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Introduction: Subclinical hypothyroidism (SCH) is a biochemical condition that is diagnosed when peripheral free thyroid hormone levels are within normal reference laboratory range but serum thyroid-stimulating hormone (TSH) levels are mildly elevated. The aim of this study was to investigate the relationship between SCH and arterial stiffness using two different non-invasive methods, including echocardiography and oscillometric arteriography. Material and Methods: The study included 33 newly diagnosed SCH patients and 34 age- and gender-matched healthy controls. Systolic and diastolic diameters and elastic parameters of the aorta were calculated by 2D Transthoracic echocardiography (TTE). Central blood pressure and aortic stiffness values of patient groups were measured noninvasively from the brachial artery using Mobil-O-Graph arteriography. Pulse wave velocity (PWV) and augmentation index (AIx) were used as arterial stiffness indicators. Results: There was no significant difference between SCH and control groups with regard to age, gender, and body mass index (BMI). Aortic strain and aortic distensibility, were significantly lower in the SCH group than in the control group (p < 0.001). PWV and AIx which measured by Mobil-O-Graph arteriography were found to be significantly higher in the subclinical hypothyroid group compared to the control group (p < 0.05). Conclusion: Aortic stiffness assessed by TTE and Mobil-O-Graph arteriography deteriorated in patients with SCH after excluding other cardiovascular risk factors. The assessment of aortic stiffness by the oscillometric method was easy and useful for widespread clinical use. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the relationship between APV and CAD and to compare AS and AD in patients with and without CAD. Material and Methods: A total of 100 subjects presenting to Government General Hospital, Guntur, with chest pain and undergoing coronary angiogram were selected for the study. Patients were divided into two groups, the study group comprises patients with >50% stenosis in at least one of the coronary artery on coronary angiogram, and control group comprises patients with normal coronaries on angiography. Two-dimensional echocardiography (Philips Affinity 70) was performed with the recording of data. AS and AD were calculated and APV was determined. Result: In the present study, it was observed that there was a statistically significant increased incidence of deranged lipid profile, diabetes, hypertension, alcohol consumption, and a positive family history of CAD in the study group. Mean APV, mean AD, and mean AS was significantly low in the study group as compared to the control group (P < 0.001). Conclusion: APV, AS, and AD can be used as surrogate markers to predict the presence of significant CAD and, hence, can be safely recommended as a simple, economical, and non-invasive means to screen CAD. [ABSTRACT FROM AUTHOR]

While mounting evidence suggests that wildland fire smoke (WFS) inhalation may increase the burden of cardiopulmonary disease, the occupational risk of repeated exposure during wildland firefighting remains unknown. To address this concern, we evaluated the cardiopulmonary function in mice following a cumulative exposure to lab-scale WFS equivalent to a mid-length wildland firefighter (WLFF) career. Dosimetry analysis indicated that 80 exposure hours at a particulate concentration of 22 mg/m3 yield in mice the same cumulative deposited mass per unit of lung surface area as 3600 h of wildland firefighting. To satisfy this condition, male Apoe-/- mice were whole-body exposed to either air or smoldering Douglas fir smoke (DFS) for 2 h/day, 5 days/week, over 8 consecutive weeks. Particulate size in DFS fell within the respirable range for both mice and humans, with a count median diameter of 110 ± 20 nm. Expiratory breath hold in mice exposed to DFS significantly reduced their minute volume (DFS: 27 ± 4; Air: 122 ± 8 mL/min). By the end of the exposure time frame, mice in the DFS group exhibited a thicker (DFS: 109 ± 3; Air: 98 ± 3 μm) and less distensible (DFS: 23 ± 1; Air: 28 ± 1 MPa-1) aorta with reduced diastolic blood augmentation capacity (DFS: 53 ± 2; Air: 63 ± 2 kPa). Cardiac magnetic resonance imaging further revealed larger end-systolic volume (DFS: 14.6 ± 1.1; Air: 9.9 ± 0.9 μL) and reduced ejection-fraction (DFS: 64.7 ± 1.0; Air: 75.3 ± 0.9 %) in mice exposed to DFS. Consistent with increased airway epithelium thickness (DFS: 10.4 ± 0.8; Air: 7.6 ± 0.3 μm), airway Newtonian resistance was larger following DFS exposure (DFS: 0.23 ± 0.03; Air: 0.20 ± 0.03 cmH2O-s/mL). Furthermore, parenchyma mean linear intercept (DFS: 36.3 ± 0.8; Air: 33.3 ± 0.8 μm) and tissue thickness (DFS: 10.1 ± 0.5; Air: 7.4 ± 0.7 μm) were larger in DFS mice. Collectively, mice exposed to DFS manifested early signs of cardiopulmonary dysfunction aligned with self-reported events in mid-career WLFFs.

BACKGROUND: Increased systemic vascular resistance and, in older people, reduced aortic distensibility, are thought to be the hemodynamic determinants of primary hypertension but cardiac output could also be important. We examined the hemodynamics of elevated blood pressure and hypertension in the middle to older-aged UK population participating in the UK Biobank imaging studies. METHODS: Cardiac output, systemic vascular resistance, and aortic distensibility were measured from cardiac magnetic resonance imaging in 31 112 (distensibility in 21 178) participants (46.3% male, mean age±SD 63±7 years). Body composition including visceral adipose tissue volume and abdominal subcutaneous adipose tissue volume were measured in 19 645 participants. RESULTS: Participants with higher blood pressure had higher cardiac output (higher by 17.9±26.6% in hypertensive compared with those with optimal blood pressure) and higher systemic vascular resistance (higher by 11.4±27.9% in hypertensive compared with those with optimal blood pressure). These differences were little changed after adjustment for body size and adiposity. The contribution of cardiac output relative to systemic vascular resistance was more marked in younger compared with older subjects. Aortic distensibility decreased with age and was lower in participants with higher compared with lower blood pressure but with a greater difference in younger compared with older subjects. CONCLUSIONS: In the middle to older-aged UK population, cardiac output plays an important role in contributing to elevated mean arterial blood pressure, particularly in younger compared with older subjects. Reduced aortic distensibility contributes to a rise in pulse pressure and systolic blood pressure at all ages. [ABSTRACT FROM AUTHOR]

Congenital heart defects (CHD) introduce haemodynamic changes; e.g., bicuspid aortic valve (BAV) presents a turbulent helical flow, which activates aortic pathological processes. Flow quantification is crucial for diagnostics and to plan corrective strategies. Multiple imaging modalities exist, with phase contrast magnetic resonance imaging (PC-MRI) being the current gold standard; however, multiple predetermined site measurements may be required, while 4D MRI allows for measurements of area (A) and velocity (U) in all spatial dimensions, acquiring a single volume and enabling a retrospective analysis at multiple locations. We assessed the feasibility of gathering hemodynamic insight into aortic hemodynamics by means of wave intensity analysis (WIA) derived from 4D MRI. Data were collected in n = 12 BAV patients and n = 7 healthy controls. Following data acquisition, WIA was successfully derived at three planes (ascending, thoracic and descending aorta) in all cases. The values of wave speed were physiological and, while the small sample limited any clinical interpretation of the results, the study shows the possibility of studying wave travel and wave reflection based on 4D MRI. Below, we demonstrate for the first time the feasibility of deriving wave intensity analysis from 4D flow data and open the door to research applications in different cardiovascular scenarios. [ABSTRACT FROM AUTHOR]

Purpose. 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. Methods and materials. 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. Results. 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). Conclusion. 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. [ABSTRACT FROM AUTHOR]

Background Increased aortic wall stiffness, which even persists after repair, has been reported in patients with tetralogy of Fallot (TOF). We aimed to observe the distensibility of the ascending aorta and descending aorta in fetuses with TOF and explore its relation with aortic blood flow volume and aortic and pulmonary annular size. Methods and Results Twenty‐three fetuses with TOF and 23 gestational age–matched normal fetuses were included in this prospective cross‐sectional study. The distensibilities of the ascending aorta and descending aorta were assessed by aortic strain (AS), which was defined as follows: 100×(maximum internal diameter in the systolic phase–minimum internal diameter in the diastolic phase)/minimum internal diameter in the diastolic phase. The maximum internal diameter in the systolic phase and minimum internal diameter in the diastolic phase of the ascending aorta and descending aorta were measured by M‐mode echocardiography. Associations between AS and aortic blood flow volume and aortic and pulmonary valve diameters were assessed in both groups. AS of the ascending aorta in TOF group was lower than that in controls (20.48%±4.19% versus 28.17%±4.54%; P

Michael R Sood,1,2 Sahar S Abdelmoneim,1 Nripen Dontineni,1 Alexander Ivanov,1 Ernest Lee,1 Michael Rubin,1 Michael Vittoria,1 Marcella Meykler,1 Vidhya Ramachandran,1 Terrence Sacchi,1 Sorin Brener,1 Igor Klem,3 John F Heitner1,4 1Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA; 2Division of Cardiology, Mount Sinai South Nassau, Oceanside, NY, USA; 3Duke University, Raleigh Durham, NC, USA; 4Division of Cardiology, New York University-Langone Health, Brooklyn, NY, USACorrespondence: Michael R Sood, Division of Cardiology, Mount Sinai South Nassau, Oceanside, NY, USA, Email mike.sood@gmail.comBackground: Aortic distensibility (AD) is an important determinant of cardiovascular (CV) morbidity and mortality. There is scant data on the association between AD measured within the descending thoracic aorta and CV outcomes.Objective: We evaluated the association of AD at the descending thoracic aorta (AD desc) with the primary outcome of all-cause mortality, myocardial infarction (MI), stroke or coronary revascularization in patients referred for a cardiovascular magnetic resonance (CMR) study.Methods: 928 consecutive patients [(mean age 60 ± 17; 33% with prior cardiovascular disease (CVD))] were evaluated. AD desc was measured at the cross-section of the descending thoracic aorta in the 4-chamber view (via steady-state free precession [SSFP] cine sequences) and was grouped into quintiles (with the 1st quintile corresponding to the least AD, i.e., the stiffest aorta). Cox proportional-hazards regression analysis were performed for the primary outcome.Results: A total of 315 patients (34%) experienced the primary outcome during a median (25% IQR, 75% IQR) follow-up of 5.0 (0.56, 9.3) years. A decreased AD was significantly associated with hypertension, diabetes, renal disease, and dyslipidemia (p < 0.0001). A primary outcome occurred in 43% of patients with AD desc ≤ median compared to 25% with AD desc > median, p < 0.0001, and in 44% of patients with AD desc in the 1st quintile compared to 31% with AD desc in the other quintiles (p = 0.0004). Event free survival was incrementally reduced amongst quintiles (p < 0.0001). However, AD desc ≤ median was not an independent predictor of the primary endpoint after multivariable adjustment in the overall population [adjusted HR 1.09 (95% CI:0.82– 1.45), p = 0.518] or in the subgroup analysis of patients with or without prior CVD.Conclusion: In this real-world cohort of 928 patients referred for CMR, AD desc is not an independent predictor of CV outcomes.Keywords: cardiovascular magnetic resonance, aortic distensibility, descending aorta, AD, CMR

BackgroundWomen experience a steeper decline in aortic elasticity related to aging compared to men. We examined whether sex hormone levels were associated with ascending aortic distensibility (AAD) in the Multi-Ethnic Study of Atherosclerosis.MethodsWe studied 1,345 postmenopausal women and 1,532 men aged 45-84 years, who had serum sex hormone levels, AAD measured by phase-contrast cardiac magnetic resonance imaging, and ejection fraction>50% at baseline. Among these participants, 457 women and 548 men returned for follow-up magnetic resonance imaging 10-years later. Stratified by sex, and using mixed effects linear regression methods, we examined associations of sex hormones (as tertiles) with baseline and annual change in log-transformed AAD (mm Hg-110-3), adjusting for demographics, body size, lifestyle factors, mean arterial pressure, heart rate, hypertensive medication use (and in women, for hormone therapy use and years since menopause).ResultsThe mean (SD) age was 65 (9) for women and 62 (10) years for men. AAD was lower in women than men (P < 0.001). In adjusted cross-sectional analysis, the highest tertile of free testosterone (compared to lowest) in women was significantly associated with lower AAD [-0.10 (-0.19, -0.01)] and the highest tertile of estradiol in men was associated with greater AAD [0.12 (0.04, 0.20)]. There were no associations of sex hormones with change in AAD over 10 years, albeit in a smaller sample size.ConclusionsLower free testosterone in women and higher estradiol in men were associated with greater aortic distensibility at baseline, but not longitudinally. Sex hormone levels may account for differences in AAD between women and men.

To evaluate the prognostic value of aortic distensibility measured by cardiovascular magnetic resonance (CMR) as predictors of prophylactic aortic valve or aortic surgery in patients with bicuspid aortic valve (BAV). 110 patients with BAV were included. Distensibility of middle ascending aorta (AscAo) and proximal descending aorta (DescAo) at baseline was determined using CMR. The association between aortic distensibility and primary endpoint of aortic valve and/or aortic surgery was investigated with Cox proportional hazard regression analyses. The receiver operating characteristics curves (ROC) of the area under receiver-operator (AUC) and DeLong test were used to evaluate and compare the performance of different models. During a median follow-up of 66.5 months [IQR 13–75 months], 42 patients experienced surgical treatments. After adjusting for traditional risk factors, aortic distensibility (P = 0.003) and severe valve dysfunction (P < 0.001) were found significantly associated with aortic valve and/or aortic surgery. The model 2 (aortic distensibility and severe valve dysfunction) is slightly better in predicting primary endpoint than the model 1 (aortic diameter and severe valve dysfunction) (AUC: 0.893 vs. 0.842, P = 0.106). In BAV patients, aortic distensibility and severe valve dysfunction are valuable predictors for final aortic valve and/or aortic surgery. [ABSTRACT FROM AUTHOR]

With the rise in maternal mortality rates and the growing body of epidemiological evidence linking pregnancy history to maternal cardiovascular health, it is essential to comprehend the vascular remodeling that occurs during gestation. The maternal body undergoes significant hemodynamic alterations which are believed to induce structural remodeling of the cardiovascular system. Yet, the effects of pregnancy on vascular structure and function have not been fully elucidated. Such a knowledge gap has limited our understanding of the etiology of pregnancy-induced cardiovascular disease. Towards bridging this gap, we measured the biaxial mechanical response of the murine descending thoracic aorta during a normotensive late-gestation pregnancy. Non-invasive hemodynamic measurements confirmed a 50% increase in cardiac output in the pregnant group, with no changes in peripheral blood pressure. Pregnancy was associated with significant wall thickening ( ∼14%), an increase in luminal diameter ( ∼6%), and material softening in both circumferential and axial directions. This expansive remodeling of the tissue resulted in a reduction in tensile wall stress and intrinsic tissue stiffness. Collectively, our data indicate that an increase in the geometry of the vessel may occur to accommodate for the increase in cardiac output and blood flow that occurs in pregnancy. Similarly, wall thickening accompanied by increased luminal diameter, without a change in blood pressure may be a necessary mechanism to decrease the tensile wall stress, and avoid pathophysiological events following late gestation.

To determine the relationship between aortic distensibility and left ventricular (LV) remodeling, myocardial strain and blood biomarkers in patients with stenotic bicuspid aortic valve (BAV) and preserved ejection fraction (EF) by cardiovascular magnetic resonance (CMR). 43 stenotic BAV patients were prospectively selected for 3.0 T CMR. Patients were divided into LV remodeling group (LV mass/volume ≥ 1.15, n = 21) and non-remodeling group (LV mass/volume < 1.15, n = 22). Clinical characteristics, biochemical data including cardiac troponin T(cTNT), N-terminal pro-B type natriuretic peptide (NT-proBNP) and creatine kinase isoenzyme (CK-MB) were noted. Distensibility of middle ascending aorta (mid-AA) and proximal descending aorta, LV structural and functional parameters, global and regional myocardial strain were measured. Compared to non-remodeling group, LV remodeling group had significantly decreased LV global strain (radial: 26.04 ± 8.70% vs. 32.92 ± 7.81%, P = 0.009; circumferential: − 17.20 ± 3.38% vs. − 19.65 ± 2.34%, P = 0.008; longitudinal: − 9.13 ± 2.34% vs. − 11.63 ± 1.99%, P < 0.001) and decreased mid-AA distensibility (1.22 ± 0.24 10–3 mm/Hg vs 1.60 ± 0.41 10–3 mm/Hg, P = 0.001). In addition, mid-AA distensibility was independently associated with LV remodeling (β = − 0.282, P = 0.003), and it was also significantly correlated with LV global strain (radial: r = 0.392, P = 0.009; circumferential: r = − 0.348, P = 0.022; longitudinal: r = − 0.333, P = 0.029), cTNT (r = − 0.333, P = 0.029) and NT-proBNP (r = − 0.440, P = 0.003). In this cohort with stenotic BAV and preserved EF, mid-AA distensibility is found significantly associated with LV remolding, which encouraging to better understand mechanism of ventricular vascular coupling. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore a possible relationship between aortic stiffness parameters and diastolic function in patients with asymptomatic or symptomatic diastolic dysfunction, and subsequently, the effect of aortic stiffness parameters on the progression from asymptomatic diastolic dysfunction to clinical diastolic heart failure. Methods: Seventy-five subjects were enrolled in the study of whom 20 had diastolic heart failure with the left ventricle ejection fraction (LVEF) >50%, 20 had asymptomatic diastolic dysfunction with LVEF>50%, 16 had hypertension with normal diastolic function, and 19 were normotensive healthy subjects. Ascending aorta recordings for measuring aortic strain and distensibility as markers of aortic stiffness were obtained from a spot nearly 3 cm above the aortic valve using 2-D echocardiography under M-mode. Doppler echocardiography and 2-D echocardiographic measurements were used to determine diastolic function. Results: While no statistically significant difference in aortic strain or distensibility values was observed between the asymptomatic group and the diastolic heart failure group; however, E/E’ values were higher in the heart failure group [12.1 (10.0-17.1) vs. 10.0 (6.2-22.5)] (p=0.014). Aortic strain and distensibility values significantly decreased as E/E’ values increased (r = −0.416; p < 0.001 and r = −0.576; p < 0.001, respectively) for pooled data from all groups. Conclusion: Although aortic stiffness parameters did not have a direct effect on the progression from asymptomatic diastolic dysfunction to diastolic heart failure, echocardiographic monitoring of these parameters may be beneficial in identifying patients who would progress to clinical heart failure from diastolic dysfunction.

Purpose. 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. Methods and materials. 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. Results. 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). Conclusion. 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.

Windkessel function is governed by conductance artery compliance that is associated with cardiovascular disease in adults independently of other risk factors. Sex-related differences in conductance artery compliance partly explain the sex-related differences in risk of cardiovascular disease. Studies on sex-related differences in conductance artery function in prepubertal children are few and inconclusive. This study determined the conductance artery compliance and cardiac function by magnetic resonance imaging in 150 healthy children (75 girls) aged 7-10 yr. Any sex-related difference in conductance artery function was determined with correction for other potential predictors in multivariable linear regression models. Our data showed that ascending [crude mean difference 1.11 95% confidence interval (CI) (0.22; 2.01)] and descending [crude mean difference 1.10 95% CI (0.09; 1.91)] aortic distensibility were higher in girls, but differences disappeared after adjustment for pubertal status and other identified potential predictors. Systolic and diastolic blood pressure, cardiac output, left ventricle (LV) systolic function, and total peripheral resistance did not differ between the sexes. In girls, heart rate was 7 beats/min higher, whereas pulse pressure (by 2 mmHg), LV end-diastolic volume index (by 7 mL), and stroke volume (by 5 mL) were lower. LV peak filling rate indexed to LV end-diastolic volume was 0.5 s-1 higher in girls. In conclusion, prepubertal girls and boys have equal conductance artery function. Thus, the well-known sex difference in adult conductance artery function seems to develop after the onset of puberty with girls initially increasing aortic distensibility. NEW & NOTEWORTHY Although it has been suggested that sex differences in conductance artery function may exist early in childhood, this study demonstrates that the well-known, sex-related difference in conductance artery stiffness (hence Windkessel function) in adulthood is not established before puberty. Thus, healthy prepubertal girls and boys have comparable conductance artery compliance. In contrast to previous studies, our study suggests that pubertal girls develop a more distensible aorta than prepubertal children. [ABSTRACT FROM AUTHOR]

Background: Exposure to high altitudes determines several adaptive mechanisms affecting in a complex way the whole cardiovascular, respiratory, endocrine systems because of the hypobaric hypoxic condition. The aim of our study was to evaluate the circulatory adaptive mechanisms at high altitudes, during a scientific expedition in the Himalayas. Methods: Arterial distensibility was assessed measuring carotid-radial and carotid-femoral pulse wave velocity. Tests were carried out at several altitudes, from 1350 to 5050 m above sea level, on 8 lowlander European researchers and 11 highlander Nepalese porters. Results: In Europeans, systolic blood pressure and pulse pressure increased slightly but significantly with altitude (p < 0.05 and p < 0.001, respectively). Norepinephrine showed a significant increase after the lowlanders had spent some time at high altitude (p < 0.001). With increasing altitude, a progressive increase in carotid-radial and carotid-femoral pulse wave velocity values was observed in lowlanders, showing a particularly significant increase (p < 0.001) after staying at high altitude (carotid-radial pulse wave velocity, median value (interquartile range) from 9.2 (7.9–10.0) to 11.2 (10.9–11.8) m/s and carotid-femoral pulse wave velocity from 8.5 (7.9–9.0) to 11.3 (10.9–11.8) m/s). At high altitudes (3400 and 5050 m above sea level), no significant differences were observed between highlanders and lowlanders in hemodynamic parameters (blood pressure, carotid-radial and carotid-femoral pulse wave velocity). Conclusions: The progressive arterial stiffening with altitude observed in European lowlanders could explain the increase in systolic and pulse pressure values observed at high altitudes in this ethnic group. Further studies are needed to evaluate the role of aortic stiffening in the pathogenesis of acute mountain sickness. [ABSTRACT FROM AUTHOR]

This study details application of deep learning for automatic segmentation of the ascending and descending aorta from 2D phase-contrast cine magnetic resonance imaging for automatic aortic analysis on the large MESA cohort with assessment on an external cohort of thoracic aortic aneurysm (TAA) patients. This study includes images and corresponding analysis of the ascending and descending aorta at the pulmonary artery bifurcation from the MESA study. Train, validation, and internal test sets consisted of 1123 studies (24,282 images), 374 studies (8067 images), and 375 studies (8069 images), respectively. The external test set of TAAs consisted of 37 studies (3224 images). CNN performance was evaluated utilizing a dice coefficient and concordance correlation coefficients (CCC) of geometric parameters. Dice coefficients were as high as 97.55% (CI: 97.47–97.62%) and 93.56% (CI: 84.63–96.68%) on the internal and external test of TAAs, respectively. CCC for maximum and minimum and ascending aortic area were 0.969 and 0.950, respectively, on the internal test set and 0.997 and 0.995, respectively, for the external test. The absolute differences between manual and deep learning segmentations for ascending and descending aortic distensibility were 0.0194 × 10−4 ± 9.67 × 10−4 and 0.002 ± 0.001 mmHg−1, respectively, on the internal test set and 0.44 × 10−4 ± 20.4 × 10−4 and 0.002 ± 0.001 mmHg−1, respectively, on the external test set. We successfully developed a U-Net-based aortic segmentation and analysis algorithm in both MESA and in external cases of TAA. [ABSTRACT FROM AUTHOR]

Background and AimsAnthracycline-based chemotherapy (ANTH-BC) has been proposed to increase arterial stiffness, however, the time-dependency of these effects remain unclear. This systematic review and meta-analysis aimed to investigate the time-dependent effect of ANTH-BC on markers of central aortic stiffness, namely aortic distensibility (AD) and pulse-wave-velocity (PWV) in cancer patients.MethodsAn extensive literature search without language restrictions was performed to identify all studies presenting longitudinal data on the effect of ANTH-BC on either AD and/or central PWV in cancer patients of all ages. An inverse-variance weighted random-effect model was performed with differences from before to after chemotherapy, as well as for short vs. mid-term effects.ResultsOf 2,130 articles identified, 9 observational studies with a total of 535 patients (mean age 52 ± 11; 73% women) were included, of which four studies measured AD and seven PWV. Short-term (2–4 months), there was a clinically meaningful increase in arterial stiffness, namely an increase in PWV of 2.05 m/s (95% CI 0.68–3.43) and a decrease in AD (albeit non-significant) of −1.49 mmHg-1 (−3.25 to 0.27) but a smaller effect was observed mid-term (6–12 months) for PWV of 0.88 m/s (−0.25 to 2.02) and AD of −0.37 mmHg-1 (−1.13 to 0.39). There was considerable heterogeneity among the studies.ConclusionsResults from this analysis suggest that in the short-term, ANTH-BC increases arterial stiffness, but that these changes may partly be reversible after therapy termination. Future studies need to elucidate the long-term consequences of ANTH-BC on arterial stiffness, by performing repeated follow-up measurements after ANTH-BC termination.Systematic Review Registration[www.crd.york.ac.uk/prospero/], identifier [CRD42019141837].

To evaluate aortic distensibility and pulse waveform patterns associated with the ascending aortic aneurysm, and to analyze the postoperative and mid-term hemodynamic changes induced by prosthetic replacement of the ascending aorta. Central blood pressure waves were recorded at the carotid artery level by means of a validated transcutaneous arterial tonometer in 30 patients undergoing prosthetic replacement of ascending aortic aneurysm and in 30 control patients. Measurements were obtained the day before surgery and 5 to 7 days and 16 to 20 months after surgery. The ascending aortic aneurysm was associated with a less steep slope of early systolic phase of the pressure curve (pulsus tardus) compared with a control group (0.54 ± 0.18 mm Hg/ms vs 0.69 ± 0.26 mm Hg/ms; P =.011). Replacing the ascending aorta with a noncompliant vascular prosthesis steepened the pulse pressure slope during the early systolic phase in the postoperative period (0.77 ±.29 mm Hg/ms), providing values comparable with those of the control group in the mid-term (0.67 ±.20 mm Hg/ms). No change in aortic stiffness was found either postoperatively or in the mid-term after ascending aorta surgical replacement (carotid-femoral pulse wave velocity: preoperative, 9.0 ± 2.6 m/s; postoperative, 9.0 ± 2.9 m/s; mid-term postoperative, 9.3 ± 2.8 m/s). This study does not confirm the assumption that substitution of the viscoelastic ascending aorta with a rigid prosthesis can cause serious hemodynamic alterations downstream, because we did not observe a worsening of global aortic distensibility after insertion of a rigid prosthetic aorta. The ascending aortic aneurysm is associated with a pulsus tardus. [ABSTRACT FROM AUTHOR]

The correct estimation of the distensibility of deformable aorta replicas is a challenging issue, in particular when its local characterization is necessary. We propose a combined in-vitro and in-silico approach to face this problem. First, we tested an aortic silicone arch in a pulse-duplicator analyzing its dynamics under physiological working conditions. The aortic flow rate and pressure were measured by a flow meter at the inlet and two probes placed along the arch, respectively. Video imaging analysis allowed us to estimate the outer diameter of the aorta in some sections in time. Second, we replicated the in-vitro experiment through a Fluid-Structure Interaction simulation. Observed and computed values of pressures and variations in aorta diameters, during the cardiac cycle, were compared. Results were considered satisfactory enough to suggest that the estimation of local distensibility from in-silico tests is reliable, thus overcoming intrinsic experimental limitations. The aortic distensibility (AD) is found to vary significantly along the phantom by ranging from 3.0 × 10−3 mmHg−1 in the ascending and descending tracts to 4.2 × 10−3 mmHg−1 in the middle of the aortic arch. Interestingly, the above values underestimate the AD obtained in preliminary tests carried out on straight cylindrical samples made with the same material of the present phantom. Hence, the current results suggest that AD should be directly evaluated on the replica rather than on the samples of the adopted material. Moreover, tests should be suitably designed to estimate the local rather than only the global distensibility. [ABSTRACT FROM AUTHOR]

Objective: Mitral valve prolapse (MVP) is a heart valve anomaly that affects a considerable segment of the population. Studies of patients with isolated MVP have shown that aortic distensibility decreased as the aortic diameter increased. The aim of this study was to compare evaluations of aortic distensibility in MVP patients using both applanation tonometry and the conventional echocardiographic examination. Methods: A total of 36 consecutive patients with MVP (16 male and 20 female) and 23 healthy controls (11 male and 12 female) were included in this study. The difference in aortic diameter and distensibility was examined using echocardiography and pulse wave velocity (PWV) was measured with applanation tonometry. Results: According to the echocardiographic measurements, the aortic distensibility was lower in the MVP patients than in the control group (6.2+-4.0 cm².dyn⁻¹.10⁻⁶ vs. 10.0+-5.2 cm². dyn⁻¹.10⁻⁶; p=0.02). The PWV measured with applanation tonometry was significantly higher in the MVP patients than in the control group (9.0+-2.4 m/s vs. 7.2+-1.4 m/s; p=0.006). Conclusion: The results of this study showed that aortic distensibility was reduced in patients with isolated MVP compared with a healthy control group. There was a moderate negative correlation between the results of both methods.

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. [ABSTRACT FROM AUTHOR]

Objective To study the effects of ascending aorta dilatation and aortic valve dysfunction on the elasticity of the middle ascending aorta (mid-AA) and proximal descending aorta (PDA) in patients with bicuspid aortic valve (BAV) by using magnetic resonance imaging (MRI). Methods From Oct 2019 to Mar 2021, a total of 130 BAV patients and 30 healthy volunteers from Zhongshan Hospital, Fudan University were prospectively undergone 3.0 T MRI for aortic distensibility. BAV patients were categorized into 4 groups according to the diameter of ascending aorta and aortic valve function as follows: BAV with normal or mild aortic valve dysfunction and nondilated ascending aorta (AA) (BAV-CTL, n=30), BAV with normal or mild aortic valve dysfunction and dilated AA (Dilated BAV-NF, n=40), BAV with moderate to severe aortic stenosis and dilated AA (Dilated BAV-AS, n=30), and BAV with moderate to severe aortic insufficiency and dilated AA (Dilated BAV-AI, n=30). The cross-sectional areas and distensibility of mid-AA and PDA were assessed at the level of right pulmonary artery.Student’s t test and Mann-Whitney U test were used to compare the continuous variables between the groups, while chi-square test or Fisher exact test was used to compare the categorical variables. Results Dilated BAV-NF group had decreased mid-AA distensibility［2.77 (IQR: 1.45-6.26) vs. 1.52 (IQR: 1.08-2.19), P=0.004] than BAV-CTL group. Compared with the Dilated BAV-NF, Dilated BAV-AI had elevated distensibility at mid- AA and PDA［mid-AA: 1.52 (IQR: 1.08-2.19) vs. 2.29 (IQR: 1.60-4.08), P=0.006；PDA: 3.70 (IQR: 2.89-4.70) vs. 4.79 (IQR: 2.93-6.80), P=0.024]. Compared with the Dilated BAV-AS, Dilated BAV-AI again showed elevated distensibility at mid-AA and PDA［mid-AA: 1.60 (IQR: 0.99-2.26) vs. 2.29 (IQR: 1.60-4.08), P=0.022；PDA: 3.73 (IQR: 2.38-4.40) vs. 4.79 (IQR: 2.93-6.80), P=0.014]. Conclusion Ascending aorta dilatation and aortic insufficiency are the main factors affecting aortic elasticity in patients with BAV. The effect of aortic dilatation on aortic elasticity is limited to the ascending aorta, while the effect of aortic insufficiency on aortic elasticity is more extensive. [ABSTRACT FROM AUTHOR]

Abstract Background Hyperglycemia, insulin resistance, and hyperinsulinemia represent important pathophysiological components of the prediabetic stage that result in arteriosclerosis and increased arterial stiffness. We sought to compare the aortic distensibility (AD) assessed by cardiac magnetic resonance (CMR) in prediabetic patients presenting with chronic coronary artery disease (CCAD) versus patients with normal HbA1C. Ninety-eight patients with CCAD were recruited. All patients were screened for HbA1C levels and then underwent a CMR study to assess AD of the aortic root and the ascending and descending thoracic aorta. Patients were classified into two groups: 52 prediabetic (HbA1C 5.7–6.4%) (study group) and 46 with normal glycemic status (HbA1C < 5.7%) (control group). Results AD values at the aortic root (AR) (13.93 ± 5.17 vs 34.3 ± 9.65 Kpa-1 × 10-3), ascending aorta (AA) (13.17 ± 4.81 vs 28.1 ± 8.33 Kpa-1 × 10-3), and descending thoracic aorta (DA) (18.12 ± 4.34 vs 33.68 ± 7.57 Kpa-1 × 10-3) were significantly lower in the study group than in the control group (P value for all was < 0.001). Twenty-eight patients fulfilled the criteria for metabolic syndrome, and in those patients, AD was significantly lower than in those without metabolic syndrome. Aortic distensibility at the AR, AA, and DA had strong significant negative correlations with the level of glycosylated hemoglobin (AA, AR, DA; r − 0.66, − 0.68, − 0.58, respectively) (P < 0.001). Conclusion AD values at different points (AR, AA, and DA) were significantly lower in prediabetic and metabolic syndrome patients than in controls. These values also showed a significant negative correlation with the levels of HBA1C.

Purpose: To determine the prevalence and degree of aortic dilatation (Adilatation), severity of aortic stiffness (Astiff), factors for Adilatation, and level of aortic root most sensitive to Astiff in patients with repaired tetralogy of Fallot (rTOF). Materials and methods: 269 patients with rTOF (mean age 14.9 ± standard deviation 5.0 years) were analyzed for Adilatation at annulus, sinus, sinotubular junction, and ascending aorta (aAo). Aortic size index was graded as Z score < 2, 2–2.99, 3–4.99 and ≥ 5. Aortic distensibility (aAdis) was categorized according to 4 aortic levels and dilatation severity. Factors for Adilatation and level of aortic root most sensitive to Astiff were analyzed. Results: Sinus and aAo were the two most common sites of Adilatation, with a prevalence of 84% and 76%, respectively. A decreased aAdis was found (mean 5.38 ± 1.79 10−3 mmHg−1). aAdis only declined significantly at the sinus level (p = 0.009). Male sex, age-at-repair and aortic regurgitation were significant factors for Adilatation, with male sex as the strongest factor (odds ratio 2.94). There was a significant decline in aAdis at sinus level (p = 0.002) as Adilatation progressed. Conclusions: We observed a high prevalence of Adilatation and Astiff in patients with rTOF. Male sex is the strongest factor for Adilatation. The sinus is the most sensitive area for determining a negative aAdis effect. [ABSTRACT FROM AUTHOR]

Purpose: Arterial stiffness has been shown as an independent predictor of cardiovascular and all-cause mortality in hypertensive patients. commonly seen in pulse wave Doppler echocardiographic examination of the left ventricle outflow tract, is related to diastolic dysfunction and arterial stiffness parameters. Our study aims to investigate the relation between aortic distensibility (AD) and presystolic A wave (PSW),. Materials and Methods: Hypertensive patients were included in the study. Aortic stiffness was calculated by measuring aortic diameters with m-mode in echocardiography, and the presence of PSW was noted from the left ventricle outflow tract just proximal to the aortic valve in apical five-chamber view. Results: A total of 149 hypertensive patients were included. Diastolic blood pressure, septum diameter, posterior wall diameter, aortic diastolic, and systolic diameter were significantly higher in the presence of PSW. Aortic distensibility (AD) was higher in patients with PSW. Multivariable logistic regression analysis showed that AD (OR: 0.812, 95% CI: 0.712 – 0.927, p = 0.002) was an independent predictor of PSW presence. Conclusion: PSW presence is associated with aortic stiffness evaluated by decreased aortic distensibility and highlights that PSW presence could be an independent predictor of aortic stiffness in patients with HT. [ABSTRACT FROM AUTHOR]

Despite a decline in popularity over the past several decades, cigarette smoking remains a leading cause of cardiovascular morbidity and mortality. Yet, the effects of cigarette smoking on vascular structure and function are largely unknown. To evaluate changes in the mechanical properties of the aorta that occur with chronic smoking, we exposed female apolipoprotein E-deficient mice to mainstream cigarette smoke daily for 24 wk, with room air as control. By the time of euthanasia, cigarette-exposed mice had lower body mass but experienced larger systolic/diastolic blood pressure when compared with controls. Smoking was associated with significant wall thickening, reduced axial stretch, and circumferential material softening of the aorta. Although this contributed to maintaining intrinsic tissue stiffness at control levels despite larger pressure loads, the structural stiffness became significantly larger. Furthermore, the aorta from cigarette-exposed mice exhibited decreased ability to store elastic energy and augment diastolic blood flow. Histological analysis revealed a region-dependent increase in the cross-sectional area due to smoking. Increased smooth muscle and extracellular matrix content led to medial thickening in the ascending aorta, whereas collagen deposition increased the thickness of the descending thoracic and abdominal aorta. Atherosclerotic lesions were larger in exposed vessels and featured a necrotic core overlaid by a thinned fibrous cap and macrophage infiltration, consistent with a vulnerable phenotype. Collectively, our data indicate that cigarette smoking decreases the mechanical functionality of the aorta, inflicts morphometric alterations to distinct segments of the aorta, and accelerates the progression of atherosclerosis. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular risk may be increased in astronauts after long term space flights based on biomarkers indicating premature vascular aging. We tested the hypothesis that 60 days of strict 6° head down tilt bed rest (HDTBR), an established space analog, promotes vascular stiffening and that artificial gravity training ameliorates the response. Methods: We studied 24 healthy participants (8 women, 24–55 years, BMI = 24.3 ± 2.1 kg/m2) before and at the end of 60 days HDTBR. 16 subjects were assigned to daily artificial gravity. We applied echocardiography to measure stroke volume and isovolumetric contraction time (ICT), calculated aortic compliance (stroke volume/aortic pulse pressure), and assessed aortic distensibility by MRI. Furthermore, we measured brachial-femoral pulse wave velocity (bfPWV) and pulse wave arrival times (PAT) in different vascular beds by blood pressure cuffs and photoplethysmography. We corrected PAT for ICT (cPAT). Results: In the pooled sample, diastolic blood pressure (+8 ± 7 mmHg, p < 0.001), heart rate (+7 ± 9 bpm, p = 0.002) and ICT (+8 ± 13 ms, p = 0.036) increased during HDTBR. Stroke volume decreased by 14 ± 15 ml (p = 0.001). bfPWV, aortic compliance, aortic distensibility and all cPAT remained unchanged. Aortic area tended to increase (p = 0.05). None of the parameters showed significant interaction between HDTBR and artificial gravity training. Conclusion: 60 days HDTBR, while producing cardiovascular deconditioning and cephalad fluid shifts akin to weightlessness, did not worsen vascular stiffness. Artificial gravity training did not modulate the response. [ABSTRACT FROM AUTHOR]

Noninvasive assessment of aortic distensibility (AD) is feasible with cardiac magnetic resonance (CMR). We investigated the relationship between AD (assessed by CMR) and coronary artery disease (CAD) severity (assessed by the SYNTAX score) in patients with premature CAD. We recruited 125 patients with CAD confirmed by coronary angiography (males were <55 years old and females <65 years old). We excluded patients with significant aortic disease or contraindications to CMR. We also recruited 25 age- and sex-matched healthy patients as controls. One-year follow-up was also carried out. Aortic distensibility at the aortic root (AR) and descending aorta (DA) was significantly (P <.001 for both) lower in the patient group. There was a significant negative correlation between SYNTAX score and AD at the AR (r = −0.56; P <.001) and DA (r = −0.34; P <.001), but insignificant correlation with distensibility at the ascending aorta (AA; r = −0.03; P =.81). AR, AA, and DA distensibility, as well as left ventricular ejection fraction were predictors of adverse events. The severity of CAD in young patients is associated with decreased AD, especially at the level of the AR. Aortic distensibility can predict adverse events in these patients. [ABSTRACT FROM AUTHOR]

Abstract Background Women with Turner Syndrome have an increased risk for aortic dissection. Arterial stiffening is a risk factor for aortic dilatation and dissection. Here we investigate if arterial stiffening can be observed in Turner Syndrome patients and is an initial step in the development of aortic dilatation and subsequent dissection. Methods Fifty-seven women with Turner Syndrome (48 years [29–66]) and thirty-six age- and sex-matched controls (49 years [26–68]) were included. Distensibility, blood pressure, carotid-femoral pulse wave velocity (PWV), the augmentation index (Aix) and central blood pressure were determined using cardiovascular magnetic resonance, a 24-h blood pressure measurement and applanation tonometry. Aortic distensibility was determined at three locations: ascending aorta, transverse aortic arch, and descending aorta. Results Mean aortic distensibility in the descending aorta was significantly lower in Turner Syndrome compared to healthy controls (P = 0.02), however, this was due to a much lower distensibility among Turner Syndrome with coarctation, while Turner Syndrome without coarctation had similar distensibility as controls. Both the mean heart rate adjusted Aix (31.4% vs. 24.4%; P = 0.02) and central diastolic blood pressure (78.8 mmHg vs. 73.7 mmHg; P = 0.02) were higher in Turner Syndrome compared to controls, and these indices correlated significantly with ambulatory night-time diastolic blood pressure. The presence of aortic coarctation (r = − 0.44, P = 0.005) and a higher central systolic blood pressure (r = − 0.34, P = 0.03), age and presence of diabetes were inversely correlated with aortic distensibility in TS. Conclusion Aortic wall function in the descending aorta is impaired in Turner Syndrome with lower distensibility among those with coarctation of the aorta, and among all Turner Syndrome higher Aix, and elevated central diastolic blood pressure when compared to sex- and age-matched controls. Trial registration The study was registered at ClinicalTrials.gov (#NCT01678274) on September 3, 2012.

Amaç: Obstrüktif uyku apne sendromu (OUAS), uykuda oksijen desatürasyonlarının sıklıkla eşlik ettiği tekrarlayan üst solunum yolu obstrüksiyonu olarak tanımlanır. OUAS’ın kardiyovasküler hastalıklar açısından bağımsız bir risk faktörü olduğu kabul edilmektedir. Bu çalışmada aort elastikiyetini gösteren parametrelerin OUAS’ın ağırlık derecesi ile olan ilişkisinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Uyku kliniğinde polisomnografi ile OUAS tanısı alan 65 hasta apne hipopne indekslerine göre hafif-orta ve ağır OUAS olmak üzere iki gruba ayrıldı. Hipertansiyon, koroner arter hastalığı, hiperlipidemi ve diyabetes mellitus komorbid hastalıklar olarak değerlendirildi. Bu kesitsel çalışmada iki grubun aortik strain ve aortik distensibilite açısından karşılaştırmaları yapıldı.Bulgular: Ortanca apne hipopne indeksi, hafif-orta OUAS’ta 15,2 (n=28) iken ağır OUAS’ta 56,5 (n=37) bulundu. Oksijen desatürasyon indeksi (p

Abstract Background We aimed to investigate in patients with type 2 diabetes whether aortic stiffness is: (i) associated with glycaemic control, (ii) associated with adverse outcomes and (iii) can be reversed on treatment with RAAS inhibition. Methods Patients with type 2 diabetes (N = 94) and low vascular risk underwent assessment of cardiovascular risk and CMR assessment of ascending aortic distensibility (AAD), descending aortic distensibility (DAD) and aortic pulse wave velocity (PWV). Of these patients a subgroup with recent onset microalbuminuria (N = 25) were treated with renin–angiotensin–aldosterone system (RAAS) inhibition and imaging repeated after 1 year. All 94 patients were followed up for 2.4 years for major adverse cardiovascular disease (CVD) events including myocardial infarction detected on late gadolinium enhancement CMR. Results Ascending aortic distensibility, DAD and PWV all had a significant association with age and 24 h systolic blood pressure but only AAD had a significant association with glycaemic control, measured as HbA1c (Beta − 0.016, P = 0.04). The association between HbA1c and AAD persisted even after correction for age and hypertension. CVD events occurred in 19/94 patients. AAD, but not DAD or PWV, was associated with CVD events (hazard ratio 0.49, 95% confidence interval 0.25–0.95, P = 0.01). On treatment with RAAS inhibition, AAD, but not DAD or PWV, showed significant improvement from 1.51 ± 1.15 to 1.97 ± 1.07 10−3 mmHg−1, P = 0.007. Conclusions Ascending aortic distensibility measured by CMR is independently associated with poor glycaemic control and adverse cardiovascular events. Furthermore it may be reversible on treatment with RAAS inhibition. AAD is a promising marker of cardiovascular risk in asymptomatic patients with type 2 diabetes and has potential use as a surrogate cardiovascular endpoint in studies of novel hypoglycaemic agents. Clinical trials registration https://clinicaltrials.gov/ct2/show/NCT01970319

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Alkaptonuria (AKU) is a rare inherited disorder of tyrosine metabolism resulting in an accumulation of homogentisic acid oxidation products in the joints and cardiovascular system. Aortic distensibility may be a non-invasive indicator of cardiovascular complications. Descending thoracic aortic distensibility in alkaptonuria has not been studied. Patients diagnosed with alkaptonuria underwent Magnetic Resonance Imaging (MRI) and gated non-contrast and contrast-enhanced cardiovascular computed tomography. Using MRI cine images, aortic distensibility of the descending thoracic aorta was determined. Seventy-six patients with alkaptonuria were imaged. When compared to literature normal values, aortic distensibility in AKU was impaired (5.2 vs 6.2 × 10−3, p <.001). Aortic distensibility was inversely related to age (r = −0.6, p =.0001). Hypertensive patients with alkaptonuria had impaired distensibility compared to normotensive patients with alkaptonuria (4.6 vs 5.6 × 10−3, p =.03), and hyperlipidemic patients with alkaptonuria had impaired distensibility compared to non-hyperlipidemic patients with alkaptonuria (4.1 vs 6.0 × 10−3, p =.001). Male hypertensive patients with alkaptonuria had greater distensibility than their female counterparts (5.3 vs 2.9 × 10−3, p =.02). Similarly, male hyperlipidemic patients with alkaptonuria had greater distensibility than their female counterparts (4.8 vs 2.5 × 10−3, p <.01). Of patients with alkaptonuria, those with a coronary artery calcium (CAC) score greater than 100 had more impaired distensibility than those with a CAC score less than 100 (3.5 vs 5.1 × 10−3, p =.01) and those with aortic calcium score greater than 100 had impaired distensibility compared to those with an aortic calcium score less than 100 (3.2 vs 4.9 × 10−3, p =.02). Univariate analysis revealed age, aortic calcification, and hyperlipidemia to be significant factors of distensibility, and multiple regression analysis showed age as the only significant risk factor of distensibility. Patients with alkaptonuria have impaired aortic distensibility, which is likely an early marker for reduced cardiovascular health. Variables such as age, hypertension, hyperlipidemia, and aortic and coronary calcification were associated with impaired distensibility. • Patients with alkaptonuria have impaired aortic distensibility in alkaptonuria compared to normal cohorts. • In patients with alkaptonuria, increased age is associated with decreased distensibility. • Hypertension and hyperlipidemia are significant CVD risk factors for impaired aortic distensibility in alkaptonuria. • Coronary artery and aortic calcification are significant determinants of aortic distensibility in alkaptonuria. [ABSTRACT FROM AUTHOR]

Objective: Aortic distensibility (AD) represents a well-established parameter of aortic stiffness. It remains unclear, however, whether AD can be obtained with high reproducibility in standard 4-chamber cine CMR images of the descending aorta. This study investigated the intra- and inter-observer agreement of AD based on different angles of the aorta and provided a sample size calculation of AD for future trials. Methods: Thirty-one patients underwent CMR. Angulation of the descending aorta was performed to obtain strictly transversal and orthogonal cross-sectional aortic areas. AD was obtained both area and diameter based. Results: For area-based values, inter-observer agreement was highest for 4-chamber AD (ICC 0.97; 95% CI 0.93–99), followed by orthogonal AD (ICC 0.96; 95% CI 0.91–98) and transversal AD (ICC 0.93; 95% CI 0.80–97). For diameter-based values, agreement was also highest for 4-chamber AD (ICC 0.97; 95% CI 0.94–99), followed by orthogonal AD (ICC 0.96; 95% CI 0.92–98) and transversal AD (ICC 0.91; 95% CI 0.77–96). Bland–Altman plots confirmed a small variation among observers. Sample size calculation showed a sample size of 12 patients to detect a change in 4-chamber AD of 1 × 10−3 mmHg−1 with either the area or diameter approach. Conclusion: AD measurements are highly reproducible and allow an accurate and rapid assessment of arterial compliance from standard 4-chamber cine CMR. [ABSTRACT FROM AUTHOR]

Increased vascular stiffness is known to be an independent predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). The effects of sacubitril-valsartan on vascular structure and function have not been systematically studied in this patient population. We hypothesized that aortic distensibility (AD) and fractional area change (AFAC), as assessed by 2D transthoracic echocardiography (TTE), would improve over time in HFrEF patients on sacubitril-valsartan therapy, due to the vasodilatory properties of the medication. We prospectively studied 30 patients with HFrEF (25 < EF < 40%) on optimal guideline-directed medical therapy who were subsequently started on sacubitril-valsartan. Patients underwent serial 2D TTE imaging at baseline, 3 and 6 months following therapy initiation. Ascending aortic diameters were measured 3 cm above the aortic valve in the parasternal long-axis view and used to calculate AD and AFAC, two markers of vascular compliance. For reference, we also measured AD and AFAC in 30 healthy, age and gender-matched controls at a single time point. Normal controls had significantly higher values of AD and AFAC than HFrEF patients at baseline (AD: 4.0 ± 1.1 vs. 2.2 ± 0.9 cm2dyne-110-3, p < 0.0001 and AFAC: 18.8 ± 3.7% vs. 10.3 ± 4.3%, p < 0.0001). In HFrEF patients on sacubitril-valsartan, both indices of aortic compliance progressively improved towards normal from baseline to 6 months: AD from 2.2 ± 0.9 to 3.6 ± 1.5 cm2dyne-110-3 (p < 0.0001) and AFAC from 10.3 ± 4.3 to 13.7 ± 4.1% (p < 0.0001). In conclusion, AD and AFAC are decreased in patients with HFrEF and gradually improve with sacubitril-valsartan treatment. The echocardiographic markers used in this study may become a useful tool to assess the effectiveness of sacubitril-valsartan therapy in HFrEF patients. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia, insulin resistance, and hyperinsulinemia represent important pathophysiological components of the prediabetic stage that result in arteriosclerosis and increased arterial stiffness. We sought to compare the aortic distensibility (AD) assessed by cardiac magnetic resonance (CMR) in prediabetic patients presenting with chronic coronary artery disease (CCAD) versus patients with normal HbA1C. Ninety-eight patients with CCAD were recruited. All patients were screened for HbA1C levels and then underwent a CMR study to assess AD of the aortic root and the ascending and descending thoracic aorta. Patients were classified into two groups: 52 prediabetic (HbA1C 5.7–6.4%) (study group) and 46 with normal glycemic status (HbA1C < 5.7%) (control group). Results: AD values at the aortic root (AR) (13.93 ± 5.17 vs 34.3 ± 9.65 Kpa-1 × 10-3), ascending aorta (AA) (13.17 ± 4.81 vs 28.1 ± 8.33 Kpa-1 × 10-3), and descending thoracic aorta (DA) (18.12 ± 4.34 vs 33.68 ± 7.57 Kpa-1 × 10-3) were significantly lower in the study group than in the control group (P value for all was < 0.001). Twenty-eight patients fulfilled the criteria for metabolic syndrome, and in those patients, AD was significantly lower than in those without metabolic syndrome. Aortic distensibility at the AR, AA, and DA had strong significant negative correlations with the level of glycosylated hemoglobin (AA, AR, DA; r − 0.66, − 0.68, − 0.58, respectively) (P < 0.001). Conclusion: AD values at different points (AR, AA, and DA) were significantly lower in prediabetic and metabolic syndrome patients than in controls. These values also showed a significant negative correlation with the levels of HBA1C. [ABSTRACT FROM AUTHOR]

Introduction: The presence of CFTR in smooth muscle and endothelial cells, systemic inflammation, and oxidative stress could explain vascular alterations in cystic fibrosis. Aortic elastic properties are determinants of left ventricular function by means of ventriculo‐arterial coupling and indicators of cardiovascular risk. Objectives: The purpose of the present study was to compare clinically stable patients affected by cystic fibrosis without overt pulmonary hypertension with controls to evaluate aortic tissue Doppler elastic properties, such as distensibility, stiffness, and strain. Methods: A total of 22 adults affected by cystic fibrosis, and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors, secondary diabetes, neither aortic stenosis nor regurgitation. All people underwent blood pressure measurement and transthoracic echocardiography. Results: Aortic diameter measured at Valsalva sinuses was significantly higher in patients with cystic fibrosis than healthy people, median 32.0 (interquartile range 29.8–35.0) vs 24.3 (22.2–30.0) mm; P < 0.001. Aortic distensibility was significantly lower among patients than controls, being 2.4 (1.3–3.3) vs 5.6 (3.4–8.3) per mm Hg (P < 0.001), while stiffness higher, 7.7 (6.0–14.8) vs 3.7 (2.9–6.7); P < 0.001. Finally, M‐mode strain of ascending aorta was lower in patients, 4.1 (3.4–7.3)% than in controls, 13.4 (7.7–19.4)%; P < 0.001. Conclusion: For the first time in humans, we demonstrated subclinical alterations in aortic elastic properties in young adults affected by cystic fibrosis without pulmonary hypertension or secondary diabetes. This phenomenon could influence left ventricular function earlier by means of ventriculo‐arterial coupling and may be a tool to identify patients who benefit from a closer follow‐up. [ABSTRACT FROM AUTHOR]

Aneurysms of the ascending aorta are frequently found in patients with a bicuspid aortic valve (BAV). This study assessed the risk factors of ascending aortic aneurysms and aortic elasticity in children with BAV. The study included 66 patients with no history of transcatheter intervention or surgical procedure who had been diagnosed with isolated BAV. Echocardiographic, blood pressure, and pulse measurements were obtained for all patients. The BAVs were classified as described by Sievers et al. (J Thorac Cardiovasc Surg 133:1226–1233, 2007), and aortic elasticity parameters were calculated using various formulas. The patients were divided into groups with and without cusp fusion, aortic stenosis (AS), aortic regurgitation (AR), or mixed lesions; the groups were then compared. The mean patient age was 10.43 ± 3.91 years; 15%he patients had no AS or AR, 33% had both AS and AR, 17% had AS alone, and 35% had AR alone. The most common type of BAV was type 5, and the ascending aorta z-scores were higher in children with mixed lesions and without a cusp fusion. Aortic distensibility (AD) was significantly higher, and the stiffness index was significantly lower, in patients with an ascending aorta z-score > 4. The ascending aortic z-scores were higher in the no-fusion and mixed lesion (AS + AR) groups, especially those originating from post-stenotic dilation due to AS. The AD was increased in patients with an ascending aorta z-score > 4. Patients should thus be monitored closely for dissection risk, and preventive medical treatment should be started early in those with AS without cusp fusion. [ABSTRACT FROM AUTHOR]

Background: In families with an inherited form of non-syndromic thoracic aortic disease (TAAD), aortic diameter alone is not a reliable marker for disease occurrence or progression. To identify other parameters of aortic function, we studied aortic stiffness in families with TAAD. We also compared diameter measurements obtained by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI).Methods: Seven families, including 116 individuals, with non-syndromic TAAD, were studied. The aortic diameter was measured by TTE and MRI. Aortic stiffness was assessed as local distensibility in the ascending aorta and as regional and global pulse wave velocity (PWV). Individuals with a dilated thoracic aorta (n = 21) were compared with those without aortic dilatation (n = 95).Results: Ascending aortic diameter measured by TTE strongly correlated with the diameter measured by MRI (r2 = 0.93). The individuals with dilated aortas were older than those without dilatation (49 vs 37 years old). Ascending aortic diameter increased and distensibility decreased with increasing age; while, PWV increased with age and diameter. Some young subjects without aortic dilatation showed increased aortic stiffness. Individuals with a dilated thoracic aorta had significantly higher PWV and lower distensibility, measured by MRI than individuals without dilatation.Conclusions: Diameters measured with TTE agree with those measured by MRI. Aortic stiffness might be a complementary marker for aortic disease and progression when used with aortic diameter, especially in young individuals. [ABSTRACT FROM AUTHOR]

Aortic flow propagation velocity (APV) is a novel echocardiographic parameter used in coronary artery disease. It has also been used for the evaluation of aortic stiffness. In the present study, APV was measured in patients with ischemic and non-ischemic dilated cardiomyopathy (DCM) and was compared with the parameters of aortic stiffness such as aortic distensibility (AD) and aortic strain (AS). A total of 140 patients who had undergone coronary angiographic imaging were included in the study. Out of these patients, 44 had ischemic DCM, 46 had non-ischemic DCM, and 50 had normal coronary angiography (control group). AS, AD, and APV were calculated echocardiographically. One-way analysis of variance (ANOVA) and the Kruskal-Wallis test were used to compare continuous variables between the groups, while the categorical variables were compared using Pearson's Chi square test. Pearson's correlation test was used to investigate the parameters associated with APV, AS, and AD. Ischemic DCM and non-ischemic DCM groups differed significantly. The comparison of these groups with the control group, in terms of AS, AD, and APV values (ANOVA p < 0.001 for all) also showed a significant difference. APV was found to be significantly correlated with AS (r = 0.645, p < 0.001) and AD (r = 0.604, p < 0.001). In ROC analysis, the area under the curve (AUC) value for APV was 0.999 (p = 0.000) for detection of patients ischemic DCM and non-ischemic DCM. APV may be considered to be a novel and a simple echocardiographic marker, for both, distinguishing ischemic from non-ischemic DCM as well as for the presence of dilated cardiomyopathy with or without critical coronary artery disease. [ABSTRACT FROM AUTHOR]

Background: Most trials regarding catheter-based renal sympathetic denervation (RDN) describe a proportion of patients without blood pressure response. Recently, we were able to show arterial stiffness, measured by invasive pulse wave velocity (IPWV), seems to be an excellent predictor for blood pressure response. However, given the invasiveness, IPWV is less suitable as a selection criterion for patients undergoing RDN. Consequently, we aimed to investigate the value of cardiac magnetic resonance (CMR) based measures of arterial stiffness in predicting the outcome of RDN compared to IPWV as reference.Methods: Patients underwent CMR prior to RDN to assess ascending aortic distensibility (AAD), total arterial compliance (TAC), and systemic vascular resistance (SVR). In a second step, central aortic blood pressure was estimated from ascending aortic area change and flow sequences and used to re-calculate total arterial compliance (cTAC). Additionally, IPWV was acquired.Results: Thirty-two patients (24 responders and 8 non-responders) were available for analysis. AAD, TAC and cTAC were higher in responders, IPWV was higher in non-responders. SVR was not different between the groups. Patients with AAD, cTAC or TAC above median and IPWV below median had significantly better BP response. Receiver operating characteristic (ROC) curves predicting blood pressure response for IPWV, AAD, cTAC and TAC revealed areas under the curve of 0.849, 0.828, 0.776 and 0.753 (p = 0.004, 0.006, 0.021 and 0.035).Conclusions: Beyond IPWV, AAD, cTAC and TAC appear as useful outcome predictors for RDN in patients with hypertension. CMR-derived markers of arterial stiffness might serve as non-invasive selection criteria for RDN. [ABSTRACT FROM AUTHOR]

Renal sympathetic denervation (RDN) is under investigation as a treatment option in patients with resistant hypertension (RH). Determinants of arterial compliance may, however, help to predict the BP response to therapy. Aortic distensibility (AD) is a well-established parameter of aortic stiffness and can reliably be obtained by CMR. This analysis sought to investigate the effects of RDN on AD and to assess the predictive value of pre-treatment AD for BP changes. We analyzed data of 65 patients with RH included in a multicenter trial. RDN was performed in all participants. A standardized CMR protocol was utilized at baseline and at 6-month follow-up. AD was determined as the change in cross-sectional aortic area per unit change in BP. Office BP decreased significantly from 173/92 ± 24/16 mmHg at baseline to 151/85 ± 24/17 mmHg (p < 0.001) 6 months after RDN. Maximum aortic areas increased from 604.7 ± 157.7 to 621.1 ± 157.3 mm2 (p = 0.011). AD improved significantly by 33% from 1.52 ± 0.82 to 2.02 ± 0.93 × 10−3 mmHg−1 (p < 0.001). Increase of AD at follow-up was significantly more pronounced in younger patients (p = 0.005) and responders to RDN (p = 0.002). Patients with high-baseline AD were significantly younger (61.4 ± 10.1 vs. 67.1 ± 8.4 years, p = 0.022). However, there was no significant correlation of baseline AD to response to RDN. AD is improved after RDN across all age groups. Importantly, these improvements appear to be unrelated to observed BP changes, suggesting that RDN may have direct effects on the central vasculature. [ABSTRACT FROM AUTHOR]

Central artery stiffening is recognized as a cardiovascular risk. The effects of hypertension and aging have been shown in human and animal models but the effect of salt is still controversial. We studied the effect of a high-salt diet on aortic stiffness in salt-sensitive spontaneously hypersensitive stroke-prone rats (SHRSP). Distensibility, distension, and β-stiffness were measured at thoracic and abdominal aortic sites in the same rats, using echotracking recording of the aortic diameter coupled with blood pressure (BP), in SHRSP-salt (5% salted diet, 5 weeks), SHRSP, and normotensive Wistar-Kyoto (WKY) rats. Hemodynamic parameters were measured at BP matched to that of WKY. Histological staining and immunohistochemistry were used for structural analysis. Hemodynamic isobaric parameters in SHRSP did not differ from WKY and only those from the abdominal aorta of SHRSP-salt presented decreased distensibility and increased stiffness compared with WKY and SHRSP. The abdominal and thoracic aortas presented similar thickening, increased fibrosis, and remodeling with no change in collagen content. SHRSP-salt presented a specific increased elastin disarray at the abdominal aorta level but a decrease in elastin content in the thoracic aorta. This study demonstrates the pro-stiffening effect of salt in addition to hypertension; it shows that only the abdominal aorta presents a specific pressure-independent stiffening, in which elastin disarray is likely a key mechanism. [ABSTRACT FROM AUTHOR]