Aortic Elasticity Research Articles

Towards a reduced order model for EVAR planning and intra-operative navigation

IntroductionThe pre-operative planning and intra-operative navigation of the endovascular aneurysm repair (EVAR) procedure are currently challenged by the aortic deformations that occur due to the insertion of a stiff guidewire. Hence, a fast and accurate predictive tool may help clinicians in the decision-making process and during surgical navigation, potentially reducing the radiations and contrast dose. To this aim, we generated a reduced order model (ROM) trained on parametric finite element simulations of the aortic wall-guidewire interaction. MethodA Design of Experiments (DOE) consisting of 300 scenarios was created spanning over seven parameters. Radial basis functions were used to achieve a morphological parametrization of the aortic geometry. The ROM was built using 200 scenarios for training and the remaining 100 for validation. ResultsThe developed ROM estimated the displacement of aortic nodes with a relative error below 5.5% for all the considered validation cases. From a preliminary analysis, the aortic elasticity, the stiffness of the guidewire and the tortuosity of the cannulated iliac artery proved to be the most influential parameters. ConclusionsOnce built, the ROM provided almost real-time and accurate estimations of the guidewire-induced aortic displacement field, thus potentially being a promising pre- and intra-operative tool for clinicians.

Evaluation of aortic elasticity properties in mucopolysaccharidosis patients; effect of enzyme replacement therapy (ERT) on aortic stiffness.

We aimed to cardiologically evaluate the consequences of glycosaminoglycan (GAG) accumulation in the large vessels of patients with mucopolysaccharidosis (MPS). The left ventricular wall thickness, left ventricular mass (LVmass) were evaluated and aortic annulus diameter (AA), aortic sinus valsalva diameter (SV), sinotubular junction diameter (STJ), systolic aortic diameter (ADs), diastolic aortic diameter (ADd) body indices were obtained by dividing by the surface area. Aortic distensibility and stiffness index were obtained using aortic strain. Ejection fraction, mitral E and A velocities, mitral early diastolic tissue velocity (e'), E/A ratio, and E/e' ratio were evaluated. The LVED-i, LVmass-i, AA-i, SV-i, STJ-i, ADs-i, and ADd-i values were significantly higher in the MPS group. While the E and e' velocities and E/A ratio were significantly low in the MPS group, the A velocity and E/e' ratio were significantly high. While the stiffness index, SBP, and PP values were significantly higher in the MPS group, the aortic strain and distensibility were significantly lower. There was a correlation between the stiffness index and the aortic strain, distensibility, SBP, PP, and ventricular function. Cardiac function, aortic diameter, and aortic elasticity characteristics were similar between patients with MPS who received ERT and those who did not. In the MPS group, aortic elasticity properties were impaired, and aortic stiffness increased. ERT has positive effects on cardiac function, aortic diameter, and aortic stiffness in MPS patients. An increased LVmass-i and impaired ventricular geometric structure in patients with MPS may be associated with increased aortic stiffness.

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.

Aortic Elasticity and Cardiovascular Risk Stratification: A Narrative Review on the Current Understanding

Cardiovascular risk stratification is a cornerstone of preventive cardiology, aiming to identify individuals at a higher risk for adverse events. In line with this, aortic elastic properties have gained recognition as crucial indicators of vascular health and predictors of cardiovascular outcomes. This narrative review delves into the significance of aortic stiffness, compliance, and distensibility in risk assessment, shedding light on their associations with cardiovascular diseases, such as hypertension, atherosclerosis, and coronary artery disease. This review aims to provide an overview of the current knowledge regarding aortic elastic properties and their role in cardiovascular risk stratification. The exploration of potential mechanisms and clinical implications outlines the need for further research to establish precise links between aortic elasticity and cardiovascular risk. Furthermore, the integration of advanced imaging, genetic factors, and personalized medicine is suggested to refine risk assessment strategies and enhance patient care. Ultimately, this review underscores the importance of aortic elastic properties in cardiovascular risk prediction, opening avenues for future research and clinical application.

Exploring cardiovascular implications of juvenile dermatomyositis: Insights from aortic stiffness analysis and 3D echocardiography.

Our goal was to use three dimensional (3D) strain analysis to evaluate myocardial function and ascending aorta elasticity changes in juvenile dermatomyositis (JDM). Between 2019 and 2021, 23 JDM patients and 20 healthy volunteers participated. Both groups underwent 2D and 3D strain analysis, assessing aortic stiffness using aortic distensibility, stiffness index, strain, and elastic modulus. JDM patients had a median age of 13.3±5.2 years, while controls had a median age of 13.8±4.76 years. 3D strain analysis revealed significantly lower global longitudinal (GLS) and circumferential strain (GCS) in JDM patients compared to controls. Specifically, 3D GLS was notably reduced in patients (-28.1% vs. -31%, p=.047) compared to controls, and 3D GCS was also lower in patients (-27.5% vs. -30.5%, p=.019) compared to controls. Aortic strain and elastic modulus were significantly lower in JDM patients, while aortic stiffness index and distensibility showed no significant differences. Correlation analyses within the JDM group revealed a negative correlation between 3D GLS and age at diagnosis (r=-.561, p=.04), as well as a positive correlation between 3D GLS and both aortic strain (r=.514, p=.0001) and elastic modulus (r=.320, p=.03) in JDM patients. Our study demonstrated a trend towards lower ejection fraction and strain in patients with JDM, along with increased aortic stiffness using 3D echocardiography. These findings suggest potential cardiovascular involvement in juvenile dermatomyositis, emphasizing the importance of comprehensive cardiac assessments in these patients.

Stiffness and Elasticity of Aorta Assessed Using Computed Tomography Angiography as a Marker of Cardiovascular Health-A Cross-Sectional Study.

Cardiovascular (CV) health can be measured using the American Health Association's Life's Simple 7 scale (ALS7). Aortic stiffness (AoS) and elasticity (AoE) can be assessed using various methods, e.g., computed tomography (CT). To measure AoE, we use aortic strain and distensibility (AoD). The aim of this study was to examine the relationship between ALS7, AoS, and AoE. The study group (SG) was composed of 96 patients (mean age 70.41 ± 8.32 years) with a BMI of 25.58 ± 3.12 kg/m2; 28.1% were smokers, 54.2% had hypertension, 11.4% had diabetes, and 67.7% had hypercholesterolemia. The SG was further divided into three subgroups (optimal (ALS7-H), intermediate (ALS7-I), and inadequate (ALS7-L)) based on the ALS7. The AoS and AoE were assessed in each of them. We found that the ALS7-I and ALS7-H had significantly lower AoS values compared to the ALS7-L (AoS: 3.50 ± 0.53 and 4.10 ± 0.70 vs. 4.57 ± 1.03, respectively). The opposite relationship was observed for AoE measured with AoD in the ALS7-H vs. ALS7-L (AoD: 0.23 ± 0.14 vs. 0.11 ± 0.09 cm2/dyn). AoS correlated (r = 0.61) with systolic blood pressure (BP). In our regression model, higher scores on the ALS7 in BP, smoking, and BMI were independent protective factors against greater AoS. Higher ALS7 scores in BP, smoking, BMI, and physical activity were protective factors against lesser aortic strain. Higher scores in ALS7 for BP and smoking were protective factors against lesser AoD. We conclude that better cardiovascular health expressed via higher scores obtained on the ALS7 is associated with lower AoS and higher AoE on CT.

Alterations in aortic elasticity indices among type 2 diabetes patients in a low and middle income country using M-mode echocardiography: A cross-sectional comparative study.

Diabetes is one of the leading causes of noncommunicable diseases worldwide. It is known to induce cardiovascular remodeling, which can result in a variety of complications, including a considerable increase in aortic stiffness. While studies in Western populations have explored these effects, data on Asians, mainly Vietnamese, are limited. This study aimed to assess aortic elasticity in type 2 diabetes mellitus (T2DM) patients compared to healthy individuals. This quantitative, cross-sectional study compared aortic elasticity indices between individuals with T2DM and healthy controls in Vietnam. Aortic elasticity indices were assessed for all participants using M-mode echocardiography. A comparison between the healthy and T2DM groups revealed substantial differences in aortic elasticity indices. The aortic stiffness index (ASI) was significantly greater in the T2DM group than in the control group, with median values of 6.10 (3.64-12.47) and 3.79 (2.40-8.50), respectively (p = 0.003). Aortic strain (AS) was substantially lower in the T2DM group than in the control group, with median values of 8.21% (4.24-13.07) and 10.66% (6.01-18.23), respectively (p = 0.039). Furthermore, the median aortic compliance (AC, 10-2mm/mmHg) and aortic distensibility (AD, 10-3mmHg-1) in individuals with T2DM were 4.07 (2.28-7.44) and 3.08 (1.57-5.26), respectively, lower than those in the control group, with median values of 6.40 (3.08-10.75) and 5.33 (2.80-9.79). A longer diabetes duration was linked to a greater ASI (r = 0.43, p < 0.05), while the AS decreased (r = -0.37, p < 0.05). Substantial variations in aorta elasticity indices were found in patients with T2DM using M-mode echocardiography. These differences highlight the impact of T2DM on vascular health. More research is needed to investigate the consequences of these discrepancies and their significance for clinical purposes.

The Effect of Number of Pregnancies on Aortic Stiffness Index, Aortic Velocity Propagation, and Epicardial Fat Thickness.

Pregnancy causes physiological, hormonal, and hemodynamic changes that affect the aortic wall dimensions and elastic properties. Multiple pregnancies increase the risk of aortic enlargement and reduce aortic elasticity. The aortic stiffness index (ASI) and aortic velocity propagation (AVP) are markers of elasticity. Additionally, epicardial fat thickness (EFT) is associated with cardiovascular risk factors. The impact of multiparity on ASI, AVP, and EFT has not been previously reported in the literature. Therefore, we aimed to investigate the association of these parameters with the number of live pregnancies in this study. A total of 410 patients were enrolled in this prospective study. Patients were divided into three groups based on the number of live births: Group 1 (n = 0, 128 patients), Group 2 (4 ≥ n > 0, 157 patients), and Group 3 (n ≥ 5, 125 patients). A linear regression analysis was conducted to investigate trend associations of ASI, AVP, and EFT between the study groups. Multiple linear regression analysis was used to evaluate the independent predictors of continuous parameters. There were increasing trends in multiparity with variables such as aortic systolic (ASD) and diastolic diameters, pulmonary artery diameters, ASI, and EFT, and a decreasing trend in AVP. The number of pregnancies was strongly and positively correlated with ASI, moderately and positively correlated with EFT and ASD, and moderately and negatively correlated with AVP. Multiparity was independently associated with ASI, EFT, ASD, and AVP, reflecting decreased elasticity and elevated cardiovascular risk in multiparous women.

MiR-22 inhibits angiotensin II-induced aortic dissection and protects aortic vessel wall in mice by targeting MAPK14

Purpose: To study the effect of miR-22 on angiotensin II-induced aortic dissection in mice, and its protective effect on aortic vessel wall, as well the involvement of MAPK-14 in these processes.&#x0D; Methods: A mouse aortic dissection model was established via subcutaneous implantation of angiotensin II (1 µg/kg/min) micropump in the dorsal region. The mice (n = 30) were assigned in equal numbers to 5 groups (n = 6). All injections were given via the tail vein. The miR-22 expressions in aortas of mice in each group were determined with quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Western blot assay was used to determine the expressions of MAPK-14 protein, while H&amp;E staining was used to measure the ratio of aortic thickness-to-diameter, and contents of collagen and elastic fibers.&#x0D; Results: The expression of miR-22 in aorta of mice in miR-22 overexpression group was significantly higher than that in overexpression control group, but significantly lower in miR-22 inhibition mouse than in inhibition control mouse (p &lt; 0.05). There was significantly lower protein expression of MAPK-14 in mice aorta in miR-22 overexpression mice than in overexpression control mice, but significantly upregulated in miR-22 inhibition mice, relative to that in inhibition control mice (p &lt; 0.05). In the miR-22 overexpression mice, the ratio of membrane thickness-to-diameter was higher than the corresponding value in miR-22 inhibition mice. There were significantly higher contents of aortic elastic and collagen fibers in miR-22 overexpression mice than in overexpression control and miR-22 inhibition groups (p &lt; 0.05).&#x0D; Conclusion: Overexpression of miR-22 inhibits the up-regulation of expression of its target gene mapk14, increases thickness of aortic media and aortic elasticity in mice, and increase the content of collagen fibers, thereby exerting protective effect on aortic wall structure.

Left atrial strain brings new insights for evaluating early diastolic dysfunction in patients with well-functioning bicuspid aortic valve.

Left atrial reservoir strain (LARS) is an early sensor of left ventricular (LV) diastolic dysfunction. Still, the clinical implications of LARS in patients with well-functioning bicuspid aortic valve (BAV) remain unknown. The study recruited 103 patients with well-functioning BAV and 50 controls with tricuspid aortic valves. LARS, LV global longitudinal strain (LVGLS) and aortic elasticity indices (aortic strain, aortic distensibility and stiffness index) were acquired. This study aimed to analyze the changes of LARS and further explore the influential factorsof LARS in patients with well-functioning BAV. Patients with BAV had lower LARS (34.17±4.85vs. 44.72±6.06 %, P<.001) and LVGLS (20.53±1.28vs. 22.30±.62 %, P<.001), and abnormal aortic elasticity indices (aortic strain:7.14±1.57vs. 10.99±1.03 %, aortic distensibility: 5.82±1.50vs. 8.98±2.42 (10-6 cm2 dyne-1 ), and stiffness index: 6.30±2.30vs. 3.92±.98, all P<.05) compared with controls. LARS was associated with LVGLS (r=.799), interventricular septum index (r=-.232), lateral e' (r=.290), septal e' (r=.308), E/e' ratio (r=-.392), aortic strain (r=.829), aortic distensibility (r=.361), and stiffness index (r=-.724) (all P<.05). LVGLS, aortic strain and E/e' ratio were independent influencers of LARS in the multifactorial analysis model (all P<.05). In patients with well-functioning BAV, decreased LARS may provide evidence of subclinical LV diastolic function impairment. LARS may be helpful for clinical risk stratification in such a population.

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 &lt; 0.001) and PSEM (MWU = 1381.00 and p &lt; 0.001) were higher when AS (MWU = 1204 and p &lt; 0.001) and AoD (MWU = 1672.00 and p &lt; 0.001) and AoD (MWU = 1672.00 and p &lt; 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.

Magnetic Resonance Imaging in the Diagnosis of Aortic Wall Elastic Properties Disorders and Its Hemodynamics

Background. Vascular stiffness is an important predictor of cardiovascular disease. The vascular wall biomechanical parameters change not only in patients with genetic disorders of the connective tissue. This means that, regardless of etiology, the early detection of a progressive loss of aortic elasticity is of great clinical importance in preventing the development of severe complications. Assessment of aortic biomechanical parameters using magnetic resonance imaging (MRI) is a new level of visualization for aortic diseases allowing to improve surgical tactics and prevent complications. A number of biomechanical parameters determined by aortic MRI demonstrates the process of its wall remodeling, so their analysis will allow to develope an algorithm for the early diagnosis of aneurysms and the threat of acute aortic syndrome.Objective: using aortic MRI data, to evaluate the aortic biomechanical parameters and hemodynamics at pre- and postoperative stages and their impact on the occurrence of complications and relapses in the long-term period.Material and methods. Between 2020 and 2023, in Petrovsky Russian Scientific Center of Surgery, aortic MRI was performed prospectively before and after surgery in 107 patients with diagnoses of ascending aortic aneurysm (55 patients: 48 (87%) males and 7 (13%) females, mean age 79.4±14.91 years) and DeBakey type I and III aortic dissection, chronic stage (52 patients: 44 (85%) males and 8 (15%) females, mean age 54.32±10.41 years).Results. The quantitative data analysis in the postoperative period showed a decrease in the aortic wall elastic properties in the form of extensibility (0.4 [0.34; 0.54] %/mm Hg in the aneurysm group; 0.5 [0.25; 0.55] %/mmHg in the dissection group) and an increase in stiffness in the form of Young’s modulus (0.6 [0.38; 0.68] MPa in the aneurysm group; 0.5 [0.39; 0.83] MPa in the dissection group). Hemodynamic changes in the dissection group after surgery demonstrated a significant increase in values of maximum velocity in the descending aorta (78.6 [66.24; 130.78] cm/sec) and pressure gradient at the celiac trunk level (2.10 [1.76; 6.84] mm Hg). When assessing the pulse wave velocity parameter in both groups, high values were noted with a tendency to increase after surgery (in the aneurysm group, 7.7 [5.7; 20.3] cm/s before surgery versus 8.7 [6.5; 10.65] cm/s after surgery; in the dissection group, 9.7 [6.8; 12.9] versus 12.7 [7.7; 15.7] cm/s, respectively).Conclusion. Monitoring general hemodynamics and blood flow patterns together with an assessment of the aortic wall elasticity will make it possible to identify patients with borderline aortic dilatation. At the same time, studies of the aortic prosthetic segment are of particular interest. The obtained data on hemodynamic changes occuring at the border of the prosthetic and native segments of the operated aorta can confirm and justify the development of a complication in the form of distal stent graft-induced new entry (dSINE).

4Dimensional XStrain Echocardiography: M-mode and Tissue Doppler Estimation of Age and Gender Specific Normative Values of Aortic Stiffness in Healthy Adults during Covid-19 Pandemic.

The elastic properties of the aorta are modified in numerous cardiovascular and non-cardiovascular diseases. Multiple studies have evaluated aortic stiffness in myriads of disease state, albeit only few Indian studies have estimated the normal values of aortic stiffness in healthy population. To the best of our knowledge, till date no research has been undertaken to determine the age and gender specific value ranges of aortic stiffness parameters in healthy subjects. Hence, in the present study we endeavoured to estimate these values in our distinctive study groups of healthy adults. This was a prospective observational study in which 58 healthy adults were enrolled during the turbulent corona pandemic. Study group was of the age group 18-60 years of either sex and was arbitrarily divided into six groups. Exhaustive M-mode and Tissue doppler Imaging was performed by 4Dimensional XStrain echocardiography system for extensive evaluation of multiple M-mode and Tissue Doppler imaging derived parameters of Aortic stiffness and superior wall velocities of ascending aorta. AOS, AOD, Aortic strain, and elasticity modulus were greater in males. On the contrary Aortic superior wall velocities (SAO, EAO, and AAO) were higher in females. Increasing age led to a decline in majority of stiffness parameters derived by M-mode echocardiography. Correspondingly EAO determined by TDI of superior wall of aorta, showed a deterioration with advancing age. The authors report a normal range of M-mode and TDI derived values of Aortic stiffness of ascending aorta, in healthy Indian adults. Difference in magnitude of aortic elasticity indices has been demonstrated in men and women, as well as in different subsets of the study group.

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.

Thoracic and abdominal aortic alterations in dogs affected with systemic hypertension

Aortic remodeling is the consequence of untreated systemic hypertension along with aortic dilatation as a marker for target organ damage in human literature. Therefore, the present study was planned to detect the changes in aorta at the level of aortic root via echocardiography, thoracic descending aorta via radiography and abdominal aorta via ultrasonography in healthy (n = 46), diseased normotensive (n = 20) and systemically hypertensive dogs (n = 60). The aortic root dimensions were measured at the level of aortic annulus, sinus of valsalva, sino-tubular junction and proximal ascending aorta via left ventricular outflow tract view of echocardiography. The thoracic descending aorta was subjectively assessed for any disparity in size and shape of aorta via lateral and dorso-ventral view of chest radiography. The abdominal aorta was assessed via left and right paralumbar window for calculating the aortic elasticity along with aortic and caudal venacaval dimensions to calculate the aortic-caval ratio. The aortic root measurements were dilated (p < 0.001) in systemically hypertensive dogs with a positive correlation (p < 0.001) with systolic blood pressure (BP). Thoracic descending aorta was also (p < 0.05) altered in the size and shape (undulation) of systemically hypertensive dogs. Abdominal aorta was markedly stiffened with reduced elasticity (p < 0.05) along with dilatation (p < 0.01) in hypertensive dogs. Also, there was a positive correlation (p < 0.001) of aortic diameters and aortic-caval ratio and negative correlation (p < 0.001) of aortic elasticity with systolic BP. Therefore, it was concluded that aorta could be considered as an important target organ damage of systemic hypertension in dogs.

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.

Left ventricular strain in pediatric patients with bicuspid aortic valves and aortopathy

BackgroundBicuspid aortic valve is the most common congenital cardiac defect. Left ventricular strain has been shown to be lower in adults with bicuspid aortic valve and preserved ejection fraction. Additionally, left ventricular strain has been independently associated with aortic valve replacement and all-cause mortality in adults. In pediatric patients, left ventricular strain in patients with bicuspid aortic valve with and without aortopathy has not been evaluated. ObjectivesWe aimed to evaluate the effect of clinical aortopathy on left ventricular strain in pediatric patients with well-functioning bicuspid aortic valve compared to normal controls. MethodsThis is a single-center retrospective study in patients <21 years of age with normal ejection fraction and no prior cardiac interventions. Patients were divided into three groups: 1) healthy controls with normal transthoracic echocardiograms 2) well-functioning BAV without clinical aortopathy 3) well-functioning BAV with isolated clinical aortopathy. TTE images were analyzed to obtain left ventricle global longitudinal strain and left ventricle global circumferential strain, respectively. Strain values were compared across the three groups. ResultsThe mean values and 95 % confidence intervals (95%CIs) for LVGLS were −23.1 (−24.3, −22.0), −22.5 (−23.8, −21.1), and −21.2 (−22.5, −20.0) for groups 1, 2 and 3 respectively. There was a statistically significant difference in Left ventricular global longitudinal strain in group 3 compared to group 1(p = 0.033). There was no significant difference in global circumferential strain between the three groups. ConclusionOur study demonstrates lower left ventricular strain in patients with a well-functioning bicuspid aortic valve and clinical aortopathy compared to controls. This is suggestive of an early effect on the left ventricular myocardium caused by a change in loading conditions from alteration in aortic elasticity. Left ventricular strain is a potential early marker for this and can be utilized for further correlation with clinical outcomes.

Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot.

Aortic wall stiffness has been reported in infants with tetralogy of Fallot (ToF) and may contribute to long-term aortic dilation even after corrective repair surgery. However, little is known about aortic elasticity in fetuses with ToF and the association with neonatal aortic dilation. The objectives of this study were to assess measures of elasticity of the ascending aorta (AAo) in fetuses with ToF and explore the association with neonatal aortic annular dilation in this population. Seventy-six singleton fetuses with ToF and 76 control fetuses of singleton low-risk pregnancies were enroled into this prospective study. Fetal measures of AAo elasticity, including mean longitudinal strain (MLS), global circumferential strain (GCS) and fractional area change (FAC), were assessed by velocity vector imaging. The z-score of the aortic valve (AV) diameter at the level of the annulus, as a measure of aortic annular dilation, was determined in newborns. Logistic regression analysis was used to investigate the association between fetal measures of AAo elasticity and neonatal aortic annular dilation (defined as an AV annular z-score > 2) in cases with ToF identified prenatally. Median MLS, GCS and FAC in fetuses with ToF were lower than those in normal fetuses (7.52%vs 12.15% for MLS, 22.05% vs 29.73% for GCS and 34.2% vs 48.3% for FAC, all P < 0.001). Aortic annular dilation was present in 53/76 (69.7%) newborns with ToF. After adjustment for gestational age at fetal echocardiography and birth weight, fetal MLS, GCS and FAC were independently associated with aortic annular dilation neonatally, with odds ratios of 0.66, 0.78 and 0.82, respectively (P < 0.05). The best cut-off values of these prenatal measures of AAo elasticity for predicting neonatal aortic annular dilation in fetuses with ToF were 9.02% for MLS, 23.56% for GCS and 37.2% for FAC (P < 0.001), with areas under the receiver-operating-characteristics curves of 0.94, 0.91 and 0.93, respectively. Measures of AAo elasticity are decreased in fetuses with ToF. Impaired AAo elasticity in the fetal period is associated with aortic annular dilation postnatally. Additional research is needed to evaluate the relationship between the AAo elasticity injury pattern and degeneration of AAo elasticity under stress as well as the long-term outcome in this population. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Computational Analysis of Hemodynamic Indices Based on Personalized Identification of Aortic Pulse Wave Velocity by a Neural Network

Adequate personalized numerical simulation of hemodynamic indices in coronary arteries requires accurate identification of the key parameters. Elastic properties of coronary vessels produce a significant effect on the accuracy of simulations. Direct measurements of the elasticity of coronary vessels are not available in the general clinic. Pulse wave velocity (AoPWV) in the aorta correlates with aortic and coronary elasticity. In this work, we present a neural network approach for estimating AoPWV. Because of the limited number of clinical cases, we used a synthetic AoPWV database of virtual subjects to train the network. We use an additional set of AoPWV data collected from real patients to test the developed algorithm. The developed neural network predicts brachial–ankle AoPWV with a root-mean-square error (RMSE) of 1.3 m/s and a percentage error of 16%. We demonstrate the relevance of a new technique by comparing invasively measured fractional flow reserve (FFR) with simulated values using the patient data with constant (7.5 m/s) and predicted AoPWV. We conclude that patient-specific identification of AoPWV via the developed neural network improves the estimation of FFR from 4.4% to 3.8% on average, with a maximum difference of 2.8% in a particular case. Furthermore, we also numerically investigate the sensitivity of the most useful hemodynamic indices, including FFR, coronary flow reserve (CFR) and instantaneous wave-free ratio (iFR) to AoPWV using the patient-specific data. We observe a substantial variability of all considered indices for AoPWV below 10 m/s and weak variation of AoPWV above 15 m/s. We conclude that the hemodynamic significance of coronary stenosis is higher for the patients with AoPWV in the range from 10 to 15 m/s. The advantages of our approach are the use of a limited set of easily measured input parameters (age, stroke volume, heart rate, systolic, diastolic and mean arterial pressures) and the usage of a model-generated (synthetic) dataset to train and test machine learning methods for predicting hemodynamic indices. The application of our approach in clinical practice saves time, workforce and funds.