130 results on '"Gisela Teixido Tura"'
Search Results
2. Domain Adaptation for Automatic Aorta Segmentation of 4D Flow Magnetic Resonance Imaging Data from Multiple Vendor Scanners.
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Jordina Aviles, Gonzalo D. Maso Talou, Oscar Camara 0001, Marcos Mejía Córdova, Xabier Morales Ferez, Daniel Romero 0003, Edward Ferdian, Kathleen Gilbert, Ayah Elsayed, Alistair A. Young, Lydia Dux-Santoy, Aroa Ruiz-Muñoz, Gisela Teixido-Tura, Jose Rodriguez-Palomares, and Andrea Guala 0002
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- 2021
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3. Aortic disease in Marfan syndrome is caused by overactivation of sGC-PRKG signaling by NO
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Andrea de la Fuente-Alonso, Marta Toral, Alvaro Alfayate, María Jesús Ruiz-Rodríguez, Elena Bonzón-Kulichenko, Gisela Teixido-Tura, Sara Martínez-Martínez, María José Méndez-Olivares, Dolores López-Maderuelo, Ileana González-Valdés, Eusebio Garcia-Izquierdo, Susana Mingo, Carlos E. Martín, Laura Muiño-Mosquera, Julie De Backer, J. Francisco Nistal, Alberto Forteza, Arturo Evangelista, Jesús Vázquez, Miguel R. Campanero, and Juan Miguel Redondo
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Science - Abstract
Aortic aneurysm and dissection, the major problem linked to Marfan syndrome (MFS), lacks effective pharmacological treatment. Here, the authors show that the NO pathway is overactivated in MFS and that inhibition of guanylate cyclase and cGMP-dependent protein kinase reverts MFS aortopathy in mice.
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- 2021
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4. P.49 Aortic Root Longitudinal Strain by Speckle-Tracking Echocardiography: Comparison with Cardiac Magnetic Resonance and Predictive Value in Marfan Syndrome Patients
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Andrea Guala, Maria Isabel Pons, Aroa Ruiz-Muñoz, Lydia Dux-Santoy, Laura Madrenas, Minerva Gandara, Filipa Valente, Angela Lopez-Sainz, Laura Galian, Laura Gutierrez, Augusto Sao-Aviles, Teresa Gonzalez-Alujas, Ignacio Ferreira, Arturo Evangelista, Jose Rodriguez-Palomares, and Gisela Teixido-Tura
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Echocardiography ,speckle-tracking ,Marfan ,strain ,Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Low longitudinal strain of the ascending aorta (AAo) by cardiac magnetic resonance (CMR) predicts dilation and aortic events in Marfan syndrome (MFS) [1], possibly reflecting aortic stiffness [2]. Speckle-tracking is established for cardiac deformation, but proximal aorta applications are challenging due to wall thickness and substantial motion. We aimed to validate a purpose-specific speckle-tracking tool for root longitudinal strain analysis by comparison with CMR-derived AAo longitudinal strain and as predictor of dilation in MFS patients. Methods: CMR feature-tracking [1] and echocardiography speckle-tracking where applied to 25 MFS patients free from previous aortic surgery by a single observer blind to clinical data. For echocardiography, two regions of interests were manually created covering both walls in a parasternal long-axis view and tracked along the cardiac cycle. Longitudinal strain was computed as the average of maximum increase in relative distance of several sub-regions covering both walls. Aortic diameter was measured on CMR images. Results: Both techniques were successfully applied to all patients. Aortic root longitudinal strain by echocardiography was linearly related to CMR-derived AAo longitudinal strain (R = 0.573, p = 0.003, Figure A) and was higher (20.4 ± 8.4 vs 10.5 ± 3.8), especially at higher absolute values (Figure B). After a mean follow up of 45 ± 13 months, aortic root diameter growth rate was 0.27 ± 0.3 mm/year. In multivariable analysis corrected for root diameter and heart rate (p = 0.083 and 0.005, respectively), baseline longitudinal strain by echocardiography was independently related to progressive dilation (B = −0.017, p = 0.005). Conclusion: Aortic root longitudinal strain by echocardiography is related to CMR-derived AAo longitudinal strain and is an independent predictor of progressive dilation in MFS patients.
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- 2020
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5. P.53 Ascending Aorta Diameter and Pulse Wave Velocity are Increased and Local Hemodynamic is Disrupted in Patients with Blunt Traumatic Thoracic Aortic Injury Treated by TEVAR
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Andrea Guala, Daniel Gil Sala, Aroa Ruiz-Muñoz, Marvin Garcia-Reyes, Lydia Dux-Santoy, Gisela Teixido-Tura, Cristina Tello, Filipa Valente, Angela Lopez-Sainz, Laura Galian, Laura Gutierrez, Kevin Johnson, Oliver Wieben, Ignacio Ferreira, Arturo Evangelista, Sergi Bellmunt-Montoya, and Jose Rodriguez-Palomares
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TEVAR ,stiffness ,hemodynamics ,MRI ,Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Thoracic endovascular aortic repair (TEVAR) is becoming the preferred treatment option to repair the proximal descending aorta after rupture following blunt traumatic injury. However, hemodynamic and mechanic implications of this intervention are poorly understood. Exploiting the possibilities of 4D flow magnetic resonance imaging, hemodynamics, stiffness and local dilation in the ascending aorta in patients following aortic repair by TEVAR are studied. Methods: Fifteen apparently healthy individuals who underwent TEVAR implantation after traumatic descending aortic injury and 44 healthy volunteers (HV) underwent 4D flow-MRI. Ascending aorta pulse wave velocity was computed [1]. Moreover, at eight planes equally distributed in the ascending aorta systolic flow reversal ratio, i.e. relative amount of backward flow during systole, and in-plane rotational flow, measuring the strength of helical flow, were computed [2,3]. Results: TEVAR patients and HV did not differ in terms of age, sex, BSA and blood pressure (Table). However, compared to HV, TEVAR patients showed reduced in-plane rotational flow in the distal ascending aorta in patients with TEVAR and increased backward systolic flow in the whole ascending aorta (Figure). Patients with TEVAR had a stiffer ascending aorta, with pulse wave velocity higher compared control (7.8 ± 4.2 vs 5.3 ± 1.9, p = 0.004). Finally, aortic root and ascending aorta diameters were larger in TEVAR patients compared to HV (Table). Healthy volunteers TEVAR patients p N 44 15 Age [years] 40 ± 12 43 ± 10 0.392 Sex [% male] 66 80 0.075 Years from intervention [years] N/A 10.3 ± 6.4 N/A Body surface area [m2] 1.87 ± 0.15 1.96 ± 0.23 0.088 Systolic blood pressure [mmHg] 127 ± 19 131 ± 15 0.389 Diastolic blood pressure [mmHg] 70 ± 11 74 ± 9 0.198 Aortic root diameter [mm] 31 ± 4 34 ± 4 0.026 Ascending aorta diameter [mm] 28 ± 4 32 ± 3 0.003 Ascending aorta PWV [m/s] 5.3 ± 1.9 7.8 ± 4.2 0.004 FigureIn-plane rotational flow (IRF, left) and systolic flow reversal ratio (SFRR, right) in healthy volunteers (black) and TEVAR patients (yellow) in the proximal (planes 1 to 4) and distal (planes 5 to 8) ascending aorta. Stars show statistically-significant differences (p < 0.05). Conclusions: The implantation of TEVAR in apparently healthy individuals after traumatic rupture of the proximal descending aorta is associated with altered hemodynamics, higher stiffness and larger aortic diameter in the region proximal to the TEVAR.
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- 2020
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6. P57 In Patients with Chronic Descending Aorta Dissection the Maximum Systolic Flow Deceleration Rate in the False Lumen is Associated with Aortic Dilatation: a 4D-flow MRI Study
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Andrea Guala, Aroa Ruiz-Muñoz, Lydia Duz-Santoy, Gisela Teixido-Tura, Chiara Granato, Augusto Sao-Aviles, Lucia La Mura, Angela Lopez-Sainz, Maria Luz Servato, Arturo Evangelista, Ignacio Ferreira, and Jose Rodriguez-Palomares
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Aortic type B dissection is a life-threating condition in which blood flows between aortic wall layers. Despite a role for morphological variables, such as entry tear location and dimension, in the prediction of progressive false lumen (FL) dilation has been suggested, the role of flow characteristics has not been studied due to the unavailability of proper flow descriptions. Now that 4D phase-contrast magnetic resonance imaging (4D-flow MRI) allows for the evaluation of flow field with unprecedented detail, we tested whether flow deceleration in the FL, being a marker of occluded flow exit, is related to FL dilation. Methods: In 29 patients with a patent FL and with a retrospective CT-based follow-up >3 years underwent 4D-flow MRI. Flow acceleration in the FL was calculated in a standardized sub-volume of the descending aorta. The maximum systolic flow deceleration rate (MSDR) was quantified as maximum minus minimum acceleration during systole divided by the corresponding time interval (Figure 1a). Results: Demographic and clinical variables were similar among growth-rate (GR) tertiles. MSDR was statistically different in patients with a GR
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- 2020
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7. P26 Ascending Aorta Longitudinal Strain is not Altered in Bicuspid Aortic Valve Patients
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Andrea Guala, Lydia Dux-Santoy, Gisela Teixido-Tura, Aroa Ruiz-Muñoz, Laura Madrenas, Minerva Gandara, Augusto Sao-Aviles, Filipa Valente, Laura Galian-Gay, Laura Gutierrez, Teresa Gonzalez-Alujas, Ignacio Ferreira, Arturo Evangelista, and Jose Rodriguez-Palomares
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Impaired ascending aorta (AAo) longitudinal strain, a marker of AAo deformation due to aorto-ventricular mechanical interaction, is related to progressive dilation and aortic events in Marfan syndrome [1]. Whether the high prevalence of dilation in bicuspid aortic valve (BAV) is due to intrinsically-altered aortic wall properties [2] or hemodynamic [3] is widely-discussed [4]. Whether AAo longitudinal strain is altered in BAV patients has never been assessed. Methods: One-hundred five BAV patients, 47 patients with AAo dilation and tricuspid aortic valve (TAV) and 31 healthy volunteers, free from previous cardiac/aortic surgery, dissection and moderate/severe valvular disease had cine MR images to compute AAo longitudinal strain [1]. Results: Compared to healthy volunteers, the 25 non-dilated (z-score < 2) BAV patients were older (p < 0.001), had higher systolic blood pressure (SBP, p = 0.001), clinically-meaningless (BAV z-score = 0.74 ± 1.1) larger AAo diameter (p < 0.001) and similar diastolic blood pressure (DBP), BSA, stroke volume and heart rate. AAo longitudinal strain was lower in non-dilated BAV compared to healthy volunteers (13.7 vs 10.3%, p = 0.008) but this difference was not significant after correction for age. Compared to dilated TAV, dilated BAV patients were younger (p < 0.001), had lower BSA (p = 0.010) and AAo diameter (p = 0.003), higher DBP (p = 0.032) and similar SBP, stroke volume and heart rate. AAo longitudinal strain was higher in dilated BAV compared to dilated TAV (10 vs 7.2%, p < 0.001) but this difference was not significant after correction for age, BSA and DBP. Conclusion: AAo longitudinal strain is similar in BAV and TAV matched for aortic dilation.
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- 2020
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8. Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve
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Angela Lopez, Ilaria Dentamaro, Laura Galian, Francisco Calvo, Josep M. Alegret, Violeta Sanchez, Rodolfo Citro, Antonella Moreo, Fabio Chirillo, Paolo Colonna, María Celeste Carrero, Eduardo Bossone, Sergio Moral, Augusto Sao-Aviles, Laura Gutiérrez, Gisela Teixido-Tura, Jose Rodríguez-Palomares, and Arturo Evangelista
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bicuspid aortic valve ,aneurysm ,aortic stenosis ,aortic regurgitation ,Medicine - Abstract
Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients.
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- 2021
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9. Machine learning for the automatic assessment of aortic rotational flow and wall shear stress from 4D flow cardiac magnetic resonance imaging
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Juan Garrido-Oliver, Jordina Aviles, Marcos Mejía Córdova, Lydia Dux-Santoy, Aroa Ruiz-Muñoz, Gisela Teixido-Tura, Gonzalo D. Maso Talou, Xabier Morales Ferez, Guillermo Jiménez, Arturo Evangelista, Ignacio Ferreira-González, Jose Rodriguez-Palomares, Oscar Camara, and Andrea Guala
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Machine Learning ,Aortic Valve ,Humans ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Magnetic Resonance Imaging ,Aorta ,Blood Flow Velocity - Abstract
Three-dimensional (3D) time-resolved phase-contrast cardiac magnetic resonance (4D flow CMR) allows for unparalleled quantification of blood velocity. Despite established potential in aortic diseases, the analysis is time-consuming and requires expert knowledge, hindering clinical application. The present research aimed to develop and test a fully automatic machine learning-based pipeline for aortic 4D flow CMR analysis.Four hundred and four subjects were prospectively included. Ground-truth to train the algorithms was generated by experts. The cohort was divided into training (323 patients) and testing (81) sets and used to train and test a 3D nnU-Net for segmentation and a Deep Q-Network algorithm for landmark detection. In-plane (IRF) and through-plane (SFRR) rotational flow descriptors and axial and circumferential wall shear stress (WSS) were computed at ten planes covering the ascending aorta and arch.Automatic aortic segmentation resulted in a median Dice score (DS) of 0.949 and average symmetric surface distance of 0.839 (0.632-1.071) mm, comparable with the state of the art. Aortic landmarks were located with a precision comparable with experts in the sinotubular junction and first and third supra-aortic vessels (p = 0.513, 0.592 and 0.905, respectively) but with lower precision in the pulmonary bifurcation (p = 0.028), resulting in precise localisation of analysis planes. Automatic flow assessment showed excellent (ICC0.9) agreement with manual quantification of SFRR and good-to-excellent agreement (ICC0.75) in the measurement of IRF and axial and circumferential WSS.Fully automatic analysis of complex aortic flow dynamics from 4D flow CMR is feasible. Its implementation could foster the clinical use of 4D flow CMR.• 4D flow CMR allows for unparalleled aortic blood flow analysis but requires aortic segmentation and anatomical landmark identification, which are time-consuming, limiting 4D flow CMR widespread use. • A fully automatic machine learning pipeline for aortic 4D flow CMR analysis was trained with data of 323 patients and tested in 81 patients, ensuring a balanced distribution of aneurysm aetiologies. • Automatic assessment of complex flow characteristics such as rotational flow and wall shear stress showed good-to-excellent agreement with manual quantification.
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- 2022
10. 1.4 PROGNOSTIC VALUE OF PROXIMAL AORTA LONGITUDINAL STRAIN IN MARFAN SYNDROME
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Andrea Guala, Jose Rodríguez-Palomares, Aroa Ruiz-Muñoz, Minerva Gandara, Violeta Sanchez, Alberto Forteza, David Garcia-Dorado, Artur Evangelista, and Gisela Teixido-Tura
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Aortic root dilation and type A aortic dissection are the most common cardiovascular complications of Marfan syndrome (MFS). Current clinical management of MFS patients relies on a close follow-up of aortic root diameter and preventive aortic root surgery in case of severe or fast-progressing dilation. However, as the capacity of aortic diameter to predict type A aortic dissection is limited, new non-invasive biomarkers to improve risk stratification are needed. We investigated the capacity of proximal aorta circumferential and longitudinal strain and ascending aorta distensibility to predict aortic root diameter dilation and occurrence of major cardiovascular events in Marfan patients. Methods: Eighty-seven Marfan patients without previous cardiac/aortic surgery or dissection were prospectively included in a multicenter follow-up. Proximal aorta longitudinal and circumferential strain and distensibility were computed from baseline CMR. Results: During a follow-up of 81.6 ± 17 months, 11 patients underwent elective aortic root replacement, and 2 experienced type A aortic dissections. Mean dilation rate was 0.65 ± 0.67 mm/year and z-score growth rate 0.07 ± 0.13 1/year. In multivariable analysis, proximal aorta longitudinal strain but not circumferential strain and distensibility were independent predictors of diameter growth-rate (p = 0.001, p = 0.385 and p = 0.381, respectively), z-score growth-rate (p = 0.018, p = 0.515 and p = 0.484, respectively) and major cardiovascular events (p = 0.018, p = 0.064 and p = 0.205, respectively) corrected for demographic and clinical characteristics and baseline aortic root diameter. Conclusions: In Marfan syndrome, proximal aorta longitudinal strain is an independent predictor of aortic root dilation and major cardiovascular events beyond aortic root diameter and established risk factors.
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- 2018
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11. P47 ABNORMAL FLOW PATTERN IN MARFAN PATIENTS IS RELATED TO AORTIC GEOMETRIC FEATURES: A 4D FLOW MRI STUDY
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Andrea Guala, Gisela Teixido-Tura, Jose Rodriguez-Palomares, Aroa Ruiz-Muñoz, David Garcia-Dorado, and Artur Evangelista
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction: Ascending aorta aneurysm and dissection are the most common cardiovascular complications affecting Marfan syndrome patients (MFS). Recent large increase in life expectancy of MFS driven the growing prevalence of descending aorta (DAo) dilation and dissection. Despite local abnormal vortices in the proximal Dao were related to local dilation, their origins have never been explored. We investigated the link between aortic geometrical characteristics and abnormal flow pattern in the thoracic aorta of MFS. Methods: Fifty-tree MFS without significant aortic valve disease and forty age-matched healthy volunteers (HV) were prospectively included in 4D flow-MRI study, obtaining flow field and angiography. Spatial distribution of flow (in-plane rotational flow (IRF) and systolic flow reversal ratio (SFRR)) and geometric (diameter, ellipticity and curvature) parameters were investigated. Results: Compared to HV, MFS presented larger aortic diameters only in the proximal AAo (p < 0.001) and DAo (p = 0.028). Increased ellipticity and a more distal location for the peak of aortic curvature were evident, even in the absence of dilation. Through most of the thoracic aorta, IRF was substantially lower in MFS, while SFRR was larger. Interestingly, non-dilated MFS had decreased IRF in the thoracic aorta compared to HV, although SFRR was not increased. Statistically-significant bivariate relations were found between arch IRF and arch ellipticity (R = -0.34) and proximal DAo peak curvature (R = -0.35). Local diameter was negatively correlated with local IRF (R = -0.3) and positively correlated to local SFRR (R = 0.605). Conclusions: MFS presented altered ellipticity and curvature distribution, which are related to abnormal flow patterns even in the absence of dilation.
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- 2018
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12. Wall Shear Stress Predicts Aortic Dilation in Patients With Bicuspid Aortic Valve
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Arturo Evangelista, Laura Galian-Gay, Laura Gutiérrez, Andrea Guala, Maria Luz Servato, Lydia Dux-Santoy, Ignacio Ferreira-González, Oliver Wieben, Aroa Ruiz-Muñoz, José Rodríguez-Palomares, Teresa González-Alujas, Rubén Fernández-Galera, Guillem Casas-Masnou, Filipa Valente, Gisela Teixido-Tura, Kevin M. Johnson, and Augusto Sao Avilés
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medicine.medical_specialty ,business.industry ,Heart Valve Diseases ,Hemodynamics ,medicine.disease ,Dilatation ,Predictive value ,Aortic aneurysm ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Predictive Value of Tests ,Aortic Valve ,medicine.artery ,Internal medicine ,Ascending aorta ,cardiovascular system ,Cardiology ,Shear stress ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Aortic dilation - Abstract
This study sought to assess the predictive value of wall shear stress (WSS) for colocalized ascending aorta (AAo) growth rate (GR) in patients with bicuspid aortic valve (BAV).BAV is associated with AAo dilation, but there is limited knowledge about possible predictors of aortic dilation in patients with BAV. An increased WSS has been related to aortic wall damage in patients with BAV, but no previous prospective study tested its predictive value for dilation rate. Recently, a registration-based technique for the semiautomatic mapping of aortic GR has been presented and validated.Forty-seven patients with BAV free from valvular dysfunction prospectively underwent 4-dimensional flow cardiac magnetic resonance to compute WSS and subsequent follow-up with 2 electrocardiogram-gated high-resolution contrast-enhanced computed tomography angiograms for GR assessment.During a median follow-up duration of 43 months, mid AAo GR was 0.24 mm/year. WSS and its circumferential component showed statistically significant association with mid AAo GR in bivariate (P = 0.049 and P = 0.014, respectively) and in multivariate analysis corrected for stroke volume and either baseline AAo diameter (P = 0.046 and P = 0.014, respectively) or z-score (P = 0.036 and P = 0.012, respectively). GR mapping further detailed that GR was heterogeneous in the AAo and that circumferential WSS, but not WSS magnitude, showed statistically significant positive associations with GR in the regions with the fastest growth.4D flow cardiac magnetic resonance-derived WSS and, in particular, its circumferential component predict progressive dilation of the ascending aorta in patients with BAV. Thus, the assessment of WSS may be considered in the follow-up of these patients.
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- 2022
13. Genetically Triggered Aortic Disease Outcomes
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Arturo Evangelista and Gisela Teixido-Tura
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Cardiology and Cardiovascular Medicine - Published
- 2022
14. P127 FLOW DYNAMICS AND ITS RELATION TO BICUSPID AORTOPATHY ASSESSED BY 4D FLOW CMR
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Lydia Dux-Santoy Hurtado, Jose F. Rodriguez-Palomares, Andrea Guala, Raquel Kale, Gisela Teixido-Tura, Filipa Valente, Giuliana Maldonado, David Garcia- Dorado, and Artur Evangelista
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Purpose: Different altered flow dynamics may influence ascending aorta (AAo) dilation morphotypes in bicuspid aortic valve (BAV) (1). Using 4D-flow CMR, we aimed to identify flow variables related to root or ascending dilation in BAV. Methods: One-hundred and one BAV patients (no severe valvular disease, aortic diameters 2. Univariate and multivariate linear regression were used to identify factors related to dilation. ROC curves were performed to assess the relationship between variables obtained in the multivariate analysis and dilation morphotypes. Results: Fusion phenotype was right-left (RL) in 78 patients, and right-non coronary (RN) in 23. Dilation morphotype was non-dilated in 24 patients, root in 11 and ascending in 66. On univariate analysis, BAV phenotype (RN), displacement and circumferential WSS presented the highest odds ratios (Table). On multivariate analysis, sex (male), proximal velocity and axial WSS were related to root morphotype (AUC 0.91, P < 0.001), while RN-BAV, distal IRF, and mid-AAo SFRR and circumferential WSS were related to ascending morphotype (AUC 0.81, P < 0.001) (Table and Figure). Univariate analysis of aortic dilation Multivariate analysis of aortic dilation Root morphotype Ascending morphotype Odds Ratio P-value Odds Ratio P-value Odds Ratio P-value BAV phenotype (RL/RN) 3.23 0.02 1.33 0.008 Sex (Male) 1.10 0.02 4.67 0.005 Prox Peak velocity 1.02 0.028 1.10 0.043 Jet angle 1.05 0.037 Displacement 3.56 0.001 1.11 0.021 IRF 1.01 0.002 WSSaxial 1.20 0.003 7.64 0.008 WSSCireumf 1.65 0.05 Mid Jet angle 1.07 0.006 Displacement 2.46 0.002 IRF 1.01 0.007 SFRR (%) 1.20 0.001 1.2
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- 2017
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15. 3.2 ASCENDING AND DESCENDING AORTA PULSE WAVE VELOCITY AND DISTENSIBILITY IN BICUSPID AORTIC VALVE PATIENTS
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Andrea Guala, Jose Rodriguez-Palomares, Lydia Dux-Santoy, Gisela Teixido-Tura, Giuliana Maldonado, Nicolas Villalva, Filipa Valente, Laura Galian, Marina Huguet, Laura Gutierrez, Teresa Gonzalez, Ruben Fernandez, Augusto Sao-Aviles, David Garcia-Dorado, and Artur Evangelista
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Purpose: Bicuspid aortic valve (BAV) is a cardiac congenital disease associated with ascending aorta (AAo) dilation. The study of the impact of aortic biomechanics in this population has been limited by technical difficulties. Contrasting results have been reported for distensibility while studies including regional pulse wave velocity (PWV) are still lacking. Using 4D-flow MRI, we assessed AAo and descending aortic (DAo) biomechanical properties and determined their association in BAV aortopathy. Methods: One-hundred thirty-six BAV patients with no severe valvular disease and 40 healthy volunteers were recruited. The protocol included a 4D-flow acquisition and a set of 2D CINE PC-MRI at 1.5 T. Aortic 3D geometry was reconstructed from 4D-flow-derived angiography and at least 100 analysis planes were identified in the thoracic aorta. Transit time was calculated on the velocity upslope through wavelet analysis [1]. CINE PC-MRI were used to compute distensibility. Statistical significance is reported corrected for confounding factors. Results: Non-dilated BAV and controls have similar AAo and DAo PWV and distensibility. Dilated patients presented lower AAo PWV and higher DAo PWV compared to non-dilated (p < 0.001 and p = 0.017, respectively). Distensibility did not differentiate dilated from non-dilated patients and presented lower association with dilation severity (see Figure). Conclusions: Confirming for the first time previous findings in abdominal aorta aneurysm and fluid-mechanics theory, AAo PWV is reduced in aneurysmatic BAV patients. BAV aortopathy is related to a stiffer DAo. Regional PWV outperforms distensibility as a marker of local aortic biomechanics. These data exclude congenital aortic wall pathology related to BAV
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- 2017
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16. Clinical Risk Prediction in Patients With Left Ventricular Myocardial Noncompaction
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Josep Ramon Marsal, Laura Gutierrez-Garcia, Juan Ramón Gimeno-Blanes, Pier Giorgio Masci, Juan Jiménez-Jáimez, Gisela Teixido-Tura, Marta Codina-Solà, Gerard Oristrell, Coloma Tiron, Ignacio Ferreira-González, Andrea Guala, Pablo García-Pavía, Paula Fernández-Álvarez, Juan José Santos-Mateo, Esther Zorio, José Luis de la Pompa, Artur Evangelista, José Manuel García-Pinilla, Daniele Andreini, Eduardo Villacorta, Tomás Ripoll-Vera, Ángela López-Sainz, José Rodríguez-Palomares, José Antonio Sorolla-Romero, Gianluca Pontone, Lucia La Mura, Javier Limeres, Jan Bogaert, Mar Borregan, Augusto Sao Avilés, Julián Palomino-Doza, Rafaela Soler-Fernandez, Aida Ribera, Josefa González-Carrillo, José M. Larrañaga-Moreira, Guillem Casas, Giovanni Donato Aquaro, Roberto Barriales-Villa, Antoni Bayes-Genis, Sociedad Catalana de Cardiología, Hospital Universitario Virgen de la Arrixaca, Fundación La Marató TV3, Hospital Universitario y Politécnico La Fe, Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), and Centro de Investigación Biomédica en Red - CIBERCV (Enfermedades Cardiovasculares)
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Patient-Specific Modeling ,Adult ,Male ,Noncompaction cardiomyopathy ,medicine.medical_specialty ,Embolism ,Risk Assessment ,Young Adult ,noncompaction cardiomyopathy ,Internal medicine ,medicine ,Humans ,In patient ,Longitudinal Studies ,cardiovascular diseases ,Aged ,Retrospective Studies ,Heart Failure ,late gadolinium enhancement ,Isolated Noncompaction of the Ventricular Myocardium ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Arrhythmias, Cardiac ,Magnetic resonance imaging ,Middle Aged ,major adverse cardiovascular events ,medicine.disease ,physiologic hypertrabeculation ,Spain ,left ventricular ejection fraction ,Heart failure ,Cardiology ,Left ventricular noncompaction ,Female ,genotype ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Cohort study - Abstract
Left ventricular noncompaction (LVNC) is a heterogeneous entity with uncertain prognosis. This study sought to develop and validate a prediction model of major adverse cardiovascular events (MACE) and to identify LVNC cases without events during long-term follow-up. This is a retrospective longitudinal multicenter cohort study of consecutive patients fulfilling LVNC criteria by echocardiography or cardiovascular magnetic resonance. MACE were defined as heart failure (HF), ventricular arrhythmias (VAs), systemic embolisms, or all-cause mortality. A total of 585 patients were included (45 ± 20 years of age, 57% male). LV ejection fraction (LVEF) was 48% ± 17%, and 18% presented late gadolinium enhancement (LGE). After a median follow-up of 5.1 years, MACE occurred in 223 (38%) patients: HF in 110 (19%), VAs in 87 (15%), systemic embolisms in 18 (3%), and 34 (6%) died. LVEF was the main variable independently associated with MACE (P < 0.05). LGE was associated with HF and VAs in patients with LVEF >35% (P < 0.05). A prediction model of MACE was developed using Cox regression, composed by age, sex, electrocardiography, cardiovascular risk factors, LVEF, and family aggregation. C-index was 0.72 (95% confidence interval: 0.67-0.75) in the derivation cohort and 0.72 (95% confidence interval: 0.71-0.73) in an external validation cohort. Patients with no electrocardiogram abnormalities, LVEF ≥50%, no LGE, and negative family screening presented no MACE at follow-up. LVNC is associated with an increased risk of heart failure and ventricular arrhythmias. LVEF is the variable most strongly associated with MACE; however, LGE confers additional risk in patients without severe systolic dysfunction. A risk prediction model is developed and validated to guide management. The project was partially funded by a grant from the Catalan Society of Cardiology (Barcelona, Spain). Hospital Universitario Virgen de la Arrixaca (Murcia, Spain) was supported by a grant from the Foundation Marató TV3 (218/C/2015) (Barcelona, Spain). Hospital Universitario y Politécnico La Fe (Valencia, Spain) was partially supported by Fondo Europeo de Desarrollo Regional (“Unión Europea, Una forma de hacer Europa”) (Madrid, Spain) and the Instituto de Salud Carlos III (La Fe Biobank PT17/0015/ 0043) (Madrid, Spain). Dr Guala was supported by funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I) (Madrid, Spain). Dr La Mura was supported by a research grant from the Cardiopath PhD program (Naples, Italy). Prof de la Pompa was supported by grants PID2019-104776RB-I00 and CB16/11/00399 (CIBER CV) from the Spanish Ministry of Science, Innovation and Universities. Dr Bayes-Genis was supported by grants from CIBER Cardiovascular (CB16/11/00403 and 16/11/00420) (Madrid, Spain) and AdvanceCat 2014-2020 (Barcelona, Spain); and has received advisory board and lecture fees from Novartis, Boehringer Ingelheim, Vifor, Roche Diagnostics, and Critical Diagnostics. Dr Pontone has received speaker honorarium and/or institutional research grants from GE Healthcare, Bracco, Boehringer Ingelheim, and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sí
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- 2021
17. Leaflet fusion length is associated with aortic dilation and flow alterations in non-dysfunctional bicuspid aortic valve
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Lydia Dux-Santoy, Ignacio Ferreira-González, Aroa Ruiz-Muñoz, Lucia La Mura, Oliver Wieben, Filipa Valente, Andrea Guala, Laura Gutiérrez, Arturo Evangelista, Kevin M. Johnson, Laura Galian-Gay, Augusto Sao Avilés, Gisela Teixido-Tura, Ilaria Dentamaro, Teresa González-Alujas, and J F Rodriguez-Palomares
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Aortic valve ,medicine.medical_specialty ,Heart Valve Diseases ,Diastole ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Aortic valve replacement ,medicine.artery ,Aortic sinus ,Ascending aorta ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Systole ,business.industry ,Reproducibility of Results ,General Medicine ,medicine.disease ,Dilatation ,medicine.anatomical_structure ,Aortic Valve ,030220 oncology & carcinogenesis ,cardiovascular system ,Radiology ,business - Abstract
Bicuspid aortic valve (BAV), the most common congenital valve defect, is associated with increased risk of aortic dilation and related complications; however, current risk assessment is not effective. Most of BAV have three leaflets with a fusion between two of them of variable length. This study aimed to ascertain whether the extent of leaflet fusion (often called raphe) is related to aortic dilation and flow abnormalities in BAV with no significant valvular dysfunction. One hundred and twenty BAV patients with no significant valvular dysfunction or history of surgical repair or aortic valve replacement were consecutively and prospectively enrolled (September 2014–October 2018). Cardiac magnetic resonance protocol included a 4D flow sequence for haemodynamic assessment. Moreover, a stack of double-oblique cine images of the aortic valve were used to quantify fusion length (in systole) and leaflet length (diastole). Inter- and intra-observer reproducibility was tested in 30 randomly selected patients. Aortic valve leaflet fusion was measurable in 112 of 120 (93%) cases with good reproducibility (ICC = 0.826). Fusion length varied greatly (range: 2.3–15.4 mm; mean: 7.8 ± 3.2 mm). After correction for demographic and clinical conditions, fusion length was independently associated with diameter and z-score at the sinus of Valsalva (p = 0.002 and p = 0.002, respectively) and ascending aorta (p = 0.028 and p = 0.046). Fusion length was positively related to flow asymmetry, vortices and circumferential wall shear stress, thereby possibly providing a pathophysiological link with aortic dilation. Aortic valve fusion length is related to aortic dilation and flow abnormalities in BAV patients. • The length of the fusion between leaflets in non-dysfunctional bicuspid aortic valves varies substantially and can be reliably measured by cine CMR. • Aortic valve leaflet fusion length is independently related to aortic sinus and ascending aorta diameter. • Increased flow asymmetry, circumferential wall shear stress and presence of vortices are positively related to aortic valve leaflet fusion length.
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- 2021
18. A systematic study and literature review of parental somatic mosaicism of FBN1 pathogenic variants in Marfan syndrome
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María Antolín, Marta Codina-Solà, Teresa Vendrell, Paula Fernández-Álvarez, Ida Paramonov, Elena García-Arumí, Anna M. Cueto-González, Artur Evangelista, Irene Valenzuela, Eduardo F. Tizzano, Gisela Teixido-Tura, and Fermina López-Grondona
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Marfan syndrome ,Genetics ,medicine.diagnostic_test ,Genetic counseling ,Amplicon ,Biology ,medicine.disease ,Deep sequencing ,Germline ,Somatic mosaicism ,medicine ,Gene ,Genetics (clinical) ,Genetic testing - Abstract
BackgroundA proportion of de novo variants in patients affected by genetic disorders, particularly those with autosomal dominant (AD) inheritance, could be the consequence of somatic mosaicism in one of the progenitors. There is growing evidence that germline and somatic mosaicism are more common and play a greater role in genetic disorders than previously acknowledged. In Marfan syndrome (MFS), caused by pathogenic variants in the fibrillin-1 gene (FBN1) gene, approximately 25% of the disease-causing variants are reported as de novo. Only a few cases of parental mosaicism have been reported in MFS.MethodsEmploying an amplicon-based deep sequencing (ADS) method, we carried out a systematic analysis of 60 parents of 30 FBN1 positive, consecutive patients with MFS with an apparently de novo pathogenic variant.ResultsOut of the 60 parents studied (30 families), the majority (n=51, 85%) had a systemic score of 0, seven had a score of 1 and two a score of 2, all due to minor criteria common in the normal population. We detected two families with somatic mosaicism in one of the progenitors, with a rate of 6.6% (2/30) of apparently de novo cases.ConclusionsThe search for parental somatic mosaicism should be routinely implemented in de novo cases of MFS, to offer appropriate genetic and reproductive counselling as well as to reveal masked, isolated clinical signs of MFS in progenitors that may require specific follow-up.
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- 2021
19. Prevalence of Periodontitis among Patients Diagnosed with Marfan Syndrome: A Cross-Sectional Study Comparing Samples of Healthy Patients
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Cosimo Galletti, Jorge Toledano-Serrabona, Octavi Camps-Font, Gisela Teixido-Tura, Inmaculada Llobet-Poal, Carles Subirà-Pifarré, Luca Fiorillo, and Cosme Gay-Escoda
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Cross-Sectional Studies ,Article Subject ,General Immunology and Microbiology ,Dental Plaque Index ,Connective tissues diseases ,Prevalence ,Humans ,Gingival Recession ,Malalties del teixit connectiu ,General Medicine ,Periodontitis ,General Biochemistry, Genetics and Molecular Biology ,Marfan Syndrome - Abstract
Periodontitis is an inflammatory condition caused by a bacterial plaque and characterized by progressive destruction of the tooth-supporting apparatus. Patients with Marfan syndrome (MFS) exhibit a connective tissue disorder, which can also affect oral soft and hard tissue. Thus, the aims of this cross-sectional study were to assess the association between periodontitis and MFS and secondly, to compare periodontal parameters and prevalence of disease with a control group (CG) without MFS. 152 patients ( MFS = 76 , CG = 76 ) were recruited to evaluate the following periodontal parameters: probing depth, gingival margin, clinical attachment level, plaque index, and bleeding on probing. The 2017 World Workshop guideline was followed for the diagnosis of the periodontal status. A multivariate analysis was performed using a multinomial logistic regression adjusted for age, gender, and smoking. The level of significance required was p < 0.05 . Patients with MFS did not show a higher prevalence of periodontitis compared to the CG. However, patients with MFS did have higher values in probing depth, gingival recession, clinical attachment level, and plaque index compared to the CG patients ( p < 0.05 ). In conclusion, although similar prevalence of periodontitis was found among the studied groups, MFS patients showed worse periodontal parameters.
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- 2022
20. Síndrome Metabólica, Strain e Redução da Função Miocárdica: Multi-Ethnic Study of Atherosclerosis
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André Luiz Cerqueira de Almeida, Gisela Teixido-Tura, Eui-Young Choi, Anders Opdahl, Verônica R. S. Fernandes, Colin O. Wu, David A. Bluemke, and João A. C. Lima
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Aterosclerose ,Síndrome X metabólica ,Diabetes mellitus / mortalidade ,Disfunção ventricular / fisiopatologia ,Grupos étnicos ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Fundamento: A doença cardiovascular subclínica é prevalente em pacientes com síndrome metabólica (SM). O strain circunferencial (εCC) e o strain longitudinal (εLL) do ventriculo esquerdo (VE), avaliados pelo ecocardiograma com speckle tracking (STE), são índices de função sistólica: o encurtamento das fibras circunferenciais e longitudinais do VE é indicado por um valor negativo do strain. Portanto, quanto mais negativo o strain, melhor a função sistólica do VE. O εCC e o εLL têm sido usados para demonstrar disfunção ventricular subclínica em vários distúrbios clínicos. Objetivo: Levantamos a hipótese de que a SM está associada com comprometimento da função miocárdica, quando avaliada pelo STE. Métodos: Este estudo analisou participantes do Multi-Ethnic Study of Atherosclerosis (MESA) que realizaram o STE e foram avaliados para todos os componentes da SM. Resultados: Entre os 133 participantes incluídos (mulheres: 63%; idade: 65 ± 9 anos), a prevalência de SM foi de 31% (41/133). Indivíduos com SM apresentaram valores menores do εCC e do εLL que aqueles sem SM (-16,3% ± 3,5% vs. -18,4% ± 3,7%, p < 0,01; e -12,1% ± 2,5% vs. -13,9% ± 2,3%, p < 0,01, respectivamente). A fração de ejeção do VE (FEVE) foi semelhante nos dois grupos (p = 0,09). Na análise multivariada, a SM associou-se a um valor mais baixo do strain circunferencial (B = 2,1%, IC 95%: 0,6-3,5; p < 0,01), mesmo após ajuste para idade, etnia, massa VE e FEVE. De maneira semelhante, a presença de SM (B = 1,3%, IC 95%: 0,3-2,2; p < 0,01) e a massa do VE (B = 0,02%, IC 95%: 0,01 0,03; p = 0,02) associaram-se a um valor menor do strain longitudinal após ajuste para etnia, FEVE e creatinina. Conclusão: O εCC e o εLL do VE, marcadores de doença cardiovascular subclínica, estão comprometidos em indivíduos assintomáticos com SM e sem história prévia de infarto miocárdico, insuficiência cardíaca e/ou de FEVE < 50%.
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- 2014
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21. Evolución en el diagnóstico, el tratamiento y la mortalidad del síndrome aórtico agudo en los últimos 20 años
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Jordi Maeso, Arturo Evangelista, Ignacio Ferreira-González, José A. Barrabés, Teresa González-Alujas, Augusto Sao-Aviles, Ángela López-Sainz, Carlos Sureda, Hug Cuéllar, David Garcia-Dorado, Rafael Rodríguez-Lecoq, Rosa-Maria Lidón, Sergi Bellmunt, José Rodríguez-Palomares, and Gisela Teixido-Tura
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business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Abstract
Resumen Introduccion y objetivos El sindrome aortico agudo (SAA) tiene una alta mortalidad que obliga a un tratamiento precoz. El proposito del presente estudio es analizar los cambios en el abordaje y el tratamiento del SAA a lo largo de 20 anos. Metodos Se incluyo prospectivamente a 451 pacientes (336 varones; media de edad, 60,9 ± 12,4 anos) diagnosticados de SAA, 270 con el tipo A y 181 con el tipo B, desde 1999 hasta 2018. Se analizaron variables clinicas, diagnosticas y del tratamiento y las complicaciones hospitalarias. Resultados El uso de la tomografia computarizada (TC) como primera tecnica diagnostica se incremento del 62,8 al 94,2% (p Conclusiones El diagnostico y el tratamiento del SAA han presentado importantes cambios en las ultimas 2 decadas. La TC se ha consolidado como la tecnica diagnostica de eleccion. La mortalidad del SAA tipo A ha disminuido de manera muy importante debido a la mejora de los resultados del tratamiento quirurgico. En el SAA tipo B, el tratamiento medico solo se ha reducido debido a la aparicion del tratamiento endovascular, pero la mortalidad hospitalaria no ha disminuido de manera significativa.
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- 2021
22. Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve
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Sergio Uribe, Laura Galian-Gay, Ignacio Ferreira, Arturo Evangelista, Filipa Valente, Laura Gutiérrez, Aroa Ruiz-Muñoz, José Rodríguez-Palomares, Lydia Dux-Santoy, Gisela Teixido-Tura, Oliver Wieben, Kevin M. Johnson, Daniel E. Hurtado, Andrea Guala, Teresa González-Alujas, and Julio Sotelo
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Male ,Heart Valve Diseases ,thoracic aortic aneurysm ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Phase contrast magnetic resonance imaging ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,magnetic resonance imaging ,Prospective Studies ,medicine.diagnostic_test ,Middle Aged ,Prognosis ,Aortic Valve ,cardiovascular system ,Cardiology ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Cardiology and Cardiovascular Medicine ,Shear Strength ,Adult ,medicine.medical_specialty ,Materials science ,bicuspid aortic valve ,vascular remodeling ,Magnetic Resonance Imaging, Cine ,Thoracic aortic aneurysm ,03 medical and health sciences ,Imaging, Three-Dimensional ,Predictive Value of Tests ,medicine.artery ,Internal medicine ,medicine ,Shear stress ,Humans ,In patient ,Aortic dilation ,Aorta ,Aortic Aneurysm, Thoracic ,mechanical stress ,Magnetic resonance imaging ,medicine.disease ,regional blood flow ,aorta ,Stress, Mechanical ,Follow-Up Studies ,Clinical and Population Studies - Abstract
Supplemental Digital Content is available in the text., Objective: To assess the relationship between regional wall shear stress (WSS) and oscillatory shear index (OSI) and aortic dilation in patients with bicuspid aortic valve (BAV). Approach and Results: Forty-six consecutive patients with BAV (63% with right-left-coronary-cusp fusion, aortic diameter ≤ 45 mm and no severe valvular disease) and 44 healthy volunteers were studied by time-resolved 3-dimensional phase-contrast magnetic resonance imaging. WSS and OSI were quantified at different levels of the ascending aorta and the aortic arch, and regional WSS and OSI maps were obtained. Seventy percent of BAV had ascending aorta dilation. Compared with healthy volunteers, patients with BAV had increased WSS and decreased OSI in most of the ascending aorta and the aortic arch. In both BAV and healthy volunteers, regions of high WSS matched regions of low OSI and vice versa. No regions of both low WSS and high OSI were identified in BAV compared with healthy volunteers. Patients with BAV with dilated compared with nondilated aorta presented low and oscillatory WSS in the aortic arch, but not in the ascending aorta where dilation is more prevalent. Furthermore, no regions of concomitant low WSS and high OSI were identified when BAV were compared according to leaflet fusion pattern, despite the well-known differences in regional dilation prevalence. Conclusions: Regions with low WSS and high OSI do not match those with the highest prevalence of dilation in patients with BAV, thus providing no evidence to support the low and oscillatory shear stress theory in the pathogenesis of proximal aorta dilation in the presence of BAV.
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- 2019
23. Further delineation of neuropsychiatric findings in Tatton-Brown-Rahman syndrome due to disease-causing variants in DNMT3A: seven new patients
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Mario Solís, Bardón Rivera Mb, Jair Tenorio, Salvador Climent, Pablo Lapunzina, Pablo Alarcón, Gisela Teixido-Tura, Fermina López Grondona, Victor L. Ruiz-Perez, Antonio Martinez Monseny, Juan C. Cigudosa, Mercedes Serrano, Eduardo F. Tizzano, Sara Alvarez, Irene Valenzuela, Gema Gordo, Sergio Ramos, Fernando Santos-Simarro, Fernández Jaén A, Julián Nevado, Palomares Bralo M, Sixto García-Miñaur, Irene Dapía, Jaime Campistol, Alicia Hernández, Pedro Arias, Javier Botet, Instituto de Salud Carlos III, and European Commission
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Disease ,Bioinformatics ,Article ,DNA Methyltransferase 3A ,03 medical and health sciences ,Intellectual Disability ,Genetics research ,Intellectual disability ,Genetics ,medicine ,Humans ,DNA (Cytosine-5-)-Methyltransferases ,Child ,Growth Disorders ,Genetics (clinical) ,Cerebral atrophy ,0303 health sciences ,business.industry ,Medical genetics ,030305 genetics & heredity ,Macrocephaly ,Syndrome ,Middle Aged ,medicine.disease ,Phenotype ,Psychotic Disorders ,Schizophrenia ,Overgrowth syndrome ,Mutation ,Female ,Differential diagnosis ,medicine.symptom ,business - Abstract
Tatton-Brown-Rahman (TBRS) syndrome is a recently described overgrowth syndrome caused by loss of function variants in the DNMT3A gene. This gene encodes for a DNA methyltransferase 3 alpha, which is involved in epigenetic regulation, especially during embryonic development. Somatic variants in DNMT3A have been widely studied in different types of tumors, including acute myeloid leukemia, hematopoietic, and lymphoid cancers. Germline gain-of-function variants in this gene have been recently implicated in microcephalic dwarfism. Common clinical features of patients with TBRS include tall stature, macrocephaly, intellectual disability (ID), and a distinctive facial appearance. Differential diagnosis of TBRS comprises Sotos, Weaver, and Malan Syndromes. The majority of these disorders present other clinical features with a high clinical overlap, making necessary a molecular confirmation of the clinical diagnosis. We here describe seven new patients with variants in DNMT3A, four of them with neuropsychiatric disorders, including schizophrenia and psychotic behavior. In addition, one of the patients has developed a brain tumor in adulthood. This patient has also cerebral atrophy, aggressive behavior, ID, and abnormal facial features. Clinical evaluation of this group of patients should include a complete neuropsychiatric assessment together with psychological support in order to detect and manage abnormal behaviors such as aggressiveness, impulsivity, and attention deficit-hyperactivity disorder. TBRS should be suspected in patients with overgrowth, ID, tall stature, and macrocephaly, who also have some neuropsychiatric disorders without any genetic defects in the commonest overgrowth disorders. Molecular confirmation in these patients is mandatory., This project was supported by ISCII, FEDER funds grant: FIS-PI15/01481.
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- 2019
24. Contemporary Management of Severe Symptomatic Aortic Stenosis
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Marc Eugène, Piotr Duchnowski, Bernard Prendergast, Olaf Wendler, Cécile Laroche, Jean-Luc Monin, Yannick Jobic, Bogdan A. Popescu, Jeroen J. Bax, Alec Vahanian, Bernard Iung, Jeroen Bax, Michele De Bonis, Victoria Delgado, Michael Haude, Gerhard Hindricks, Aldo P. Maggioni, Luc Pierard, Susanna Price, Raphael Rosenhek, Frank Ruschitzka, Stephan Windecker, Souad Mekhaldi, Katell Lemaitre, Sébastien Authier, Magdy Abdelhamid, Astrid Apor, Gani Bajraktari, Branko Beleslin, Alexander Bogachev-Prokophiev, Daniela Cassar Demarco, Agnes Pasquet, Sait Mesut Dogan, Andrejs Erglis, Arturo Evangelista, Artan Goda, Nikolaj Ihlemann, Huseyin Ince, Andreas Katsaros, Katerina Linhartova, Julia Mascherbauer, Erkin Mirrakhimov, Vaida Mizariene, Shelley Rahman-Haley, Regina Ribeiras, Fuad Samadov, Antti Saraste, Iveta Simkova, Elizabeta Srbinovska Kostovska, Lidia Tomkiewicz-Pajak, Christophe Tribouilloy, Eliverta Zera, Mimoza Metalla, Ervina Shirka, Elona Dado, Loreta Bica, Jorida Aleksi, Gerti Knuti, Lidra Gjyli, Rudina Pjeci, Eritinka Shuperka, Erviola Lleshi, Joana Rustemaj, Marsjon Qordja, Mirald Gina, Senada Husi, Daniel Basic, Regina Steringer-Mascherbauer, Charlotte Huber, Christian Ebner, Elisabeth Sigmund, Andrea Ploechl, Thomas Sturmberger, Veronica Eder, Tanja Koppler, Maria Heger, Andreas Kammerlander, Franz Duca, Christina Binder, Matthias Koschutnik, Leonard Perschy, Lisa Puskas, Chen-Yu Ho, Farid Aliyev, Vugar Guluzada, Galib Imanov, Firdovsi Ibrahimov, Abbasali Abbasaliyev, Tahir Ahmedov, Fargana Muslumova, Jamil Babayev, Yasmin Rustamova, Tofig Jahangirov, Rauf Samadov, Muxtar Museyibov, Elnur Isayev, Oktay Musayev, Shahin Xalilov, Saleh Huseynov, Madina Yuzbashova, Vuqar Zamanov, Vusal Mammadov, Gery Van Camp, Martin Penicka, Hedwig Batjoens, Philippe Debonnaire, Daniel Dendooven, Sebastien Knecht, Mattias Duytschaever, Yves Vandekerckhove, Luc Missault, Luc Muyldermans, René Tavernier, Tineke De Grande, Patrick Coussement, Joyce DeTroyer, Katrien Derycker, Kelly De Jaegher, Antoine Bondue, Christophe Beauloye, Céline Goffinet, Daniela Corina Mirica, Frédéric Vanden Eynden, Philippe Van de Borne, Béatrice Van Frachen, David Vancraeynest, Jean Louis Vanoverschelde, Sophie Pierard, Mihaela Malanca, Florence Sinnaeve, Séverine Tahon, Marie De Clippel, Frederic Gayet, Jacques Loiseau, Nico Van de Veire, Veronique Moerman, Anne-Marie Willems, Bernard Cosyns, Steven Droogmans, Andreea Motoc, Dirk Kerkhove, Daniele Plein, Bram Roosens, Caroline Weytjens, Patrizio Lancellotti, Elena Raluca Dulgheru, Ilona Parenicova, Helena Bedanova, Frantisek Tousek, Stepanka Sindelarova, Julia Canadyova, Milos Taborsky, Jiri Ostransky, null Ivona simkova, Marek Vicha, Libor Jelinek, Irena Opavska, Miroslav Homza, Miriam Kvrayola, Radim Brat, Dan Mrozek, Eva Lichnerova, Iveta Docekalova, Marta Zarybnicka, Marketa Peskova, Patrik Roucka, Vlasta Stastna, Dagmar Jungwirtova Vondrackova, Alfred Hornig, Matus Niznansky, Marian Branny, Alexandra Vodzinska, Miloslav Dorda, Libor Snkouril, Krystyna Kluz, Jana Kypusova, Radka Nezvalova, Niels Thue Olsen, Hosam Hasan Ali, Salma Taha, Mohamed Hassan, Ahmed Afifi, Hamza Kabil, Amr Mady, Hany Ebaid, Yasser Ahmed, Mohammad Nour, Islam Talaat, CairoMaiy El Sayed, Ahmad Elsayed Mostafa, CairoYasser Sadek, CairoSherif Eltobgi, Sameh Bakhoum, Ramy Doss, Mahmoud Sheashea, Abd Allah Elasry, Ahmed Fouad, Mahmoud Baraka, Sameh Samir, Alaa Roshdy, Yasmin AbdelRazek, Mostafa M. Abd Rabou, Ahmed Abobakr, Moemen Moaaz, Mohamed Mokhtar, Mohamed Ashry, Khaled Elkhashab, Haytham Soliman Ghareeb, Mostafa Kamal, Gomaa AbdelRazek, GizaNabil Farag, Giza:Ahmed Elbarbary, Evette Wahib, Ghada Kazamel, Diaa Kamal, Mahmoud Tantawy, Adel Alansary, Mohammed Yahia, Raouf Mahmoud, Tamer El Banna, Mohamed Atef, Gamela Nasr, Salah Ahmed, Ehab E. El Hefny, Islam Saifelyazal, Mostafa Abd El Ghany, Abd El Rahman El Hadary, Ahmed Khairy, Jyri Lommi, Mika Laine, Minna Kylmala, Katja Kankanen, Anu Turpeinen, Juha Hartikainen, Lari Kujanen, Juhani Airaksinen, Tuija Vasankari, Catherine Szymanski, Yohann Bohbot, Mesut Gun, Justine Rousseaux, Loic Biere, Victor Mateus, Martin Audonnet, Jérémy Rautureau, Charles Cornet, Emmanuel Sorbets, BourgesKarine Mear, Adi Issa, Florent Le Ven, Marie-Claire Pouliquen, Martine Gilard, Alice Ohanessian, Ali Farhat, Alina Vlase, Fkhar Said, Caroline Lasgi, Carlos Sanchez, Romain Breil, Marc Peignon, Jean-Philippe Elkaim, Virginie Jan-Blin, Sylvain Ropars BertrandM'Ban, Hélène Bardet, Samuel Sawadogo, Aurélie Muschoot, Dieudonné Tchatchoua, Simon Elhadad, Aline Maubert, Tahar Lazizi, Kais Ourghi, Philippe Bonnet, Clarisse Menager-Gangloff, Sofiene Gafsi, Djidjiga Mansouri, Victor Aboyans, Julien Magne, Elie Martins, Sarah Karm, Dania Mohty, Guillaume Briday, Amandine David, Sylvestre Marechaux, Caroline Le Goffic, Camille Binda, Aymeric Menet, Francois Delelis, Anne Ringlé, Anne-Laure Castel, Ludovic Appert, Domitille Tristram, Camille Trouillet, Yasmine Nacer, Lucas Ngoy, MarseilleGilbert Habib, Franck Thuny, Julie Haentjens, Jennifer Cautela, Cécile Lavoute, Floriane Robin, Pauline Armangau, Ugo Vergeylen, Khalil Sanhadji, Nessim Hamed Abdallah, Hassan Kerzazi, Mariana Perianu, François Plurien, Chaker Oueslati, Mathieu Debauchez, Zannis Konstantinos, Alain Berrebi, Alain Dibie, Emmanuel Lansac, Aurélie Veugeois, Christelle Diakov, Christophe Caussin, Daniel Czitrom, Suzanna Salvi, Nicolas Amabile, Patrice Dervanian, Stéphanie Lejeune, Imane Bagdadi, Yemmi Mokrane, Gilles Rouault, Jerome Abalea, Marion Leledy, Patrice Horen, Erwan Donal, Christian Bosseau, Elise Paven, Elena Galli, Edouard Collette, Jean-Marie Urien, Valentin Bridonneau, Renaud Gervais, Fabrice Bauer, Houzefa Chopra, Arthur Charbonnier, David Attias, Nesrine Dahouathi, Moukda Khounlaboud, Magalie Daudin, Christophe Thebault, Cécile Hamon, Philippe Couffon, Catherine Bellot, Maelle Vomscheid, Anne Bernard, Fanny Dion, Djedjiga Naudin, Mohammed Mouzouri, Mathilde Rudelin, Alain Berenfeld, Thibault Vanzwaelmen, Tarik Alloui, Marija Gjerakaroska Radovikj, Slavica Jordanova, Werner Scholtz, Eva Liberda-Knoke, Melanie Wiemer, Andreas Mugge, Georg Nickenig, Jan-Malte Sinning, Alexander Sedaghat, Matthias Heintzen, Jan Ballof, Daniel Frenk, Rainer Hambrecht, Harm Wienbergen, Annemarie Seidel, Rico Osteresch, Kirsten Kramer, Janna Ziemann, Ramona Schulze, Wolfgang Fehske, Clarissa Eifler, Bahram Wafaisade, Andreas Kuhn, Sören Fischer, Lutz Lichtenberg, Mareike Brunold, Judith Simons, Doris Balling, Thomas Buck, Bjoern Plicht, Wolfgang Schols, Henning Ebelt, Marwan Chamieh, Jelena Anacker, Tienush Rassaf, Alexander Janosi, Alexander Lind, Julia Lortz, Peter Lüdike, Philipp Kahlert, Harald Rittger, Gabriele Eichinger, Britta Kuhls, Stephan B. Felix, Kristin Lehnert, Ann-Louise Pedersen, Marcus Dorr, Klaus Empen, Sabine Kaczmarek, Mathias Busch, Mohammed Baly, Fikret Er, Erkan Duman, Linda Gabriel, Christof Weinbrenner, Johann Bauersachs, Julian Wider, Tibor Kempf, Michael Bohm, Paul-Christian Schulze, C. Tudor Poerner, Sven Möbius-Winkler, Karsten Lenk, Kerstin Heitkamp, Marcus Franz, Sabine Krauspe, Burghard Schumacher, Volker Windmuller, Sarah Kurwitz, Holger Thiele, Thomas Kurz, Roza Meyer-Saraei, Ibrahim Akin, Christian Fastner, Dirk Lossnitzer, Ursula Hoffmann, Martin Borggrefe, Stefan Baumann, Brigitte Kircher, Claudia Foellinger, Heike Dietz, Bernhard Schieffer, Feraydoon Niroomand, Harald Mudra, Lars Maier, Daniele Camboni, Christoph Birner, Kurt Debl, Michael Paulus, Benedikt Seither, Nour Eddine El Mokhtari, Alper Oner, Evren Caglayan, Mohammed Sherif, Seyrani Yucel, Florian Custodis, Robert Schwinger, Marc Vorpahl, Melchior Seyfarth, Ina Nover, Till Koehler, Sarah Christiani, David Calvo Sanchez, Barbel Schanze, Holger Sigusch, Athir Salman, Jane Hancock, John Chambers, Camelia Demetrescue, Claire Prendergast, Miles Dalby, Robert Smith, Paula Rogers, Cheryl Riley, Dimitris Tousoulis, Ioannis Kanakakis, Konstantinos Spargias, Konstantinos Lampropoulos, Tolis Panagiotis, Athanasios Koutsoukis, Lampros Michalis, Ioannis Goudevenos, Vasileios Bellos, Michail Papafaklis, Lampros Lakkas, George Hahalis, Athanasios Makris, Haralampos Karvounis, Vasileios Kamperidis, Vlasis Ninios, Vasileios Sachpekidis, Pavlos Rouskas, Leonidas Poulimenos, Georgios Charalampidis, Eftihia Hamodraka, Athanasios Manolis, Robert Gabor Kiss, Tunde Borsanyi, Zoltan Jarai, Andras Zsary, Elektra Bartha, Annamaria Kosztin, Alexandra Doronina, Attila Kovacs, Barabas Janos Imre, Chun Chao, Kalman Benke, Istvan Karoczkai, Kati Keltai, Zsolt Förchécz, Zoltán Pozsonyi, Zsigmond Jenei, Adam Patthy, Laszlo Sallai, Zsuzsanna Majoros, Tamás Pál, Jusztina Bencze, Ildiko Sagi, Andrea Molnar, Anita Kurczina, Gabor Kolodzey, Istvan Edes, Valeria Szatmari, Zsuzsanna Zajacz, Attila Cziraki, Adam Nemeth, Reka Faludi, Laszlone Vegh, Eva Jebelovszki, Geza Karoly Lupkovics, Zsofia Kovacs, Andras Horvath, Gezim Berisha, Pranvera Ibrahimi, Luan Percuku, Rano Arapova, Elmira Laahunova, Kseniia Neronova, Zarema Zhakypova, Gulira Naizabekova, Gulnazik Muratova, Iveta Sime, Nikolajs Sorokins, Ginta Kamzola, Irina Cgojeva-Sproge, Gita Rancane, Ramune Valentinaviciene, Laima Rudiene, Rasa Raugaliene, Aiste Bardzilauske, Regina Jonkaitiene, Jurate Petrauskaite, Monika Bieseviciene, Raimonda Verseckaite, Ruta Zvirblyte, Danute Kalibatiene, Greta Radauskaite, Gabija Janaviciute-Matuzeviciene, Dovile Jancauskaite, Deimile Balkute, Juste Maneikyte, Ingrida Mileryte, Monika Vaisvilaite, Lina Gedvilaite, Mykolas Biliukas, Vaiva Karpaviciene, Robert George Xuereb, Elton Pllaha, Roxana Djaberi, Klaudiusz Komor, Agnieszka Gorgon-Komor, Beata Loranc, Jaroslaw Myszor, Katarzyna Mizia-Stec, Adrianna Berger-Kucza, Magdalena Mizia, Mateusz Polak, Piotr Bogacki, Piotr Podolec, Monika Komar, Ewa Sedziwy, Dorota Sliwiak, Bartosz Sobien, Beata Rog, Marta Hlawaty, Urszula Gancarczyk, Natasza Libiszewska, Danuta Sorysz, Andrzej Gackowski, Malgorzata Cieply, Agnieszka Misiuda, Franciszek Racibor, Anna Nytko, Kazimierz Widenka, Maciej Kolowca, Janusz Bak, Andrzej Curzytek, Mateusz Regulski, Malgorzata Kamela, Mateusz Wisniowski, Tomasz Hryniewiecki, Piotr Szymanski, Monika Rozewicz, Maciej Grabowski, Andrzej Budaj, Beata Zaborska, Ewa Pilichowska-Paskiet, Malgorzata Sikora-Frac, Tomasz Slomski, Isabel Joao, Ines Cruz, Hélder Pereira, Rita Cale, Ana Marques, Ana Rita Pereira, Carlos Morais, Antonio Freitas, David Roque, Nuno Antunes, Antonio Costeira Pereira, Catarina Vieira, Nuno Salome, Juliana Martins, Isabel Campos, Goncalo Cardoso, Claudia Silva, Afonso Oliveira, Mariana Goncalves, Rui Martins, Nuno Quintal, Bruno Mendes, Joseline Silva, Joao Ferreira, James Milner, Patricia Alves, Vera Marinho, Paula Gago, Jose Amado, Joao Bispo, Dina Bento, Inocencia Machado, Margarida Oliveira, Lucy Calvo, Pedro von Hate, Bebiana Faria, Ana Galrinho, Luisa Branco, Antonio Goncalves, Tiago Mendonca, Mafalda Selas, Filipe Macedo, Carla Sousa, Sofia Cabral, Filomena Oliveira, Maria Trepa, Marta Fontes-Oliveira, Alzira Nunes, Paulo Araújo, Vasco Gama Ribeiro, Joao Almeida, Alberto Rodrigues, Pedro Braga, Sonia Dias, Sofia Carvalho, Catarina Ferreira, Alberto Ferreira, Pedro Mateus, Miguel Moz, Silvia Leao, Renato Margato, Ilidio Moreira, Jose Guimanaes, Joana Ribeiro, Fernando Goncalves, Jose Cabral, Ines Almeida, Luisa Goncalves, Mariana Tarusi, Calin Pop, Claudia Matei, Diana Tint, Sanziana Barbulescu, Sorin Micu, Ioana Pop, Costica Baba, Doina Dimulescu, Maria Dorobantu, Carmen Ginghina, Roxana Onut, Andreea Popescu, Brandusa Zamfirescu, Raluca Aflorii, Mihaela Popescu, Liviu Ghilencea, Andreeea Rachieru, Monica Stoian, Nicoleta Oprescu, Silvia Iancovici, Iona Petre, Anca Doina Mateescu, Andreea Calin, Simona Botezatu, Roxana Enache, Monica Rosca, Daniela Ciuperca, Evelyn Babalac, Ruxandra Beyer, Laura Cadis, Raluca Rancea, Raluca Tomoaia, Adela Rosianu, Emese Kovacs, Constantin Militaru, Alina Craciun, Oana Mirea, Mihaela Florescu, Lucica Grigorica, Daniela Dragusin, Luiza Nechita, Mihai Marinescu, Teodor Chiscaneanu, Lucia Botezatu, Costela Corciova, Antoniu Octavian Petris, Catalina Arsenescu-Georgescu, Delia Salaru, Dan Mihai Alexandrescu, Carmjen Plesoianu, Ana Tanasa, Ovidiu Mitu, Irina Iuliana Costache, Ionut Tudorancea, Catalin Usurelu, Gabriela Eminovici, Ioan Manitiu, Oana Stoia, Adriana Mitre, Dan-Octavian Nistor, Anca Maier, Silvia Lupu, Mihaela Opris, Adina Ionac, Irina Popescu, Simina Crisan, Cristian Mornos, Flavia Goanta, Liana Gruescu, Oana Voinescu, Madalina Petcu, Ramona Cozlac, Elena Damrina, Liliya Khilova, Irina Ryazantseva, Dmitry Kozmin, Maria Kiseleva, Marina Goncharova, Kamila Kitalaeva, Victoria Demetskay, Artem Verevetinov, Mikhail Fomenko, Elena Skripkina, Viktor Tsoi, Georgii Antipov, Yuri Schneider, Denis Yazikov, Marina Makarova, Aleksei Cherkes, Natalya Ermakova, Aleksandr Medvedev, Anastasia Sarosek, Mikhail Isayan, Tatyana Voronova, Oleg Kulumbegov, Alina Tuchina, Sergei Stefanov, Margarita Klimova, Konstantin Smolyaninov, Zhargalma Dandarova, Victoriya Magamet, Natalia Spiropulos, Sergey Boldyrev, Kirill Barbukhatty, Dmitrii Buyankov, Vladimir Yurin, Yuriy Gross, Maksim Boronin, Mariya Mikhaleva, Mariya Shablovskaya, Alex Zotov, Daniil Borisov, Vasily Tereshchenko, Ekaterina Zubova, A. Kuzmin, Ivan Tarasenko, Alishir Gamzaev, Natalya Borovkova, Tatyana Koroleva, Svetlana Botova, Ilya Pochinka, Vera Dunaeva, Victoria Teplitskaya, Elena I. Semenova, Olga V. Korabel'Nikova, Denis S. Simonov, Elena Denisenko, Natalia Harina, Natalia Yarohno, Svetlana Alekseeva, Julia Abydenkova, Lyubov Shabalkina, Olga Mayorova, Valeriy Tsechanovich, Igor Medvedev, Michail Lepilin, PenzaEvgenii Nemchenko, Vadim Karnahin, Vasilya Safina, Yaroslav Slastin, Venera Gilfanova, Roman Gorbunov, Ramis Jakubov, Aigul Fazylova, Mansur Poteev, Laysan Vazetdinova, Indira Tarasova, Rishat Irgaliyev, Olga Moiseeva, Mikhail Gordeev, Olga Irtyuga, Raisa Moiseeva, Nina Ostanina, Dmitry Zverev, Patimat Murtazalieva, Dmitry Kuznetsov, Mariya Skurativa, Larisa Polyaeva, Kirill Mihaiilov, Biljana Obrenovic-Kircanski, Svetozar Putnik, Dragan Simic, Milan Petrovic, Natasa Markovic Nikolic, Ljiljana Jovovic, Dimitra Kalimanovska Ostric, Milan Brajovic, Milica Dekleva Manojlovic, Vladimir Novakovic, Danijela Zamaklar-Trifunovic, Bojana Orbovic, Olga Petrovic, Marija Boricic-Kostic, Kristina Andjelkovic, Marko Milanov, Maja Despotovic-Nikolic, Sreten Budisavljevic, Sanja Veljkovic, Nataša Cvetinovic, Daniijela Lepojevic, Aleksandra Todorovic, Aleksandra Nikolic, Branislava Borzanovic, Ljiljana Trkulja, Slobodan Tomic, Milan Vukovic, Jelica Milosavljevic, Mirjana Milanovic, Vladan Stakic, Aleksandra Cvetkovic, Suzana Milutinovic, Olivera Bozic, Miodrag Miladinovic, Zoran Nikolic, Dinka Despotovic, Dimitrije Jovanovic, Anastazija Stojsic-Milosavljevic, Aleksandra Ilic, Mirjana Sladojevic, Stamenko Susak, Srdjan Maletin, Salvo Pavlovic, Vladimir Kuzmanovic, Nikola Ivanovic, Jovana Dejanovic, Dusan Ruzicic, Dragana Drajic, Danijel Cvetanovic, Marija Mirkovic, Jon Omoran, Roman Margoczy, Katarina Sedminova, Adriana Reptova, Eva Baranova, Tatiana Valkovicova, Gabriel Valocik, Marian Kurecko, Marianna Vachalcova, Alzbeta Kollarova, Martin Studencan, Daniel Alusik, Marek Kozlej, Jana Macakova, Sergio Moral, Merce Cladellas, Daniele Luiso, Alicia Calvo, Jordi Palet, Juli Carballo, Gisela Teixido Tura, Giuliana Maldonado, Laura Gutierrez, Teresa Gonzalez-Alujas, Rodriguez Palomares Jose Fernando, Nicolas Villalva, Ma Jose Molina-Mora, Ramon Rubio Paton, Juan Jose Martinez Diaz, Pablo Ramos Ruiz, Alfonso Valle, Ana Rodriguez, Edgardo Alania, Emilio Galcera, Julia Seller, Gonzalo de la Morena Valenzuela, Daniel Saura Espin, Dolores Espinosa Garcia, Maria Jose Oliva Sandoval, Josefa Gonzalez, Miguel Garcia Navarro, Maria Teresa Perez-Martinez, Jose Ramon Ortega Trujillo, Irene Menduina Gallego, Daniel San Roman, Eliu David Perez Nogales, Olga Medina, Rodolfo Antonio Montiel Quintero, Pablo Felipe Bujanda Morun, Marta Lopez Perez, Jimmy Plasencia Huaripata, Juan Jose Morales Gonzalez, Veronica Quevedo Nelson, Jose Luis Zamorano, Ariana Gonzalez Gomez, Alfonso Fraile, Maria Teresa Alberca, Joaquin Alonso Martin, Covadonga Fernandez-Golfin, Javier Ramos, Sergio Hernandez Jimenez, Cristina Mitroi, Pedro L. Sanchez Fernandez, Elena Diaz-Pelaez, Beatriz Garde, Luis Caballero, Fermin Martinez Garcia, Francisco Cambronero, Noelia Castro, Antonio Castro, Alejandro De La Rosa, Pastora Gallego, Irene Mendez, David Villagomez Villegas, Manuel Gonzalez Correa, Roman Calvo, Francisco Florian, Rafael Paya, Esther Esteban, Francisco Buendia, Andrés Cubillos, Carmen Fernandez, Juan Pablo Cárdenas, José Leandro Pérez-Boscá, Joan Vano, Joaquina Belchi, Cristina Iglesia-Carreno, Francisco Calvo Iglesias, Aida Escudero-Gonzalez, Sergio Zapateria-Lucea, Juan Sterling Duarte, Lara Perez-Davila, Rafael Cobas-Paz, Rosario Besada-Montenegro, Maribel Fontao-Romeo, Elena Lopez-Rodriguez, Emilio Paredes-Galan, Berenice Caneiro-Queija, Alba Guitian Gonzalez, Abdi Bozkurt, Serafettin Demir, Durmus Unlu, Caglar Emre Cagliyan, Muslum Firat Ikikardes, Mustafa Tangalay, Osman Kuloglu, Necla Ozer, Ugur Canpolat, Melek Didem Kemaloglu, Abdullah Orhan Demirtas, Didar Elif Akgün, Eyup Avci, Gokay Taylan, Mustafa Adem Yilmaztepe, Fatih Mehmet Ucar, Servet Altay, Muhammet Gurdogan, Naile Eris Gudul, Mujdat Aktas, Mutlu Buyuklu, Husnu Degirmenci, Mehmet Salih Turan, Kadir Ugur Mert, Gurbet Ozge Mert, Muhammet Dural, Sukru Arslan, Nurten Sayar, Batur Kanar, Beste Ozben Sadic, Ahmet Anil Sahin, Ahmet Buyuk, Onur Kilicarslan, Cem Bostan, Tarik Yildirim, Seda Elcim Yildirim, Kahraman Cosansu, Perihan Varim, Ersin Ilguz, Recep Demirbag, Asuman Yesilay, Abdullah Cirit, Eyyup Tusun, Emre Erkus, Muhammet Rasit Sayin, Zeynep Kazaz, Selim Kul, Turgut Karabag, Belma Kalayci, Clinical sciences, Cardio-vascular diseases, and Cardiology
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Male ,medicine.medical_specialty ,Multivariate analysis ,Clinical Decision-Making ,Risk Assessment ,Severity of Illness Index ,decision making ,surgery ,Risk Factors ,Internal medicine ,Intervention (counseling) ,medicine ,Clinical endpoint ,Humans ,03.02. Klinikai orvostan ,guidelines ,Symptomatic aortic stenosis ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,valvular heart disease ,Disease Management ,aortic stenosis ,Aortic Valve Stenosis ,Odds ratio ,medicine.disease ,Europe ,Stenosis ,Treatment Outcome ,Echocardiography ,Aortic Valve ,Charlson comorbidity index ,transcatheter aortic valve replacement ,Female ,Morbidity ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,surgical aortic valve replacement - Abstract
BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.
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- 2021
25. Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve
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José Rodríguez-Palomares, Sergio Moral, María Celeste Carrero, Laura Galian, Rodolfo Citro, Laura Gutierrez, Josep M. Alegret, Ilaria Dentamaro, Arturo Evangelista, Francisco Calvo, Antonella Moreo, Violeta Sánchez, Paolo Colonna, Augusto Sao-Aviles, Gisela Teixido-Tura, Angela Lopez, Eduardo Bossone, Fabio Chirillo, Institut Català de la Salut, [Lopez A, Dentamaro I, Galian L, Sao-Aviles A, Gutiérrez L, Teixido-Tura G, Rodríguez-Palomares J] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBERCV, Barcelona, Spain. [Calvo F] Cardiology Department, Hospital Alvaro Cunqueiro, Vigo, Spain. [Alegret JM] Cardiology Department, Hospital Universitari Sant Joan de Reus, IISPV, Universitat Rovira i Virgili, Reus, Spain. [Sanchez V] Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain. [Evangelista A] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBERCV, Barcelona, Spain. Heart Institute, Teknon Medical Center-Quirón Salud, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Lopez, A., Dentamaro, I., Galian, L., Calvo, F., Alegret, J. M., Sanchez, V., Citro, R., Moreo, A., Chirillo, F., Colonna, P., Carrero, M. C., Bossone, E., Moral, S., Sao-Aviles, A., Gutierrez, L., Teixido-Tura, G., Rodriguez-Palomares, J., and Evangelista, A.
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Aortic valve ,Pathological Conditions, Signs and Symptoms::Pathological Conditions, Anatomical::Dilatation, Pathologic [DISEASES] ,medicine.medical_specialty ,Aortic stenosi ,bicuspid aortic valve ,Regurgitation (circulation) ,enfermedades cardiovasculares::enfermedades cardíacas::enfermedades de las válvulas cardíacas [ENFERMEDADES] ,Article ,Otros calificadores::Otros calificadores::/complicaciones [Otros calificadores] ,Bicuspid aortic valve ,Aneurysm ,Internal medicine ,medicine.artery ,Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve Insufficiency [DISEASES] ,Ascending aorta ,medicine ,Outpatient clinic ,afecciones patológicas, signos y síntomas::afecciones patológicas anatómicas::dilatación patológica [ENFERMEDADES] ,business.industry ,aortic stenosis ,General Medicine ,Cor - Vàlvules - Malalties - Complicacions ,medicine.disease ,Insuficiència aòrtica ,enfermedades cardiovasculares::enfermedades cardíacas::enfermedades de las válvulas cardíacas::insuficiencia de la válvula aórtica [ENFERMEDADES] ,aortic regurgitation ,Stenosis ,medicine.anatomical_structure ,Cardiology ,Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases [DISEASES] ,cardiovascular system ,aneurysm ,Vasos sanguinis - Dilatació ,Medicine ,business ,Dyslipidemia ,Other subheadings::Other subheadings::/complications [Other subheadings] - Abstract
Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >, 5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>, 0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients.
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- 2021
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26. Are Aortic Root and Ascending Aorta Diameters Measured by the Pediatric versus the Adult American Society of Echocardiography Guidelines Interchangeable?
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Ignacio Ferreira, Laura Galian-Gay, Maria Luz Servato, Gisela Teixido-Tura, Laura Gutierrez, Rubén Fernández-Galera, Filipa Valente, Guillem Casas, Anna Sabaté-Rotés, Arturo Evangelista, Ángela López-Sainz, M. Teresa González-Alujas, José Rodríguez-Palomares, Augusto Sao-Aviles, Institut Català de la Salut, [Servato ML, Teixidó-Turá G, Galian-Gay L, Gutiérrez L, Valente F, Fernandez-Galera R, Casas G, López-Sainz A, González-Alujas MT, Sao-Aviles A, Ferreira I, Rodríguez-Palomares J] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBERCV, Barcelona, Spain. [Sabate-Rotes A] Servei de Cardiologia Pediàtrica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBERCV, Barcelona, Spain. [Evangelista A] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBERCV, Barcelona, Spain. Teknon Medical Center-Quirón Salud, Heart Institute, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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medicine.medical_specialty ,aortic dimensions ,Aortic root ,Population ,Diastole ,Sistema cardiovascular - Malalties ,Aortic disease ,Article ,Internal medicine ,medicine.artery ,Ascending aorta ,medicine ,echocardiography ,education ,Other subheadings::Other subheadings::/diagnostic imaging [Other subheadings] ,enfermedades cardiovasculares [ENFERMEDADES] ,diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::técnicas de imagen cardíaca::ecocardiografía [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Aorta ,education.field_of_study ,Cardiovascular Diseases [DISEASES] ,business.industry ,Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Cardiac Imaging Techniques::Echocardiography [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,guideline’s recommendations ,Otros calificadores::Otros calificadores::/diagnóstico por imagen [Otros calificadores] ,General Medicine ,Cardiovascular System::Blood Vessels::Arteries::Aorta [ANATOMY] ,Clinical Practice ,Aorta - Malalties - Imatgeria per ressonància magnètica ,aorta ,Cardiology ,cardiovascular system ,Medicine ,Aorta diameter ,business ,sistema cardiovascular::vasos sanguíneos::arterias::aorta [ANATOMÍA] ,Ecocardiografia - Abstract
Ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. However, there is no uniformity among experts regarding ascending aorta diameter quantification by echocardiography. The aim of this study was to compare maximum aortic root and ascending aorta diameters determined by the diastolic leading edge (DLE) and the systolic inner edge (SIE) conventions in adult and pediatric patients with inherited cardiovascular diseases. Transthoracic echocardiograms were performed in 328 consecutive patients (260 adults and 68 children). Aorta diameters were measured twice at the root and ascending aorta by the DLE convention following the 2015 American Society of Echocardiography (ASE) adult guidelines and the SIE convention following the 2010 ASE pediatric guidelines. Comparison of the diameters measured by the two conventions in the overall population showed a non-significant underestimation of the diameter measured by the SIE convention at root level of 0.28 mm (CI -1.36, 1.93) and at tubular ascending aorta level of 0.17 mm (CI-1.69, 2.03). Intraobserver and interobserver variability were excellent. Maximum aorta diameter measured by the leading edge convention in end-diastole and the inner edge convention in mid-systole had similar values to a mild non-significant underestimation of the inner-to-inner method that permits them to be interchangeable when used in clinical practice.
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- 2021
27. Circumferential wall shear stress predicts co-localized progressive dilation in bicuspid aortic valve patients
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Kevin M. Johnson, Maria Luz Servato, Oliver Wieben, Laura Gutiérrez, Laura Galian-Gay, Gisela Teixido-Tura, Andrea Guala, Aroa Ruiz-Muñoz, Lydia Dux-Santoy, Ignacio Ferreira-González, Teresa González-Alujas, Filipa Valente, J F Rodriguez Palomares, Augusto Sao-Aviles, and Artur Evangelista
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medicine.medical_specialty ,Bicuspid aortic valve ,business.industry ,Internal medicine ,cardiovascular system ,Cardiology ,Shear stress ,Medicine ,Dilation (morphology) ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Abstract
Background Bicuspid aortic valve (BAV), a congenital heart defect, is associated with ascending aorta (AAo) dilation. Whether the high prevalence of dilation in BAV patients is related to alteration of aortic blood flow and thus in wall shear stress (WSS) [1,2], which have been associated with aortic wall degeneration [3], or intrinsic abnormalities of the aortic wall, such as altered aortic stiffness [4], has not been established. Recently, a technique for the semi-automatic quantification of progressive aortic dilation maps via image registration has been introduced [5]. Purpose To test whether ascending aorta WSS predicts co-localized progressive dilation in BAV patients. Methods Forty BAV patients free from moderate and severe aortic valve regurgitation (regurgitant fraction Results Demographic and clinical characteristics of the patients are shown in Table 1. WSS and growth rate maps are shown in Figure 1. Follow-up duration was 44.8±2.6 months. Growth rate (Figure 1A) was heterogeneously distributed, being highest (up to 0.26 mm/year) in the outer region of the mid AAo and in the inner region of the proximal-mid AAo. Circumferential WSS showed highest values in the outer region of the mid AAo (Figure 1C) while WSS (magnitude) and its axial component (Figure 1B and D) presented maximum values in the right region of the mid AAo. Maps of statistically significant association between GR and WSS values showed circumferential WSS to be correlated with GR in regions where progressive dilation was fastest, while WSS magnitude and its axial component resulted in limited associations with GR maps. Conclusions Circumferential wall shear stress predicts location-matched progressive dilation in bicuspid aortic valve patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study has received funding from the Instituto de Salud Carlos III (PI17/00381). Guala A. has received funding from Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I). Table 1. DemographicsFigure 1. GR and WSS maps and correlations
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- 2021
28. Accurate and reproducible aortic growth rate mapping via registration of serial contrast-enhanced computed tomography angiograms
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Rubén Fernández-Galera, Filipa Valente, Andrea Guala, Aroa Ruiz-Muñoz, Laura Gutiérrez, Laura Galian-Gay, Lydia Dux-Santoy, Guillem Casas, Maria Luz Servato, Ignacio Ferreira-González, Artur Evangelista, J F Rodriguez Palomares, Gisela Teixido-Tura, and Teresa González-Alujas
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medicine.diagnostic_test ,business.industry ,media_common.quotation_subject ,medicine ,Contrast (vision) ,Computed tomography ,Growth rate ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,media_common - Abstract
Introduction Accurate assessment of aortic diameters and growth rates is key for clinical management of patients with aortic aneurysms [1]. Manual assessment on multiplanar reformatted views of computed tomography angiograms (CTA) is recommended [1], although its reproducibility in the assessment of growth rates has not been reported [2]. Image registration has been proposed to provide 3D maps of aortic diameters and growth [3], but its accuracy and reproducibility have not been established. Purpose To quantify accuracy and inter-observer reproducibility of aortic root and thoracic aorta diameters and growth rate by registration of serial CTAs compared to current standard. Methods Forty non-operated patients with ≥2 contrast-enhanced ECG-gated CTA acquired at least 6 months apart were included. Aortic diameters and growth rates were measured in the aortic root and thoracic aorta by two independent observers, both with the current standard and with the registration-based technique. To perform registration-based assessment, each observer semi-automatically segmented the aorta at baseline and located typical anatomical landmarks (Fig. 1A). Then, deformable image registration was used to map baseline and follow-up CT scans and deformation was applied to the baseline aortic surface points to obtain their location at follow-up (Fig. 1B). Finally, aortic root diameters and growth rate and 3D maps of thoracic aortic diameters and growth rate were automatically obtained (Fig. 1C). Agreement between techniques and their inter-observer reproducibility were calculated. Results Follow-up duration was 3.3±1.5 years (range 0.52–6.2). Compared with manual assessment, registration-based aortic diameters presented low bias and excellent agreement in the aortic root (0.42 mm, ICC=0.99) and the thoracic aorta (0.55 mm, ICC=0.99), and similar inter-observer reproducibility (ICC=0.99 for both). Compared with manual assessment, registration-based growth rates presented low bias and good agreement in the aortic root (0.12 mm/y, ICC=0.84) and the thoracic aorta (0.03 mm/y, ICC=0.77) (Fig. 2A), and much higher inter-observer reproducibility (ICC=0.96 vs 0.68 in the aortic root, ICC=0.96 vs 0.80 in the thoracic aorta) (Fig. 2B and C). Registration-based aortic growth rates reproducibility at 6 months follow-up was comparable to that obtained by manual assessment at 2.7 years (LoA = [−0.01, 0.33] and LoA = [−0.13, 0.21], respectively). Aortic diameters and growth rate 3D maps were highly reproducible (ICC>0.9) in the whole thoracic aorta. Conclusions Progressive aortic dilation assessment via registration of CTAs is accurate and more reproducible than the current standard even over follow-ups as short as 6 months, and further provides robust 3D mapping of aortic diameters and growth rates. Its application may provide new insights in aneurysms pathophysiology and improve the clinical management of these patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study has received funding from the Instituto de Salud Carlos III (PI17/00381). Guala A. has received funding from Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I). Figure 1. Methodology.Figure 2. Growth rate comparison.
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- 2021
29. Arrhythmia and cardiomyopathy in Heritable Thoracic Aortic Disease: an international retrospective cohort study
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Laura Muiño Mosquera, Anthony Demolder, Katalin Szöcs, Artur Evangelista, Gisela Teixido-Tura, Guillaume Jondeau, A Sabate-Rotes, Elena Cervi, Ángela López-Sainz, Y Von Kodolitsch, Julie De Backer, A Pini, M Caruana, E Montanes-Delmas, and L Buttigieg
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiomyopathy ,Cardiology ,Retrospective cohort study ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Background Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS) and related heritable thoracic aortic diseases (HTAD) are well-known for their aortic complications. Myocardial dysfunction and arrhythmia are less known in this setting but have been increasingly reported as additional causes of morbidity and mortality. Related to the rarity of the disorders, data on the prevalence of these features and clinical characteristics of the patients are difficult to obtain, calling for a multicentre initiative. Purpose To study the prevalence of myocardial dysfunction and arrhythmia in patients with HTAD and describe their clinical and genetic profile. Methods Nine centres from seven countries participated in this multicentre retrospective study. Medical records of patients 12 years or older carrying a (likely) pathogenic variant in the FBN1 gene, LDS genes (TGFBR1, TGFBR2, TGFB2, TGFB3 and SMAD3) or ACTA2 gene were screened. Patients presenting myocardial dysfunction and/or arrhythmia were identified, and clinical and genetic data were collected. Myocardial dysfunction included (a)symptomatic reduced ejection fraction (EF Results In total, 3219 patients with HTAD were screened: 2761 with a variant in FBN1, 385 with a variant in one of the LDS genes (TGFBR1, TGFBR2, TGFB2, TGFB3 and SMAD3) and 73 carrying a variant in ACTA2. Myocardial dysfunction and arrhythmia were not reported in patients carrying an ACTA2 variant. Myocardial dysfunction was observed in patients with a variant in FBN1 and the LDS genes, without significant differences in prevalence (2.3% vs. 1.8%, p=0.563). Patients with a variant in the LDS genes presenting myocardial dysfunction were younger than patients carrying a variant in FBN1 (25±11 years vs. 39±17 years, p=0.034). The prevalence of VT/VF/SCD was similar in patients with a variant in one of the LDS genes compared to those with a variant in FBN1 (1.6% vs. 0.8%, p=0.132) and there was no difference in age at time of event (26±13 years vs. 33±14 years, p=0.289). Among patients with a variant in the LDS genes, the prevalence of VT/VF/SCD was highest in patients carrying a variant in the TGFBR2 gene and was significantly higher compared to patients with a variant in FBN1 (3.4% vs. 0.8%, p=0.017). In contrast, AF/AFL was significantly more often reported in patients with a variant in FBN1 compared to those with a variant in one of the LDS genes (1.7% vs. 0.3%, p=0.033). Conclusions Myocardial dysfunction and arrhythmia are rare features in patients with HTAD. They occur predominantly in patients with a variant in FBN1 and LDS genes, but were not reported in patients carrying a variant in the ACTA2 gene. Further analysis to identify other contributing factors is necessary. Funding Acknowledgement Type of funding sources: None. Figure 1
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- 2021
30. Mitral annular disjunction in patients with syndromic hereditary aorthopaties
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M T Gonzalez-Alujas, G Casas-Masnou, A Lopez-Sainz, M.L Servato, Augusto Sao-Aviles, F Valente, J Limeres, Artur Evangelista, R Fernandez-Galera, L Gutierrez, J F Rodriguez-Palomares, and Gisela Teixido-Tura
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Marfan syndrome ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Cardiology ,medicine ,In patient ,cardiovascular diseases ,Atrium (heart) ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Background Mitral annular disjunction (MAD) is a structural abnormality of the mitral annular fibrosus characterized by a separation between the atrial wall-mitral valve junction, and the left ventricular attachment (1). It has been associated with mitral valve prolapse (MVP) (2) but also, with arrhythmias and sudden cardiac death (SCD) (3). There is no evidence of its prevalence and clinical significance in patients with syndromic hereditary aortopathies. Purpose To evaluate the prevalence of MAD, PMV, and the combination of both in patients with syndromic hereditary thoracic aortic disease (HTAD) including Marfan (MFS), Loeys-Dietz (LDS) and vascular Ehlers-Danlos syndromes (vEDS), and its relationship with arrhythmias, SCD, mitral regurgitation (MR) severity and the need for mitral surgery at the follow-up. Methods Adult patients with syndromic HTAD seen at our specialized unit were retrospectively included. The presence of MAD, MVP, and significant MR at first echocardiogram were evaluated. Electronic medical records were reviewed to register the occurrence of arrhythmic events and the need of mitral surgery. Last echocardiogram available was also assessed to evaluate MR progression. Results A total of 295 patients were included (235 MFS, 42 LDS and 18 vEDS). Mean age at baseline was 39.0±14.4 and 52.9% were female. MAD was present in 87 (37.0%) of MFS, 6 (14.3%) of LDS and was not present in vEDS (p In MFS, the presence of MAD was significantly associated with MVP (p≤0.001) (Table 1). However, 14 (6.0%) of patients had isolated MAD (Table 2). At baseline, significant MR was observed in 18 (24.7%) of patients with concurrent MAD and MVP and was not present in patients with isolated MAD (Table 2). MVP (OR 16.85 IC 4.43 – 64.07) but not MAD (p=0.607), was associated with significant MR in the multivariate analysis. A second echocardiogram was available in 220 patients at ≥1 year (mean 4.1±1.4 years). Overall, 25 (11.4%) presented significant progression of MR, 0 in the isolated MAD group, 13 (19.4%) in the MAD/MVP group and 6 (20.0%) of the isolated MVP (p=0.007). After a mean clinical follow-up of 7.5±3.2 years, 10 patients required mitral surgery (6 prosthesis, 4 valvuloplasty), 22 (9.4%) presented atrial fibrillation, flutter or supraventricular tachycardia (SVT), and 2 (0.9%) SCD. After adjustment for the presence of MVP and time of follow-up, MAD was not associated with progression of MR (p=0.529) need for mitral surgery (p=0.096), atrial fibrillation-flutter or SVT (p=0.510) nor SCD. (p=0.997). Conclusions The prevalence of MAD in syndromic HTAD is high, especially in Marfan syndrome, and absent in vEDS. In this retrospective observational study, the presence of MAD in Marfan was not associated with mitral regurgitation evolution or arrhythmic events. Funding Acknowledgement Type of funding sources: None. Characteristics of MFS patientsPresence of significant MR by groups.
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- 2021
31. False Lumen Flow Assessment by Magnetic Resonance Imaging and Long-Term Outcomes in Uncomplicated Aortic Dissection
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Arturo Evangelista, Victor Pineda, Andrea Guala, Bart Bijnens, Hug Cuellar, Paula Rudenick, Augusto Sao-Aviles, Aroa Ruiz, Gisela Teixido-Tura, Rafael Rodriguez-Lecoq, Sergi Bellmunt, Ignacio Ferreira, and Jose Rodríguez-Palomares
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Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Aortic Aneurysm, Thoracic ,Endovascular Procedures ,Humans ,Cardiology and Cardiovascular Medicine ,Tomography, X-Ray Computed ,Magnetic Resonance Imaging ,Aorta ,Retrospective Studies - Abstract
Despite the absence of clinical complications after an acute aortic dissection (AD) with persistent patent false lumen (FL), a high risk for clinical events may persist.The aim of this study was to assess the natural evolution of noncomplicated AD and ascertain whether different FL flow patterns by magnetic resonance imaging (MRI) have independent prognostic value for AD-related events beyond established morphologic parameters.One hundred thirty-one consecutive patients, 78 with surgically treated type A dissections and 53 with medically treated type B dissections, were followed up prospectively after acute AD with persistent patent FL in the descending aorta. Maximum aortic diameter, true lumen compression, entry tear, and partial FL thrombosis by computed tomography were assessed. Systolic antegrade true lumen and FL flow volumes and diastolic antegrade and retrograde flows were analyzed by MRI during the first year after AD.After a median follow-up period of 8.0 years (IQR: 4.6-10.9 years), 43 patients presented aorta-related events (25 died and 18 required endovascular treatment). FL systolic antegrade flow ≥30% with respect to total systolic antegrade flow and retrograde diastolic flow ≥80% with respect to total diastolic FL flow were predictors of aortic events. In multivariate analysis, aortic diameter45 mm (HR: 2.91), type B dissection (HR: 2.44), and MRI flow pattern (HR: 16.87) were independent predictors of AD-related events.High systolic antegrade flow volume in the FL with significant diastolic retrograde flow assessed by MRI and aortic diameter45 mm identify patients with higher risk for complications in whom more aggressive management would be indicated.
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- 2021
32. Automatic segmentation of the aorta on multi-center and multi-vendor phase-contrast enhanced magnetic resonance angiographies and the advantages of transfer learning
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Lydia Dux-Santoy, A Ruiz-Munoz, G. D. Maso Talou, G Kat, J Aviles, M Mejia Cordova, Oscar Camara, Alistair A. Young, Gisela Teixido-Tura, E Ferdian, J F Rodriguez-Palomares, and Andrea Guala
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medicine.diagnostic_test ,business.industry ,Vendor ,Phase contrast microscopy ,Deep learning ,Magnetic resonance imaging ,General Medicine ,Convolutional neural network ,Magnetic resonance angiography ,law.invention ,Signal-to-noise ratio ,law ,Medicine ,Radiology, Nuclear Medicine and imaging ,Computer vision ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,Transfer of learning - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Guala A. received funding from the Spanish Ministry of Science, Innovation and Universities Background Phase-contrast (PC) enhanced magnetic resonance (MR) angiography (MRA) is a class of angiogram exploiting velocity data to increase the signal-to-noise ratio, thus avoiding the administration of external contrast agent, normally used to segment 4D flow MR data. To train deep-learning algorithms to segment PC-MRA a large amount of manually annotated data is needed: however, the relatively novelty of the sequence, its rapid evolution and the extensive time needed to manually segment data limit its availability. Purpose The aim of this study was to test a deep learning algorithm in the segmentation of multi-center and multi-vendor PC-MRA and to test if transfer learning (TL) improves performance. Methods A large dataset (LD) of 262 and a small one (SD) of 22 PC-MRA, acquired without contrast agent at 1.5 T in a General Electric and a Siemens scanner, respectively, were manually annotated and divided into training (232 and 15 cases) and testing (30 and 7) sets. They both included PC-MRA of healthy subjects and patients with aortic diseases (excluding dissections) and native aorta. A convolutional neural networks (CNN) based on nnU-Net framework [1] was trained in the LD and another in the SD. The left ventricle was removed semi-automatically from the DL segmentations of the LD as it was not relevant for this application. Networks were then tested on the test sets of the dataset there were trained and the other dataset to assess generalizability. Finally, a fine-tuning transfer learning approach was applied to LD network and the performance on both test sets were tested. Dice score, Hausdorff distance, Jaccard score and Average Symmetrical Surface Distance were used as segmentation quality metrics. Results LD network achieved good performance in LD test set, with a DS of 0.904, ASSD of 1.47, J of 0.827 and HD of 6.35, which further improve after removing the left ventricle in the post-processing to a DS of 0.942, ASSD of 0.93, J of 0.892 and HD of 3.32. SD network results in an average DS of 0.895, ASSD of 0.59, J of 0.812 and HD of 2.05. Once tested on the testing set of the other dataset, LD network resulted in a DS of 0.612 while SD network in DS of 0.375, thus showing limited generalizability. However, the application of transfer learning to LD network resulted in the improvement of the evaluation metrics on the SD from a DS of 0.612 to 0.858, while slightly worsening in the first one without post-processing to 0.882. Conclusions nnU-net framework is effective for fast automatic segmentation of the aorta from multi-center and multi-vendor PC-MRA, showing performance comparable with the state of the art. The application of transfer learning allows for increased generalization to data from center not included in the original training. These results unlock the possibility for fully-automatic analysis of multi-vendor multi-center 4D flow MR.
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- 2021
33. Bicuspid aortic valve fusion length correlates with maximum aortic diameter and heamodynamic abnormalities: a 4D flow CMR study
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A Ruiz-Munoz, Oliver Wieben, Kevin M. Johnson, Gisela Teixido-Tura, Augusto Sao-Aviles, Artur Evangelista, L Gutierrez, L Galian, Teresa González-Alujas, Ignacio Ferreira-González, F Valente, Andrea Guala, J F Rodriguez-Palomares, and Lydia Dux-Santoy
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Aortic valve ,Aortic arch ,Body surface area ,Aorta ,medicine.medical_specialty ,business.industry ,Aortic valve disorder ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Bicuspid aortic valve ,medicine.artery ,Internal medicine ,Ascending aorta ,cardiovascular system ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Systole ,Cardiology and Cardiovascular Medicine ,business - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Guala A. received funding from the Spanish Ministry of Science, Innovation and Universities. Background Bicuspid aortic valve (BAV), a congenital heart defect, is associated with ascending aorta dilation, possibly via alteration of aortic blood flow [1]. In BAV abnormal flow condition have been associated with aortic extracellular matrix dysregulation and elastic fiber degeneration [2]. Current morphological classification of BAV patients with aortic valve with a single fusion between two adjacent leaflets does not allow for risk stratification. Purpose This research work tested whether the extent of fusion between leaflets is related to AAo diameter and flow alterations. Methods Ninety BAV patients free from moderate and severe aortic valve disease and with no previous aortic or aortic valve surgery or replacement were prospectively enrolled. A comprehensive magnetic resonance protocol comprised a stack of double-oblique 2D balanced steady-state free-precession (bSSFP) cine CMR of the aortic valve, which was used to measure the length of the fusion between leaflets, a cine CMR at the level of the pulmonary bifurcation to assess aortic diameter and 4D flow MRI sequence to assess flow characteristics and regional stiffness [3]. Jet angle and flow radial displacement, quantifying the extent of flow eccentricity, and systolic flow reversal ratio (SFRR), assessing the relative amount of backward flow during systole, were computed at 8 equidistant planes in the ascending aorta and 4 equidistant planes in the aortic arch [4]. A two-tailed p-value < 0.05 was considered statistically significant. Results The length of leaflet fusion varied widely (median 7.7 mm, inter-quartile range [5.5; 10.2]), Table 1). In bivariate analysis, fusion length was also associated to ascending aortic diameter (R = 0.391, p Conclusions Bicuspid aortic valve fusion extent varies greatly and it is associated with aortic diameter, possibly through flow alterations. Prospective longitudinal studies are needed to establish whether fusion length may allow for risk stratification in bicuspid aortic valve patients.
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- 2021
34. Aortic rotational flow patterns and stiffness by 4D flow CMR in patients with Loeys-Dietz syndrome compared to healthy volunteers and patients with Marfan syndrome
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Ángela López-Sainz, L Servato, Luis Gutiérrez, Lydia Dux-Santoy, L La Mura, Oliver Wieben, Artur Evangelista, Andrea Guala, Laura Galian-Gay, A Ruiz Munoz, I Ferreira, J F Rodriguez-Palomares, Kevin M. Johnson, Gisela Teixido-Tura, and Teresa González-Alujas
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Marfan syndrome ,medicine.medical_specialty ,Aorta ,business.industry ,Hemodynamics ,General Medicine ,Stroke volume ,medicine.disease ,Loeys–Dietz syndrome ,Internal medicine ,medicine.artery ,cardiovascular system ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Aortic stiffness ,Systole ,Cardiology and Cardiovascular Medicine ,business ,Pulse wave velocity - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): La Marató de TV3, Instituto de Salud Carlos III through the project and Spanish Ministry of Science, Innovation and Universities. BACKGROUND Loeys-Dietz (LDS) and Marfan (MFS) syndromes are rare genetic connective tissue disorders associated with progressive aortic dilation, however, aortic dissections have been observed at lower aortic root diameters in LDS than in MFS. Recent CMR studies in MFS patients reported increased aortic stiffness (1–3) and altered rotational flow (4), but research on aortic flow dynamics and biomechanics in LDS is lacking. PURPOSE The aim of this study was to assess rotational aortic flow and aortic stiffness in LDS compared to healthy volunteers (HV) and MFS patients, using 4Dflow CMR. METHODS Twenty-one LDS and 44 MFS patients, without previous aortic dissection or surgery, and 43 HV underwent a non-contrast-enhanced 4D flow CMR. Aortic stiffness was quantified at the AAo and DAo using pulse wave velocity (PWV). In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR) (5) and local aortic diameters were obtained at 20 equidistant planes from the ascending (AAo) to the proximal descending aorta (DAo). RESULTS LDS patients had lower IRF at the distal AAo and proximal DAo compared to HV (p = 0.053 and 0.004, respectively), once adjusted for age, stroke volume and local aortic diameter; but no differences were found with respect to MFS (Figure). Although SFRR at the proximal DAo was increased in LDS patients compared to both HV (p = 0.037) and MFS populations (p = 0.015), once adjusted for age and aortic diameter, the difference in magnitude was small (Figure). On the other hand, AAo and DAo PWV revealed stiffer aortas in LDS patients compared to HV but no differences versus MFS patients (Table). CONCLUSIONS Patients with Loeys-Dietz syndrome showed decreased in-plane rotational flow and abnormally-high regional aortic stiffness compared to healthy controls, and similar hemodynamics and aortic stiffness with respect to patients with Marfan syndrome.
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- 2021
35. Machine learning to automatically detect anatomical landmarks on phase-contrast enhanced magnetic resonance angiography
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Lydia Dux-Santoy, J F Rodriguez-Palomares, Xabier Morales, Guillermo Jimenez-Perez, Ignacio Ferreira-González, Andrea Guala, Gisela Teixido-Tura, M Mejia Cordova, A Ruiz-Munoz, Oscar Camara, and J Aviles
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medicine.diagnostic_test ,law ,business.industry ,Phase contrast microscopy ,Medicine ,Radiology, Nuclear Medicine and imaging ,Computer vision ,General Medicine ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,Magnetic resonance angiography ,law.invention - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Guala A. received funding from the Spanish Ministry of Science, Innovation and Universities Introduction The heterogeneous characteristic of the thoracic aorta implies that all biomarkers with potential for risk stratification need to be references to a specific location. This is the case, for example, of diameter [1], stiffness [2] and wall shear stress [3]. This is normally achieved by the manual identification of a limited number of key anatomic landmarks [4], which is a time-demanding task and may impact biomarkers accuracy and reproducibility. Automatic identification of these anatomic landmarks may speed-up the analysis and allow for the creation of fully automatic image analysis pipelines. Machine learning (ML) algorithms might be suitable for this task. Purpose The aim of this study was to test the performance of a ML algorithm in localizing key thoracic anatomical landmarks on phase-contrast enhanced magnetic resonance angiograms (PC-MRA). Methods PC-MRA of 323 patients with native aorta and aortic valve and a variety of aortic conditions (141 bicuspid aortic valve patients, 60 patients with degenerative aortic aneurysms, 82 patients with genetic aortopathy and 40 healthy volunteers) were included in this study. Four anatomical landmarks were manually identified on PC-MRA by an experienced researcher: sinotubular junction, the pulmonary artery bifurcation and the first and third supra-aortic vessel braches. A reinforcement learning algorithm (DQN), combining Q-learning with deep neural networks, was trained. The algorithm was tested in a separate set of 30 PC-MRA with similar distribution of aortic conditions in which human intra-observer reproducibility was quantified. The distance between points was used as quality metric and human annotation was considered as ground-truth. Repeated-measures ANOVA was used for statistical testing. Results ML algorithm resulted in performance similar to the intra-observer variability obtained by the experienced human reader in the identification of the sinotubular junction (11.1 ± 8.6 vs 11.0 ± 8.1 mm, p = 0.949) and first (6.8 ± 5.6 vs 6.6 ± 3.9 mm, p = 0.886) and third (8.4 ± 7.4 vs 6.8 ± 4.0 mm, p = 0.161) supra-aortic vessels branches. However, the algorithm did not reach human-level performance in the localization of the pulmonary artery bifurcation (15.2 ± 13.1 vs 10.2 ± 7.0 mm, p = 0.008). The time needed to the ML algorithm to locate all points ranged between 0.8 and 1.6 seconds on a standard computer while manual annotation required around two minutes to be performed. Conclusions The rapid identification of key aortic anatomical landmarks by a reinforced learning algorithm is feasible with human-level performance. This approach may thus be used for the design of fully-automatic pipeline for 4D flow CMR analysis.
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- 2021
36. The role of echocardiography
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Arturo Evangelista and Gisela Teixido-Tura
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body regions ,cardiovascular system ,human activities - Abstract
Echocardiography plays an important role in the diagnosis and follow-up of aortic diseases. Evaluation of the aorta is a routine part of the echocardiographic examination. Transthoracic echocardiography (TTE) is an excellent modality for imaging the aortic proximal ascending aorta, which is important in the diagnosis and follow-up of aorta aneurysms. Transoesophageal echocardiography (TEE) overcomes the limitations of TTE in thoracic aorta assessment. Although TEE is the technique of choice in the diagnosis of aortic dissection, TTE may be used as the initial modality in the emergency setting. Intimal flap in proximal ascending aorta, pericardial effusion/tamponade, and left ventricular function can be easily visualized by TTE. However, a negative TTE does not rule out aortic dissection and other imaging techniques must be considered. TEE should define entry tear size and location, mechanisms and severity of aortic regurgitation, and true lumen compression. TEE is essential in selecting and monitoring surgical and endovascular treatment and in detecting possible complications.
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- 2021
37. Registration-based semi-automatic assessment of aortic diameter growth rate from contrast-enhanced computed tomography outperforms manual quantification
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Rubén Fernández-Galera, Filipa Valente, Maria Luz Servato, Laura Gutierrez, Laura Galian-Gay, Guillem Casas, Lydia Dux-Santoy, Ignacio Ferreira-González, Arturo Evangelista, Andrea Guala, José Rodríguez-Palomares, Aroa Ruiz-Muñoz, Gisela Teixido-Tura, and Teresa González-Alujas
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medicine.medical_specialty ,Computed Tomography Angiography ,media_common.quotation_subject ,Image registration ,Computed tomography ,Aorta, Thoracic ,Aortic aneurysm ,medicine.artery ,medicine ,Contrast (vision) ,Thoracic aorta ,Humans ,Radiology, Nuclear Medicine and imaging ,Aorta ,media_common ,Computed tomography angiography ,Observer Variation ,Reproducibility ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Reproducibility of Results ,General Medicine ,medicine.disease ,Radiology ,business ,Nuclear medicine ,Tomography, X-Ray Computed - Abstract
Manual assessment of aortic diameters on double-oblique reformatted computed tomography angiograms (CTA) is considered the current standard, although the reproducibility for growth rates has not been reported. Deformable registration of CTA has been proposed to provide 3D aortic diameters and growth maps, but validation is lacking. This study aimed to quantify accuracy and inter-observer reproducibility of registration-based and manual assessment of aortic diameters and growth rates. Forty patients with ≥ 2 CTA acquired at least 6 months apart were included. Aortic diameters and growth rate were obtained in the aortic root and the entire thoracic aorta using deformable image registration by two independent observers, and compared with the current standard at typical anatomical landmarks. Compared with manual assessment, the registration-based technique presented low bias (0.46 mm), excellent agreement (ICC = 0.99), and similar inter-observer reproducibility (ICC = 0.99 for both) for aortic diameters; and low bias (0.10 mm/year), good agreement (ICC = 0.82), and much higher inter-observer reproducibility for growth rates (root: ICC = 0.96 vs 0.68; thoracic aorta: ICC = 0.96 vs 0.80). Registration-based growth rate reproducibility over a 6-month-long follow-up was similar to that obtained by manual assessment after 2.7 years (LoA = [− 0.01, 0.33] vs [− 0.13, 0.21] mm/year, respectively). Mapping of diameter and growth rate was highly reproducible (ICC > 0.9) in the whole thoracic aorta. Registration-based assessment of aortic dilation on CTA is accurate and substantially more reproducible than the current standard, even at follow-up as short as 6 months, and provides robust 3D mapping of aortic diameters and growth rates beyond the pre-established anatomic landmarks. • Registration-based semi-automatic assessment of progressive aortic dilation on CTA is accurate and substantially more reproducible than the current standard. • The registration-based technique allows robust growth rate assessment at follow-up as short as 6 months, with a similar reproducibility to that obtained by manual assessment at around 3 years. • The use of image registration provides robust 3D mapping of aortic diameters and growth rates beyond the pre-established anatomic landmarks.
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- 2021
38. Genetic counselling and testing in adults with congenital heart disease: A consensus document of the ESC Working Group of Grown-Up Congenital Heart Disease, the ESC Working Group on Aorta and Peripheral Vascular Disease and the European Society of Human Genetics
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Antoine Bondue, Gisela Teixido-Tura, Aline Verstraeten, Guillaume Jondeau, Bart Loeys, Arturo Evangelista, Werner Budts, Ingrid M.B.H. van de Laar, María Luisa Arranz M.L. Peña, Pastora Gallego, Jolien W. Roos Hesselink, Julie De Backer, Clinical Genetics, and Cardiology
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Heart Defects, Congenital ,medicine.medical_specialty ,Consensus ,Genetic testing ,Heart disease ,Cardiologie et circulation ,Epidemiology ,Genetic counseling ,Aortic Diseases ,Cardiology ,Genetic Counseling ,030204 cardiovascular system & hematology ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,medicine.artery ,adult congenital heart disease ,medicine ,Humans ,Genetic Testing ,Intensive care medicine ,Societies, Medical ,030304 developmental biology ,Peripheral Vascular Diseases ,0303 health sciences ,Aorta ,genetic counseling ,Modalities ,medicine.diagnostic_test ,Vascular disease ,business.industry ,medicine.disease ,Precision medicine ,Human genetics ,Europe ,heritable thoracic aortic disease ,Human medicine ,Cardiology and Cardiovascular Medicine ,business ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Thanks to a better knowledge of the genetic causes of many diseases and an improvement in genetic testing techniques, genetics has gained an important role in the multidisciplinary approach to diagnosis and management of congenital heart disease and aortic pathology. With the introduction of strategies for precision medicine, it is expected that this will only increase further in the future. Because basic knowledge of the indications, the opportunities as well as the limitations of genetic testing is essential for correct application in clinical practice, this consensus document aims to give guidance to care-providers involved in the follow-up of adults with congenital heart defects and/or with hereditary aortic disease. This paper is the result of a collaboration between the ESC Working Group of Grown-Up Congenital Heart Disease, the ESC Working Group on Aorta and Peripheral Vascular Disease and the European Society of Human Genetics. Throughout the document, the importance of correct counseling in the process of genetic testing is emphasized, indications and timing for genetic studies are discussed as well as the technical modalities of genetic testing. Finally, the most important genetic diseases in adult congenital heart disease and aortic pathology are also discussed., SCOPUS: ar.j, info:eu-repo/semantics/published
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- 2019
39. Influence of Aortic Dilation on the Regional Aortic Stiffness of Bicuspid Aortic Valve Assessed by 4-Dimensional Flow Cardiac Magnetic Resonance
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Kevin M. Johnson, Augusto Sao Avilés, Marina Huguet, Arturo Evangelista, David Garcia-Dorado, Teresa González-Alujas, Laura Galian, Laura Gutiérrez, Filipa Valente, José Rodríguez-Palomares, Gisela Teixido-Tura, Giuliana Maldonado, Andrea Guala, Oliver Wieben, and Lydia Dux-Santoy
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Aortic valve ,Marfan syndrome ,medicine.medical_specialty ,Aorta ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,medicine.anatomical_structure ,Bicuspid aortic valve ,medicine.artery ,Internal medicine ,Descending aorta ,Ascending aorta ,cardiovascular system ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Aortic stiffness ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives This study sought to ascertain whether patients with a bicuspid aortic valve (BAV) have an intrinsic alteration in regional aortic stiffness compared with patients with tricuspid aortic valve (TAV) and Marfan syndrome (MFS) patients with similar aortic sizes, as well as to assess the influence of ascending aorta (AAo) dilation on regional stiffness parameters in BAV patients. Background Imaging biomarkers as predictors of BAV, MFS, and degenerative AAo aneurysms in TAV patients (DA-TAV) are lacking. Biomechanical characterization has been proposed as a possible tool for further aneurysm stratification. Methods A total 234 subjects (136 BAV, 44 MFS, and 18 DA-TAV patients and 36 healthy control subjects) were included. The cardiac magnetic resonance protocol comprised 4-dimensional flow to assess AAo and descending aorta (DAo) pulse wave velocities (PWVs) and double-oblique, 2-dimensional, steady-state free-precession cine cardiac magnetic resonance to compute aortic distensibility (AD). Results On adjusted analysis, nondilated BAV patients had similar PWV and AD as healthy control subjects in both AAo and DAo, whereas dilated BAV did not differ from DA-TAV. In contrast, AAo and DAo stiffness in MFS patients was markedly greater than in BAV patients, increasing slightly with dilation severity. AAo PWV showed a biphasic pattern in BAV patients: it first decreased and then increased throughout AAo dilation, with a clear turning point at 50 mm, whereas distensibility did not discern mildly dilated aorta. In multivariate analysis adjusted for clinical and demographic characteristics, only PWV was related to AAo dilation in BAV patients. Conclusions The mechanical properties of AAo aneurysms are similar in BAV and TAV patients, whereas MFS patients have a stiffer aorta. Aortic stiffness strongly depends on dilation severity. AAo PWV resulted in a potentially clinically useful biphasic trend with respect to aneurysm diameter, whereas distensibility did not discern mildly dilated aorta. Beyond clinical risk factors, PWV but not AD was independently related to AAo dilation in BAV patients.
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- 2019
40. Implications of Asymmetry and Valvular Morphotype on Echocardiographic Measurements of the Aortic Root in Bicuspid Aortic Valve
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David Garcia-Dorado, Andrea Guala, Gisela Teixido-Tura, Arturo Evangelista, José Rodríguez-Palomares, Jeroen C. Vis, Teresa González-Alujas, Augusto Sao-Aviles, Chiara Granato, Laura Galian-Gay, and Laura Gutiérrez
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Adult ,Male ,Aortic valve ,medicine.medical_specialty ,Diameter measurement ,Aortic root ,Population ,Heart Valve Diseases ,Magnetic Resonance Imaging, Cine ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,education ,Retrospective Studies ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Magnetic resonance imaging ,Mean age ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI) have yielded excellent results in aortic root diameter measurement in patients with tricuspid aortic valve. However, accuracy in bicuspid aortic valve (BAV), often associated with aortic root asymmetry, is not fully defined. The aim of this study was to determine the agreement between TTE and MRI in proximal ascending aortic diameters in patients with BAVs.Seventy-six consecutive patients with BAVs (mean age, 53 ± 15 years; 65% men) who underwent both TTE and MRI for ascending aortic assessment in a follow-up protocol were included in the study. Maximum aortic root and ascending aortic diameters were compared.For the whole population, TTE slightly underestimated aortic root diameter (difference, -0.8 ± 2.9 mm; P = .02). However, agreement was significantly better in BAV with fusion of the left and right coronary cusps than with fusion of the right coronary and noncoronary cusps, both with (type 1) and without (type 0) raphe (mean difference, 0.1 ± 2.5 vs -2.8 ± 2.8 mm, P .001, respectively). In raphe BAV, mean absolute differences of maximum diameters between both techniques were significantly greater in asymmetric versus symmetric aortic roots (3.3 ± 2.2 vs 1.6 ± 1.9 mm, P = .002). BAV type and root asymmetry were independent related to measurement disagreement between both modalities.Although TTE is the technique of choice in the follow-up of patients with BAVs, aortic root diameter measurements may be inaccurate in the presence of root asymmetry and in BAV with fusion of the right coronary and noncoronary cusps. In these cases, cross-sectional imaging, with MRI or computed tomography, to confirm aortic diameters may be advisable.
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- 2019
41. Deep Learning-based Automated Aortic Area and Distensibility Assessment: The Multi-Ethnic Study of Atherosclerosis (MESA)
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Vivek P. Jani, Nadjia Kachenoura, Alban Redheuil, Gisela Teixido-Tura, Kevin Bouaou, Emilie Bollache, Elie Mousseaux, Alain De Cesare, Shelby Kutty, Colin O. Wu, David A. Bluemke, Joao A. C. Lima, Bharath Ambale-Venkatesh, Laboratoire d'Imagerie Biomédicale (LIB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), and Bollache, Emilie
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Radiological and Ultrasound Technology ,[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging ,Image and Video Processing (eess.IV) ,Electrical Engineering and Systems Science - Image and Video Processing ,Atherosclerosis ,Magnetic Resonance Imaging ,Quantitative Biology - Quantitative Methods ,Article ,Computer Science Applications ,[SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging ,Deep Learning ,FOS: Biological sciences ,FOS: Electrical engineering, electronic engineering, information engineering ,cardiovascular system ,Humans ,Radiology, Nuclear Medicine and imaging ,Quantitative Methods (q-bio.QM) ,Algorithms ,Aorta - Abstract
This study applies convolutional neural network (CNN)-based automatic segmentation and distensibility measurement of the ascending and descending aorta from 2D phase-contrast cine magnetic resonance imaging (PC-cine MRI) within the large MESA cohort with subsequent assessment on an external cohort of thoracic aortic aneurysm (TAA) patients. 2D PC-cine MRI images of the ascending and descending aorta at the pulmonary artery bifurcation from the MESA study were included. Train, validation, and internal test sets consisted of 1123 studies (24282 images), 374 studies (8067 images), and 375 studies (8069 images), respectively. An external test set of TAAs consisted of 37 studies (3224 images). A U-Net based CNN was constructed, and performance was evaluated utilizing dice coefficient (for segmentation) and concordance correlation coefficients (CCC) of aortic geometric parameters by comparing to manual segmentation and parameter estimation. Dice coefficients for aorta segmentation were 97.6% (CI: 97.5%-97.6%) and 93.6% (84.6%-96.7%) on the internal and external test of TAAs, respectively. CCC for comparison of manual and CNN maximum and minimum ascending aortic areas were 0.97 and 0.95, respectively, on the internal test set and 0.997 and 0.995, respectively, for the external test. CCCs for maximum and minimum descending aortic areas were 0.96 and 0. 98, respectively, on the internal test set and 0.93 and 0.93, respectively, on the external test set. We successfully developed and validated a U-Net based ascending and descending aortic segmentation and distensibility quantification model in a large multi-ethnic database and in an external cohort of TAA patients., 25 pages, 5 figures
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- 2021
42. Aortic Branch Aneurysms and Vascular Risk in Patients With Marfan Syndrome
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Albert Roque, Ángela López-Sainz, Laia Mila, Laura Gutiérrez, Ignacio Ferreira-González, Hug Cuellar-Calabria, Augusto Sao-Aviles, Gisela Teixido-Tura, Artur Evangelista, J F Rodriguez-Palomares, Andrea Guala, Sergi Bellmunt, Ana Sabaté, J Limeres, Lucia La Mura, Laura Galian-Gay, Chiara Granato, and Rafael Rodriguez
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musculoskeletal diseases ,Marfan syndrome ,Adult ,Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Computed Tomography Angiography ,030204 cardiovascular system & hematology ,Vascular risk ,Marfan Syndrome ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Risk Factors ,medicine.artery ,Internal medicine ,medicine ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,skin and connective tissue diseases ,Aorta ,business.industry ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,Aortic Dissection ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Aortic branch aneurysms are not included in the diagnostic criteria for Marfan syndrome (MFS); however, their prevalence and eventual prognostic significance are unknown.The goal of this study was to assess the prevalence of aortic branch aneurysms in MFS and their relationship with aortic prognosis.MFS patients with a pathogenic FBN1 genetic variant and at least one magnetic resonance or computed tomography angiography study assessing aortic branches were included. Aortic events and those related to aneurysm complications were recorded during follow-up.A total of 104 aneurysms were detected in 50 (26.7%) of the 187 patients with MFS (mean age 37.9 ± 14.4 years; 54% male) included in this study, with the iliac artery being the most common location (45 aneurysms). Thirty-one patients (62%) had1 peripheral aneurysm, and surgery was performed in 5 (4.8%). Patients with aneurysms were older (41.9 ± 12.7 years vs. 36.7 ± 14.8 years; p = 0.040) and had more dilated aortic root (42.2 ± 6.4 mm vs. 38.8 ± 8.0 mm; p = 0.044) and dyslipidemia (31.0% vs. 9.7%; p = 0.001). In a subgroup of 95 patients with no previous aortic surgery or dissection followed up for 3.3 ± 2.6 years, the presence of arterial aneurysms was associated with a greater need for aortic surgery (hazard ratio: 3.4; 95% confidence interval: 1.1 to 10.3; p = 0.028) in a multivariable Cox analysis adjusted for age and aortic diameter.Aortic branch aneurysms are present in one-quarter of patients with MFS and are related to age and aortic dilation, and they independently predict the need for aortic surgery. The systematic use of whole-body vascular assessment is recommended to identify other sites of vascular involvement at risk for complications and to define the subgroup of patients with more aggressive aortic disease.
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- 2021
43. Diagnostic value of quantitative parameters for myocardial perfusion assessment in patients with suspected coronary artery disease by single- and dual-energy computed tomography myocardial perfusion imaging
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Andrea Guala, Laura Gutiérrez, Teresa González-Alujas, Arturo Evangelista, Lydia Dux-Santoy, Gisela Teixido-Tura, José Rodríguez-Palomares, Laura Galian-Gay, Ignacio Ferreira-González, Guillem Casas, Aroa Ruiz-Muñoz, Rubén Fernández-Galera, Filipa Valente, Institut Català de la Salut, [Ruiz-Muñoz A, Valente F, Dux-Santoy L, Guala A, Teixidó-Turà G, Galián-Gay L, Gutiérrez L, Fernández-Galera R, Casas G, González-Alujas T, Evangelista A, Rodríguez-Palomares J] Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain. Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Ferreira-González I] Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. CIBERESP, Instituto de Salud Carlos III, Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus
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lcsh:Diseases of the circulatory (Cardiovascular) system ,Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Coronary Disease::Coronary Artery Disease [DISEASES] ,Tomografia computada per emissió de fotó simple ,enfermedades cardiovasculares::enfermedades cardíacas::isquemia miocárdica::enfermedad coronaria::enfermedad arterial coronaria [ENFERMEDADES] ,Perfusion scanning ,diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::técnicas de imagen cardíaca::imágenes de perfusión miocárdica [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,030204 cardiovascular system & hematology ,Myocardial ischaemia ,Malalties coronàries ,Coronary artery disease ,03 medical and health sciences ,Myocardial perfusion imaging ,0302 clinical medicine ,medicine ,In patient ,030212 general & internal medicine ,CT myocardial perfusion imaging ,Original Paper ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Transmural perfusion ratio ,Estimació de paràmetres ,Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Cardiac Imaging Techniques::Myocardial Perfusion Imaging [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Dual-Energy Computed Tomography ,medicine.disease ,Environmental Health::General Aspects::Parameters [PUBLIC HEALTH] ,lcsh:RC666-701 ,Concomitant ,salud ambiental::aspectos generales::parámetros [SALUD PÚBLICA] ,Dual-energy CT-based iodine imaging ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Perfusion - Abstract
Imatge de perfusió miocàrdica per TC; Isquèmia miocàrdica; Relació de perfusió transmural CT myocardial perfusion imaging; Myocardial ischaemia; Transmural perfusion ratio Imágenes de perfusión miocárdica por TC; Isquemia miocárdica; Relación de perfusión transmural Purpose To compare performance of visual and quantitative analyses for detecting myocardial ischaemia from single- and dual-energy computed tomography (CT) in patients with suspected coronary artery disease (CAD). Methods Eighty-four patients with suspected CAD were scheduled for dual-energy cardiac CT at rest (CTA) and pharmacological stress (CTP). Myocardial CT perfusion was analysed visually and using three parameters: mean attenuation density (MA), transmural perfusion ratio (TPR) and myocardial perfusion reserve index (MPRI), on both single-energy CT and CT-based iodine images. Significant CAD was defined in AHA-segments by concomitant myocardial hypoperfusion identified visually or quantitatively (parameter < threshold) and coronary stenosis detected by CTA. Single-photon emission CT and invasive coronary angiography were used as reference. Perfusion-parameter cut-off values were calculated in a randomly-selected subgroup of 30 patients. Results The best-performing thresholds for TPR, MPRI and MA were 0.96, 23 and 0.5 for single-energy CT and 0.97, 47 and 0.3 for iodine imaging. For both CT-imaging modalities, TPR yielded the highest area under receiver operating characteristic curve (AUC) (0.99 and 0.97 for single-energy CT and iodine imaging, respectively, in vessel-based analysis) compared to visual analysis, MA and MPRI. Visual interpretation on iodine imaging resulted in higher AUC compared to that on single-energy CT in per-vessel (AUC: 0.93 vs 0.86, respectively) and per-patient (0.94 vs 0.93) analyses. Conclusion Transmural perfusion ratio on both CT-imaging modalities is the best-performing parameter for detecting myocardial ischaemia compared to visual method and other perfusion parameters. Visual analysis on CT-based iodine imaging outperforms that on single-energy CT.
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- 2021
44. Reinforcement machine learning-based aortic anatomical landmarks detection from phase-contrast enhanced magnetic resonance angiography
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J F Rodriguez-Palomares, Lydia Dux-Santoy, M Mejia Cordova, Guillermo Jimenez-Perez, Xabier Morales, Gisela Teixido-Tura, I Ferreira, A Ruiz-Munoz, Andrea Guala, Artur Evangelista, and Oscar Camara
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medicine.diagnostic_test ,law ,business.industry ,Phase contrast microscopy ,medicine ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,Reinforcement ,business ,Magnetic resonance angiography ,law.invention ,Biomedical engineering - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Science, Innovation and Universities; La Marató de TV3 Introduction Automatic analysis of medical imaging data may improve their clinical impact by reducing analysis time and improving reproducibility. Many medical imaging data, like 4D-flow magnetic resonance imaging (MRI), are often quantified regionally, implying the need for anatomical landmark identification to locate correspondences in the extracted data and compare among patients. Machine learning (ML) techniques hold potential for automatic analysis of medical imaging. Phase-contrast enhanced magnetic resonance angiography (PC-MRA) is a class of angiograms not requiring the administration of contrast agents. Purpose We aimed to test whether a machine learning algorithm can be trained to identify key anatomical cardiovascular landmarks on PC-MRA images and compare its performance with humans. Methods Three-hundred twenty-three aortic PC-MRA were manually annotated with the location of 4 landmarks: sinotubular junction, pulmonary artery bifurcation and first and third supra-aortic vessels (Figure 1), often used to separate the aorta in sub-regions. Patients included in the training dataset comprised healthy volunteers (40), bicuspid aortic valve patients (141), patients with degenerative aortic disease (60) and patients with genetically-triggered aortic disease (82), all without previous aortic surgery and with native aortic valve. PC-MRA images and manual annotations were used to train a DQN, a reinforcement learning algorithm that combines Q-learning with deep neural networks. The agents can navigate the images and optimally find the landmarks by following the policies learned during training. Data from thirty patients, distributed in terms of aortic condition as the training set, unseen by the algorithm in the training phase, were used to quantify intra-observer reproducibility and to assess ML algorithm performance. Distance between points was used as metric for comparisons, original human annotation was used as ground-truth and repeated-measures ANOVA was used for statistical testing. Results Human and machine learning performed similarly in the identification of the sinotubular junction (distance between points of 11.0 ± 8.1 vs. 11.1 ± 8.6 mm, respectively, p = 0.949) and first (6.6 ± 3.9 vs. 6.8 ± 5.6 mm, p = 0.886) and third (6.8 ± 4.0 vs. 8.4 ± 7.4 mm, p = 0.161) supra-aortic vessels branches but human annotation outperformed ML landmark detection in the identification of the pulmonary artery bifurcation (10.2 ± 7.0 vs. 15.2 ± 13.1 mm, p = 0.008). Computation time for landmark detection by ML was between 0.8 and 1.6 seconds on a standard computer while human annotation took approximatively two minutes. Conclusions ML-based aortic landmarks detection from phase-contrast enhanced magnetic resonance angiography is feasible and fast and performs similarly to human. Reinforced learning anatomical landmark identification unlock automatic extraction of a variety of regional aortic data, including complex 4D flow parameters. Abstract Figure
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- 2021
45. Regional curvature in thoracic aortic aneurysms of different aetiologies and its relationship with established risk factors
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Andrea Guala, Gisela Teixido-Tura, L La Mora, I Ferreira, Oliver Wieben, Lydia Dux-Santoy, A Lopez-Sainz, L Galian, Kevin M. Johnson, F Valente, L Gutierrez, Teresa González-Alujas, J F Rodriguez-Palomares, A Ruiz-Munoz, and Artur Evangelista
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medicine.medical_specialty ,business.industry ,cardiovascular system ,medicine ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Curvature - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Science, Innovation and Universities ; Instituto de Salud Carlos III Introduction The aorta is a 3D hollow, curvilinear elastic structure whose diseases have life-threatening consequences. Despite much effort has been paid to study aortic diameter, diameter is a poor predictor of events. Conversely, much less is known about aortic curvature, its distribution in the thoracic aorta and the potential impact of risk factors in aneurysms associated with different conditions. Currently, 4D flow magnetic resonance imaging (4D flow CMR) allows to obtain 3D geometry, 4D flow data and regional aortic stiffness. Purpose We aim to study regional aortic curvature in thoracic aorta aneurysms of different aetiologies and define its relationship with established risk factors. Methods One-hundred twenty patients (40 for each group, selected out of prospective cohorts of 156 bicuspid aortic valve – BAV-, 77 Marfan –MFS- and 67 patients with a degenerative aneurysm – TAVdeg-) were matched for age, sex and BSA via propensity score with 40 healthy volunteers (HV). The thoracic aorta was semi-automatically segmented from angiograms and the centreline was computed. Local curvature was assessed at 20 planes covering the thoracic aorta from the sinotubular junction to the proximal descending aorta (DAo) at the level of the pulmonary artery bifurcation. Local curvature was normalized by subject mean thoracic aorta curvature. Length was measured as centreline length. Aortic stiffness was measured in the DAo by pulse wave velocity (PWV). Aneurysm was defined by z-score ≥ 2 using diameters measured by double-oblique cine CMR. Results Matching was successful in all groups with the exception of a residual age difference between HV and TAVdeg. Curvature in HV showed a fairly smooth transition between the straighter ascending aorta (AAo) and DAo to a more curved aortic arch, with a peak in the mid aortic arch (Figure 1A). Conversely, all patients’ groups presented a peak in curvature in the proximal DAo and a decreased local curvature in the aortic arch and mid DAo close to the level of the pulmonary artery. BAV and TAVdeg patients showed also increased curvature in the mid AAo, were dilation is prevalent. Conversely, in the same area MFS showed a reduced curvature and limited prevalence of aneurysm. In the overall population, age, AAo and root diameters, mean blood pressure, DAo PWV and aortic length, all established risk factors for aortic events, were inversely related to curvature in the distal AAo and aortic arch (Figure 1B). Conclusions Aneurysms related to different aetiologies show similar abnormalities in aortic curvature, with limited curvature in the aortic arch and a peak soon after the third supra-aortic vessel. Age, aortic diameter, length, stiffness and blood pressure, all known risk factors, are all related to reduced curvature in the distal ascending aorta and aortic arch. Abstract Figure.
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- 2021
46. Domain Adaptation for Automatic Aorta Segmentation of 4D Flow Magnetic Resonance Imaging Data from Multiple Vendor Scanners
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Daniel Romero, A. Elsayed, Edward Ferdian, Lydia Dux-Santoy, Andrea Guala, Kathleen Gilbert, Aroa Ruiz-Muñoz, Gonzalo D. Maso Talou, Gisela Teixido-Tura, Alistair A. Young, Jordina Aviles, José Rodríguez-Palomares, Marcos Mejía Córdova, Oscar Camara, and Xabier Morales Ferez
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0301 basic medicine ,Scanner ,medicine.diagnostic_test ,business.industry ,Computer science ,Deep learning ,Pattern recognition ,Dice ,Magnetic resonance imaging ,Image processing ,Magnetic resonance angiography ,030218 nuclear medicine & medical imaging ,Image (mathematics) ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,medicine ,Segmentation ,Artificial intelligence ,business - Abstract
The lack of standardized pipelines for image processing has prevented the application of deep learning (DL) techniques for the segmentation of the aorta in phase-contrast enhanced magnetic resonance angiography (PC-MRA). Furthermore, large, well-curated and annotated datasets, which are needed to create DL-based models able to generalize, are rare. We present the adaptation of the popular nnU-net DL framework to automatically segment the aorta in 4D flow MRI-derived angiograms. The resulting segmentations in a large database (\(> 300\) cases) with normal cases and examples of different pathologies of the aorta provided from a single centre were excellent after post-processing (Dice score of 0.944). Subsequently, we explored the generalisation of the trained network in a small dataset of images (around 20 cases) acquired in a different hospital with another scanner. Without domain adaptation, only with a model trained with the large dataset, the obtained results were substantially worst than with adding a few cases of the small dataset (Dice scores of 0.61 vs 0.86, respectively). The obtained results created good quality segmentations of the aorta in 4D flow MRI, which can later be post-processed to assess blood flow patterns, similarly than with manual annotations. However, advanced domain adaptation schemes are very important in 4D flow MRI due to the large differences in image characteristics between different vendor scanners available in multiple centers.
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- 2021
47. Aortic root longitudinal strain by speckle-tracking echocardiography predicts progressive aortic root dilation in Marfan syndrome patients
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L Madrenas, A Lopez-Sainz, Gisela Teixido-Tura, I Ferreira, MI Pons, J F Rodriguez-Palomares, Andrea Guala, L Galian, L Gutierrez, Lydia Dux-Santoy, A Ruiz-Munoz, Teresa González-Alujas, F Valente, Augusto Sao-Aviles, and Artur Evangelista
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Marfan syndrome ,medicine.medical_specialty ,Longitudinal strain ,business.industry ,Aortic root ,Speckle tracking echocardiography ,General Medicine ,medicine.disease ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Aortic root dilation - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Science, Innovation and Universities; Instituto de Salud Carlos III Introduction In Marfan syndrome (MFS) patients reduced longitudinal strain of the ascending aorta (AAo) as measured by applying feature-tracking on cine cardiac magnetic resonance (CMR) images predicts aortic root dilation and aortic events during the follow-up. Speckle-tracking is well established for cardiac deformation assessment but proximal aorta applications are challenging due to limited wall thickness and substantial cardiac motion. Moreover, echocardiography is widely used in the clinical assessment aortic diseases. Purpose We aimed to test a speckle-tracking tool for root longitudinal strain analysis in terms of comparison with CMR-derived AAo longitudinal strain and reproducibility and as predictor of dilation in MFS patients. Methods Thirty-five MFS patients diagnosed by original GHENT criteria, with maximum aortic root diameter of 45 mm and free from previous aortic dissection or cardiac/aortic surgery and non-severe aortic regurgitation were consecutive enrolled and followed-up. CMR and echocardiography were performed less than 2 months apart. Baseline and final aortic root diameter were measured on CMR images. To quantify aortic root cyclic elongation by echocardiography, two regions of interests were manually created covering both walls in a parasternal long-axis view and tracked along the cardiac cycle (Figure 1). Longitudinal strain was computed as the average of maximum increase in relative distance of several sub-regions covering both walls. CMR-derived AAo longitudinal strain was available in 29 patients. Intra-observer reproducibility was tested in 15 patients via intraclass correlation coefficient (ICC) for single-rater absolute agreement. Results Aortic root longitudinal strain by echocardiography was mildly related to CMR-derived AAo longitudinal strain (R = 0.27) and was larger compared to CMR-derived values (16.2 ± 6.0 vs 11.3 ± 4.3). Reproducibility was high, with ICC of 0.811, R = 0.802, p Conclusions The measurement of aortic root longitudinal strain by speckle-tracking echocardiography is feasible. Aortic root longitudinal strain is an independent predictor of progressive dilation in MFS patients. This may permit the improvement of risk-stratification in aortic diseases in large scale studies. Abstract Figure 1
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- 2021
48. Semi-automatic quantification of aortic root progressive dilation by automatic co-registration of computed tomography angiograms: a preliminary comparison with manual assessment in Marfan patients
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Laura Galian, Andrea Guala, Lydia Dux-Santoy, Filipa Valente, Luis Gutiérrez, L La Mura, I Ferreira Gonzalez, Teresa González-Alujas, Augusto Sao-Aviles, Artur Evangelista, Aroa Ruiz-Muñoz, Ángela López-Sainz, J F Rodriguez-Palomares, and Gisela Teixido-Tura
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Dilation (metric space) ,medicine.diagnostic_test ,business.industry ,Aortic root ,Co registration ,Medicine ,Radiology, Nuclear Medicine and imaging ,Computed tomography ,General Medicine ,Semi automatic ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Spanish Ministry of Science, Innovation and Universities Instituto de Salud Carlos III Background. Dilation of the aortic root is a key feature of Marfan syndrome and it is related to the occurrence of aortic events and death. On top of maximum diameter, rapid annual growth rate is suggested by guidelines for indication of aortic root replacement. Current gold-standard for aortic root diameter assessment is manual quantification on multiplanar reformatted 3D computed tomography (CT) or magnetic resonance angiogram. However, inter- and intra-observer reproducibility are limited and different measurement methods, i.e. cusp-to-cusp and cusp-to-commissure, may be used in different clinical centres, leading to difficulties in the clinical assessment of progressive dilation. Purpose. We aimed to test whether aortic root growth rate during follow-up can be reliably quantified by semi-automatic co-registration of two CT angiograms. Methods. Seven Marfan syndrome patients, free from previous aortic surgery, with a total of 11 pairs of CT were identified. Manual assessment of six aortic root diameters (right-non coronary -RN- , right-left -RL- and left-non coronary -LN- cusp-to-cusp and R, L and N cusp-to-commissure) was obtained from all CTs by an experienced researcher blind to semi-automatic results. The thoracic aorta and the outflow tract were semi-automatically segmented in the baseline CT and commissure and cusps were manually located. A 10 mm-thick region of interest containing the aortic wall was automatically generated from segmentation boundary. Co-registration was obtained with three, fully-automatic steps. Firstly, baseline and follow-up CT scans were aligned by means of a rigid registration. Then, scans were co-registered with multi-resolution affine followed by b-spline non-rigid registrations based on mutual information metric. The transformation pertaining to the location of baseline commissure and cusps points was used to locate the same points in the follow-up scan (Fig. 1 top). Results. Follow-up duration was 35 ± 22 (range 12-70.3) months. Automatic quantification of diameter growth during the follow-up was obtained in 62 out of 66 (94%) diameter comparisons. High Pearson correlation coefficients (R) and ICC were found between manual and semi-automatic assessment of growth rate, both for cusp-to-cusp and cusp-to-commissure diameters: R = 0.727 and ICC = 0.678 for RN; R = 0.822 and ICC = 0.602 for RL; R = 0.648 and ICC = 0.668 for LN; R = 0.726 and ICC = 0.711 for R; R = 0.911 and ICC = 0.895 for L and R = 0.553 and ICC = 0.482 for N. Scatter and Bland-Altman plots for all growth rates (Fig. 1) confirmed very good correlation (R = 0.810) but a slight tendency (R=-0.270) for underestimation at high growth rate. No correlation was found between follow-up duration and difference between techniques (R = 0.06). Conclusions. Semi-automatic quantification of aortic root growth rate by co-registration of pairs of CT angiograms is feasible for follow-up as short as one year. Larger studies are needed to confirm these preliminary data. Abstract Figure. CT measurements. Automatic vs manual.
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- 2021
49. P.53 Ascending Aorta Diameter and Pulse Wave Velocity are Increased and Local Hemodynamic is Disrupted in Patients with Blunt Traumatic Thoracic Aortic Injury Treated by TEVAR
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Sergi Bellmunt-Montoya, Arturo Evangelista, Kevin M. Johnson, Ignacio Ferreira, Oliver Wieben, Laura Galian, Ángela López-Sainz, José Rodríguez-Palomares, Laura Gutiérrez, Lydia Dux-Santoy, Daniel Gil Sala, Aroa Ruiz-Muñoz, Gisela Teixido-Tura, Marvin García-Reyes, Andrea Guala, Filipa Valente, and Cristina Tello
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medicine.medical_specialty ,TEVAR ,business.industry ,Aortic injury ,Hemodynamics ,Specialties of internal medicine ,General Medicine ,hemodynamics ,stiffness ,Blunt ,RC581-951 ,Internal medicine ,medicine.artery ,RC666-701 ,Ascending aorta ,medicine ,Cardiology ,Diseases of the circulatory (Cardiovascular) system ,In patient ,business ,Pulse wave velocity ,MRI - Abstract
Background: Thoracic endovascular aortic repair (TEVAR) is becoming the preferred treatment option to repair the proximal descending aorta after rupture following blunt traumatic injury. However, hemodynamic and mechanic implications of this intervention are poorly understood. Exploiting the possibilities of 4D flow magnetic resonance imaging, hemodynamics, stiffness and local dilation in the ascending aorta in patients following aortic repair by TEVAR are studied. Methods: Fifteen apparently healthy individuals who underwent TEVAR implantation after traumatic descending aortic injury and 44 healthy volunteers (HV) underwent 4D flow-MRI. Ascending aorta pulse wave velocity was computed [1]. Moreover, at eight planes equally distributed in the ascending aorta systolic flow reversal ratio, i.e. relative amount of backward flow during systole, and in-plane rotational flow, measuring the strength of helical flow, were computed [2,3]. Results: TEVAR patients and HV did not differ in terms of age, sex, BSA and blood pressure (Table). However, compared to HV, TEVAR patients showed reduced in-plane rotational flow in the distal ascending aorta in patients with TEVAR and increased backward systolic flow in the whole ascending aorta (Figure). Patients with TEVAR had a stiffer ascending aorta, with pulse wave velocity higher compared control (7.8 ± 4.2 vs 5.3 ± 1.9, p = 0.004). Finally, aortic root and ascending aorta diameters were larger in TEVAR patients compared to HV (Table). Healthy volunteers TEVAR patients p N 44 15 Age [years] 40 ± 12 43 ± 10 0.392 Sex [% male] 66 80 0.075 Years from intervention [years] N/A 10.3 ± 6.4 N/A Body surface area [m2] 1.87 ± 0.15 1.96 ± 0.23 0.088 Systolic blood pressure [mmHg] 127 ± 19 131 ± 15 0.389 Diastolic blood pressure [mmHg] 70 ± 11 74 ± 9 0.198 Aortic root diameter [mm] 31 ± 4 34 ± 4 0.026 Ascending aorta diameter [mm] 28 ± 4 32 ± 3 0.003 Ascending aorta PWV [m/s] 5.3 ± 1.9 7.8 ± 4.2 0.004 FigureIn-plane rotational flow (IRF, left) and systolic flow reversal ratio (SFRR, right) in healthy volunteers (black) and TEVAR patients (yellow) in the proximal (planes 1 to 4) and distal (planes 5 to 8) ascending aorta. Stars show statistically-significant differences (p < 0.05). Conclusions: The implantation of TEVAR in apparently healthy individuals after traumatic rupture of the proximal descending aorta is associated with altered hemodynamics, higher stiffness and larger aortic diameter in the region proximal to the TEVAR.
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- 2020
50. Relationship between aortic distensibility and aortic regurgitation depending on aortic valve anatomy. A CMR study
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I Ferreira, A Lopez-Sainz, Maurizio Galderisi, Andrea Guala, Gisela Teixido-Tura, M.L Servato, N Fassano, F Valente, J F Rodriguez-Palomares, L Galian-Gay, L La Mura, Artur Evangelista, A Ruiz-Munoz, Teresa González-Alujas, and A Cinque
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Aortic valve ,Aorta ,business.industry ,Diastole ,Regurgitation (circulation) ,Anatomy ,Aortic Valve Insufficiency ,medicine.anatomical_structure ,Mitral valve ,medicine.artery ,Descending aorta ,cardiovascular system ,Medicine ,Aortic diameter ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Aortic regurgitation (AR) can be evaluated by cardiac magnetic resonance (CMR).The most commonly used method to quantify AR is direct measurement using phase contrast (PC) imaging, at the aortic root (as close as possible to the aortic valve), for the calculation of regurgitant fraction (RF). Aortic distensibility (AD) may affect aortic valve dynamics and, as a result, aortic regurgitation grade. However, the impact of aortic distensibility in this evaluation remains unknown. Purpose The aim of the study was to evaluate the relationship between AD and AR in patients with different aortic valve anatomy. Methods 213 patients with different AR severity grades and aortic valve anatomy (tricuspid (TAV) and bicuspid valve (BAV) patients) were enrolled (32.2% female, 74% BAV, 55.5±15.4 years), excluding connective tissue disease. All patients underwent a CMR study with PC sequences for the evaluation of regurgitant fraction at the aortic valve level. AR was considered as mild (30%) depending on RF value. Furthermore we used cine-sequences to estimate aortic diameters and distensibilities, using Art Fun software. Distensibility was calculated as (change in aortic area between systole and diastole/diastolic area)/brachial pulse pressure. Results 159 (73.7%) AR were mild, 30 (14.1%) moderate and 24 (11.3%) severe. RF significantly correlated with aortic root diameter (r=0.337, p Conclusions In our study, aortic regurgitation is positively related to descending aorta distensibility in BAV patients, regardless of age and aortic root diameter. Thus, AD may play a role in the evaluation of AR in case of bicuspid valves. In contrast, in TAV patients, distensibility does not seem to influence the assessment of AR severity. Descending aorta distensibility Funding Acknowledgement Type of funding source: Other. Main funding source(s): Research grant provided by the Cardiopath PhD program
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- 2020
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