Aortic Elasticity Parameters Research Articles

Is aortic elasticity associated with hydration status in stage of chronic renal disease in children?

Objective: We aimed to evaluate cardiovascular risks and influencing factors by measuring aortic elasticity parameters and carotid intima thickness in children with cronic kidney disease (CKD), and also evaluated the hydration status of patients with bioimpedance spectroscopy (BIS) measurements and investigated the effect of hydration status on vascular functions. Patients and Methods: The study group included an average of 13.3 ± 3.7 years (16 girls and 22 boys, 38 CKD patients), control group on average 12.1 ± 2.9 (16 girls and 15 boys, 31 healthy children). Systolic and diastolic diameters of the aortic annulus and aorta at each level were obtained; z-scores, aortic strain, distensibility, stiffness index were calculated. Carotid intima-media thickness and flow – mediated dilatation were studied. Bioimpedance spectroscopy was performed to all patients. Results: Interventricular septum and left atrial (p=0.002, p=0.013), sinus valsalva and sinotubular junction z scores (p=0.009, p=0.012) were found to be higher and distensibility and strain decreased, stiffness index increased in the abdominal aorta of patients with CKD (p=0.007, p=0.002, p=0.004). Patients with CKD had statistically significant over-hydration. Conclusion: Vascular wall changes that affect the elastic properties of the aortic wall begin to develop in childhood in patients with CKD.

Elasticity and Lipids Changes in Children with Type I Diabetes Mellitus Compared with Controls and the Effect of Lipids on Elasticity in Diabetic Children

Abstract Background Increased atrial elasticity is a marker of cardiovascular events. This study aimed to compare the parameters of elasticity and lipids in children with type 1 diabetes mellitus (TIDM) compared with controls and the effect of lipids on elasticity in children with diabetes. Method This case-control study was performed in 186 children aged 6 to 18 years. The aortic diameter was obtained from 3 cm above the aortic valve using M mode and was calculated as the distance between the medial edge of the anterior and posterior walls of the aorta at systole and diastole. AoS and AoD were recorded when the aortic wall was fully open. The parameters of aortic elasticity, aortic stiffness beta index, aortic tension, and elastic modulus of pressure were measured. Cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were measured. For data analysis, SPSS 20 considers the applicable error to be 0.05. Results The participants were matched by sex and age. The right CHO, LDL, HDL, and MPI lipids, systolic, diastolic, and aortic systolic blood pressure were different among patients. The analysis also showed that ASβI (MWU = 1582.50, p < 0.001) and PSEM (MWU = 1381.00 and p < 0.001) were higher when AS (MWU = 1204 and p < 0.001) and AoD (MWU = 1672.00 and p < 0.001) and AoD (MWU = 1672.00 and p < 0.001) were lower in patients than in controls. No lipid profiles were significantly correlated with stiffness parameters before and after controlling for age. Conclusion It was concluded that lipid profiles were different, and ASβI and PSEM were lower when AoS and AoD were higher in children with diabetes. None of the lipid profiles were significantly correlated with stiffness parameters before and after controlling for age.

Is There a Relationship between P Wave Dispersion and Aortic Elasticity Parameters in Ankylosing Spondylitis?

Is There a Relationship between P Wave Dispersion and Aortic Elasticity Parameters in Ankylosing Spondylitis?

Thickness and Volume of Epicardial Adipose Tissue in Relation to Stiffness and Elasticity of Aorta Assessed by Computed Tomography Angiography.

The aim of the study was to assess the importance of the measurements of thickness and volume of epicardial adipose tissue (EAT) in coronary computed tomography angiography (CCTA) as a predictive factor of increased stiffness and impaired elasticity of aorta. The study involved a group of 97 patients (63.48 ± 8.50 years). In accordance with the medians of epicardial adipose tissue (EAT) parameters, aortic elasticity and stiffness parameters, patients were divided into subgroups: EAT thickness median 9.40 mm, EAT volume median 61.95 mL, EAT thickness index 5.08 mm/m2 and EAT volume index 34.33 mL/m2. The mean coronary artery calcium score was 162.24 (±317.69). The mean aortic stiffness index was 4.18 (±0.81). The assessed mean aortic elasticity parameters were 3.29% (±2.37) and 0.12 cm2/dyn (±0.09) for strain and distensibility, respectively. A positive linear correlation was observed between EAT parameters and aortic stiffness (0.21), volume (0.51), thickness index (0.24), volume index (0.55) and, for aorta elasticity, a negative linear correlation between the following EAT parameters was observed: thickness (-0.32 and -0.30), volume (-0.49 and -0.48), thickness index (-0.34 and -0.31), volume index (-0.51 and -0.49) and aortic elasticity parameters (aorta strain and aorta distensibility, respectively). The study showed that CCTA illustrates a relationship between the parameters of EAT and an increased stiffness of the aorta, while the most predictive factor of stiffness was the volume index.

Relation between aortic elasticity parameters and SYNTAX score in postmenopausal diabetic women

BackgroundPostmenopausal women are at increased risk of coronary artery disease (CAD). Diabetes Mellitus is a major risk factor for CAD. The stiffening of the aorta is associated with increased cardiovascular morbidity and mortality. We aimed to investigate the relation of aortic elasticity parameters to CAD severity assessed by SYNTAX score (SS) in diabetic postmenopausal women. The study prospectively included 200 consecutive diabetic postmenopausal women with CAD who underwent elective coronary angiography. Patients were classified into 3 groups based on SS, low-SS ≤ 22, intermediate-SS ≥ 23– ≤ 32, and high-SS ≥ 33. Echocardiographic aortic elasticity parameters, including aortic stiffness index (ASI), aortic strain (AS) (%) and aortic distensibility (AD) were obtained in all patients.ResultsPatients in the high SS group were older age and had a higher aortic stiffness. After adjusting different co-variates AD, AS, and ASI could be used as independent predictors of high SS with the following P-values (0.019, 0.016 and 0.010) and cut-off values (2.5, 3.6 and 2.9), respectively.ConclusionsIn diabetic postmenopausal women, the simple echocardiography-derived aortic elasticity parameters might predict the severity and complexity of angiographic coronary lesions assessed by the SS.

Endotrophin and matrix metalloproteinase-2 levels in bicuspid aortic valve and hypertension associated aortopathy and their relationship with strain parameters of the ascending aorta.

Bicuspid aortic valve (BAV) is the most common congenital heart defect. Ascending aorta dilatation is related to BAV- and hypertension (HTN)-associated aortopathy. The aim of this study was to investigate aortic elasticity, as well as aortic deformation of the ascending aorta, using strain imaging, and to evaluate the possible relationship of biomarkers, such as endotrophin and matrix metalloproteinase-2 (MMP-2), with ascending aorta dilatation in patients with BAV- or HTN-associated aortopathy. This prospective study included patients with ascending aorta dilatation with BAV (n = 33), or normal tricuspid aortic valve with HTN (n = 33), and 20 control subjects. The mean age of the total patients was 42.76 ± 10.4 years (67% male, 33% female). We calculated aortic elasticity parameters using the relevant formula by M-mode echocardiography and determined layer-specific longitudinal and transverse strains of the proximal aorta by speckle-tracking echocardiography. Blood samples of the participants were drawn for the analysis of endotrophin and MMP-2. Aortic strain and aortic distensibility were significantly decreased, whereas the aortic stiffness index was significantly increased in patient groups with BAV or HTN compared to the control group (p < 0.001). Moreover, longitudinal strain of both the anterior and posterior aortic walls of the proximal aorta were significantly impaired in BAV and HTN patients (p < 0.001). Serum endotrophin levels were significantly reduced in the patient cohort compared to the controls (p = 0.001). Endotrophin was noted to be significantly positively correlated with aortic strain and aortic distensibility (r = 0.37, p = 0.001; r = 0.45, p < 0.001, respectively), whereas inversely associated with aortic stiffness index (r = -0.402, p < 0.001). Furthermore, endotrophin was the single independent predictor of ascending aorta dilatation (OR = 0.986, p < 0.001). A cut-off value of endotrophin ≤ 82.38 ng/mL predicted ascending aorta dilatation with a sensitivity of 80.3% and specificity of 78.5% (p < 0.0001). The present study showed that aortic deformation parameters and elasticity are impaired in BAV and HTN patients, and strain imaging allows for a good analysis of ascending aorta deformation. Endotrophin could be a predictive biomarker of ascending aorta dilatation in BAV and HTN aortopathy.

Evaluation of Aortic Elasticity Parameters Measured by Transthoracic Echocardiography in a Normotensive Population: A Single-Center Study.

Impaired arterial elastic features is one of the earliest manifestations of atherosclerosis in the vessel wall and is associated with the development of cardiovascular disease and increased mortality and morbidity. In this study, we aimed to investigate the mean values of aortic elasticity parameters in a normotensive population with transthoracic echocardiography and to evaluate these values in different age groups and their relationship with other risk factors. This retrospective study included 405 subjects who met the inclusion criteria among 2880 individuals screened between 2020 and 2022. The study population was divided into 5 groups according to their age. Aortic elasticity parameters (aortic strain, aortic stiffness index, and aortic distensibility) were calculated from the associated formulas by measurements made from the ascending aorta in the parasternal long axis. In 405 subjects (mean age 42.18 ± 10.39, 54.3% female), the mean aortic strain value was 15.14 ± 3.56%, the mean aortic stiffness index was 3.24 ± 1.05, and the mean aortic distensibility was 7.48 ± 2.36 cm2/dyn1/103. It was observed that aortic strain and distensibility values significantly decreased with increasing age groups, while aortic stiffness significantly increased. All 3 aortic elasticity parameters were strongly correlated to age. In the multivariate linear regression analysis, age was found to be an independent factor for all aortic elasticity parameters. Aortic elasticity parameters can be evaluated with transthoracic echocardiography in daily practice. Comparing these measurements with normal values in similar age groups may help to detect patients with increased cardiovascular risk in the early period, regardless of the other risk factors.

Assessment of aortic elasticity parameters in obese and overweight children.

Aortic elasticity is a predictor and recognized factor for future cardiovascular events in children. The aim of the study was to evaluate the aortic stiffness in obese and overweight children compared to healthy ones. The study evaluated 98 sex matched children aged 4 to 16 years that were equally distributed in asymptomatic obese or overweight and healthy children groups. All the participants were free of any heart diseases. Arterial stiffness indices were determined using two-dimensional echocardiography. The mean ages in the obese and healthy children were 10.40±2.50 years and 10.06±1.53 years, respectively. Aortic strain was significantly higher in obese children (20.70±5.04%), compared to healthy (7.06±3.77%) and overweight children (18.59±8.08%, p < 0.001). Aortic distensibility (AD) was significantly higher in obese children (0.010±0.005 cm < sup > 2 < /sup > dyn-1x10-6), compared to healthy (0.0036±0.004 cm < sup > 2 < /sup > dyn-1x10 < sup > -6 < /sup > ) and overweight children (0.009±0.005 cm < sup > 2 < /sup > dyn-1x10 < sup > -6 < /sup > , p < 0.001). Aortic strain beta (ASβ) index, was significantly higher in healthy children (9.26±6.17). Pressure-strain elastic modulus (PSEM) was significantly higher in healthy children (7.52±4.76 kPa). Systolic blood pressure increased with body mass index (BMI) significantly (p < 0.001) but diastolic blood pressure did not change (p=0.143). BMI had significant effect on arterial stiffness (AS) (β=0.732, p < 0.001), AD (β=0.636, p < 0.001), ASβ index (β=-0.573, p < 0.001) and PSEM (β=-0.578, p < 0.001). Age had significant effect on systolic diameter of the aorta (β=0.340, p < 0.001) and diastolic diameter of the aorta (β=0.407, p < 0.001). We concluded that aortic strain and aortic distensibility increased in obese children when aortic strain beta index and PSEM decreased. This result suggests that, as atrial stiffness is a predictor for future heart diseases, dietary treatment for children with overweight or obese status is important.

Evaluation of aortic stiffness by echocardiography in tympanosclerosis patients

Tympanosclerosis (TS) is a scarring process that may occur during otitis media. Aortic stiffness (AS) is a significant predictor for the development of heart diseases due to its close relationship with atherosclerosis. Similar pathophysiological processes based on inflammation may explain both TS and AS formation. We hypothesized that aortic elasticity, an indicator of AS, might be impaired in patients suffering from TS. The present study aimed to evaluate echocardiographically the aortic elasticity properties and measure blood inflammatory parameters in TS-detected patients.Ninety-eight participants diagnosed with chronic otitis media were enrolled in the study. TS-detected 42 participants were subjected to the study group, while 56 without TS constituted the control group. The two groups' demographic, clinical, echocardiographic, and laboratory characteristics were compared.Demographic, clinical, and laboratory parameter differences were found insignificant. Hs-CRP, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index were significantly higher in the study group than the control group (p=0.018, p=0.003, p=0.019, respectively).The study group had significantly lower aortic strain (11.80 ± 4.84 vs. 16.30 ± 3.91; p<0.001) and distensibility (5.23 ± 2.68 vs. 7.24 ± 2.89; p=0.001) values than the control group. The AS index was meaningfully higher in the study group than in the control group (4.81 ± 2.41 vs. 3.12 ± 1.02; p<0.001). Other echocardiographic parameters between the two groups were found to be insignificant.In TS-detected patients, AS parameters were found to be impaired. Aortic elasticity parameters measured by echocardiography, a non-invasive and easily accessible method, can help predict the risk of atherosclerosis and related diseases in TS-developed patients.

Evaluation of Aortic Elasticity Parameters in Survivors of COVID-19 Using Echocardiography Imaging

Objective: While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects lung tissue, it may cause direct or indirect damage to the cardiovascular system, and permanent damage may occur. Arterial stiffness is an early indicator of cardiovascular disease risk. The aim of our study was to establish the potential effects of SARS-CoV-2 on the vascular system evaluated by transthoracic echocardiographic examination. Subjects and Methods: This study compared arterial stiffness between the survivors of COVID-19 and those without a history of COVID-19 infection. The difference in aortic diameter was examined using echocardiography. Results: The study included 50 patients who survived COVID-19 in the last 3–6 months and 50 age- and gender-matched healthy volunteers. In surviving COVID-19 patients, aortic diastolic diameter in cm ([3.1 ± 0.2] vs. [2.9 ± 0.1], p < 0.001), pulse pressure (PP) ([43.02 ± 14.05] vs. [35.74 ± 9.86], p = 0.004), aortic distensibility ([5.61 ± 3.57] vs. [8.31 ± 3.82], p < 0.001), aortic strain ([10.56 ± 4.91] vs. [13.88 ± 5.86], p = 0.003), PP/stroke volume index ([1.25 ± 0.47] vs. [0.98 ± 0.28], p = 0.001), and aortic stiffness index ([2.82 ± 0.47] vs. [2.46 ± 0.45], p < 0.001) were statistically significant compared to the control group. Conclusion: SARS-CoV-2 may cause reduced or impaired aortic elasticity parameters linked to impaired arterial wall function in COVID-19 survivors compared with controls.

Echocardiographic Evaluation of Aortic Elasticity Parameters in Aortic Stenosis Patients with Preserved Ejection Fractions Undergoing Transcatheter Aortic Valve Implantation

INTRODUCTION: Aortic stiffness is an important risk factor that reflects the mechanical tension and elasticity of the aorta and predicts cardiovascular mortality and morbidity. However, it has been found that aortic stiffness contributes to both symptom burden and clinical outcomes in patients with aortic stenosis (AS). In our study, we aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) on aortic elasticity parameters by echocardiography in patients with severe aortic stenosis, especially with preserved ejection fraction. METHODS: A total of 55 consecutive patients with symptomatic severe AS who underwent TAVI were included in the study. Demographic data, echocardiographic and aortic elasticity measurements of all patients were measured before and 6 months after the procedure. To evaluate the elastic properties of the aorta, aortic strain, distensibility and stiffness index were calculated. RESULTS: Left ventricular mass index (LVMI) (p &lt;0.001) and aortic stiffness (p &lt;0.001) were decreased, while aortic strain (p &lt;0.001) and aortic distensibility (p &lt;0.001) were found to be increased in the measurements performed at 6 months after TAVI. In the regression analysis, age and LVMI were found to be independent predictors for predicting improvement in aortic stiffness, on the other hand, LVMI also independently predicted the increase in aortic distensibility. CONCLUSION: Improvement in aortic elastic properties and left ventricular functions were found in patients who underwent TAVI. Age and LVMI were observed to predict the improvement in stiffness and distensibility of the aorta in patients undergoing TAVI, especially in AS patients with preserved ejection fraction.

Relationship between Retinal Nerve Fiber Layer Thickness and Aortic Distensibility in Peripheral Arterial Disease Patients.

Aim and objectiveTo evaluate the relationship between aortic distensibility (AD) and aortic stiffness B index (ASBI) with retinal nerve fiber layer (RNFL) thickness measured with HD-OCT in peripheral arterial disease (PAD) patients.Materials and methodsTwenty-six PAD patients and 22 age-matched healthy control were enrolled. Subjects with PAD were classified into two groups. Patients with diabetes (DM) or hypertension (HT) comprised group I (n = 18) and without DM or HT comprised group II (n = 8). Color Doppler imaging was performed on all patients and PAD was diagnosed by using the ankle-brachial index (ABI). Retinal nerve fiber layer thickness values between control and PAD patients and correlations between RNFL thickness and aortic stiffness parameters (AD and ASBI) were evaluated.ResultsThe inferior-nasal and inferior-temporal quadrant were the thickest in healthy subjects and the PAD group. Retinal nerve fiber layer thickness significantly decreased in superior-nasal, temporal, inferior-nasal quadrants in group I than healthy subjects (p < 0.001, p = 0.005, p < 0.001). Temporal and inferior-nasal quadrant thicknesses were statistically significantly thinner in group II than controls (p = 0.02, p < 0.001). The nasal RNFL quadrant was significantly thinner in group I than group II (p = 0.014). The correlation between RNFL thickness and aortic elasticity parameters in each group was not found to be significant.Conclusion and clinical significanceIsolated PAD without DM or HT may lead to localized RNFL loss in temporal and inferior-nasal quadrants. Aortic elasticity parameters did not seem to be correlated with RNFL thickness in PAD.How to cite this articleKumova D, Aktas Z, Eyiol A, et al. Relationship between Retinal Nerve Fiber Layer Thickness and Aortic Distensibility in Peripheral Arterial Disease Patients. J Curr Glaucoma Pract 2021;15(2):86–90.

The association of aortic elasticity properties with novel inflammatory marker CRP /albumin ratio

ABSTRACT Objective Hypertension (HT) is the most important preventable cause of cardiovascular disease and mortality. Aortic elasticity parameters are affected in HT, and inflammation plays a central role in the development of HT. C-reactive protein (CRP) to albumin ratio (CAR) is a novel inflammatory marker. We aimed to evaluate the association of aortic elasticity properties with CAR. Methods A total of newly diagnosed untreated 101 hypertensive patients and 98 control participants were included to study. Clinical, demographic parameters, and blood sample parameters were recorded. Aortic strain, aortic stiffness index (ASI), and aortic distensibility (AoD) as aortic elasticity parameters were obtained from transthoracic echocardiography. Results CRP, CAR, ASI were significantly higher in hypertensive patients. (6.32 ± 2.48 vs 8.41 ± 3.35, p:<0.001; 0.158 ± 0.065 vs. 0.204 ± 0.083, p: <0.001; 6.73 ± 1.00 vs. 10.93 ± 1.81, p: <0.001, respectively) Aortic strain and AoD levels were significantly lower in hypertensive patients. (6.75 ± 2.17 vs 7.98 ± 2.27; p: <0.001 vs. 3.05 ± 0.97 vs 5.16 ± 1.01; p: <0.001, respectively) Conclusion CAR a novel inflammatory marker, which can be obtained from blood samples without additional time and cost, can be useful to predict aortic elasticity properties of hypertensive patients in daily clinical practice.

Evaluation of Aortic Elasticity in Children with Celiac Disease Compared with Controls

Background Celiac disease (CD) is a lifelong, chronic and immune-mediated disorder. Recent studies have turned on a new light on the importance of inflammation in the pathogenesis of arterial stiffness. The aim of this study was to evaluate arterial stiffness in children with celiac disease compared with controls. Materials and Methods: In this case-control study, fifty children aged from 3.5 to 18 year- old with celiac compared with 50 age and sex-matched controls. The study performed in Ali Asghar pediatric hospital in Zahedan city, Iran during the year 2019. Echocardiography, aortic elasticity, blood pressure, tissue transglutaminase IgA (tTG-IgA), and anthropomorphic parameters were measured. Arterial stiffness indices determined using 2D and Doppler echocardiography. Data were analyzed using SPSS software version 20.0. Results: In all and CD children, 51% and 56% were girls, respectively. Systolic and diastolic blood pressure were lower in patients (p <0.001). Aortic diameter in diastole was lower in patients significantly (p <0.001). Aortic strain (<0.001), PSEM (<0.001), AD (<0.001), and ASI (p <0.001) were different between celiac patients and controls. Tissue transglutaminase IgA (tTG-IgA) was changed significantly with Marsh classification (p <0.001); tTG-IgA was correlated with strain (r= 0.417, p=0.003), and AD (r= 0.282, p=0.047) before age control when the trends did not change after age control for AD (r=0.241, p=0.096). LVMI was correlated with strain (r=-0309, p=0.029), PSEM (r=0.322, p=0.023), and AD (r=0.326, p=0.021) before controlling age when after age control this significant correlation omitted. Conclusion Concluded that aortic elastic risk is higher in celiac children when is free of modified marsh classification. Most of the aortic elastic parameters had significant correlation with changes of tTG-IgA antibody in children with celiac disease.

Left ventricular rotational abnormalities in adult patients with corrected tetralogy of Fallot following different surgical procedures (Results from the CSONGRAD Registry and MAGYAR-Path Study)

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD). Abnormal aortic dimensions and elasticity parameters have been long described for corrected TOF (cTOF) together with left ventricular (LV) rotational abnormalities, but results are conflicting. The present study focuses on investigating LV rotational mechanics in cTOF, and possible correlation of these parameters with aortic elasticity. It was also aimed to be examined whether different surgical strategies have any effect on these results. The study involved 26 adult cTOF patients, from which 14 had palliative surgery first and a late total correction (pcTOF), while early total correction was the treatment of choice in 12 patients (etrTOF). Their results were compared to those of 37 age- and gender-matched healthy adults. Routine transthoracic two-dimensional Doppler echocardiography extended with assessment of aortic elastic properties and three-dimensional speckle-tracking echocardiography (3DSTE) was performed in all cTOF patients and controls. Sixteen out of 26 cTOF patients showed normally directed LV rotational mechanics, while apical or basal LV rotations were in the same clockwise or counterclockwise directions in 7 and 3 cTOF cases, respectively (LV 'rigid body rotation', RBR). Significantly reduced LV apical rotation and twist could be demonstrated in all cTOF patients with preserved LV basal rotation regardless of previous procedure. pcTOF patients showed significantly reduced LV apical rotation as compared to that of etrTOF cases. Significant correlations could be demonstrated between LV apical rotation and aortic stiffness index (r=-0.55, P=0.03) and aortic distensibility (r=0.52, P=0.04). Significant LV rotational abnormalities could be demonstrated in cTOF with the high prevalence of LV-RBR. pcTOF patients showed significantly reduced LV apical rotation as compared to that of etrTOF cases. Unexpected abnormal physiologic response of LV rotational mechanics to increased aortic stiffness can be detected in cTOF patients without LV-RBR.

The effect of Celiac disease on cardiac functions and aortic elasticity parameters in children.

We aimed to investigate the effect of Celiac disease on myocardial functions and aortic elasticity parameters. Thirty children with Celiac disease and 30 healthy children were enrolled in the study. Both the groups were similar in terms of age and gender. Cardiac functions of all children in the patients and control group were evaluated using conventional transthoracic echocardiography and tissue Doppler imaging. Aortic strain, distensibility, and stiffness index were calculated by M-mode echocardiography. The demographic findings, height, weight, and body mass index of cases were similar among two groups. No statistical difference was found between E wave velocity for conventional transthoracic echocardiography and tissue Doppler imaging measurements of the mitral valve; early diastolic flow peak velocity, A wave velocity; late diastolic flow peak velocity; and E/A ratio. Isovolumetric relaxation time and isovolumetric contraction time ratios were statistically different between the groups (p = 0.000, p = 0.000, p = 0.000). The myocardial performance index calculated according to the pulse Doppler measurement results was found to be statistically different between the groups (p = 0.000). There was no statistical difference between the groups in terms of aortic strain, distensibility, and stiffness index. In this study, both conventional transthoracic echocardiography and tissue Doppler imaging revealed the affection of the myocardial functions during systole and diastole in children with Celiac disease. Therefore, early follow-up and routine cardiac evaluation of celiac patients may be appropriate due to the increased risk of cardiac affection.

Left ventricular rotational abnormalities in adult patients with corrected tetralogy of Fallot following different surgical procedures – a three-dimensional speckle-tracking echocardiographic study

Abstract Introduction Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Abnormal aortic dimensions and elasticity parameters have been long described for corrected TOF (cTOF) together with left ventricular (LV) rotational abnormalities. The present study focuses on investigating LV rotational mechanics in cTOF, and possible correlation of these parameters with aortic elastic properties. It was also aimed to be examined whether different surgical strategies has any effect on the results. Methods The study involved 26 adult cTOF patients, from which 14 had palliative surgery first [Blaloc-Taussig (n=10), Waterstone-Cooley (n=2) shunts, or Brock procedure (n=2)] (mean age at the repair: 7.3±10.2 years) and a late total correction (mean age at the repair: 10.0±13.3 years) (pcTOF), while the early total correction was the treatment of choice in 12 patients (mean age at the repair: 4.2±3.2 years) (etrTOF). Their results were compared to that of 37 age- and gender-matched healthy adults. Routine transthoracic two-dimensional Doppler echocardiography extended with assessment of aortic elastic properties and three-dimensional speckle-tracking echocardiography (3DSTE) was performed in all cTOF patients and controls. Results Sixteen out of 26 cTOF patients showed normally directed LV rotational mechanics, while apical and basal LV rotations were in the same clockwise and counterclockwise directions in 7 and 3 cTOF cases, respectively (38%). This sort of LV movement is called as LV rigid body rotation (RBR). The ratio of LV-RBR between etrTOF and pcTOF patients did not differ significantly (33% vs. 43%, p=0.70). Significantly reduced LV apical rotation (5.2±3.7 degree vs. 10.2±4.5 degree, p&amp;lt;0.05) and twist (9.0±3.3 degree vs. 14.6±4.9 degree, p&amp;lt;0.05) could be demonstrated in cTOF patients with normally directed LV rotational mechanics with preserved LV basal rotation regardless of previous procedure. pcTOF patients showed significantly reduced LV apical rotation as compared to that of etrTOF cases (3.2±3.7 degree vs. 7.1±2.5 degree, p&amp;lt;0.05). From the 7 cTOF patients with clockwise LV-RBR, apical and basal LV rotation proved to be −6.8±5.4 degree and −4.9±2.4 degree, respectively with LV apico-basal gradient of 4.3±3.6 degree. The mean LV apical and basal LV rotation of 3 cTOF patients with counterclockwise LV-RBR prove to be −2.1±3.4 degree and 0.2±0.9 degree, respectively with LV apico-basal gradient of 2.5±2.4 degree. Significant correlations could be demonstrated between LV apical rotation and aortic stiffness index (r=−0.55, p=0.03) and aortic distensibility (r=0.52, p=0.04). Conclusions Significant LV rotational abnormalities could be demonstrated in cTOF with the high prevalence of LV-RBR. cTOF patients with early total reconstruction proved to have beneficial results. Abnormal physiologic response of LV rotational mechanics to increased aortic stiffness can be detected in cTOF patients without LV-RBR. Funding Acknowledgement Type of funding source: None

Aortic Strain -Threshold Analysis of Non-Cancer Outcome from Arsenic Exposure

Background: While arsenic has been shown in many studies to behave as a threshold carcinogen, analyses of non-cancer outcomes (e.g., cardiovascular) have generally been presented only using linear models. Alternative models have received little consideration. We choose here to examine aortic strain data, a known risk factor for hypertension and cardiovascular disease, on arsenic-exposed workers with alternative analytic modeling.Method: A previously published study (Karakulak et al., 2016) of aortic strain measurements in arsenic-exposed workers had demonstrated that aortic strain was markedly reduced among workers with high levels of arsenic exposure (urinary arsenic in ug/L). The original analysis was limited to a linear model without model validation. We have analyzed the data using alternative models.Results: Examination of the linear analysis and its residuals demonstrated significant heteroscedascity with unequal variances, particularly at urinary levels of &gt; 160 ug arsenic per liter (ug/L). The test of equal variances from samples with &gt;160 and samples &lt;= 160 demonstrated inequality (p &lt; 0.0001). The better alternative model was a step-function with a mean aortic strain of 11.3% for those with urinary arsenic &lt;= 160 ug/L and with a mean aortic strain of 5.3% for those with urinary arsenic &gt; 160 ug/L. A further stratified analysis with bins of 40 ug/L showed no effect on aortic strain for the urinary arsenic range of &lt;= 160 ug/L and, separately, no effect for the urinary arsenic range of &gt; 160 ug/L.Conclusion: Aortic elasticity parameters show an adverse effect from arsenic exposure only at urinary exposure levels of &gt; 160 ug/L and not below, indicating a step-function rather than a linear function. Restriction of analyses to a linear no-threshold model may have blinded the finding of a more useful demonstration of a dose-response pattern that may offer different toxicological interpretations.

Relationship of growth differentiation factor-15 with aortic stiffness in essential hypertension.

Aim:We aimed to assess the relationship between echocardiographic parameters of aortic elasticity, namely aortic strain, aortic distensibility and aortic β-index, and serum growth differentiation factor (GDF)-15 in patients with newly diagnosed essential hypertension (HT).Methods:Grade-1 HT patients (n = 50), grade-2 HT (n = 70) patients and 35 healthy controls were included.Results:GDF-15 was greater in grade-2 HT group compared with the other groups. All aortic elasticity parameters were worse in grade-2 HT group compared with the other groups. GDF-15 correlated positively with E/E′ ratio (the ratio of transmitral E velocity to mean diastolic mitral annular velocity) and β-index; and aortic strain and aortic distensibility correlated negatively with serum GDF-15. β-index, aortic diastolic diameter and diastolic blood pressure were independently associated with GDF-15.Conclusion:GDF-15 may be utilized in the prediction of increased aortic stiffness.

Aortic elastic properties do not differ in patients with mitral valve prolapse

Objective: Mitral valve prolapse (MVP) is one of the most frequently seen cardiac disorders. The basic pathophysiologic mechanism is deterioration in the connective tissue leading to increased elasticity of mitral leaflets. Elasticity of the aorta which is a well established predictor of adverse cardiovascular outcomes may also differ in these patients when alteration in the connective tissue is taken into account. The aim of this study is to investigate the elastic properties of the aorta in patients with MVP. Method: Thirty seven patients with MVP and 38 healthy controls were evaluated in terms of aortic elastic properties using aortic strain, aortic stiffness index and aortic distensibility. Results: Median value for aortic strain was 0.07 (0.0338-0.231) in MVP group and 0.079 (0.0345-0.28) in the control group (p=0.359). Aortic stiffness was calculated on the basis of aortic strain. The mean value for stiffness index was 6.87 ± 3.59 and 6.21 ± 2.83 in the MVP and control groups respectively (p=0.388). Distensibility of the aorta was quantified with a median value of 3286 (1229-12700) in patients with MVP and 3400 (1087-13790) in healthy subjects (p=0.346). Eventually, when the aortic elastic parameters were compared (aortic strain, stiffness index and distensibility), no difference was found between MVP and control groups. Conclusions: The elastic properties of the aorta do not differ in patients with MVP when compared to healthy individuals. It will not be accurate to predict long term cardiovascular outcomes based on elastic properties of the aorta in patients with MVP.