Aortic diameter is a poor predictor of aortic tissue failure metrics in patients with ascending aneurysms

Vianna, Emily; Kramer, Benjamin; Tarraf, Samar; Gillespie, Callan; Colbrunn, Robb; Bellini, Chiara; Roselli, Eric E.; Cikach, Frank; Germano, Emídio; Emerton, Kelly; Hargrave, Jennifer; Richardson, Ria A.

doi:10.1016/j.jtcvs.2022.10.021

Cited by 10 publications

(7 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Correlation with aortic diameter : Aortic diameter has been widely used as a clinical metric to assess aortic disease severity and progression [ 25 , 37 , 38 ]. However, numerous studies have demonstrated its poor predictive value [ 39 , 40 , 41 ]. Our results agree with such studies as we have observed no significant correlation between sinus diameter, distensibility, and aortic displacement (see Appendix A , Figure A2 ).…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping

Kim

Tjahjadi

et al. 2023

JCM

View full text Add to dashboard Cite

The aorta is in constant motion due to the combination of cyclic loading and unloading with its mechanical coupling to the contractile left ventricle (LV) myocardium. This aortic root motion has been proposed as a marker for aortic disease progression. Aortic root motion extraction techniques have been mostly based on 2D image analysis and have thus lacked a rigorous description of the different components of aortic root motion (e.g., axial versus in-plane). In this study, we utilized a novel technique termed vascular deformation mapping (VDM(D)) to extract 3D aortic root motion from dynamic computed tomography angiography images. Aortic root displacement (axial and in-plane), area ratio and distensibility, axial tilt, aortic rotation, and LV/Ao angles were extracted and compared for four different subject groups: non-aneurysmal, TAA, Marfan, and repair. The repair group showed smaller aortic root displacement, aortic rotation, and distensibility than the other groups. The repair group was also the only group that showed a larger relative in-plane displacement than relative axial displacement. The Marfan group showed the largest heterogeneity in aortic root displacement, distensibility, and age. The non-aneurysmal group showed a negative correlation between age and distensibility, consistent with previous studies. Our results revealed a strong positive correlation between LV/Ao angle and relative axial displacement and a strong negative correlation between LV/Ao angle and relative in-plane displacement. VDM(D)-derived 3D aortic root motion can be used in future studies to define improved boundary conditions for aortic wall stress analysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping

Kim

Tjahjadi

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…The current clinical guideline for informing surgical intervention is an aortic diameter exceeding 5cm. However, it has long been observed that diameter is a poor predictor of aortic failure in aneurysmal disease ( 10 , 11 ). For suitable alternative guidelines to be proposed, a better understanding of disease progression as a function of the genetic underpinnings of ATAAs is necessary.…”

Section: Introductionmentioning

confidence: 99%

The Fbn1 gene variant governs passive ascending aortic mechanics in the mgΔlpn mouse model of Marfan syndrome when superimposed to perlecan haploinsufficiency

Tarraf,

de Souza,

Herrick

et al. 2024

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

IntroductionAscending thoracic aortic aneurysms arise from pathological tissue remodeling that leads to abnormal wall dilation and increases the risk of fatal dissection/rupture. Large variability in disease manifestations across family members who carry a causative genetic variant for thoracic aortic aneurysms suggests that genetic modifiers may exacerbate clinical outcomes. Decreased perlecan expression in the aorta of mgΔlpn mice with severe Marfan syndrome phenotype advocates for exploring perlecan-encoding Hspg2 as a candidate modifier gene.MethodsTo determine the effect of concurrent Hspg2 and Fbn1 mutations on the progression of thoracic aortopathy, we characterized the microstructure and passive mechanical response of the ascending thoracic aorta in female mice of four genetic backgrounds: wild-type, heterozygous with a mutation in the Fbn1 gene (mgΔlpn), heterozygous with a mutation in the Hspg2 gene (Hspg2+/−), and double mutants carrying both the Fbn1 and Hspg2 variants (dMut).ResultsElastic fiber fragmentation and medial disarray progress from the internal elastic lamina outward as the ascending thoracic aorta dilates in mgΔlpn and dMut mice. Concurrent increase in total collagen content relative to elastin reduces energy storage capacity and cyclic distensibility of aortic tissues from mice that carry the Fbn1 variant. Inherent circumferential tissue stiffening strongly correlates with the severity of aortic dilatation in mgΔlpn and dMut mice. Perlecan haploinsufficiency superimposed to the mgΔlpn mutation curbs the viability of dMut mice, increases the occurrence of aortic enlargement, and reduces the axial stretch in aortic tissues.DiscussionOverall, our findings show that dMut mice are more vulnerable than mgΔlpn mice without an Hspg2 mutation, yet later endpoints and additional structural and functional readouts are needed to identify causative mechanisms.

show abstract

“…To ensure failure in the tissue center and not at the grips, samples are often cut into a dog-bone shape. Though not an accurate reflection of multi-axial in-vivo loading conditions, uniaxial testing offers a crude assessment of tissue rupture conditions [141,142,143], as well as 2.5. Aortic Biomechanics some insight into directional (intra-patient) and etiological differences across patient groups (inter-patient) [144,145,146].…”

Section: In-vitro Experimentsmentioning

confidence: 99%

“…As discussed in Chapter 3, despite knowing that hypertension is a risk factor for aneurysm, and the prevalence of hypertension in our patient cohort (≈50%), we could not ascertain the independent effects of elevated blood pressure on Ascending Thoracic Aortic Aneurysm (ATAA) mechanics. Alternative approaches to assessing statistical significance in studies of human aneurysmal mechanics have been to utilize linear mixed effect [159] or random forest regression models [183,143], though such approaches are not without their pitfalls [270]. We urge that in future extensions of the work of this dissertation, investigators employ more powerful and complex statistical tools, as well as draw from an even larger patient cohort, to reliably appreciate the individual contributions of specimen location, aortic geometry, and patient medical history on mechanics.…”

Section: Summary Of Main Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Development of a methodological framework to probe regional mechanics of the aneurysmal ascending thoracic aorta

Tarraf

View full text Add to dashboard Cite

Aortic diameter is a poor predictor of aortic tissue failure metrics in patients with ascending aneurysms

Cited by 10 publications

References 35 publications

Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping

Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping

The Fbn1 gene variant governs passive ascending aortic mechanics in the mgΔlpn mouse model of Marfan syndrome when superimposed to perlecan haploinsufficiency

Development of a methodological framework to probe regional mechanics of the aneurysmal ascending thoracic aorta

Contact Info

Product

Resources

About