj/ehae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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2
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Mansouri H, Kemerli M, MacIver R, Amili O. Development of idealized human aortic models for in vitro and in silico hemodynamic studies. Front Cardiovasc Med 2024; 11:1358601. [PMID: 39161662 PMCID: PMC11330894 DOI: 10.3389/fcvm.2024.1358601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/25/2024] [Indexed: 08/21/2024] Open
Abstract
Background The aorta, a central component of the cardiovascular system, plays a pivotal role in ensuring blood circulation. Despite its importance, there is a notable lack of idealized models for experimental and computational studies. Objective This study aims to develop computer-aided design (CAD) models for the idealized human aorta, intended for studying hemodynamics or solid mechanics in both in vitro and in silico settings. Methods Various parameters were extracted from comprehensive literature sources to evaluate major anatomical characteristics of the aorta in healthy adults, including variations in aortic arch branches and corresponding dimensions. The idealized models were generated based on averages weighted by the cohort size of each study for several morphological parameters collected and compiled from image-based or cadaveric studies, as well as data from four recruited subjects. The models were used for hemodynamics assessment using particle image velocimetry (PIV) measurements and computational fluid dynamics (CFD) simulations. Results Two CAD models for the idealized human aorta were developed, focusing on the healthy population. The CFD simulations, which align closely with the PIV measurements, capture the main global flow features and wall shear stress patterns observed in patient-specific cases, demonstrating the capabilities of the designed models. Conclusions The collected statistical data on the aorta and the two idealized aorta models, covering prevalent arch variants known as Normal and Bovine types, are shown to be useful for examining the hemodynamics of the aorta. They also hold promise for applications in designing medical devices where anatomical statistics are needed.
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Affiliation(s)
- Hamid Mansouri
- Department of Mechanical, Industrial, and Manufacturing Engineering, University of Toledo, Toledo, OH, United States
| | - Muaz Kemerli
- Department of Mechanical, Industrial, and Manufacturing Engineering, University of Toledo, Toledo, OH, United States
- Department of Mechanical Engineering, Sakarya University, Sakarya, Turkey
| | - Robroy MacIver
- Children’s Heart Clinic, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, United States
| | - Omid Amili
- Department of Mechanical, Industrial, and Manufacturing Engineering, University of Toledo, Toledo, OH, United States
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Storlund RL, Rosen DAS, Haulena M, Sanatani S, Vander Zaag J, Trites AW. Ultrasound images of the ascending aorta of anesthetized northern fur seals and Steller sea lions confirm that the aortic bulb maintains continuous blood flow. JOURNAL OF EXPERIMENTAL ZOOLOGY. PART A, ECOLOGICAL AND INTEGRATIVE PHYSIOLOGY 2024; 341:458-469. [PMID: 38409932 DOI: 10.1002/jez.2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
The increased size and enhanced compliance of the aortic bulb-the enlargement of the ascending aorta-are believed to maintain blood flow in pinnipeds during extended periods of diastole induced by diving bradycardia. The aortic bulb has been described ex vivo in several species of pinnipeds, but in vivo measurements are needed to investigate the relationship between structure and function. We obtained ultrasound images using electrocardiogram-gated transesophageal echocardiography during anesthesia and after atropine administration to assess the relationship between aortic bulb anatomy and cardiac function (heart rate, stroke volume, cardiac output) in northern fur seals (Callorhinus ursinus) and Steller sea lions (Eumetopias jubatus). We observed that the aortic bulb in northern fur seals and Steller sea lions expands during systole and recoils over the entire diastolic period indicating that blood flow is maintained throughout the entire cardiac cycle as expected. The stroke volumes we measured in the fur seals and sea lions fit the values predicted based on body size in mammals and did not change with increased heart rates, suggesting that greater stroke volumes are not needed for aortic bulb function. Overall, our results suggest that peripheral vasoconstriction during diving is sufficient to modulate the volume of blood in the aortic bulb to ensure that flow lasts over the entire diastolic period. These results indicate that the shift of blood into the aortic bulb of pinnipeds is a fundamental mechanism caused by vasoconstriction while diving, highlighting the importance of this unique anatomical adaptation.
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Affiliation(s)
- Rhea L Storlund
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A S Rosen
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Aquarium, Vancouver, British Columbia, Canada
| | | | - Shubhayan Sanatani
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Vander Zaag
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Andrew W Trites
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Pedersen MW, Duch K, Lindgren FL, Lundgren NLO, Tayal B, Hagendorff A, Jensen GB, Biering-Sørensen T, Schnohr P, Møgelvang R, Høst N, Kragholm K, Andersen NH, Søgaard P. Aortic Root Dimension Using Transthoracic Echocardiography: Results from the Copenhagen City Heart Study. Am J Cardiol 2024; 218:86-93. [PMID: 38452843 DOI: 10.1016/j.amjcard.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
Findings regarding the relation between aortic size and risk factors are heterogeneous. This study aimed to generate new insights from a population-based adult cohort on aortic root dimensions and their association with age, anthropometric measures, and cardiac risk factors and evaluate the incidence of acute aortic events. Participants from the fifth examination round of the Copenhagen City Heart study (aged 20 to 98 years) with applicable echocardiograms and no history of aortic disease or valve surgery were included. Aorta diameter was assessed at the annulus, sinus of Valsalva, sinotubular junction, and the tubular part of the ascending aorta. The study population comprised 1,796 men and 2,316 women; mean age: 56.4 ± 17.0 and 56.9 ± 18.1 years, respectively. Men had larger aortic root diameters than women regardless of height indexing (p <0.01). Age, height, weight, systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, hypertension, diabetes, ischemic heart disease, and smoking were positively correlated with aortic sinus diameter in the crude and gender-adjusted analyses. However, after full adjustment, only height, weight, and diastolic blood pressure remained significantly positively correlated with aortic sinus diameter (p <0.001). For systolic blood pressure and pulse pressure, the correlation was inverse (p <0.001). During follow-up (median 5.4 [quartile 1 to quartile 3 4.5 to 6.3] years), the incidence rate of first-time acute aortic events was 13.6 (confidence interval 4.4 to 42.2) per 100,000 person-years. In conclusion, beyond anthropometric measures, age, and gender, diastolic blood pressure was the only cardiac risk factor that was independently correlated with aortic root dimensions. The number of aortic events during follow-up was low.
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Affiliation(s)
- Maria W Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Kirsten Duch
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Filip L Lindgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nils L O Lundgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Gorm B Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Nordsjællands Hospital, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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5
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Chinawa JM, Chinawa AT, Chukwu BF, Onyia JT. Assessment of descending aortic blood flow velocities with continuous wave Doppler echocardiography among healthy Children in South East Nigeria. Malawi Med J 2024; 36:1-6. [PMID: 39086365 PMCID: PMC11287811 DOI: 10.4314/mmj.v36i.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Background The descending aorta velocity is important predictor of aortic disease in children and can be very helpful in some clinical and surgical decision making. Aim The purpose of this study is to assess the normative values of descending aorta velocity among children from South-East Nigeria. It also aimed to assess the correlation between age, body surface area and mean velocity across the descending aorta. Methods This is a cross-sectional study where the descending aorta velocity of one hundred and eleven children were enrolled consecutively using digitized two-dimensional and Doppler echocardiography. Results A total of 111 children had echocardiography to study their cardiac structures and compute their mean scores of their descending aorta velocity. The mean velocity across the descending aorta was 1.3±0.2m/s with maximum and minimum velocities of 2.06 and 0.84cm respectively. The mean descending aorta velocity in males (1.37±0.24 m/s) was significantly higher than that in females (1.24±0.18); (Student T test 3.09, p = 0.03). There was no correlation between age and mean velocity across the descending aorta (Pearson correlation coefficient; -0.03, p = 0.7) nor between body surface area and descending aorta velocity (correlation coefficient 0.01, p= 0.8). Conclusions The presented normalized values of the descending aorta velocity using a digitized two-dimensional and Doppler echocardiography among healthy children will serve as a reference values for further studies and can be applied for clinical and surgical use in children with various cardiac anomalies.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria Ituku/Ozalla and University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Awoere T Chinawa
- Department of Community Medicine, ESUCOM, Parklane Enugu, Enugu State, Nigeria
| | | | - Jude T Onyia
- Department of Community Medicine, ESUCOM, Parklane Enugu, Enugu State, Nigeria
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Cosentino F, Sherifova S, Sommer G, Raffa G, Pilato M, Pasta S, Holzapfel GA. Regional biomechanical characterization of human ascending aortic aneurysms: Microstructure and biaxial mechanical response. Acta Biomater 2023; 169:107-117. [PMID: 37579911 DOI: 10.1016/j.actbio.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
The ascending thoracic aortic aneurysm (ATAA) is a permanent dilatation of the vessel with a high risk of adverse events, and shows heterogeneous properties. To investigate regional differences in the biomechanical properties of ATAAs, tissue samples were collected from 10 patients with tricuspid aortic valve phenotype and specimens from minor, anterior, major, and posterior regions were subjected to multi-ratio planar biaxial extension tests and second-harmonic generation (SHG) imaging. Using the data, parameters of a microstructure-motivated constitutive model were obtained considering fiber dispersion. SHG imaging showed disruptions in the organization of the layers. Structural and material parameters did not differ significantly between regions. The non-symmetric fiber dispersion model proposed by Holzapfel et al. [25] was used to fit the data. The mean angle of collagen fibers was negatively correlated between minor and anterior regions, and the parameter associated with collagen fiber stiffness was positively correlated between minor and major regions. Furthermore, correlations were found between the stiffness of the ground matrix and the mean fiber angle, and between the parameter associated with the collagen fiber stiffness and the out-of-plane dispersion parameter in the posterior and minor regions, respectively. The experimental data collected in this study contribute to the biomechanical data available in the literature on human ATAAs. Region-specific parameters for the constitutive models are fundamental to improve the current risk stratification strategies, which are mainly based on aortic size. Such investigations can facilitate the development of more advanced finite element models capable of capturing the regional heterogeneity of pathological tissues. STATEMENT OF SIGNIFICANCE: Tissue samples of human ascending thoracic aortic aneurysms (ATAA) were collected. Samples from four regions underwent multi-ratio planar biaxial extension tests and second-harmonic generation imaging. Region-specific parameters of a microstructure-motivated model considering fiber dispersion were obtained. Structural and material parameters did not differ significantly between regions, however, the mean fiber angle was negatively correlated between minor and anterior regions, and the parameter associated with collagen fiber stiffness was positively correlated between minor and major regions. Furthermore, correlations were found between the stiffness of the ground matrix and the mean fiber angle, and between the parameter associated with the collagen fiber stiffness and the out-of-plane dispersion parameter in the posterior and minor regions, respectively. This study provides a unique set of mechanical and structural data, supporting the microstructural influence on the tissue response. It may facilitate the development of better finite element models capable of capturing the regional tissue heterogeneity.
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Affiliation(s)
- Federica Cosentino
- Ri.MED Foundation, Palermo, Italy; Department of Engineering, University of Palermo, Italy
| | - Selda Sherifova
- Institute of Biomechanics, Graz University of Technology, Austria
| | - Gerhard Sommer
- Institute of Biomechanics, Graz University of Technology, Austria
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Salvatore Pasta
- Department of Engineering, University of Palermo, Italy; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Austria; Department of Structural Engineering, Norwegian Institute of Science and Technology (NTNU), Trondheim, Norway.
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7
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Zhao X, Garg P, Assadi H, Tan RS, Chai P, Yeo TJ, Matthews G, Mehmood Z, Leng S, Bryant JA, Teo LLS, Ong CC, Yip JW, Tan JL, van der Geest RJ, Zhong L. Aortic flow is associated with aging and exercise capacity. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead079. [PMID: 37635784 PMCID: PMC10460199 DOI: 10.1093/ehjopen/oead079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/02/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
Aims Increased blood flow eccentricity in the aorta has been associated with aortic (AO) pathology, however, its association with exercise capacity has not been investigated. This study aimed to assess the relationships between flow eccentricity parameters derived from 2-dimensional (2D) phase-contrast (PC) cardiovascular magnetic resonance (CMR) imaging and aging and cardiopulmonary exercise test (CPET) in a cohort of healthy subjects. Methods and Results One hundred and sixty-nine healthy subjects (age 44 ± 13 years, M/F: 96/73) free of cardiovascular disease were recruited in a prospective study (NCT03217240) and underwent CMR, including 2D PC at an orthogonal plane just above the sinotubular junction, and CPET (cycle ergometer) within one week. The following AO flow parameters were derived: AO forward and backward flow indexed to body surface area (FFi, BFi), average flow displacement during systole (FDsavg), late systole (FDlsavg), diastole (FDdavg), systolic retrograde flow (SRF), systolic flow reversal ratio (sFRR), and pulse wave velocity (PWV). Exercise capacity was assessed by peak oxygen uptake (PVO2) from CPET. The mean values of FDsavg, FDlsavg, FDdavg, SRF, sFRR, and PWV were 17 ± 6%, 19 ± 8%, 29 ± 7%, 4.4 ± 4.2 mL, 5.9 ± 5.1%, and 4.3 ± 1.6 m/s, respectively. They all increased with age (r = 0.623, 0.628, 0.353, 0.590, 0.649, 0.598, all P < 0.0001), and decreased with PVO2 (r = -0.302, -0.270, -0.253, -0.149, -0.219, -0.161, all P < 0.05). A stepwise multivariable linear regression analysis using left ventricular ejection fraction (LVEF), FFi, and FDsavg showed an area under the curve of 0.769 in differentiating healthy subjects with high-risk exercise capacity (PVO2 ≤ 14 mL/kg/min). Conclusion AO flow haemodynamics change with aging and predict exercise capacity. Registration NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
| | - Pankaj Garg
- Cardiology Department, Norfolk and Norwich University Hospitals NHS
Foundation Trust,Colney Ln, Norwich, NR4 7UY Norfolk, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School,
University of East Anglia, Rosalind Franklin Rd, Norwich, NR4
7UQ Norfolk, UK
| | - Hosamadin Assadi
- Cardiology Department, Norfolk and Norwich University Hospitals NHS
Foundation Trust,Colney Ln, Norwich, NR4 7UY Norfolk, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School,
University of East Anglia, Rosalind Franklin Rd, Norwich, NR4
7UQ Norfolk, UK
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
| | - Ping Chai
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - Tee Joo Yeo
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - Gareth Matthews
- Cardiology Department, Norfolk and Norwich University Hospitals NHS
Foundation Trust,Colney Ln, Norwich, NR4 7UY Norfolk, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School,
University of East Anglia, Rosalind Franklin Rd, Norwich, NR4
7UQ Norfolk, UK
| | - Zia Mehmood
- Cardiology Department, Norfolk and Norwich University Hospitals NHS
Foundation Trust,Colney Ln, Norwich, NR4 7UY Norfolk, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School,
University of East Anglia, Rosalind Franklin Rd, Norwich, NR4
7UQ Norfolk, UK
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
| | - Lynette L S Teo
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - James W Yip
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center,
Albinusdreef 2, 2333 ZA Leiden, TheNetherlands
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
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8
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Salmasi MY, Pirola S, Mahuttanatan S, Fisichella SM, Sengupta S, Jarral OA, Oo A, O'Regan D, Xu XY, Athanasiou T. Geometry and flow in ascending aortic aneurysms are influenced by left ventricular outflow tract orientation: Detecting increased wall shear stress on the outer curve of proximal aortic aneurysms. J Thorac Cardiovasc Surg 2023; 166:11-21.e1. [PMID: 34217540 DOI: 10.1016/j.jtcvs.2021.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The geometrical characterization of ascending thoracic aortic aneurysms in clinical practice is limited to diameter measurements. Despite growing interest in hemodynamic assessment, its relationship with ascending thoracic aortic aneurysm pathogenesis is poorly understood. This study examines the relationship between geometry of the ventriculo-aortic junction and blood flow patterns in ascending thoracic aortic aneurysm disease. METHODS Thirty-three patients with ascending thoracic aortic aneurysms (exclusions: bicuspid aortic valves, connective tissue disease) underwent 4-dimensional flow magnetic resonance imaging. After image segmentation, geometrical parameters were measured, including aortic curvature, tortuosity, length, and diameter. A unique angular measurement made by the trajectory of the left ventricular outflow tract axis and the proximal aorta was also conducted. Velocity profiles were quantitatively and qualitatively analyzed. In addition, 11 patients (33%) underwent wall shear stress mapping of the ascending thoracic aortic aneurysm region using computational fluid dynamics simulation. RESULTS Greater left ventricular outflow tract aortic angles were associated with larger aortic diameters at the levels of the sinus (coefficient = 0.387, P = .014) and ascending aorta (coefficient = 0.284, P = .031). Patients with left ventricular outflow tract aortic angles greater than 60° had marked asymmetric flow acceleration on the outer curvature in the proximal aorta, ascertained from 4-dimensional flow analysis. For patients undergoing computational fluid dynamics assessment, regression analysis found that higher left ventricular outflow tract aortic angles were associated with significantly higher wall shear stress values in the outer curve of the aorta (coefficient 0.07, 95% confidence interval 0.04-0.11, P = .002): Angles greater than 50° yielded time-averaged wall shear stress values greater than 2.5 Pa, exhibiting a linear relationship. CONCLUSIONS Our findings strengthen the hypothesis of flow-mediated ascending thoracic aortic aneurysm disease progression and that left ventricular outflow tract aortic angle may be a predictor of disease severity.
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Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery, Imperial College London, London, United Kingdom.
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Suchaya Mahuttanatan
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Serena M Fisichella
- Department of Chemical Engineering, Imperial College London, London, United Kingdom; Politecnico di Milano, Milan, Italy
| | - Sampad Sengupta
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Omar A Jarral
- Department of Surgery, Imperial College London, London, United Kingdom
| | - Aung Oo
- Barts Heart Centre, London, United Kingdom
| | - Declan O'Regan
- London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery, Imperial College London, London, United Kingdom
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9
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Ríos L, Sleeper MM, Danforth MD, Murphy HW, Kutinsky I, Rosas A, Bastir M, Gómez-Cambronero J, Sanjurjo R, Campens L, Rider O, Pastor F. The aorta in humans and African great apes, and cardiac output and metabolic levels in human evolution. Sci Rep 2023; 13:6841. [PMID: 37100851 PMCID: PMC10133235 DOI: 10.1038/s41598-023-33675-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
Humans have a larger energy budget than great apes, allowing the combination of the metabolically expensive traits that define our life history. This budget is ultimately related to the cardiac output, the product of the blood pumped from the ventricle and the number of heart beats per minute, a measure of the blood available for the whole organism physiological activity. To show the relationship between cardiac output and energy expenditure in hominid evolution, we study a surrogate measure of cardiac output, the aortic root diameter, in humans and great apes. When compared to gorillas and chimpanzees, humans present an increased body mass adjusted aortic root diameter. We also use data from the literature to show that over the human lifespan, cardiac output and total energy expenditure follow almost identical trajectories, with a marked increase during the period of brain growth, and a plateau during most of the adult life. The limited variation of adjusted cardiac output with sex, age and physical activity supports the compensation model of energy expenditure in humans. Finally, we present a first study of cardiac output in the skeleton through the study of the aortic impression in the vertebral bodies of the spine. It is absent in great apes, and present in humans and Neanderthals, large-brained hominins with an extended life cycle. An increased adjusted cardiac output, underlying higher total energy expenditure, would have been a key process in human evolution.
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Affiliation(s)
- Luis Ríos
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Universidad Complutense de Madrid, 28040, Madrid, Spain.
- Department of Physical Anthropology, Aranzadi Sciences Society, 20014, Donostia, Basque Country, Spain.
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales (MNCN-CSIC), 28006, Madrid, Spain.
| | - Meg M Sleeper
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, PO Box 100126, Gainesville, FL, 32610-0126, USA
| | - Marietta D Danforth
- Great Ape Heart Project, Detroit Zoological Society, 8450 W. 10 Mile Rd., Royal Oak, MI, 48067, USA
| | - Hayley Weston Murphy
- Great Ape Heart Project, Detroit Zoological Society, 8450 W. 10 Mile Rd., Royal Oak, MI, 48067, USA
| | - Ilana Kutinsky
- Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI, 48309, USA
| | - Antonio Rosas
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales (MNCN-CSIC), 28006, Madrid, Spain
| | - Markus Bastir
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales (MNCN-CSIC), 28006, Madrid, Spain
| | - José Gómez-Cambronero
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Ricardo Sanjurjo
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Laurence Campens
- Cardiology Department, Ghent University Hospital, 9000, Ghent, Belgium
| | - Oliver Rider
- University of Oxford Centre for Cardiac Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Francisco Pastor
- Department of Anatomy and Radiology, University of Valladolid, 47005, Valladolid, Spain
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10
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Ascending Aorta Diameter Changes after Aortic Valve Replacement in Elderly Patients with Aortic Valve Stenosis. Cardiol Res Pract 2022; 2022:5509364. [PMID: 36124293 PMCID: PMC9482509 DOI: 10.1155/2022/5509364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To describe the natural history of the ascending aorta in elderly patients after aortic valve replacement (AVR) for aortic valve stenosis and to clarify the risk factors associated with the progression of the ascending aorta. Methods This retrospective review included a total of 87 elderly patients who had undergone aortic valve replacement for severe aortic valve stenosis in Fuwai Hospital. The patients were categorized into two groups based on the height-based aortic height index (AHI) before AVR, as determined by echocardiography and computed tomography: Group A (n = 28) was defined as an AHI > 2.44 cm/m, and Group B (n = 59) was defined as an AHI ≤ 2.44 cm/m. The perioperative and follow-up data were collected, and a linear mixed-effect model was used to analyze and compare the change rate of the ascending aorta after AVR. Results The mean follow-up period was 4.0 ± 1.3 years. The diameter of ascending aorta in group A increased from 37.2 ± 5.0 mm at discharge to 40.7 ± 4.7 mm at the last follow-up (P=0.001), while that of group B increased only from 33.3 ± 4.4 mm to 33.7 ± 4.1 mm (P > 0.05).The ascending aorta diameter expansive rate was 0.81 mm/year in group A and 0.14 mm/year in group B. The expansive rate was significantly greater in patients with an AHI>2.44 cm/m than in those with anything else (P = 0.009). A univariable linear mixed model analysis revealed that the AHI>2.44 cm/m was the only significant risk factor for ascending aortic dilatation rate after AVR. There were 4 patients who died in hospital and 11 late follow-up deaths. Particularly, there was no aortic event that occurred during follow-up. Conclusion For elderly patients with aortic stenosis, the possibility of progressive ascending aortic dilatation after AVR demands regular follow-up, and AHI may be an important risk factor for the change rate of the diameter of the ascending aorta.
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11
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Sun L, Li X, Wang G, Sun J, Zhang X, Chi H, Cao H, Ma W, Yan Z, Liu G. Relationship Between Length and Curvature of Ascending Aorta and Type a Dissection. Front Cardiovasc Med 2022; 9:927105. [PMID: 35795370 PMCID: PMC9251172 DOI: 10.3389/fcvm.2022.927105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Type A aortic dissection (TAAD) has a rapid onset and high mortality. Currently, aortic diameter is the major criterion for evaluating the risk of TAAD. We attempted to find other aortic morphological indicators to further analyze their relationships with the risk of type A dissection. Methods We included the imaging and clinical data of 112 patients. The patients were divided into three groups, of which Group 1 had 49 patients with normal aortic diameter, Group 2 had 22 patients with ascending aortic aneurysm, and Group 3 had 41 patients with TAAD. We used AW Server software, version 3.2, to measure aorta-related morphological indicators. Results First, in Group 1, the univariate analysis results showed that ascending aortic diameter was correlated with patient age (r2 = 0.35) and ascending aortic length (AAL) (r2 = 0.43). AAL was correlated with age (r2 = 0.12) and height (r2 = 0.11). Further analysis of the aortic morphological indicators among the three groups found that the median aortic diameter was 36.20 mm in Group 1 (Q1–Q3: 33.40–37.70 mm), 42.5 mm in Group 2 (Q1–Q3: 41.52–44.17 mm) and 48.6 mm in Group 3 (Q1–Q3: 42.4–55.3 mm). There was no significant difference between Groups 2 and 3 (P > 0.05). Group 3 had the longest AAL (median: 109.4 mm, Q1–Q3: 118.3–105.3 mm), followed by Group 2 (median: 91.0 mm, Q1–Q3: 95.97–84.12 mm) and Group 1 (81.20 mm, Q1–Q3: 76.90–86.20 mm), and there were statistically significant differences among the three groups (P < 0.05). The Aortic Bending Index (ABI) was 14.95 mm/cm in Group 3 (Q1–Q3: 14.42–15.78 mm/cm), 13.80 mm/cm in Group 2 (Q1–Q3: 13.42–14.42 mm/cm), and 13.29 mm/cm in Group 1 (Q1–Q3: 12.71–13.78 mm/cm), and the difference was statistically significant in comparisons between any two groups (P < 0.05). Regression analysis showed that aortic diameter + AAL + ABI differentiated Group 2 and Group 3 with statistical significance (area under the curve (AUC) = 0.834), which was better than aortic diameter alone (AUC = 0.657; P < 0.05). Conclusions We introduced the new concept of ABI, which has certain clinical significance in distinguishing patients with aortic dissection and aneurysm. Perhaps the ascending aortic diameter combined with AAL and ABI could be helpful in predicting the occurrence of TAAD.
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Affiliation(s)
- Lianjie Sun
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Guoqing Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianchao Sun
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoming Zhang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Honghui Chi
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huihui Cao
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wanteng Ma
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhisheng Yan
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Gaoli Liu
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Gaoli Liu
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12
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Mehrabi Nasab E, Athari SS. The prevalence of thoracic aorta aneurysm as an important cardiovascular disease in the general population. J Cardiothorac Surg 2022; 17:51. [PMID: 35321745 PMCID: PMC8944034 DOI: 10.1186/s13019-022-01767-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aorta is the largest and main artery in the body. The enlargement of the aortic diameter known as ectasia results in aneurysm. Thoracic aorta aneurysm can involve one or more segments of the aorta. Non-invasive imaging techniques play an important role in identifying patients, estimating maximal aneurysm diameter, following up patients, and detecting complications. So, this study was performed to estimate the prevalence of ascending thoracic aorta aneurysm in the general population of Iran. METHODS People with an abnormal aortic size (˃ 36 mm) were enrolled and subjected to diagnostic tests, and related risk factors were assessed. RESULT Of the 3400 people examined, 410 (12%) had abnormal aorta sizes, and 42 (1.2%) had ascending aorta aneurysm. Out of the 410 patients with elevated aorta size, 235 (57%) were males, and 175 (43%) were females. Overall, 229 patients (56%) had hypertension, and 255 (62%) were over 60 years old. CONCLUSION In this study, we showed that the prevalence of ascending aorta aneurysm in the general population of Iran was about 1.2%. Ascending aorta aneurysm is a threatening pathology of the aorta. The high prevalence of hypertension may explain the high incidence of aneurysm in our studied population. Therefore, it is necessary to implement an accurate screening plan to identify patients with hypertension and provide appropriate treatment and adequate follow up to patients. Patients with ascending aorta aneurysm are also recommended to modify their lifestyles.
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Affiliation(s)
- Entezar Mehrabi Nasab
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Shamsadin Athari
- Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
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13
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Recent Progress of Chronic Stress in the Development of Atherosclerosis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:4121173. [PMID: 35300174 PMCID: PMC8923806 DOI: 10.1155/2022/4121173] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/04/2021] [Accepted: 02/09/2022] [Indexed: 12/13/2022]
Abstract
With the development of the times, cardiovascular diseases have become the biggest cause of death in the global aging society, causing a serious social burden. Atherosclerosis is a chronic inflammatory disease, which can occur in large and medium-sized blood vessels in the whole body. It takes atherosclerotic plaque as the typical pathological change and endothelial injury as the core pathophysiological mechanism. It is the pathological basis of coronary heart disease, peripheral artery disease, cerebrovascular disease, and other diseases. Recent studies have shown that chronic stress plays an important role in the occurrence and development of atherosclerosis, endothelial injury, lipid metabolism, and chronic inflammation. This process involves a large number of molecular targets. It is usually the cause of atherosclerotic cardiovascular and cerebrovascular diseases. If chronic stress factors exist for a long time, patients have genetic susceptibility, and the combination of environmental factors triggers the pathogenesis, which may eventually lead to complete blockage of the blood vessels, unstable rupture of plaques, and serious adverse cardiovascular events. This paper reviews the role of chronic stress in the occurrence and development of atherosclerosis, focusing on the pathophysiological mechanism.
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14
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Mohammed AFA, Frick M, Kerst G, Hatam N, Elgamal MAF, Essa KM, Hövels-Gürich HH, Vazquez-Jimenez JF, Zayat R. Proximal Aortic Dilatation and Pulmonary Valve Replacement in Patients with Repaired Tetralogy of Fallot: Is There a Relationship? A Cardiac Magnetic Resonance Imaging Study. J Clin Med 2021; 10:5296. [PMID: 34830578 PMCID: PMC8625773 DOI: 10.3390/jcm10225296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Aortopathy is a known complication whose incidence is growing within the population of tetralogy of Fallot (TOF) patients. Its pathology and relationship with other comorbidities remain unclear. This study was designed to determine the prevalence and predictors of proximal aortic dilatation after TOF repair. We retrospectively investigated all patients who underwent follow-up cardiac magnetic resonance imaging (CMR; at least 4 years after TOF repair) between March 2004 and December 2019. The dimensions at the ascending aorta (AAo) and sinus of Valsalva (SoV) levels were measured. Aortic dilatation was defined as an internal aortic diameter that was >2 standard deviation of the previously published normal values. We included 77 patients (mean age 28.9 ± 10.5 years, 41.5% female, mean follow-up of 24.5 ± 8.1 years). AAo and SoV were dilated in 19 (24.6%) and 43 (55.8%) patients, respectively. Patients with dilated AAo and SoV were older during the corrective surgery (p < 0.001 and p = 0.004, respectively) and during CMR (p = 0.002 and 0.024, respectively) than patients without AAo and SoV dilatation. Patients of the dilated AAo group were more likely to have prior palliative shunt (p = 0.008), longer shunt duration (p = 0.005), and a higher degree of aortic valve regurgitation (AR) fraction (p < 0.001) and to undergo pulmonary (PVR) and/or aortic valve replacement (p < 0.001 and p = 0.013, respectively). PVR (p = 0.048, odds ratio = 6.413, and 95% CI = 1.013-40.619) and higher AR fraction (p = 0.031, odds ratio = 1.194, and 95% CI = 1.017-1.403) were independent predictors for AAo dilatation. Aortopathy is a common progressive complication that may require reintervention and lifelong follow-up. Our study shows that proximal aortic dilatation may be attributed to factors that increase the volume overload across the proximal aorta, including late corrective surgery and palliative shunt. We also found that PVR and higher AR fraction are independent predictors of AAo dilatation.
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Affiliation(s)
- Ahmed Farghal A. Mohammed
- Department of Pediatric Cardiac Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany
- Department of Cardiothoracic Surgery, Qena University Hospitals, Faculty of Medicine, South Valley University, Qena 83511, Egypt;
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (N.H.); (R.Z.)
| | - Michael Frick
- Department of Cardiology, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52070 Aachen, Germany;
| | - Gunter Kerst
- Department of Pediatric Cardiology, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (G.K.); (H.H.H.-G.)
| | - Nima Hatam
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (N.H.); (R.Z.)
| | | | - Karam M. Essa
- Department of Cardiothoracic Surgery, Qena University Hospitals, Faculty of Medicine, South Valley University, Qena 83511, Egypt;
| | - Hedwig H. Hövels-Gürich
- Department of Pediatric Cardiology, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (G.K.); (H.H.H.-G.)
| | - Jaime F. Vazquez-Jimenez
- Department of Pediatric Cardiac Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Rashad Zayat
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Faculty of Medicine, Pauwelsstr. 30, 52074 Aachen, Germany; (N.H.); (R.Z.)
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15
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Kulthinee S, Nernpermpisooth N, Poomvanicha M, Satiphop J, Chuang-Ngu T, Kaleeluan N, Thawnashom K, Manin A, Kongchan R, Yinmaroeng K, Kitipawong P, Chotimol P. Cold Pressor Test Influences the Cardio-Ankle Vascular Index in Healthy Overweight Young Adults. Pulse (Basel) 2021; 9:30-37. [PMID: 34722353 DOI: 10.1159/000517617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/29/2021] [Indexed: 11/19/2022] Open
Abstract
Objective The cold pressor test (CPT) has been shown a potential sympathoexcitatory stimulus which increases aortic pulse wave velocity and the aortic augmentation index, suggesting that noninvasively, arterial stiffness parameters are altered by the CPT. The cardio-ankle vascular index (CAVI) is widely used for reflecting arterial stiffness, and the ankle-brachial index (ABI) for evaluating peripheral artery disease in obesity. We aimed to assess CAVI and ABI in overweight young adults in the context of sympathetic activation by using the CPT. Methods 160 participants were divided into 2 groups: 86 normal-weight (body mass index [BMI] 18.50-22.99 kg/m2) and 74 overweight (BMI ≥23 kg/m2). The CPT was performed by immersing a participant's left hand into cold water (3-5°C) for 3 min, and CAVI and ABI assessment. Results At baseline, the CAVI in the overweight group was significantly less than that in the normal-weight group (5.79 ± 0.85 vs. 6.10 ± 0.85; p < 0.05). The mean arterial pressure (MAP) for overweight was significantly greater than that for normal-weight subjects (93.89 ± 7.31 vs. 91.10 ± 6.72; p < 0.05). During the CPT, the CAVI increased in both normal-weight and overweight subjects, the CAVI value was greater during the CPT in overweight subjects by 14.36% (6.62 ± 0.95 vs. 5.79 ± 0.85, p < 0.05) and in normal-weight subjects by 8.03% (6.59 ± 1.20 vs. 6.10 ± 0.85, p < 0.05) than those baseline values. The CPT evoked an increase in systolic blood pressure (SBP), diastolic BP (DBP), heart rate (HR,) and pulse pressure (PP) in both groups. After a 4-min CPT period, the CAVI returned values similar to the baseline values in both groups, and the SBP, DBP, MAP, and PP in overweight participants were significantly higher than those in normal-weight participants. However, there was no significant difference in the ABI at baseline, during CPT, and post-CPT in either group. Conclusions Our results indicated that the CAVI was influenced by sympathetic activation response to the CPT in both normal-weight and overweight young adults. Specifically, during the CPT, the percentage change of the CAVI in overweight response was greater in normal-weight participants than baseline values in each group. The ABI was not found significantly associated with CPT. These findings suggesting that sympathoexcitatory stimulus by CPT influence CAVI results.
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Affiliation(s)
- Supaporn Kulthinee
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Nitirut Nernpermpisooth
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Montatip Poomvanicha
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Jidapa Satiphop
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Thizanamadee Chuang-Ngu
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Napaporn Kaleeluan
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Kittisak Thawnashom
- Department of Medical Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Anuchit Manin
- Cardiac Centre, Naresuan University Hospital, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Rosarin Kongchan
- Cardiac Centre, Naresuan University Hospital, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Kingkarn Yinmaroeng
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Peerapong Kitipawong
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Phatiwat Chotimol
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
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16
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Chiu P, Lee HP, Dalal AR, Koyano T, Nguyen M, Connolly AJ, Chaudhuri O, Fischbein MP. Relative strain is a novel predictor of aneurysmal degeneration of the thoracic aorta: An ex vivo mechanical study. JVS Vasc Sci 2021; 2:235-246. [PMID: 34806052 PMCID: PMC8585654 DOI: 10.1016/j.jvssci.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/28/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Current guidelines for prophylactic replacement of the thoracic aorta, primarily based on size alone, may not be adequate in identifying patients at risk for either progression of disease or aortic catastrophe. We undertook the current study to determine whether the mechanical properties of the aorta might be able to predict aneurysmal dilatation of the aorta using a clinical database and benchtop mechanical testing of human aortic tissue. METHODS Using over 400 samples from 31 patients, mechanical properties were studied in (a) normal aorta and then (b) between normal and diseased aorta using linear mixed-effects models. A machine learning technique was used to predict aortic growth rate over time using mechanical properties and baseline clinical characteristics. RESULTS Healthy aortic tissue under in vivo loading conditions, after accounting for aortic segment location, had lower longitudinal elastic modulus compared with circumferential elastic modulus: -166.8 kPa (95% confidence interval [CI]: -210.8 to -122.7, P < .001). Fracture toughness was also lower in the longitudinal vs circumferential direction: -201.2 J/m3 (95% CI: -272.9 to -129.5, P < .001). Finally, relative strain was lower in the longitudinal direction compared with the circumferential direction: -0.01 (95% CI: -0.02 to -0.004, P = .002). Patients with diseased aorta, after accounting for segment location and sample direction, had decreased toughness compared with normal aorta, -431.7 J/m3 (95% CI: -628.6 to -234.8, P < .001), and increased relative strain, 0.09 (95% CI: 0.04 to 0.14, P = .003). CONCLUSIONS Increasing relative strain was identified as a novel independent predictor of aneurysmal degeneration. Noninvasive measurement of relative strain may aid in the identification and monitoring of patients at risk for aneurysmal degeneration. (JVS-Vascular Science 2021;2:1-12.). CLINICAL RELEVANCE Aortic aneurysm surveillance and prophylactic surgical recommendations are based on computed tomographic angiogram aortic dimensions and growth rate measurements. However, aortic catastrophes may occur at small sizes, confounding current risk stratification models. Herein, we report that increasing aortic relative strain, that is, greater distensibility, is associated with growth over time, thus potentially identifying patients at risk for dissection/rupture.
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Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Hong-Pyo Lee
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Alex R. Dalal
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Tiffany Koyano
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Marie Nguyen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Andrew J. Connolly
- Department of Pathology, University of California San Francisco, San Francisco, Calif
| | - Ovijit Chaudhuri
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Michael P. Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
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17
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Zhu F, Arshi B, Ikram MA, De Knegt RJ, Kavousi M. Sex-specific normal values and determinants of infrarenal abdominal aortic diameter among non-aneurysmal elderly population. Sci Rep 2021; 11:17762. [PMID: 34493798 PMCID: PMC8423780 DOI: 10.1038/s41598-021-97209-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/28/2021] [Indexed: 01/16/2023] Open
Abstract
To establish age- and sex-specific distribution of the infrarenal abdominal aortic diameters (IAD) among non-aneurysmal elderly population and to investigate the associations between traditional cardiovascular risk factors and IAD in men and women. We included 4032 participants (mean age 67.2 years; 60.4% women) from the population-based Rotterdam Study, free of cardiovascular disease, who underwent IAD ultrasound assessment between 2009-2014. Linear regression analysis was used to identify determinants of IAD. The medians (inter-quartile range) of absolute IAD and body surface area (BSA)-adjusted IAD were 17.0 (15.0-18.0) mm and 9.3 (8.5-10.2) mm for women and 19.0 (18.0-21.0) mm and 9.4 (8.6-10.3) mm for men, respectively. There was a non-linear relationship between age and IAD. IAD increased steeply with advancing age and up to 70 years. After around 75 years of age, the diameter values reached a plateau. Waist circumference and diastolic blood pressure were associated with larger diameters in both sexes. Body mass index [Effect estimate (95% CI): 0.04 (0.00 to 0.08)], systolic blood pressure [- 0.01(- 0.02 to 0.00)], current smoking [0.35 (0.06 to 0.65)], total cholesterol levels [- 0.21 (- 0.31 to - 0.11)], and lipid-lowering medication [- 0.43 (- 0.67 to - 0.19)] were significantly associated with IAD in women. Sex differences in IAD values diminished after taking BSA into account. The increase in diameters was attenuated after 70 years. Differences were observed in the associations of several cardiovascular risk factors with IAD among men and women.
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Affiliation(s)
- Fang Zhu
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robert J De Knegt
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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18
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Boateng SY, Olfert IM, Chantler PD. Role of Perivascular Adipose Tissue and Exercise on Arterial Function with Obesity. Exerc Sport Sci Rev 2021; 49:188-196. [PMID: 33831902 PMCID: PMC8195847 DOI: 10.1249/jes.0000000000000251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adipose tissue and arterial dysfunction are common in the obese state. Perivascular adipose tissue (PVAT) plays an important role in mediating arterial health, and with obesity, the PVAT dysfunction negatively affects arterial health. Exercise training exerts direct and beneficial effects on PVAT, providing an additional and novel pathway by which exercise can improve arterial health in diseased populations.
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Affiliation(s)
- Samuel Y Boateng
- Biological Sciences, School of Biological Sciences, University of Reading, UK
| | - I. Mark Olfert
- Department of Human Performance, Division of Exercise Physiology, School of Medicine, West Virginia University, USA
- West Virginia Clinical and Translational Science Institute (WVCTSI), Morgantown, WV
| | - Paul D Chantler
- Department of Human Performance, Division of Exercise Physiology, School of Medicine, West Virginia University, USA
- West Virginia Clinical and Translational Science Institute (WVCTSI), Morgantown, WV
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19
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Sutzko DC, Beck AW. Wide necks, worse outcomes: Is this still a debate? J Vasc Surg 2021; 74:316. [PMID: 34172187 DOI: 10.1016/j.jvs.2021.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Danielle C Sutzko
- Division of Vascular and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
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20
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Wang X, Ren XS, An YQ, Hou ZH, Yu YT, Lu B, Wang F. A Specific Assessment of the Normal Anatomy of the Aortic Root in Relation to Age and Gender. Int J Gen Med 2021; 14:2827-2837. [PMID: 34234516 PMCID: PMC8242149 DOI: 10.2147/ijgm.s312439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background A limitation associated with coronary computed tomography angiography (CCTA) is the lack of a normal reference value for aortic root dimensions and the uncertainty of the influence of age and gender on these dimensions. The purpose of the present study was to identify the normal values and variations of aortic root dimensions in healthy individuals and investigate how gender and age affect aortic root size. Methods A total of 1286 healthy yellow population (52.7 ± 11.0 years, 634 male) who underwent CCTA were retrospectively included in the present study. Male and female patients were divided into seven groups according to age (< 30 years old, 30–39, 40–49, 50–59, 60–69, 70–79, ≥ 80 years old). In these age groups, we measured and compared the parameters of the aortic root. Results After body surface area (BSA) correction, the aortic root parameters of females were found to be greater than those of males in the 40–49 age group (P<0.05). There were no significant differences in aortic root parameters between genders in other age groups, except for the diameter of the ascending aorta, which was greater in females (P<0.05). In males, age was positively correlated with aortic root parameters (P<0.05), except for the annulus short diameter and LVOT short diameter. In females, age was positively correlated with aortic root parameters (P<0.05), except for the left coronary ostia height and the LVOT short diameter. Conclusion Aortic root dimensions are affected by age and gender. After BSA correction, females show larger aortic root dimensions than males, and aortic root diameters increase with age.
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Affiliation(s)
- Xiang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, People's Republic of China
| | - Xin-Shuang Ren
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yun-Qiang An
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Zhi-Hui Hou
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yi-Tong Yu
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, People's Republic of China
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21
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Okida LF, Sasson M, Wolfers M, Hong L, Balzan J, Lo Menzo E, Szomstein S, Grove M, Navia J, Rosenthal RJ. Bariatric surgery is associated with reduced admission for aortic dissection: a nationwide case-control analysis. Surg Obes Relat Dis 2021; 17:1603-1610. [PMID: 34144915 DOI: 10.1016/j.soard.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Aortic dissection (AD) is an uncommon but life-threatening condition associated with high morbidity and mortality. Hypertension (HTN) and hyperlipidemia (HLD) are common modifiable risk factors. OBJECTIVES Since bariatric surgery is associated with remission of obesity-related co-morbidities, we hypothesize that surgical weight loss might be protective against this feared aortic pathology. SETTING A cross-sectional analysis was performed using the National Inpatient Sample database from 2010 to 2015. METHODS The treatment group included bariatric patients and the control group patients with obesity (body mass index [BMI] ≥ 35kg/m2) without previous bariatric surgery. Analyzed covariates included demographics, co-morbidities, aortic diseases, and AD. A multivariate logistic regression analysis (MLRA) was performed to assess the odds of admission for AD in both groups. RESULTS A total of 2,300,845 patients were identified (2,004,804 controls and 296,041 cases). The mean (SEM) age was 54.4 (.05) versus 51.9 (.05) years, for the control and treatment groups, respectively (P < .0001). Bariatric patients posed a significantly lower prevalence of type 2 diabetes (T2D), HTN, HLD, aortic aneurysm, and bicuspid aortic valve (P < .0001) than control subjects. In the control group, 1411 individuals (.070%) had AD, whereas only 94 patients (.032%) in the bariatric surgery group had such diagnosis (P < .0001). The MLRA showed that non-bariatric obese patients had a significantly higher likelihood of suffering from AD (OR = 1.8 [95%CI 1.44-2.29] P < .0001). Considering different age groups, bariatric surgery was found to be less associated with admission for AD for individuals below and above 40 years of age (OR = 2.95 [95%CI 1.09-7.99] P = .0345) and (OR = 1.75 [95%CI 1.38-2.22] P < .0001), respectively. CONCLUSIONS Bariatric surgery could be a protective factor against aortic dissection and should be considered in patients with obesity and risk factors for this cardiovascular complication.
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Affiliation(s)
- Luis Felipe Okida
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Morris Sasson
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Matthew Wolfers
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Liang Hong
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Jorge Balzan
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Mark Grove
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Jose Navia
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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22
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Dietenbeck T, Houriez-Gombaud-Saintonge S, Charpentier E, Gencer U, Giron A, Gallo A, Boussouar S, Pasi N, Soulat G, Mousseaux E, Redheuil A, Kachenoura N. Quantitative magnetic resonance imaging measures of three-dimensional aortic morphology in healthy aging and hypertension. J Magn Reson Imaging 2021; 53:1471-1483. [PMID: 33426700 DOI: 10.1002/jmri.27502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 01/16/2023] Open
Abstract
Automated segmentation of three-dimensional (3D) aortic magnetic resonance imaging (MRI) renders a possible retrospective selection of any location to perform quantification of aortic caliber perpendicular to its centerline and provides regional and global 3D biomarkers such as length, diameter, or volume. However, normative age-related values of such measures are still lacking. The aim of this study was to provide normal values for 3D aortic morphological measures and investigate their changes in aging and hypertension. This was a retrospective study, in which 119 healthy controls (HC: 48 ± 14 years, 61 men) and 82 hypertensive patients (HT: 60 ± 14 years, 43 men) were enrolled. 1.5 and 3 T/3D steady state free precession or spoiled gradient echo were used. Automated 3D aortic segmentation provided aortic length, diameter, volume for the ascending (AAo), and descending aorta (DAo), along with cross-sectional diameters at three aortic landmarks. Age, sex, body surface area (BSA), smoking, and blood pressures were recorded. Both groups were divided into two subgroups (≤50 years, >50 years). Statistical tests performed were linear regression for age-related normal values and confidence intervals, Wilcoxon rank sum test for differences between groups (HC or HT), and multivariate analysis to identify main determinants of aortic morphological changes. In HC, linear regression revealed an increase in the AAo (respectively DAo) length by 2.84 mm (7.78 mm), maximal diameter by 1.36 mm (1.29 mm), and volume by 4.28 ml (8.71 ml) per decade. AAo morphological measures were higher in HT patients than in HC both ≤50 years but did not reach statistical significance (length: +2 mm, p = 0.531; diameter: +1.4 mm, p = 0.2936; volume:+6.8 ml, p = 0.1857). However, length (+6 mm, p = 0.003), maximal diameter (+4 mm, p < 0.001) and volume (+12 ml, p < 0.001) were significantly higher in HT patients than in HC, both >50 years. In a multivariate analysis, age, sex, and BSA were the major determinants of aortic morphology, irrespective of the presence of hypertension. Global and segmental aortic length, volume, and diameters at specific landmarks were automatically measured from 3D MRI to serve as normative measures of 3D aortic morphology. Such indices increased significantly with age and hypertension among the elderly subjects. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Thomas Dietenbeck
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France
| | - Sophia Houriez-Gombaud-Saintonge
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France.,ESME Sudria Research Lab, Paris, France
| | - Etienne Charpentier
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France
| | - Umit Gencer
- PARCC, Université de Paris, INSERM, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Giron
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
| | - Antonio Gallo
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France
| | - Samia Boussouar
- Département d'Imagerie Cardiovasculaire DICVRIT, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France
| | - Nicoletta Pasi
- Département d'Imagerie Cardiovasculaire DICVRIT, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France
| | - Gilles Soulat
- PARCC, Université de Paris, INSERM, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Elie Mousseaux
- PARCC, Université de Paris, INSERM, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Alban Redheuil
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France.,Département d'Imagerie Cardiovasculaire DICVRIT, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France.,Institute of Cardiometabolism and Nutrition (ICAN), Groupe Hospitalier Pitié Salpêtrière APHP, Paris, France
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23
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Gallo C, Olbers J, Ridolfi L, Scarsoglio S, Witt N. Testing a Patient-Specific In-Silico Model to Noninvasively Estimate Central Blood Pressure. Cardiovasc Eng Technol 2021; 12:144-157. [PMID: 33438147 DOI: 10.1007/s13239-020-00512-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To show some preliminary results about the possibility to exploit a cardiovascular mathematical model-made patient-specific by noninvasive data routinely measured during ordinary clinical examinations-in order to obtain sufficiently accurate central blood pressure (BP) estimates. METHODS A closed-loop multiscale (0D and 1D) model of the cardiovascular system is made patient-specific by using as model inputs the individual mean heart rate and left-ventricular contraction time, weight, height, age, sex and mean/pulse brachial BPs. The resulting framework is used to determine central systolic, diastolic, mean and pulse pressures, which are compared with the beat-averaged invasive pressures of 12 patients aged 72 ± 6.61 years. RESULTS Errors in central systolic, diastolic, mean and pulse pressures by the model are 4.26 ± 2.81, 5.86 ± 4.38, 4.98 ± 3.95 and 3.51±2.38 mmHg, respectively. CONCLUSION The proposed modeling approach shows a good patient-specific response and appears to be potentially useful in clinical practice. However, this approach needs to be evaluated in a larger cohort of patients and could possibly be improved through more accurate oscillometric BP measurement methods.
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Affiliation(s)
- Caterina Gallo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy.
| | - Joakim Olbers
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Nils Witt
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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24
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Adluru G. Editorial for "Quantitative measures of 3D aortic morphology from cardiac MRI in healthy aging and hypertension". J Magn Reson Imaging 2021; 53:1484-1485. [PMID: 33403693 DOI: 10.1002/jmri.27501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ganesh Adluru
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
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25
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Li S, Zhuang B, Yin G, Yang X, Zhao S, Lu M. Reference values of thoracic aorta and pulmonary artery diameters by age and gender in healthy Chinese adults assessed by cardiac magnetic resonance imaging: data from national center for cardiovascular diseases of China. Int J Cardiovasc Imaging 2021; 37:1423-1431. [PMID: 33392881 DOI: 10.1007/s10554-020-02116-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
The aim of the study was to define normal ranges for thoracic aorta and pulmonary artery diameters relative to gender, age, body surface area (BSA) and body mass index (BMI) in healthy Chinese adults by cardiac magnetic resonance (CMR). We studied 200 healthy participants (100 men, 100 women; age range from 20-70) by using a 3.0-T CMR system. The diameters of the ascending aorta (AA), main pulmonary artery (PA), proximal descending aorta (DA) and Valsalva sinus (VAS) were measured manually by two experienced doctors on half-Fourier single-shot spin echo (HASTE) and balanced steady-state free precession (bSSFP) cine images. The mean value and age specific and gender adjusted normal limits were calculated. The linear regression analysis were performed between diameters and gender, age, BMI and BSA. The mean and 95% confidence interval(CI) of AA, PA, DA and VAS were 28.95 ± 4.61 mm(95% CI 19.92-37.99 mm), 22.41 ± 2.59 mm(95% CI 17.31-27.47 mm), 20.61 ± 2.96 mm(95% CI 14.81-26.42 mm), 31.15 ± 3.65 mm(95% CI 24.00-38.29 mm), respectively. The gender differences of all the parameters above were statistically significant (all p < 0.01). Both thoracic aorta and pulmonary artery dilates with the increase of age, while AA has the highest dilation rate. The mean PA/AA was 0.79 and showed no gender difference, but there was statistical difference among all age groups (p < 0.01). AA and DA had stronger association with age and BSA than BMI. Age- and gender-specific reference diameters of thoracic aorta and pulmonary artery were provided in healthy Chinese adults. Age and BSA have stronger effects on the ranges of diameters than BMI.
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Affiliation(s)
- Shuang Li
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Baiyan Zhuang
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Gang Yin
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Xinling Yang
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. .,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, 100037, China.
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26
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Kawel-Boehm N, Hetzel SJ, Ambale-Venkatesh B, Captur G, Francois CJ, Jerosch-Herold M, Salerno M, Teague SD, Valsangiacomo-Buechel E, van der Geest RJ, Bluemke DA. Reference ranges ("normal values") for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update. J Cardiovasc Magn Reson 2020; 22:87. [PMID: 33308262 PMCID: PMC7734766 DOI: 10.1186/s12968-020-00683-3] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) enables assessment and quantification of morphological and functional parameters of the heart, including chamber size and function, diameters of the aorta and pulmonary arteries, flow and myocardial relaxation times. Knowledge of reference ranges ("normal values") for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. Compared to the previous version of this review published in 2015, we present updated and expanded reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques. Further, databases and references for deep learning methods are included.
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Affiliation(s)
- Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland
- Institute for Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, InselspitalBern, Switzerland
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI, 53726, USA
| | - Bharath Ambale-Venkatesh
- Department of Radiology, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Gabriella Captur
- MRC Unit of Lifelong Health and Ageing At UCL, 5-19 Torrington Place, Fitzrovia, London, WC1E 7HB, UK
- Inherited Heart Muscle Conditions Clinic, Royal Free Hospital NHS Foundation Trust, Hampstead, London, NW3 2QG, UK
| | - Christopher J Francois
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Salerno
- Cardiovascular Division, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Shawn D Teague
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA
| | - Emanuela Valsangiacomo-Buechel
- Division of Paediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
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27
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McGurk KA, Owen B, Watson WD, Nethononda RM, Cordell HJ, Farrall M, Rider OJ, Watkins H, Revell A, Keavney BD. Heritability of haemodynamics in the ascending aorta. Sci Rep 2020; 10:14356. [PMID: 32873833 PMCID: PMC7463029 DOI: 10.1038/s41598-020-71354-7] [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] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/25/2020] [Indexed: 01/27/2023] Open
Abstract
Blood flow in the vasculature can be characterised by dimensionless numbers commonly used to define the level of instabilities in the flow, for example the Reynolds number, Re. Haemodynamics play a key role in cardiovascular disease (CVD) progression. Genetic studies have identified mechanosensitive genes with causal roles in CVD. Given that CVD is highly heritable and abnormal blood flow may increase risk, we investigated the heritability of fluid metrics in the ascending aorta calculated using patient-specific data from cardiac magnetic resonance (CMR) imaging. 341 participants from 108 British Caucasian families were phenotyped by CMR and genotyped for 557,124 SNPs. Flow metrics were derived from the CMR images to provide some local information about blood flow in the ascending aorta, based on maximum values at systole at a single location, denoted max, and a 'peak mean' value averaged over the area of the cross section, denoted pm. Heritability was estimated using pedigree-based (QTDT) and SNP-based (GCTA-GREML) methods. Estimates of Reynolds number based on spatially averaged local flow during systole showed substantial heritability ([Formula: see text], [Formula: see text]), while the estimated heritability for Reynolds number calculated using the absolute local maximum velocity was not statistically significant (12-13%; [Formula: see text]). Heritability estimates of the geometric quantities alone; e.g. aortic diameter ([Formula: see text], [Formula: see text]), were also substantially heritable, as described previously. These findings indicate the potential for the discovery of genetic factors influencing haemodynamic traits in large-scale genotyped and phenotyped cohorts where local spatial averaging is used, rather than instantaneous values. Future Mendelian randomisation studies of aortic haemodynamic estimates, which are swift to derive in a clinical setting, will allow for the investigation of causality of abnormal blood flow in CVD.
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Affiliation(s)
- Kathryn A McGurk
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
| | - Benjamin Owen
- Department of Mechanical, Aerospace and Civil Engineering, Faculty of Science and Engineering, University of Manchester, Manchester, UK
- School of Engineering, Multiscale Thermofluids Institute, University of Edinburgh, Edinburgh, UK
| | - William D Watson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Richard M Nethononda
- Division of Cardiology, Chris Hani Baragwanath Hospital, Soweto and the University of Witwatersrand, Johannesburg, South Africa
| | - Heather J Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK
| | - Martin Farrall
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Alistair Revell
- Department of Mechanical, Aerospace and Civil Engineering, Faculty of Science and Engineering, University of Manchester, Manchester, UK
| | - Bernard D Keavney
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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28
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Abstract
High-quality aortic imaging plays a central role in the management of patients with thoracic aortic aneurysm. Computed tomography angiography and magnetic resonance angiography are the most commonly used techniques for thoracic aortic aneurysm diagnosis and imaging surveillance, with each having unique strengths and limitations that should be weighed when deciding patient-specific applications. To ensure optimal patient care, imagers must be familiar with potential sources of artifact and measurement error, and dedicate effort to ensure high-quality and reproducible aortic measurements are generated. This review summarizes the imaging evaluation and underlying pathology relevant to the diagnosis of thoracic aortic aneurysm.
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Affiliation(s)
- Kimberly G Kallianos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Nicholas S Burris
- University of Michigan, Frankel Cardiovascular Center, Room 5588, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5868, USA.
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29
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Scott MB, Huh H, van Ooij P, Chen V, Herrera B, Elbaz M, McCarthy P, Malaisrie SC, Carr J, Fedak PWM, Markl M, Barker AJ. Impact of age, sex, and global function on normal aortic hemodynamics. Magn Reson Med 2020; 84:2088-2102. [PMID: 32162416 DOI: 10.1002/mrm.28250] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/10/2020] [Accepted: 02/14/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE To examine the effects of age, sex, and left ventricular global function on velocity, helicity, and 3D wall shear stress (3D-WSS) in the aorta of N = 100 healthy controls. METHODS Fifty female and 50 male volunteers with no history of cardiovascular disease, with 10 volunteers per age group (18-30, 31-40, 41-50, 51-60, and 61-80 years) underwent aortic 4D-flow MRI. Quantification of systolic aortic peak velocity, helicity, and 3D-WSS distribution and the calculation of age group-averaged peak systolic velocity and 3D-WSS maps ("atlases") were computed. Age-related and sex-related changes in peak velocity, helicity, and 3D-WSS were computed and correlated with standard metrics of left ventricular function derived from short-axis cine MRI. RESULTS No significant differences were found in peak systolic velocity or 3D-WSS based on sex except for the 18- to 30-year-old group (males 8% higher velocity volume and 3D-WSS surface area). Between successively older groups, systolic velocity decreased (13%, <1%, 7%, and 55% of the aorta volume) and 3D-WSS decreased (21%, 2%, 30%, and 62% of the aorta surface area). Mean velocity, mean 3D-3D-WSS, and median helicity increased with cardiac output (r = 0.27-0.43, all P < .01), and mean velocity and 3D-WSS decreased with increasing diameter (r > 0.35, P < .001). Arch and descending aorta systolic mean velocity, mean 3D-WSS, and median helicity increased with normalized left ventricular volumes: end diastolic volume (r = 0.31-0.37, P < .01), end systolic volume (r = 0.27-0.35, P < .01), and stroke volume (r = 0.28-0.35, P < .01). CONCLUSION Healthy aortic hemodynamics are dependent on subject age, and correlate with vessel diameter and cardiac function.
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Affiliation(s)
- Michael B Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Hyungkyu Huh
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - Vincent Chen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brenda Herrera
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mohammed Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Patrick McCarthy
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Chris Malaisrie
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul W M Fedak
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Fate of the Preserved Sinuses of Valsalva After Emergency Repair for Acute Type A Aortic Dissection. Ann Thorac Surg 2020; 110:1476-1483. [PMID: 32156587 DOI: 10.1016/j.athoracsur.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/29/2019] [Accepted: 01/31/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients with acute type A aortic dissection (ATAAD) present with heterogeneous involvement of the aortic root complex. Despite this variation, the aortic root can usually be preserved the majority of the time by Teflon (WL Gore, Newark, DE) inlay patch reconstruction of the dissected sinuses of Valsalva (SOV). In this study, we report the long term anatomic, functional, and clinical outcomes associated with the preserved SOV after surgery for ATAAD. METHODS From 2002-2017, of 776 emergency ATAAD operations at a single institution, 558 (71.9%) underwent valve resuspension with SOV preservation. Echocardiography reports were reviewed to obtain postoperative SOV dimensions. Cumulative incidence of SOV dilation ≥ 4 5mm was calculated using the Fine-Gray method with death as a competing risk. Repeated-measures linear mixed effects model was used to determine risk factors for SOV growth over time. RESULTS During the follow-up period, 62 of 558 (11.1%) patients developed SOV diameter ≥ 45 mm. Cumulative incidence of SOV dilation ≥ 45 mm at 1, 5, and 10 years was 5.5%, 12.4%, and 18.9% respectively. In a multivariable Cox regression model, preoperative SOV diameter ≥ 45 mm was associated with a hazard ratio of 14.11 (95% confidence interval 7.03-31.62) for postoperative SOV dilation ≥ 45 mm. In a repeated-measures linear mixed effects model, preoperative and discharge SOV diameter were significant predictors of SOV dilation. Postoperative time course was also identified as significant indicating growth over time. CONCLUSIONS The preserved sinuses of Valsalva after surgery for ATAAD may be prone to progressive dilatation over time. Closer echocardiographic surveillance may be warranted in these patients.
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Pham MHC, Ballegaard C, de Knegt MC, Sigvardsen PE, Sørgaard MH, Fuchs A, Kühl JT, Taudorf M, Nordestgaard BG, Køber LV, Kofoed KF. Normal values of aortic dimensions assessed by multidetector computed tomography in the Copenhagen General Population Study. Eur Heart J Cardiovasc Imaging 2019; 20:939-948. [DOI: 10.1093/ehjci/jez012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/22/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Aims
Accurate assessment of aortic dimensions can be achieved using contrast-enhanced computed tomography. The aim of this study was to define normal values and determinants of aortic dimensions throughout multiple key anatomical landmarks of the aorta in healthy individuals from the Copenhagen General Population Study.
Methods and results
The study group consisted of 902 healthy subjects selected from 3000 adults undergoing cardiovascular thoracic and abdominal computed tomography-angiography (CTA), where systematic measurements of aortic dimensions were performed retrospectively. Individuals included were without any of the following predefined cardiovascular risk factors: (i) self-reported angina pectoris; (ii) hypertension; (iii) hypercholesterolaemia; (iv) taking cardiovascular prescribed medication including diuretics, statins, or aspirin; (v) overweight (defined as body mass index ≥30 kg/m2); (vi) diabetes mellitus (self-reported or blood glucose >8 mmol/L); and (vii) chronic obstructive pulmonary disease. Maximal aortic diameters were measured at seven aortic regions: sinuses of Valsalva, sinotubular junction, ascending aorta, mid-descending aorta, abdominal aorta at the diaphragm, abdominal aorta at the coeliac trunk, and infrarenal abdominal aorta. Median age was 52 years, and 396 (40%) were men. Men had significantly larger aortic diameters at all levels compared with women (P < 0.001). Multivariable analysis revealed that sex, age, and body surface area were associated with increasing aortic dimensions.
Conclusion
Normal values of maximal aortic dimensions at key aortic anatomical locations by contrast-enhanced CTA have been defined. Age, sex, and body surface area were significantly associated with these measures at all levels of aorta. Aortic dimensions follow an almost identical pattern throughout the vessel regardless of sex.
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Affiliation(s)
- Michael H C Pham
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Ballegaard
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martina C de Knegt
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mathias H Sørgaard
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jørgen T Kühl
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Køber
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Voges I, Giordano R, Koestenberg M, Marchese P, Scalese M, Ait-Ali L, Santoro G, Iervasi G, Valverde I, Kutty S, Cantinotti M. Nomograms for Cardiovascular Magnetic Resonance Measurements in the Pediatric Age Group: To Define the Normal and the Expected Abnormal Values in Corrected/Palliated Congenital Heart Disease: A Systematic Review. J Magn Reson Imaging 2019; 49:1222-1235. [DOI: 10.1002/jmri.26614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Inga Voges
- University Hospital Schleswig-Holstein; Campus Kiel Kiel Germany
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Deparment of Advanced Biomedical Sciences, University of Naples "Federico II"; Italy
| | - Martin Koestenberg
- Division of Pediatric Cardiology, Department of Pediatrics; Medical University Graz; Austria
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana; Massa and Pisa Italy
| | | | | | - Giuseppe Santoro
- University Hospital Schleswig-Holstein; Campus Kiel Kiel Germany
| | | | - Israel Valverde
- Hospital Virgen del Rocio & Institute of Biomedicine of Seville (IBIS); Seville Spain
- Guy's and St. Thomas' Hospital/Evelina Children's Hospital; London UK
| | - Shelby Kutty
- Division of Pediatric Cardiology; Johns Hopkins School of Medicine Bloomberg Children's Center; Baltimore Maryland USA
| | - Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana; Massa and Pisa Italy
- Institute of Clinical Physiology; Pisa Italy
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Hannuksela M, Johansson B, Carlberg B. Aortic stiffness in families with inherited non-syndromic thoracic aortic disease. SCAND CARDIOVASC J 2019; 52:301-307. [PMID: 30606081 DOI: 10.1080/14017431.2018.1546895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND In families with an inherited form of non-syndromic thoracic aortic disease (TAAD), aortic diameter alone is not a reliable marker for disease occurrence or progression. To identify other parameters of aortic function, we studied aortic stiffness in families with TAAD. We also compared diameter measurements obtained by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). METHODS Seven families, including 116 individuals, with non-syndromic TAAD, were studied. The aortic diameter was measured by TTE and MRI. Aortic stiffness was assessed as local distensibility in the ascending aorta and as regional and global pulse wave velocity (PWV). Individuals with a dilated thoracic aorta (n = 21) were compared with those without aortic dilatation (n = 95). RESULTS Ascending aortic diameter measured by TTE strongly correlated with the diameter measured by MRI (r2 = 0.93). The individuals with dilated aortas were older than those without dilatation (49 vs 37 years old). Ascending aortic diameter increased and distensibility decreased with increasing age; while, PWV increased with age and diameter. Some young subjects without aortic dilatation showed increased aortic stiffness. Individuals with a dilated thoracic aorta had significantly higher PWV and lower distensibility, measured by MRI than individuals without dilatation. CONCLUSIONS Diameters measured with TTE agree with those measured by MRI. Aortic stiffness might be a complementary marker for aortic disease and progression when used with aortic diameter, especially in young individuals.
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Affiliation(s)
- Matias Hannuksela
- a Department of Surgical and Perioperative Sciences, Heart Centre , Umeå University , Umeå , Sweden
| | - Bengt Johansson
- b Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Bo Carlberg
- b Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
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Dietenbeck T, Craiem D, Rosenbaum D, Giron A, De Cesare A, Bouaou K, Girerd X, Cluzel P, Redheuil A, Kachenoura N. 3D aortic morphology and stiffness in MRI using semi-automated cylindrical active surface provides optimized description of the vascular effects of aging and hypertension. Comput Biol Med 2018; 103:101-108. [DOI: 10.1016/j.compbiomed.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/17/2018] [Accepted: 10/07/2018] [Indexed: 11/28/2022]
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35
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Ayoub C, Kumar G, Smith CY, Bryant SC, Jech DM, Ionescu F, Petrescu I, Miller FA, Spittell PC. Reference Values for Mid-Ascending Aorta Diameters by Transthoracic Echocardiography in Adults. Am J Cardiol 2018; 122:1068-1073. [PMID: 30075888 DOI: 10.1016/j.amjcard.2018.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/26/2018] [Accepted: 06/01/2018] [Indexed: 11/15/2022]
Abstract
We sought to characterize mid-ascending aorta diameter reference values by age, sex, and body surface area (BSA) in a large echocardiography laboratory practice-based cohort. All subjects with transthoracic echocardiograms with mid-ascending aorta diameter measure from January 2004 to December 2009 were identified, and medical records were reviewed for medical history and anthropometric data. Those with aortic valve disease or replacement, congenital heart disease, any connective tissue or inflammatory disease that may affect the aorta, or known aortic aneurysm (>55 mm) were excluded. Mid-ascending aorta diameter was measured in a standardized manner using "leading edge to leading edge" technique at end-diastole. Of 27,839 eligible subjects, 16,620 did not have history of hypertension and were included in the analysis (56.3% female; mean age 52.0 ± 15.8 years), mean mid-ascending aorta diameter 31.7 ± 4.1 mm. Females had smaller diameter than males (30.5 ± 3.7 mm vs 33.3 ± 4.0 mm; p <0.001). Subjects with history of hypertension (n = 11,219; not included in the analysis) had larger mid-ascending aorta diameter compared with normotensive subjects (33.9 ± 3.8 mm vs 31.7 ± 4.1 mm; p < 0.001). Age had the greatest correlation with aortic size (r = 0.55), followed by sex (r = 0.35) and BSA (r = 0.35). Nomograms for predicted mid-ascending aorta diameter were generated at the 95th percentile using quantile regression for subjects without hypertension stratified by age, sex, and BSA. In conclusion, mid-ascending aorta diameter is predominantly associated with sex, age, and BSA. The nomograms established by this study may serve as useful reference values for echocardiographic screening and surveillance.
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Affiliation(s)
- Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gautam Kumar
- Division of Cardiology, Emory University, Atlanta VA Medical Center, Atlanta, Georgia
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sandra C Bryant
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Diane M Jech
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Filip Ionescu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ioana Petrescu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Fletcher A Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Peter C Spittell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Is it important to assess the ascending aorta after tetralogy of Fallot repair? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cruz C, Pinho T, Madureira AJ, Dias CC, Ramos I, Silva Cardoso J, Maciel MJ. Is it important to assess the ascending aorta after tetralogy of Fallot repair? Rev Port Cardiol 2018; 37:773-779. [PMID: 30150103 DOI: 10.1016/j.repc.2017.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/30/2017] [Accepted: 11/05/2017] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Aortic dilatation can develop late after tetralogy of Fallot repair. Its extension beyond the aortic root is not clearly understood. We aimed to assess the prevalence and predictors of ascending aorta dilatation to set up an imaging protocol. METHODS In this prospective study including adult patients after tetralogy of Fallot repair followed at a referral center, we assessed the aorta by cardiovascular magnetic resonance and defined ascending aorta dilatation as an observed-to-expected ratio >1.5. RESULTS We included 78 adults (mean age 31±10 years; 56% female), with a mean follow-up of 23±7 years since tetralogy of Fallot repair. The prevalence of ascending aorta dilatation was 11.5%. The ascending aorta was larger than the sinuses of Valsalva in 12.8% of cases. Patients with ascending aorta dilatation were older, predominantly male, with later repair and larger left ventricular mass and volumes. By multivariate analysis left ventricular mass index (LVMI) was the only factor independently associated with ascending aorta dilatation (odds ratio 1.10, 95% confidence interval 1.01-1.20, p=0.03). A cut-off value of ≥57.9 g/m2 for LVMI had 89% sensitivity and 71% specificity for ascending aorta dilatation. CONCLUSIONS Ascending aorta assessment as part of a routine cardiovascular magnetic resonance study after tetralogy of Fallot repair is recommended to screen for future aortic complications, particularly in males and older patients, and those with later repair and larger left ventricles. LVMI assessment has potential as a screening tool for ascending aorta dilatation with future clinical implications.
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Affiliation(s)
- Cristina Cruz
- Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; University of Porto, Faculty of Medicine, Porto, Portugal.
| | - Teresa Pinho
- Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; University of Porto, Faculty of Medicine, Porto, Portugal
| | - António José Madureira
- University of Porto, Faculty of Medicine, Porto, Portugal; Centro Hospitalar São João, Department of Radiology, Porto, Portugal
| | - Cláudia Camila Dias
- University of Porto, Faculty of Medicine, Department of Community Medicine, Information and Decision in Health, Porto, Portugal
| | - Isabel Ramos
- University of Porto, Faculty of Medicine, Porto, Portugal; Centro Hospitalar São João, Department of Radiology, Porto, Portugal
| | - José Silva Cardoso
- Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; University of Porto, Faculty of Medicine, Porto, Portugal
| | - Maria Júlia Maciel
- Centro Hospitalar São João, Department of Cardiology, Porto, Portugal; University of Porto, Faculty of Medicine, Porto, Portugal
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Bhave NM, Nienaber CA, Clough RE, Eagle KA. Multimodality Imaging of Thoracic Aortic Diseases in Adults. JACC Cardiovasc Imaging 2018; 11:902-919. [DOI: 10.1016/j.jcmg.2018.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/28/2022]
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Barth RF, Maximilian Buja L, Cao L, Brodsky SV. An Obesity Paradox: Increased Body Mass Index Is Associated with Decreased Aortic Atherosclerosis. Curr Hypertens Rep 2018; 19:55. [PMID: 28593612 DOI: 10.1007/s11906-017-0753-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Brodsky et al. (Cardiovasc Pathol 25(6), 515-520, 2016) recently have reported that there was an unexpected and highly significant inverse correlation between body mass index (BMI) and atherosclerosis of the aortas of morbidly obese decedents (BMI >40 kg/m2). In a series of 304 decedents, 65 of whom were morbidly obese, minimal or no atherosclerosis was seen in 46 of them (70%) versus 20 (30%) who had severe atherosclerosis (P = 0.008). This obesity paradox was unexpected and raises important questions about the etiology and pathogenesis of atherosclerosis, which will be the subject of this commentary. The concept of healthy versus unhealthy adiposity may in part provide an explanation for the "obesity paradox." Another factor that will be considered is the possible role of adipokines and their genetic determinants that may significantly reduce the risk of developing aortic atherosclerosis in morbidly obese individuals. Considering the marked variability in the pattern and extent of atherosclerosis of the aorta, hemodynamic factors and endothelial cell shear stress may be the most important determinants that might explain the obesity paradox that we have observed. Finally, the possible role of gut microbiota and inflammation as factors in the etiopathogenesis of atherosclerosis will be considered, but their importance is less clear than that of hemodynamic factors. We conclude with the remarkable finding that a 5300-year-old, well-preserved mummy of the "Iceman," Ötzi had atherosclerotic disease of a number of major arteries and the interesting questions that this raises.
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Affiliation(s)
- Rolf F Barth
- Department of Pathology, The Ohio State University, 4132 Graves Hall, 333 W. 10th Ave, Columbus, OH, 43210, USA.
| | - L Maximilian Buja
- McGovern Medical School, Department of Pathology and Laboratory Medicine, University of Texas, 6431 Fannin St. MSB2.276, Houston, TX, 77030, USA
| | - Lei Cao
- Department of Cancer Biology and Genetics, The Ohio State University, 910 Biological Research Tower, 460 W. 12th Ave, Columbus, OH, 43210, USA
| | - Sergey V Brodsky
- Department of Pathology, The Ohio State University, B078 Graves Hall, 333 W. 10th Ave, Columbus, OH, 43210, USA
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Anatomical features of the aortic root in aortic stenosis and a novel approach for transcatheter aortic valve implantation. Heart Vessels 2018; 33:908-917. [DOI: 10.1007/s00380-018-1130-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
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41
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Loughborough WW, Minhas KS, Rodrigues JCL, Lyen SM, Burt HE, Manghat NE, Brooks MJ, Stuart G, Hamilton MCK. Cardiovascular Manifestations and Complications of Loeys-Dietz Syndrome: CT and MR Imaging Findings. Radiographics 2018; 38:275-286. [DOI: 10.1148/rg.2018170120] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zafar MA, Li Y, Rizzo JA, Charilaou P, Saeyeldin A, Velasquez CA, Mansour AM, Bin Mahmood SU, Ma WG, Brownstein AJ, Tranquilli M, Dumfarth J, Theodoropoulos P, Thombre K, Tanweer M, Erben Y, Peterss S, Ziganshin BA, Elefteriades JA. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. J Thorac Cardiovasc Surg 2017; 155:1938-1950. [PMID: 29395211 DOI: 10.1016/j.jtcvs.2017.10.140] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/31/2017] [Accepted: 10/17/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. We previously introduced the aortic size index (ASI), defined as aortic size/body surface area (BSA), as a predictor of aortic dissection, rupture, and death. However, weight might not contribute substantially to aortic size and growth. We seek to evaluate the height-based aortic height index (AHI) versus ASI for risk estimation and revisit our natural history calculations. METHODS Aortic diameters and long-term complications of 780 patients with TAAA were analyzed. Growth rate estimates, yearly complication rates, and survival were assessed. Risk stratification was performed using regression models. The predictive value of AHI and ASI was compared. RESULTS Patients were stratified into 4 categories of yearly risk of complications based on their ASI and AHI. ASIs (cm/m2) of ≤2.05, 2.08 to 2.95, 3.00 to 3.95 and ≥4, and AHIs (cm/m) of ≤2.43, 2.44 to 3.17, 3.21 to 4.06, and ≥4.1 were associated with a 4%, 7%, 12%, and 18% average yearly risk of complications, respectively. Five-year complication-free survival was progressively worse with increasing ASI and AHI. Both ASI and AHI were shown to be significant predictors of complications (P < .05). AHI categories 3.05 to 3.69, 3.70 to 4.34, and ≥4.35 cm/m were associated with a significantly increased risk of complications (P < .05). The overall fit of the model using AHI was modestly superior according to the concordance statistic. CONCLUSIONS Compared with indices including weight, the simpler height-based ratio (excluding weight and BSA calculations) yields satisfactory results for evaluating the risk of natural complications in patients with TAAA.
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Affiliation(s)
- Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Yupeng Li
- Department of Political Sciences and Economics, Rowan University, Glassboro, NJ
| | - John A Rizzo
- Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Paris Charilaou
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Ayman Saeyeldin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Camilo A Velasquez
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Ahmed M Mansour
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Syed Usman Bin Mahmood
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Wei-Guo Ma
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Adam J Brownstein
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Maryann Tranquilli
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Julia Dumfarth
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | | | - Kabir Thombre
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Maryam Tanweer
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Young Erben
- Department of Vascular Surgery, Yale University School of Medicine, New Haven, Conn
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Surgical Diseases 2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
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Hernesniemi JA, Heiskanen J, Ruohonen S, Kartiosuo N, Hutri-Kähönen N, Kähönen M, Jokinen E, Tossavainen P, Kallio M, Laitinen T, Lehtimäki T, Viikari JSA, Juonala M, Raitakari OT. Aortic sinus diameter in middle age is associated with body size in young adulthood. Heart 2017; 104:773-778. [PMID: 29092920 DOI: 10.1136/heartjnl-2017-312136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Aortic sinus dilatation can lead to aortic valve regurgitation or even aortic dissection. Our objective was to examine the association between body surface area (BSA) measures from childhood to middle age and aortic sinus diameter in middle age. Understanding the relation of these two clarifies how aortic size is normally determined. METHODS Cardiovascular Risk in Young Finns Study is a longitudinal study with follow-up of over 31 years (1980-2011). The study comprises information of body composition from multiple time points of 1950 subjects with cardiac ultrasound measurements made in 2011. The association between BSA in different ages and aortic sinus diameter in middle age was analysed by linear regression modelling adjusted with age, sex and diastolic blood pressure. Missing BSA values were derived for each life year (ages 3-33 years) from subject-specific curves for body weight and height estimated from longitudinal measurements using mixed model regression splines. RESULTS BSA estimates in early 20s are most strongly associated with aortic sinus diameter in middle age. Top association was observed at age 23 years with one SD increase in estimated BSA corresponding to 1.04 mm (0.87-1.21 mm) increase in aortic diameter. Increase in body weight beyond early 20s does not associate with aortic sinus diameter, and the association between middle age BSA and aortic size is substantially weaker (0.74 mm increase (0.58-0.89 mm)). These results were confirmed in a subpopulation using only measured data. CONCLUSION The association between aortic sinus diameter and BSA is stronger when considering BSA in young adulthood compared with BSA in middle age.
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Affiliation(s)
- Jussi A Hernesniemi
- Department of Cardiology, Tays Heart Hospital, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jarkko Heiskanen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Saku Ruohonen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Noora Kartiosuo
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Eero Jokinen
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Päivi Tossavainen
- Department of Pediatrics, University of Oulu, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Merja Kallio
- Department of Pediatrics, University of Oulu, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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44
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Feasibility of performing non-contrast magnetic resonance angiography in pregnant subjects with familial aortopathies. Int J Cardiol 2017. [DOI: 10.1016/j.ijcard.2017.05.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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45
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Lim JCS, Cauldwell M, Patel RR, Uebing A, Curry RA, Johnson MR, Gatzoulis MA, Swan L. Management of Marfan Syndrome during pregnancy: A real world experience from a Joint Cardiac Obstetric Service. Int J Cardiol 2017; 243:180-184. [DOI: 10.1016/j.ijcard.2017.05.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/17/2017] [Indexed: 11/27/2022]
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46
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Garcia J, van der Palen RLF, Bollache E, Jarvis K, Rose MJ, Barker AJ, Collins JD, Carr JC, Robinson J, Rigsby CK, Markl M. Distribution of blood flow velocity in the normal aorta: Effect of age and gender. J Magn Reson Imaging 2017; 47:487-498. [PMID: 28556277 DOI: 10.1002/jmri.25773] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/10/2017] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To apply flow distribution analysis in the entire aorta across a wide age range from pediatric to adult subjects. MATERIAL AND METHODS In all, 98 healthy subjects (age 9-78 years, 41 women) underwent 4D flow MRI at 1.5T and 3T for the assessment of 3D blood flow in the thoracic aorta. Subjects were categorized into age groups: group 1 (n = 9, 5 women): 9-15 years; group 2 (n = 13, 8 women): 16-20 years; group 3 (n = 27, 14 women): 21-39 years; group 4 (n = 40, 11 women): 40-59 years; group 5 (n = 9, 3 women): >60 years. Data analysis included the 3D segmentation of the aorta, aortic valve peak velocity, mid-ascending aortic diameter, and calculation of flow velocity distribution descriptors (mean, median, standard deviation, incidence of velocities >1 m/s, skewness, and kurtosis of aortic velocity magnitude). Ascending aortic diameter was normalized by body surface area. RESULTS Age was significantly associated with normalized aortic diameter (R = 0.73, P < 0.001), skewness (R = 0.76, P < 0.001), and kurtosis (R = 0.74, P < 0.001), all adjusted by heart rate. Aortic peak velocity and velocity distribution descriptors, adjusted by heart rate, were significantly different between age groups (P < 0.001, analysis of covariance). Skewness and kurtosis significantly increased (P < 0.001) during adulthood (>40 years) as compared with childhood (<21 years). Men and women revealed significant differences (P ≤ 0.05) for peak velocity, incidence, mean, median, standard deviation, and skewness, all adjusted by heart rate. CONCLUSION Aortic hemodynamics significantly change with age and gender, indicating the importance of age- and gender-matched control cohorts for the assessment of the impact of cardiovascular disease on aortic blood flow. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:487-498.
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Affiliation(s)
- Julio Garcia
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Emilie Bollache
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Michael J Rose
- Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua Robinson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Division of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Division of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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47
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Braley KT, Tang X, Makil ES, Borroughs-Ray D, Collins RT. The impact of body weight on the diagnosis of aortic dilation-misdiagnosis in overweight and underweight groups. Echocardiography 2017; 34:1029-1034. [DOI: 10.1111/echo.13565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Katherine T. Braley
- University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Xinyu Tang
- University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Elizabeth S. Makil
- University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock AR USA
| | | | - Ronnie T. Collins
- University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Internal Medicine; University of Arkansas for Medical Sciences; Little Rock AR USA
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Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage. PLoS One 2017; 12:e0174520. [PMID: 28355242 PMCID: PMC5371310 DOI: 10.1371/journal.pone.0174520] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/10/2017] [Indexed: 11/20/2022] Open
Abstract
Background Severe postpartum hemorrhage occurs in 1/1000 women giving birth. This condition is often dramatic and may be life threatening. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has in recent years been introduced as a novel treatment for hemorrhagic shock. We present a series of fluoroscopy-free REBOA for controlling life threatening postpartum hemorrhage. Methods In 2008 an ‘aortic occlusion kit’ was assembled and used in three Norwegian university hospitals. The on-call interventional radiologist (IR) was to be contacted with a response time < 30 minutes in case of life threatening PPH. Demographics and characteristics were noted from the medical records. Results This retrospective study includes 36 patients treated with fluoroscopy-free REBOA for controlling severe postpartum hemorrhage in the years 2008–2015. The REBOA success rate was 100% and no patients died from REBOA related complications. Uterine artery embolization was performed in 17 (47%) patients and a hysterectomy in 16 (44%) patients. A short (11cm) introducer length was strongly associated with iliac artery thrombus formation (ρ = 0.50, P = 0.002). In addition, there was a strong negative correlation between uterine artery embolization and hysterectomy (ρ = -0.50, P = 0.002). Conclusions Our Norwegian experience indicates the clinical safety and feasibility of REBOA in life threatening PPH. Also, REBOA can be used in an emergency situation without the use of fluoroscopy with a high degree of technical success. It is important that safety implementation of REBOA is established, especially through limited aortic balloon occlusion time and a thorough balloon deflation regime.
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Sex differences in aortic root and vascular anatomy in patients undergoing transcatheter aortic valve implantation: A computed-tomographic study. J Cardiovasc Comput Tomogr 2017; 11:87-96. [DOI: 10.1016/j.jcct.2017.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/29/2016] [Accepted: 01/19/2017] [Indexed: 11/22/2022]
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50
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Leipsic J, Sellers S, Blanke P. Sex differences in the aortic root size: Implications for TAVR. J Cardiovasc Comput Tomogr 2017; 11:97-98. [DOI: 10.1016/j.jcct.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 01/29/2017] [Indexed: 12/20/2022]
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