Aortic Stiffness, Central Blood Pressure, and Pulsatile Arterial Load Predict Future Thoracic Aortic Aneurysm Expansion

Abstract

Thoracic aortic aneurysm is a disease associated with high morbidity and mortality. Clinically useful strategies for medical management of thoracic aortic aneurysm are critically needed. To address this need, we sought to determine the role of aortic stiffness and pulsatile arterial load on future aneurysm expansion. One hundred five consecutive, unoperated subjects with thoracic aortic aneurysm were recruited and prospectively followed. By combining arterial tonometry with echocardiography, we estimated measures of aortic stiffness, central blood pressure, steady, and pulsatile arterial load at baseline. Aneurysm size was measured at baseline and follow-up with imaging; growth was calculated in mm/y. Stepwise multivariable linear regression assessed associations of arterial stiffness and load measures with aneurysm growth after adjusting for potential confounders. Mean±SD age, baseline aneurysm size, and follow-up time were 62.6±11.4 years, 46.24±3.84 mm, and 2.92±1.01 years, respectively. Aneurysm growth rate was 0.43±0.37 mm/y. After correcting for multiple comparisons, higher central systolic (β±SE: 0.026±0.009, P =0.007), and pulse pressures (β±SE: 0.032±0.009, P =0.0002), carotid-femoral pulse wave velocity (β±SE: 0.032±0.011, P =0.005), amplitudes of the forward (β±SE: 0.044±0.012, P =0.0003) and reflected (β±SE: 0.060±0.020, P =0.003) pressure waves, and lower total arterial compliance (β±SE: −0.086±0.032, P =0.009) were independently associated with future aneurysm growth. Measures of aortic stiffness and pulsatile hemodynamics are independently associated with future thoracic aortic aneurysm growth and provide novel insights into disease activity. Our findings highlight the role of central hemodynamic assessment to tailor novel risk assessment and therapeutic strategies to patients with thoracic aortic aneurysm.

Factors Associated with Mutations: Their Matching Rates to Cardiovascular and Neurological Diseases

“…The literature survey was carried out with emphasis on diseases reported to be associated with vascular stiffening: congenital heart disease (CHD) [ 19 ], thoracic aortic aneurysm (TAA) [ 20 , 21 ], and hypertension [ 17 , 18 ]. We utilized the PubMed database, as well as Google Scholar, in order to select the source literature containing candidate genes or loci with mutations to be analyzed regarding each disease.…”

“…Arterial stiffening, an independent predictor of cardiovascular morbidity and mortality, plays an important role in cardiovascular diseases (CVDs) [ 15 , 16 ], including hypertension [ 17 , 18 ], congenital heart disease (CHD) [ 19 ], and thoracic aortic aneurysms (TAA) [ 20 , 21 ]. Given the multigenic causes of these conditions, elucidation of the genetic characteristics or factors impacting high mutation rates might reduce the burden of high mortalities [ 22 ] in these CVDs.…”

Elastin integrity in bicuspid valve-associated aortopathy is associated with altered biomechanical properties and influenced by age

“…Given the natural history of arterial aging, elastin gradually breaks down without compensatory replacement, and collagen fibers become the predominant mechanical bearing unit of the aortic wall (23,25). The result is an overall stiffening of arteries that is itself an independent predictor of aortic dilatation and the need for aortic surgery (26)(27)(28), as well as a key driver of aortopathy pathogenesis (29)(30)(31)(32). Our data suggest that the mechanical properties of the older patients follow this aging effect with a stiffening associated with elastin breakdown occurring in both the low-strain (LTM) and high-strain regions (HTM).…”

Atrial Fibrillation and Aortic Ectasia as Complications of Primary Aldosteronism: Focus on Pathophysiological Aspects

“…Measures of aortic stiffness, such as pulse wave velocity (PWV), have been shown to be independently associated with future thoracic aortic aneurysm expansion [73]. Several studies have reported that patients with PA have increased arterial stiffness, as indicated by higher values of PWV and augmentation index (AIx) as compared with patients with EH with comparable blood pressure levels [74,75].…”