Descending Aorta Pulse Wave Velocity Research Articles

Influence of Maternal Lifestyle and Diet on Perinatal DNA Methylation Signatures Associated With Childhood Arterial Stiffness at 8 to 9 Years.

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Aortic flow dynamics and stiffness in Loeys-Dietz syndrome patients: a comparison with healthy volunteers and Marfan syndrome patients.

To assess aortic flow and stiffness in patients with Loeys-Dietz syndrome (LDS) by 4D flow and cine cardiovascular magnetic resonance (CMR) and compare the results with those of healthy volunteers (HV) and Marfan syndrome (MFS) patients. Twenty-one LDS and 44 MFS patients with no previous aortic dissection or surgery and 35 HV underwent non-contrast-enhanced 4D flow CMR. In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR), and aortic diameters were obtained at 20 planes from the ascending (AAo) to the proximal descending aorta (DAo). IRF and SFRR were also quantified for aortic regions (proximal and distal AAo, arch and proximal DAo). Peak-systolic wall shear stress (WSS) maps were also estimated. Aortic stiffness was quantified using pulse wave velocity (PWV) and proximal AAo longitudinal strain. Compared to HV, LDS patients had lower rotational flow at the distal AAo (P = 0.002), arch (P = 0.002), and proximal DAo (P < 0.001) even after adjustment for age, stroke volume, and local diameter. LDS patients had higher SFRR in the proximal DAo compared to both HV (P = 0.024) and MFS patients (P = 0.015), even after adjustment for age and local diameter. Axial and circumferential WSS in LDS patients were lower than in HV. AAo circumferential WSS was lower in LDS compared to MFS patients. AAo and DAo PWV and proximal AAo longitudinal strain revealed stiffer aortas in LDS patients compared to HV (P = 0.007, 0.005, and 0.029, respectively) but no differences vs. MFS patients. Greater aortic stiffness as well as impaired IRF and WSS were present in LDS patients compared to HV. Conversely, similar aortic stiffness and overlapping aortic flow features were found in Loeys-Dietz and Marfan patients.

Regional curvature in thoracic aortic aneurysms of different aetiologies and its relationship with established risk factors

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Science, Innovation and Universities ; Instituto de Salud Carlos III Introduction The aorta is a 3D hollow, curvilinear elastic structure whose diseases have life-threatening consequences. Despite much effort has been paid to study aortic diameter, diameter is a poor predictor of events. Conversely, much less is known about aortic curvature, its distribution in the thoracic aorta and the potential impact of risk factors in aneurysms associated with different conditions. Currently, 4D flow magnetic resonance imaging (4D flow CMR) allows to obtain 3D geometry, 4D flow data and regional aortic stiffness. Purpose We aim to study regional aortic curvature in thoracic aorta aneurysms of different aetiologies and define its relationship with established risk factors. Methods One-hundred twenty patients (40 for each group, selected out of prospective cohorts of 156 bicuspid aortic valve – BAV-, 77 Marfan –MFS- and 67 patients with a degenerative aneurysm – TAVdeg-) were matched for age, sex and BSA via propensity score with 40 healthy volunteers (HV). The thoracic aorta was semi-automatically segmented from angiograms and the centreline was computed. Local curvature was assessed at 20 planes covering the thoracic aorta from the sinotubular junction to the proximal descending aorta (DAo) at the level of the pulmonary artery bifurcation. Local curvature was normalized by subject mean thoracic aorta curvature. Length was measured as centreline length. Aortic stiffness was measured in the DAo by pulse wave velocity (PWV). Aneurysm was defined by z-score ≥ 2 using diameters measured by double-oblique cine CMR. Results Matching was successful in all groups with the exception of a residual age difference between HV and TAVdeg. Curvature in HV showed a fairly smooth transition between the straighter ascending aorta (AAo) and DAo to a more curved aortic arch, with a peak in the mid aortic arch (Figure 1A). Conversely, all patients’ groups presented a peak in curvature in the proximal DAo and a decreased local curvature in the aortic arch and mid DAo close to the level of the pulmonary artery. BAV and TAVdeg patients showed also increased curvature in the mid AAo, were dilation is prevalent. Conversely, in the same area MFS showed a reduced curvature and limited prevalence of aneurysm. In the overall population, age, AAo and root diameters, mean blood pressure, DAo PWV and aortic length, all established risk factors for aortic events, were inversely related to curvature in the distal AAo and aortic arch (Figure 1B). Conclusions Aneurysms related to different aetiologies show similar abnormalities in aortic curvature, with limited curvature in the aortic arch and a peak soon after the third supra-aortic vessel. Age, aortic diameter, length, stiffness and blood pressure, all known risk factors, are all related to reduced curvature in the distal ascending aorta and aortic arch. Abstract Figure.

Impact of Obesity on Measures of Cardiovascular and Kidney Health in Youth With Type 1 Diabetes as Compared With Youth With Type 2 Diabetes.

Insulin resistance and obesity are independently associated with type 1 diabetes (T1D) and are known risk factors for cardiovascular and kidney diseases, the leading causes of death in T1D. We evaluated the effect of BMI on cardiovascular and kidney outcomes in youth with T1D versus control youth with normal weight or obesity and youth with type 2 diabetes (T2D). Pubertal youth (n = 284) aged 12-21 years underwent assessments of resting heart rate (RHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), leptin, hs-CRP, adiponectin, ratio of urine albumin to creatinine, and estimated glomerular filtration rate. Participants with T1D underwent bicycle ergometry for VO2peak, monitoring for peripheral brachial artery distensibility (BAD), endothelial function testing for reactive hyperemic index, and aortic MRI for central arterial stiffness or shear. In adolescents with T1D, RHR, SBP, DBP, mean arterial pressure, leptin, hs-CRP, and hypertension prevalence were significantly higher, and BAD, descending aorta pulse wave velocity, and VO2peak lower with an obese versus normal BMI. Although hypertension prevalence and RHR were highest in obese adolescents with T1D and adiponectin lowest in youth with T2D, other measures were similar between obese adolescents with T1D and those with T2D. Obesity, now increasingly prevalent in people with T1D, correlates with a less favorable cardiovascular and kidney risk profile, nearly approximating the phenotype of youth with T2D. Focused lifestyle management in youth-onset T1D is critically needed to reduce cardiovascular risk.

The effects of age at correction of aortic coarctation and recurrent obstruction on adolescent patients: MRI evaluation of wall shear stress and pulse wave velocity

BackgroundCoarctation patients before curative reconstruction are exposed to abnormal flow patterns which potentially could cause wall deterioration. This study evaluated the effect of age at correction on the pulse wave velocity (PWV) and peak wall shear stress (WSS) in adolescent patients with corrected coarctation. Effects of valve morphology and presence of reobstruction were also evaluated.MethodsTwenty-one patients aged 13.7 ± 2.6 years (mean ± standard deviation) were included (bicuspid aortic valve, n = 14; reobstruction, n = 9). Mean age at correction was 1.0 ± 1.8 years. PWV was determined from two high-temporal through-plane phase-contrast magnetic resonance imaging (MRI) acquisitions, for two segments: ascending aorta plus aortic arch and descending aorta. WSS was determined from four-dimensional flow MRI. Peak WSS over five systolic phases was determined for ascending aorta, aortic arch, and descending aorta.ResultsPatients with tricuspid aortic valve showed a significant correlation between the age at correction and descending aorta PWV (rs = 0.80, p = 0.010). Significant differences were found between patients without and with reobstruction for peak WSS in the aortic arch (3.9 ± 1.3 Pa versus 6.5 ± 2.2 Pa, respectively; p = 0.003) and descending aorta (5.0 ± 1.3 Pa versus 6.7 ± 1.1 Pa, respectively; p = 0.005).ConclusionsA prolonged period of abnormal haemodynamic exposure may result in increased aortic wall stiffening. The increased peak WSS as results of a reobstruction possibly promotes different disease progression, which endorse longitudinal follow-up examination of corrected coarctation patients.

Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study

BackgroundDiseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease in Marfan patients has been suggested, whether flow characteristics may be useful as early markers remains to be determined.MethodsSeventy-five Marfan patients and 48 healthy subjects were prospectively enrolled. In- and through-plane vortexes were computed by 4D flow cardiovascular magnetic resonance (CMR) in the thoracic aorta through the quantification of in-plane rotational flow and systolic flow reversal ratio, respectively. Regional pulse wave velocity and axial and circumferential wall shear stress maps were also computed.ResultsIn-plane rotational flow and circumferential wall shear stress were reduced in Marfan patients in the distal ascending aorta and in proximal descending aorta, even in the 20 patients free of aortic dilation. Multivariate analysis showed reduced in-plane rotational flow to be independently related to descending aorta pulse wave velocity. Conversely, systolic flow reversal ratio and axial wall shear stress were altered in unselected Marfan patients but not in the subgroup without dilation. In multivariate regression analysis proximal descending aorta axial (p = 0.014) and circumferential (p = 0.034) wall shear stress were independently related to local diameter.ConclusionsReduced rotational flow is present in the aorta of Marfan patients even in the absence of dilation, is related to aortic stiffness and drives abnormal circumferential wall shear stress. Axial and circumferential wall shear stress are independently related to proximal descending aorta dilation beyond clinical factors. In-plane rotational flow and circumferential wall shear stress may be considered as an early marker of descending aorta dilation in Marfan patients.

Metformin Improves Insulin Sensitivity and Vascular Health in Youth With Type 1 Diabetes Mellitus.

Cardiovascular disease is the leading cause of mortality in type 1 diabetes mellitus (T1DM) and relates strongly to insulin resistance (IR). Lean and obese adolescents with T1DM have marked IR. Metformin improves surrogate markers of IR in T1DM, but its effect on directly measured IR and vascular health in youth with T1DM is unclear. We hypothesized that adolescents with T1DM have impaired vascular function and that metformin improves this IR and vascular dysfunction. Adolescents with T1DM and control participants underwent magnetic resonance imaging of the ascending (AA) and descending aorta to assess pulse wave velocity, relative area change, and maximal (WSSMAX) and time-averaged (WSSTA) wall shear stress. Participants with T1DM also underwent assessment of carotid intima-media thickness by ultrasound, brachial distensibility by DynaPulse, fat and lean mass by dual-energy x-ray absorptiometry, fasting laboratories after overnight glycemic control, and insulin sensitivity by hyperinsulinemic-euglycemic clamp (glucose infusion rate/insulin). Adolescents with T1DM were randomized 1:1 to 3 months of 2000 mg metformin or placebo daily, after which baseline measures were repeated. Forty-eight adolescents with T1DM who were 12 to 21 years of age (40% body mass index [BMI] ≥90th percentile; 56% female) and 24 nondiabetic control participants of similar age, BMI, and sex distribution were enrolled. Adolescents with T1DM demonstrated impaired aortic health compared with control participants, including elevated AA and descending aorta pulse wave velocity, reduced AA and descending aorta relative area change, and elevated AA and descending aorta WSSMAX and WSSTA. Adolescents with T1DM in the metformin versus placebo group had improved glucose infusion rate/insulin (12.2±3.2 [mg·kg-1·min-1]/μIU/μL versus -2.4±3.6 [mg·kg-1·min-1]/μIU/μL, P=0.005; 18.6±4.8 [mg·lean kg-1·min-1]/μIU/μL versus -3.4±5.6 [mg·lean kg-1·min-1]/μIU/μL, P=0.005) and reduced weight (-0.5±0.5 kg versus 1.6±0.5 kg; P=0.004), BMI (-0.2±0.15 kg/m2 versus 0.4±0.15 kg/m2; P=0.005), and fat mass (-0.7±0.3 kg versus 0.6±0.4 kg; P=0.01). Glucose infusion rate/insulin also improved in normal-weight participants (11.8±4.4 [mg·kg-1·min-1]/μIU/μL versus -4.5±4.4 [mg·kg-1·min-1]/μIU/μL, P=0.02; 17.6±6.7 [mg·lean kg-1·min-1]/μIU/μL versus -7.0±6.7 [mg·lean kg-1·min-1]/μIU/μL, P=0.02). The metformin group had reduced AA WSSMAX (-0.3±0.4 dyne/cm2 versus 1.5±0.5 dyne/cm2; P=0.03), AA pulse wave velocity (-1.1±1.20 m/s versus 4.1±1.6 m/s; P=0.04), and far-wall diastolic carotid intima-media thickness (-0.04±0.01 mm versus -0.00±0.01 mm; P=0.049) versus placebo. Adolescents with T1DM demonstrate IR and impaired vascular health compared with control participants. Metformin improves IR, regardless of baseline BMI, and BMI, weight, fat mass, insulin dose, and aortic and carotid health in adolescents with T1DM. Metformin may hold promise as a cardioprotective intervention in T1DM. URL: https://www.clinicaltrials.gov . Unique identifier: NCT01808690.

Differential impact of local and regional aortic stiffness on left ventricular remodeling: a cardiovascular magnetic resonance study.

Left ventricular (LV) remodeling and aortic stiffness have independent predictive value for all causes and cardiovascular mortality. Because elastic properties of the arterial wall vary along the aortic pathway, we hypothesized that local and regional aortic stiffness could differently impact on LV remodeling. Regional aortic stiffness was determined from carotid-femoral pulse wave velocity (cfPWV) measured by aplanation tonometry. Aortic arch pulse wave velocity was measured by phase contrast cardiovascular magnetic resonance (CMR). Local stiffness was calculated in the ascending aorta pulse wave velocity (aaPWV) and descending aorta pulse wave velocity using central pulse pressure measurement, cine CMR acquisition, and surface change estimation. CMR LV remodeling was expressed as LV mass to end-diastolic volume ratio.We evaluated 146 study participants (41 ± 15 years) free of overt cardiovascular disease. In stepwise multivariate regression analysis, cfPWV and aaPWV were significantly and independently correlated to mass to end-diastolic volume ratio (partial R = 0.07 and R = 0.10, respectively, all P < 0.005) after adjustment for age, sex, BMI, brachial mean blood pressure, and central pulse pressure. Descending aorta pulse wave velocity was correlated with mass to end-diastolic volume ratio to a lower extent (R = 0.04, P = 0.0115) and aortic arch pulse wave velocity was not independently associated with mass to end-diastolic volume ratio. CfPWV and aaPWV were both independently associated with mass to end-diastolic volume ratio, explaining 5 and 8% of mass to end-diastolic volume ratio variance, respectively. In study participants free of overt cardiovascular disease, stiffness of the ascending aorta representing the local proximal aortic function face to the LV and of the downstream aortic pathway assessed by cfPWV reflecting more advanced alterations of material properties involving the entire aorta, are independent determinants of LV remodeling after adjustment to age, BMI, mean blood pressure, and sex.

Ascending and descending aorta pulse wave velocity and distensibility in bicuspid aortic valve patients

PurposeBicuspid aortic valve (BAV) is a cardiac congenital disease associated with ascending aorta (AAo) dilation. The study of the impact of aortic biomechanics in this population has been limited by technical difficulties. Contrasting results have been reported for distensibility while studies including regional pulse wave velocity (PWV) are still lacking. Using 4D-flow MRI, we assessed AAo and descending aortic (DAo) biomechanical properties and determined their association in BAV aortopathy.MethodsOne-hundred thirty-six BAV patients with no severe valvular disease and 40 healthy volunteers were recruited. The protocol included a 4D-flow acquisition and a set of 2D CINE PC-MRI at 1.5 T. Aortic 3D geometry was reconstructed from 4D-flow-derived angiography and at least 100 analysis planes were identified in the thoracic aorta. Transit time was calculated on the velocity upslope through wavelet analysis[1].CINE PC-MRI were used to compute distensibility. Statistical significance is reported corrected for confounding factors.ResultsNon-dilated BAV and controls have similar AAo and DAo PWV and distensibility. Dilated patients presented lower AAo PWV and higher DAo PWV compared to non-dilated (p < 0.001 and p = 0.017, respectively). Distensibility did not differentiate dilated from non-dilated patients and presented lower association with dilation severity (see Figure).ConclusionsConfirming for the first time previous findings in abdominal aorta aneurysm and fluid-mechanics theory, AAo PWV is reduced in aneurysmatic BAV patients. BAV aortopathy is related to a stiffer DAo. Regional PWV outperforms distensibility as a marker of local aortic biomechanics. These data exclude congenital aortic wall pathology related to BAV

Prognostic value of cardiovascular MR imaging biomarkers on outcome in peripheral arterial disease: a 6-year follow-up pilot study.

The objective of this pilot study was to explore the prognostic value of outcome of cardiovascular magnetic resonance (MR) imaging biomarkers in patients with symptomatic peripheral arterial disease (PAD) in comparison with traditional risk factors. Forty-two consecutive patients (mean age 64 ± 11 years, 22 men) referred for contrast-enhanced MR angiography (CE-MRA) were included. At baseline a comprehensive cardiovascular MRI examination was performed: CE-MRA of the infra-renal aorta and run-off vessels, carotid vessel wall imaging, cardiac cine imaging and aortic pulse wave velocity (PWV) assessment. Patients were categorized for outcome at 72 ± 5 months follow-up. One patient was lost to follow-up. Over 6 years, six patients had died (mortality rate 14.6 %), six patients (14.6 %) had experienced a cardiac event and three patients (7.3 %) a cerebral event. The mean MRA stenosis class (i.e., average stenosis severity visually scored over 27 standardized segments) was a significant independent predictor for all-cause mortality (beta 3.0 ± standard error 1.3, p = 0.02). Descending aorta PWV, age and diabetes mellitus were interrelated with stenosis severity but none of these were significant independent predictors. For cardiac morbidity, left ventricular ejection fraction (LVEF) and mean MRA stenosis class were associated, but only LVEF was a significant independent predictor (beta -0.14 ± 0.05, p = 0.005). Diabetes mellitus was a significant independent predictor for cerebral morbidity (beta 2.8 ± 1.3, p = 0.03). Significant independent predictors for outcome in PAD are mean MRA stenosis class for all-cause mortality, LVEF for cardiac morbidity and diabetes mellitus for cerebral morbidity.

Higher oily fish consumption in late pregnancy is associated with reduced aortic stiffness in the child at age 9 years.

Higher pulse wave velocity (PWV) reflects increased arterial stiffness and is an established cardiovascular risk marker associated with lower long-chain n-3 polyunsaturated fatty acid intake in adults. Experimentally, maternal fatty acid intake in pregnancy has lasting effects on offspring arterial stiffness. To examine the association between maternal consumption of oily fish, a source of long-chain n-3 polyunsaturated fatty acids, in pregnancy and child's aortic stiffness age 9 years. In a mother-offspring study (Southampton Women's Survey), the child's descending aorta PWV was measured at the age of 9 years using velocity-encoded phase-contrast MRI and related to maternal oily fish consumption assessed prospectively during pregnancy. Higher oily fish consumption in late pregnancy was associated with lower childhood aortic PWV (sex-adjusted β=-0.084 m/s per portion per week; 95% confidence interval, -0.137 to -0.031; P=0.002; n=226). Mother's educational attainment was independently associated with child's PWV. PWV was not associated with the child's current oily fish consumption. Level of maternal oily fish consumption in pregnancy may influence child's large artery development, with potential long-term consequences for later cardiovascular risk.