Coupling between MRI-assessed regional aortic pulse wave velocity and diameters in patients with thoracic aortic aneurysm: a feasibility study

E S J Kröner,A J H A Scholte,P J Van Den Boogaard,L J M Kroft,J J M Westenberg,N J Brouwer

doi:10.1007/s12471-015-0735-0

Abstract

Thoracic aortic aneurysm (TAA) is potentially life-threatening and requires close follow-up to prevent aortic dissection. Aortic stiffness and size are considered to be coupled. Regional aortic stiffness in patients with TAA is unknown. We aimed to evaluate coupling between regional pulse wave velocity (PWV), a marker of vascular stiffness, and aortic diameter in TAA patients. In 40 TAA patients (59 ± 13 years, 28 male), regional aortic diameters and regional PWV were assessed by 1.5T MRI. The incidence of increased diameter and PWV were determined for five aortic segments (S1, ascending aorta; S2, aortic arch; S3, thoracic descending aorta; S4, suprarenal and S5, infrarenal abdominal aorta). In addition, coupling between regional PWV testing and aortic dilatation was evaluated and specificity and sensitivity were assessed. Aortic diameter was 44 ± 5mm for the aortic root and 39 ± 5mm for the ascending aorta. PWV was increased in 36 (19 %) aortic segments. Aortic diameter was increased in 28 (14 %) segments. Specificity of regional PWV testing for the prediction of increased regional diameter was ≥ 84 % in the descending thoracic to abdominal aorta and ≥ 68 % in the ascending aorta and aortic arch. Normal regional PWV is related to absence of increased diameter, with high specificity in the descending thoracic to abdominal aorta and moderate results in the ascending aorta and aortic arch.

Highlights

Thoracic aortic aneurysm (TAA) is a life-threatening disease which requires close follow-up to intervene before aortic dissection and/or rupture occurs
Normal regional pulse wave velocity (PWV) is related to absence of increased diameter, with high specificity in the descending thoracic to abdominal aorta and moderate results in the ascending aorta and aortic arch
The main finding of the study is that normal regional PWV is related to absence of increased diameter in patients with TAA, with high specificity in the descending thoracic to abdominal aorta and moderate results in the ascending aorta and aortic arch

Summary

Introduction

Thoracic aortic aneurysm (TAA) is a life-threatening disease which requires close follow-up to intervene before aortic dissection and/or rupture occurs. In patients with Marfan syndrome, increased global and regional aortic wall stiffness has been reported [11]. PWV in the aortic arch showed statistically significantly more increase with age, suggesting more pronounced aortic involvement in the proximal aorta [11]. This is a possible risk factor for aortic dissection and regional PWV assessment can be of clinical value in patients with TAA. It is expected that in TAA patients without Marfan syndrome, local aortic wall stiffness measured by PWV is increased. The local aortic wall stiffness, measured by PWV in TAA patients, has not been reported before. The purpose of the present study was (1) to investigate the local aortic wall stiffness measured by PWV in TAA patients and (2) to evaluate coupling between regional PWV and aortic diameter and (3) to assess sensitivity and specificity for the coupling between regional PWV testing and aortic dilatation in TAA patients

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