Aortic Elastic Properties Research Articles

Impact of renin-angiotensin system targeted therapy on aortic elastic properties assessed by computed tomography

BackgroundAortic stiffening is a well-known cardiovascular risk factor. Computed tomography (CT) has proven to be a valuable tool in the assessment of aortic elastic properties. Drugs that inhibit the renin-angiotensin system (RAS) play a central role in cardioprotective therapy. We aimed to evaluate the relationship between aortic elastic properties and RAS-targeted therapy in hypertensive patients. MethodsThis is an observational prospective study of hypertensive patients with nonobstructive coronary artery disease who underwent coronary CT angiography (CCTA). Aortic compliance and distensibility were calculated from the ECG-gated CCTA image. Patients were divided into two groups − those with RAS-targeted therapy − RAS(+) and those with non-RAS-targeted therapy − RAS(−). The elastic properties of the aorta were compared between the two groups. ResultsA total of 142 patients were included in the final analysis. 53.5 % of the population were in the RAS(+) group and 46.5 % in the RAS(−) group. Elastic properties of ascending and descending aorta were significantly higher in the RAS(+) group compared to the RAS(−) group: AA compliance 1.42 ± 0.75 mm2/mmHg in the RAS(+) vs 1.03 ± 0.91 mm2/mmHg in the RAS(−), p = 0.024; AA distensibility 2.86 ± 1.11 x10-3mm3 in the RAS(+) vs 1.82 ± 0.97 x10-3mm3 in RAS(−), p < 0.001; DA compliance 1.45 ± 1.10 mm2/mmHg in the RAS(+) vs 1.11 ± 0.91 mm2/mmHg in the RAS(−), p 0.031; DA distensibility 2.35 ± 0.84 x10-3mm3 in the RAS(+) vs 1.73 ± 1.21 x10-3mm3 in RAS(−), p < 0.001. There was an excellent correlation between RAS therapy and ascending aorta compliance and distensibility (r = 0.901, p < 0.001 andr = 0.875, p < 0.001, respectively). ConclusionPatients receiving RAS-blocking treatment revealed significantly higher compliance and distensibility of ascending and descending aorta. In addition, aortic elastic properties were significantly correlated with the RAS-targeted therapy.

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.

Young hearts, early risks: novel cardiovascular biomarkers in former very preterm infants at kindergarten age

BackgroundPreterm birth is associated with long-term cardiovascular morbidity and mortality. In adults, fibroblast growth factor-23 (FGF-23), α-Klotho, and secretoneurin have all garnered attention as cardiovascular biomarkers, but their utility in pediatric populations has not yet been ascertained. The aim of this pilot study was to evaluate these novel cardiovascular biomarkers and their association with indicators of cardiovascular impairment in the highly vulnerable population of former very preterm infants.MethodsFive- to seven-year-old children born at < 32 weeks’ gestation were eligible for the study. Healthy same-aged children born at term served as controls. Biomarkers were quantified in fasting blood samples, and echocardiographic measurements including assessment of aortic elastic properties were obtained.ResultsWe included 26 former very preterm infants and 21 term-born children in the study. At kindergarten age, former very preterm infants exhibited significantly higher plasma concentrations of biologically active intact FGF-23 (iFGF-23; mean 43.2 pg/mL vs. 29.1 pg/mL, p = 0.003) and secretoneurin (median 93.8 pmol/L vs. 70.5 pmol/L, p = 0.046). iFGF-23 inversely correlated with distensibility of the descending aorta.ConclusionIn preterm-born children, iFGF-23 and secretoneurin both offer prospects as valuable cardiovascular biomarkers, potentially allowing for risk stratification and timely implementation of preventive measures.ImpactFormer very preterm infants have increased plasma concentrations of the novel cardiovascular biomarkers intact fibroblast growth factor-23 (iFGF-23) and secretoneurin at kindergarten age.Increases in iFGF-23 concentrations are associated with decreased distensibility of the descending aorta even at this early age.Monitoring of cardiovascular risk factors is essential in individuals with a history of preterm birth. Both iFGF-23 and secretoneurin hold promise as clinically valuable biomarkers for risk stratification, enabling the implementation of early preventive measures.

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.

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.

Additional effects of combination therapy of antihypertensive medication on aortic elastic properties beyond blood pressure lowering effect in spontaneously hypertensive rats

Abstract Background Combination therapy in the treatment of hypertension provides better therapeutic efficacy, improved tolerability by lowering the dose and reduced potential for side effects than monotherapy. Especially, combinations of calcium channel blocker (CCB), angiotensin receptor blocker (ARB) or diuretics (thiazide) are generally effective and well tolerated regimen in antihypertensive treatment. However, we have focused more on the antihypertensive power of the combination therapy rather than the effect on the vessel itself. Purpose The purpose of this study is to determine the efficacy of antihypertensive medications as ARB and CCB and its combination with or without thiazide on the aortic structural and functional properties beyond the effect of blood pressure (BP) lowering. Methods Fourteen-week-old male spontaneous hypertensive rats were randomly divided into 5 groups, and treated with 1) vehicle (V), 2) amlodipine besylate (A), 3) olmesartan (O), 4) combined amlodipine and olmesartan (AO) or 5) combined amlodipine, olmesartan and thiazide (AOD), respectively. After 8 weeks of treatment, hemodynamic parameters and structural and functional properties of aorta as intima-media thickness (IMT) and velocity vector imaging (VVI) parameters of aorta including fractional area change (FAC), circumferential strain (CS) and strain rate (CSR) were assessed in each group and collagen contents of aorta were quantified as well. Results During the study period, systolic and diastolic BP were serially decreased in all treatment groups. Especially, AOD group showed lowest systolic and diastolic BP levels and also showed smallest IMT and vessel area and highest elasticity (FAC and CS) among the other groups (p&amp;lt;0.01) at 8 weeks (Table 1). In histologic analysis, collagen contents of aorta in all treatment groups showed significant associations with BP, IMT and VVI parameters (FAC, CS, CSR) (p&amp;lt;0.05), respectively. Particularly, aorta of AO and AOD groups showed significantly lower levels of collagen contents than that of control group. (p&amp;lt; 0.05) (Figure 1) Conclusion(s) Beyond the BP lowering effect, combination of amlodipine and olmesartan with or without thiazide minimize structural changes and shows better protection for the progression of arteriosclerosis than individual monotherapy in treatment of hypertension.Table 1Figure 1

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).

Elastic properties of aorta with respect to its dilatation vs aneurysm according to ECG-synchronized CT-angiography

Purpose: to compare the indicators of elasticity of the thoracic aorta, determined by ECG-Gated-CT angiography, in patients with ascending aortic aneurysm and dilatation.Materials and methods. The study included 20 patients with dilatation of the ascending aorta (40 mm ≤ maximum aortic diameter (Dmax) &lt; 50 mm) (group 1a), 30 patients with non-syndromic aneurysms of the ascending aorta (n = 30, Dmax ≥ 50 mm) (group 1b), as well as 19 patients with normal aortic sizes (Dmax &lt; 40 mm) as controls (group 2). All patients underwent multispiral computed tomography angiography of the aorta in ECG-Gated mode (ECG-Gated -CT). Maximum systolic and diastolic aortic diameters (Dmax) were measured at different levels of the thoracic aorta, followed by calculation of the difference between them and calculation of the circular deformation (CS), compliance, stiffness (Stiff), wall distensibility, longitudinal deformation (LS).Results. Moderate negative correlation between the age of the patients and CS at all levels of the thoracic aorta (rmaximum = –0.33, rminimum = –0.41) was revealed. Groups 1a and 1b did not differ significantly in all parameters. Group 1a differed from the control group (p &lt; 0.05) in Stiff at the level of the aortic annulus (AA) (0.07 [–0.14; 0.15] vs –0.04 [–0.1; 0.06]), as well as CS at the level of AA and sinuses of Valsalva (SV ) (0.49 [–2.94; 3.36] vs –1.18 [–4.51; 3.87]), and group 1b – in CS at the level of SV (3.73 [0.24; 6.56] vs 0.13 [–1.42; 3.04]) and proximal part of the descending aorta (distal to the left subclavian artery) (5.48 [1.27; 8.40] vs 1.97 [–0.32; 6.08]), also in LS (5.96 [–8.98; 9.25] vs –2.58 [–7.75; 1.89]) at the level of the aortic arch.Conclusion. According to ECG-Gated-CT angiography, the indicators of elasticity of the thoracic aorta in patients with ascending aortic aneurysm and dilatation did not differ. Compared with the control group, patients with aneurysm of the ascending aorta showed an increased pulse deformity of the non-dilated aortic arch.

Intravascular ultrasound imaging in evaluation of aortic stiffness: A proof-of-concept study.

Aortic stiffness is a well-known cardio-vascular risk factor. For years, different methods have been studied in the assessment of aortic elastic properties and large arterial stiffness for risk stratification. Herein is an assessment of the role of intravascular ultrasound (IVUS) imaging for the evaluation of aortic elastic properties. Intravascular ultrasound imaging of the aorta was performed in 12 patients with transthoracic echocardiography (TTE) and computed tomography (CT) evidence for enlargement of the ascending aorta - diameter ≥ 40.0 mm. Mechanical properties of the aorta were derived from the measured diameters and intra-aortic pressure. Paired samples T-test analyses were performed to determine differences between measurements derived by TTE, CT and IVUS. Mean values of the calculated elastic properties via IVUS of the ascending aorta were as follows: compliance 0.021 ± 0.02; strain 205 ± 4.3; aortic stiffness index 4.3 ± 0.75; elastic modulus 0.31 ± 0.05. On paired T-test analysis maximum ascending aortic diameter measured by CT aortography and IVUS did not differ significantly (t = -0.19, p = 0.985), but a significant difference between IVUS measurements and TTE derived diameters was found (t = 13.118, p = 0.034). On average, IVUS diameters were 2.3 mm larger than the results acquired by TTE (95% confidence interval: 14.21-17.13). Intravascular ultrasound examination of the ascending aorta provided larger diameters than the ones collected by means of TTE. However, IVUS measurements did not differ significantly from diameters derived by CT aortography.

Impaired Elastic Properties of the Ascending Aorta in Fetuses With Coarctation of the Aorta.

Background Abnormal aortic elastic properties are major notable vasculopathy involved in coarctation of the aorta (CoA). However, there are no reports on aortic wall elastic characteristics in fetuses with CoA. Methods and Results Fifty-six fetuses with CoA and 56 normal controls were included in this prospective case-control study. The dimensions of the cardiac chamber, the size of the aorta, left ventricular myocardial performance indexes, and aortic elastic properties, including the global circumferential strain, fractional area change and mean longitudinal strain, were measured serially in utero. The global circumferential strain, fractional area change, and mean longitudinal strain in fetuses with CoA were smaller than those in the normal group at both the first and last examinations (18.50% versus 37.73% for global circumferential strain, 38.90% versus 57.55% for fractional area change, 6.61% versus 11.81% for mean longitudinal strain at first scan, 16.62% versus 42.05% for global circumferential strain, 36.54% versus 59.7% for fractional area change, 6.2% versus 11.46% for mean longitudinal strain at last scan, all P<0.001). There were negative correlations between aortic elastic properties and left ventricular myocardial performance indexes in fetuses with CoA (P<0.01). Aortic elastic properties were correlated positively with aortic isthmus size in fetuses with CoA (P<0.01). Conclusions Aortic strain and the fractional area change were decreased in fetuses with CoA. Impairments of these aortic elastic properties were associated with diminished heart function and aortic isthmus size in utero. Further large-scale longitudinal studies are required to confirm the potential predictive value of cardiovascular morbidity (ie, hypertension) in fetuses with CoA.

Comparison of In-Vivo and Ex-Vivo Ascending Aorta Elastic Properties through Automatic Deep Learning Segmentation of Cine-MRI and Biomechanical Testing.

Ascending aortic aneurysm is a pathology that is important to be supervised and treated. During the years the aorta dilates, it becomes stiff, and its elastic properties decrease. In some cases, the aortic wall can rupture leading to aortic dissection with a high mortality rate. The main reference standard to measure when the patient needs to undertake surgery is the aortic diameter. However, the aortic diameter was shown not to be sufficient to predict aortic dissection, implying other characteristics should be considered. Therefore, the main objective of this work is to assess in-vivo the elastic properties of four different quadrants of the ascending aorta and compare the results with equivalent properties obtained ex-vivo. The database consists of 73 cine-MRI sequences of thoracic aorta acquired in axial orientation at the level of the pulmonary trunk. All the patients have dilated aorta and surgery is required. The exams were acquired just prior to surgery, each consisting of 30 slices on average across the cardiac cycle. Multiple deep learning architectures have been explored with different hyperparameters and settings to automatically segment the contour of the aorta on each image and then automatically calculate the aortic compliance. A semantic segmentation U-Net network outperforms the rest explored networks with a Dice score of 98.09% (±0.96%) and a Hausdorff distance of 4.88 mm (±1.70 mm). Local aortic compliance and local aortic wall strain were calculated from the segmented surfaces for each quadrant and then compared with elastic properties obtained ex-vivo. Good agreement was observed between Young's modulus and in-vivo strain. Our results suggest that the lateral and posterior quadrants are the stiffest. In contrast, the medial and anterior quadrants have the lowest aortic stiffness. The in-vivo stiffness tendency agrees with the values obtained ex-vivo. We can conclude that our automatic segmentation method is robust and compatible with clinical practice (thanks to a graphical user interface), while the in-vivo elastic properties are reliable and compatible with the ex-vivo ones.

Differences in Left atrial stain, endothelial glycocalyx, arterial elasticity and myocardial efficiency between ESUS, lacunar and atherosclerotic type of stroke

Abstract Background and aims Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS). Patients and methods In 111 patients (age 57,1±10.6) with acute cerebral stroke (37 lacunar, 36 atherosclerotic and 38 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, (4) left ventricular global longitudinal strain and (5) left ventricular myocardial work index (GWI), constructive work (GCW), wasted work (GWW) and work efficiency (GWE). Results Compared with controls, patients with stroke had higher PWV (11.74±3.18 vs 9.61±1.28 m/sec, p=0.003), PBR (2.16±0.28 vs 1.94±0.20, p=0.029) and central SBP (142±25 vs 121±17 mmHg, p=0.025), while ventricular (−18.31±3.21 vs −20.89±2.45%, p=0.001) and atrial deformation (28.59±6.99 vs 37.05±5.08%, p&amp;lt;0.001) were impaired in patients with stroke (p&amp;lt;0.05). GWI and GCW were similar between two groups and GWW and GWE were worse in patients with stroke (106.98±81.52 vs 68.92±36.52 mmHg%, p=0.022, 94.00±4.51 vs 96.46±1.75%, p=0.007, respectively). LA reservoir strain and contraction strain were more impaired in patients with thromboembolic strain compared to other 2 stroke types (ESUS 30.55±6.02%, −15.57±3.57%, Lacunar 28.19±6.92%, −13.76±3,74%, atherosclerotic 24.73±7.86%, −12.65±2,53%, p&amp;lt;0.05). Regarding endothelial glycocalyx, PBR5–25 was similar between all stroke types (ESUS 2.12±0.21 μm, LACUNAR 2.23±0.32 μm, ATHEROSCLEROTIC 2.11±0.30 μm, p&amp;gt;0.05). PWV was significantly higher in patients with atherosclerotic stroke (13.50±3.83 m/sec, p=0.007), while in patients with lacunar (11.31±3.01 m/sec) and in ESUS patients it was mildly elevated (11.66±2.63 m/sec). Despite there was no significant difference in GWI, GCW and GWW between patients with different types of stroke, GWE was higher in patients with ESUS (95.41±2.32%) than in patients with lacunar 92.86±6.13%) and atherothrombotic stoke (92.27±6.21%) (p&amp;lt;0.05). Conclusions Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness and LA deformation are more affected in atherosclerotic stroke, while GWE is preserved in ESUS patients. Funding Acknowledgement Type of funding sources: None.

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.

Maturation Fetus Ascending Aorta Elastic Properties: Circumferential Strain and Longitudinal Strain by Velocity Vector Imaging.

ObjectiveThis study aimed to assess the circumferential and longitudinal strain of the fetal ascending aortic (AA) wall and establish a gestational age-associated longitudinal reference for aortic wall strain during the second half of pregnancy.MethodsSingleton fetuses with gestational age (GA) at 20 + 0 to 24 + 6 weeks were prospectively collected from a low-risk population. Global circumferential strain (GCS) and mean longitudinal strain (MLS) of the ascending aorta were measured serially at 4-week intervals using the velocity vector imaging (VVI) technique. Fractional polynomials were conducted to obtain the best-fitting curves between GA and AA strains. GA-specific reference percentiles of GCS and MLS were established by multilevel modeling.ResultsA total of 223 fetuses with a total of 1,127 serial observations were enrolled. GCS presented a second-degree fractional polynomial smoothing regression along GA (R2 = 0.635, P < 0.05). Fetal aortic GCS remained unchanged at ~27.29% (20.36–35.6%) before 31 weeks and increased significantly from 31.36% (26.38–37.12%) at 31 weeks to 43.29% (30.5–56.78%) at term. MLS presented a third-degree fractional polynomial smoothing regression along GA (R2 = 0.465, P < 0.05). MLS remained steady at ~10.03% (3.28–17.62%) between 20 and 31 weeks and then increased significantly from 12.68% (7.42–20.1%) at 32 weeks to 17.5% (9.67–25.34%) at term. The GCS was significantly higher than the MLS in the ascending aorta wall (p < 0.001).ConclusionThe fetal ascending aorta wall demonstrates obviously greater circumferential strain than longitudinal strain. Both strains remained steady before the late trimester and then gradually increased until delivery, suggesting progressive maturation of aortic elasticity mechanics.

Differences in Left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke

Abstract Funding Acknowledgements Type of funding sources: None. Background and Aims Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS). Patients and methods In 75 patients (age 55.2 ± 10.6) with acute cerebral stroke (25 lacunar, 20 atherosclerotic and 30 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 µm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain. Results Compared with controls, patients with stroke had higher PWV (11.38 ± 3.62 vs 9.51 ± 1.57 m/sec, p = 0.045), PBR (2.10 ± 0.27 vs 1.94 ± 0.20, p = 0.039) and central SBP (139.64 ± 26.31 vs 116.36 ± 37.23 mmHg, p = 0.039), while ventricular (-17.902 ± 3.77 vs - 19.87 ± 1.17%, p = 0.025) and atrial deformation (24.8 ± 9.99 vs 39.05 ± 2.08%, p &amp;lt; 0.001) were impaired in patients with stroke (p &amp;lt; 0.05). LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21.7 ± 6.6%, Lacunar 25.6 ± 13.2%, atherosclerotic 22.3 ± 7.8%, P &amp;lt; 0.05). Regarding endothelial glycocalyx, PBR5-9 (the smallest vessels with diameter 5-9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1.22 ± 0.12 μm, LACUNAR 1.19 ± 0.12 μm, ATHEROSCLEROTIC 1.15 ± 0.09 μm, p &amp;lt; 0.05), despite the fact that PBR5-25 was similar between all stroke types (ESUS 2.09 ± 0.23 μm, LACUNAR 2.13 ± 0.33 μm, ATHEROSCLEROTIC 2.09 ± 0.24 μm, p = 0.8). PWV was significantly higher in patients with atherosclerotic stroke (15.57 ± 5.50 m/sec, p = 0.007), while in patients with lacunar it was mildly elevated (10.53 ± 3.22 m/sec) and in ESUS patients it was moderately increased (11.7 ± 3 m/sec). Conclusions Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.

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.

Assessment of Aortic Stiffness by Transthoracic Echocardiographic in Young COVID-19 Patients.

Background:Deteriorated aortic elasticity is part of the atherosclerotic process. Inflammation is an underlying factor in both COVID-19 and atherosclerosis.Aims and Objectives:Using aortic elastic properties, we aimed to assess the subclinical indicators of susceptibility to inflammatory atherosclerosis in patients with COVID-19.Materials and Methods:Out of 194 participants included in this study, 100 were diagnosed with COVID-19 in the last 6 months (60 women and 40 men with a mean age of 34.13 ± 6.45 years) and 94 were healthy controls (55 women and 39 men with a mean age of 30.39 ± 7.21 years). We analyzed transthoracic echocardiographic and aortic stiffness parameters in all participants.Results:Values of systolic blood pressure (110 [85–140] vs. 110 [80–140], P = 0.037) and pulse pressure (PP) (37 [25–55] vs. 40 [25–55], P < 0.01) were significantly different between the groups. As for laboratory parameters, levels of glucose (97.89 ± 20.23 vs. 92.00 ± 9.95, P = 0.003) and creatinine (0.80 ± 0.13 vs. 0.75 ± 0.09, P = 0.003) were significantly higher in the COVID-19 group. Echocardiographic parameters showed that both groups differed significantly in diastolic aortic diameter (2.42 ± 0.28 vs. 2.31 ± 0.35, P = 0.017), aortic strain (9.66 [1.20–31.82] vs. 12.82 [2.41–40.11], P = 0.025), aortic distensibility (0.502 [0.049–2.545] vs. 0.780 [0.120–2.674], P < 0.01), and aortic stiffness (16.67 [4.19–139.43] vs. 11.71 [3.43–65.21], P = 0.006).Conclusion:Measurement of aortic stiffness is a simple, practical yet inexpensive method in COVID-19 patients, and therefore, may be used as an early marker for COVID-19-induced subclinical atherosclerosis.

Rare case of aortopathy revealing hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most prevalent (0.2%) heritable, genetic cardiovascular disease. Aortopathies also represent a spectrum of familial inheritance with prevalence of ~4%. Previous research evaluating characteristics of the aorta in HCM patients have demonstrated increased vascular stiffness and differences in aortic elastic properties compared to healthy controls. However, a prevalence of aortopathy in HCM patients has not been previously described and a potential relationship between HCM and aortic dilation has not been established limited by relatively small patient cohorts. We report the case of a 64 years old patient who was admitted to our cardiology department for the treatment of obstructive hypertrophic cardiomyopathy associated with anevrysmal dilation of the ascending aorta.

Differences in left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke

Abstract Background and purpose Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS). Methods In 68 patients (age 56,1±10.9) with acute cerebral stroke (22 lacunar, 19 atherosclerotic and 27 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) LA volume and strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain. Results Compared with controls, patients with stroke had higher PWV (11,38±3,62 vs 9,51±1,57 m/sec, p=0,045), PBR (2,10±0,27 vs 1,94±,020, p=0,039) and central SBP (139,64±26,31 vs 116,36±37,23 mmHg, p=0,039), while ventricular (−17,902±3,77 vs −19,87±1,17%, p=0,025) and atrial deformation (24,8±9,99 vs 39,050±2,08%, p&amp;lt;0.001) were impaired in patients with stroke (p&amp;lt;0.05). LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21,7±6,6%, Lacunar 25,6±13,2%, atherosclerotic 22,3±7,8%, P&amp;lt;0.05). Regarding endothelial glycocalyx, PBR5–9 (the smallest vessels with diameter 5–9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1,22±0,12 μm, LACUNAR 1,19±0,12 μm, ATHEROSCLEROTIC 1,15±0,09 μm, p&amp;lt;0.05), despite the fact that PBR5–25 was similar between all stroke types (ESUS 2,09±0.23 μm, LACUNAR 2,13±0,33 μm, ATHEROSCLEROTIC 2,09±0,24 μm, p=0.8). PWV was significantly higher in patients with atherosclerotic stroke (15,57±5,50 m/sec, p=0,007), while in patients with lacunar it was mildly elevated (10,53±3,22 m/sec) and in ESUS patients it was moderately increased (11,7±3 m/sec). Conclusion Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients. Funding Acknowledgement Type of funding sources: None.

Tobacco cigarette smoking accelerates impairment of aortic elastic properties in middle-aged patients with high normal blood pressure

Abstract Background The impact of smoking on atherosclerosis progression is greater in patients with arterial hypertension. High blood pressure (BP) is a major determinant of increased aortic stiffness which is an independent predictor of cardiovascular events. Aim of this study was to examine whether there are differences between office BP categorization and aortic stiffness on the basis of smoking status. Methods We measured carotid-femoral pulse wave (PWV) in 185 men (mean age: 55±10 years) who were not receiving antihypertensive medications and they had no history of diabetes and cardiovascular disease. The cohort was divided into three groups according to office systolic BP (SBP) and diastolic BP (DBP): normal (SBP &amp;lt;130 and DBP &amp;lt;85 mmHg, n=79), high normal (130≤SBP&amp;lt;140 or DBP 85≤DBP&amp;lt;90mmHg, n=42), and hypertension (SBP≥140 or DBP≥90mmHg, n=64). Results The three groups had similar age and metabolic parameters (body mass index, fasting blood glucose and LDL-C). PWV progressively increased from normotensive to high normal BP, and to hypertensive patients (7.8±1.4 vs 8.2±1.4 vs 8.6±1.6 m/s, respectively, overall P&amp;lt;0.01). Then we subdivided the three office BP groups into subgroups according to smoking status. Figure shows PWV of the three groups stratified by smoking status. The three subgroups of smokers had similar tobacco exposure (40 pack-years). There were not statistically significant differences between smokers and non smokers in each office BP category with regard to age and metabolic parameters. In separate analysis, among individuals with either normal BP the association of smoking status with PWV level was not significant. However, in hypertensive patients but also in patients with high normal BP, smoking status was significantly correlated with PWV (all P&amp;lt;0.01). Furthermore, the differences in mean PWV between smokers with high normal BP and patients with hypertension were not statistically significant reflecting a detrimental effect of smoking on aortic stiffness among males with high normal BP. Conclusion Smoking has an unfavorable effect on aortic elastic properties in men with high normal BP. The smokers with high normal BP have PWV comparable to that of hypertensive patients. This finding imply that smoking cessation should be a premising non pharmacological intervention in men with high-normal BP and increased aortic stiffness who are considered to be at a higher cardiovascular risk. Funding Acknowledgement Type of funding sources: None. Smoking, BP categories and PWV