Assessment of Aortic Arch Stiffness Using Pulse‐Wave Tissue Doppler Imaging: A Transesophageal Echocardiographic Comparison Study of Acute Ischemic Stroke Patients and Stroke‐Free Patients

Abstract

Elevated aortic stiffness determined by transesophageal echocardiography (TEE), and presence of complicated aortic plaque provide prognostic information about cerebrovascular disease risk. Recently, pulse-wave tissue Doppler imaging (PW-TDI) has offered a new technique for assessing aortic wall stiffness. The following aortic long-axis view TEE measurements were carried out in 103 consecutive acute ischemic stroke patients and 72 controls (stroke-free patients requiring TEE for conditions such as atrial fibrillation and valvular heart disease): (a) PW-TDI motion velocities measured as expansion peak velocity during systole (Vs) and contraction peak velocity during diastole (Vd); (b) aortic arch stiffness parameter β (Aoβ), defined as β=ln (systolic blood pressure/diastolic blood pressure)/([Dmax-Dmin]/Dmin), where ln is the natural logarithm, Dmax is maximum aortic lumen diameter, and Dmin is minimum aortic lumen diameter. The PW-TDI of Vs and Vd was compared with conventional vessel parameters brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI, calculated from blood pressure and PWV). Comparing acute ischemic stroke patients versus controls, Vs and Vd were significantly decreased (3.3±1.6 vs. 3.9±2.0cm/sec, P<0.05; 1.7±0.6 vs. 2.1±0.8cm/sec, P<0.01, respectively), and Aoβ and aortic arch intima-media thickness (AoIMT) were significantly increased (15.3±12.5 vs. 11.6±6.5, P<0.05; 3.2±2.5 vs. 2.4±2.1mm, P<0.05; respectively). Furthermore, Vs and Vd were significantly negatively correlated with age, Aoβ, AoIMT, CAVI, and baPWV in all cases. The use of aortic arch wall PW-TDI for Vs and Vd evaluation constitutes an easily and readily assessed parameter for evaluating aortic arch stiffness.