Assessment of Aortic Stiffness by Transesophageal Echocardiography

Go, Orson; Safar, Michel E.; Smulyan, Harold

doi:10.1111/echo.12528

Cited by 10 publications

(7 citation statements)

References 32 publications

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“…The luminal diameter of the proximal aorta is assessed easily in transthoracic or transesophageal M-Mode ultrasound [ 14 ], although associated calculations of distensibility can be compromised by using brachial, not central, pulse pressure. Despite this limitation, local assessment of thoracic aortic distensibility via ultrasound is thought to be comparable to PWV in terms of predictive ability [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Combining in vivo and in vitro biomechanical data reveals key roles of perivascular tethering in central artery function

et al. 2018

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Considerable insight into effectors of cardiovascular function can be gleaned from controlled studies on mice, especially given the diverse models that are available. Toward this end, however, there is a need for consistent and complementary methods of in vivo and in vitro data analysis, synthesis, and interpretation. The overall objective of this study is twofold. First, we present new semi-automated methods to quantify in vivo measurements of vascular function in anesthetized mice as well as new approaches to synthesize these data with those from in vitro biaxial mechanical characterizations. Second, we contrast regional differences in biomechanical behaviors along the central vasculature by combining biaxial strains measured in vivo with data on the unloaded geometry and biaxial material properties measured in vitro. Results support the hypothesis that the healthy ascending aorta stores significant elastic energy during systole, which is available to work on the heart and blood during diastole, particularly during periods of physical exertion, and further suggest that perivascular tethering allows arteries to work at lower values of wall stress and material stiffness than often assumed. The numerous measurements of vascular function and properties provided herein can also serve as reference values for normal wild-type male and female mice, to which values for myriad genetic, surgical, and pharmacological models can be compared in future studies.

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Section: Introductionmentioning

confidence: 99%

Combining in vivo and in vitro biomechanical data reveals key roles of perivascular tethering in central artery function

et al. 2018

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“…However, little is known of the prognostic value of altered proximal aortic function, which is responsible for most of the mechanical buffering and cushioning in the circulatory system, thus influencing ventricular-vascular coupling (10). Recently, Maroules et al reported modest associations of aortic distensibility with a composite of soft and hard cardiovascular endpoints in the Dallas Heart Study (11), while thoracic aorta compliance, measured by transesophageal echocardiography, may be comparable to carotid-femoral PWV for predicting mortality (12). …”

Section: Introductionmentioning

confidence: 99%

Proximal Aortic Distensibility Is an Independent Predictor of All-Cause Mortality and Incident CV Events

Redheuil

Kachenoura

et al. 2014

Journal of the American College of Cardiology

174

134

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BACKGROUND The predictive value of ascending aortic distensibility (AAD) for mortality and hard cardiovascular disease (CVD) events is not fully established. OBJECTIVES We sought to assess the utility of AAD to predict mortality and incident CVD events beyond conventional risk factors in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS AAD was measured with magnetic resonance imaging at baseline in 3,675 MESA participants free of overt CVD. Cox proportional-hazards regression was used to evaluate risk of death, heart failure (HF), and incident CVD in relation to AAD, CVD risk factors, indices of subclinical atherosclerosis, and Framingham risk score. RESULTS There were 246 deaths and 171 hard CVD (myocardial infarction, resuscitated cardiac arrest, stroke and cardiovascular [CV] death) and 88 HF events over a median 8.5-year follow-up. Decreased AAD was associated with increased all-cause mortality with a hazard ratio (HR) for the first verus fifth quintile of AAD of 2.7 (p = 0.008) independent of age, sex, ethnicity, other CVD risk factors, and indices of subclinical atherosclerosis. Overall, subjects with lowest AAD had an independent 2-fold risk of hard CVD events. Decreased AAD was associated with CV events in low-to-intermediate CVD risk individuals with an HR for the first quintile of AAD of 5.3 (p = 0.03) as well as with incident HF but not after full adjustment. CONCLUSIONS Decreased proximal aorta distensibility significantly predicts all-cause mortality and hard CV events among individuals without overt CVD. AAD may help refine risk stratification, especially among asymptomatic, low-to-intermediate risk individuals.

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“…Our results indicate that pathological changes in biaxial valve tissue stiffness can potentially be observed and quantitatively measured on the order of days rather than months. Future studies may determine whether early onset stiffness changes can be observed clinically using high resolution echocardiography [58] or MRI-based [59] non-invasive imaging techniques.…”

Section: Discussionmentioning

confidence: 99%

Acute pergolide exposure stiffens engineered valve interstitial cell tissues and reduces contractility in vitro

Capulli

MacQueen

O’Connor

et al. 2016

Cardiovascular Pathology

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Medications based on ergoline-derived dopamine and serotonin agonists are associated with off-target toxicities that include valvular heart disease (VHD). Reports of drug-induced VHD resulted in the withdrawal of appetite suppressants containing fenfluramine and phentermine from the U.S. market in 1997 and pergolide, a Parkinson’s disease medication, in 2007. Recent evidence suggests that serotonin receptor activity affected by these medications modulates cardiac valve interstitial cell activation and subsequent valvular remodeling, which can lead to cardiac valve fibrosis and dysfunction similar to that seen in carcinoid heart disease. Failure to identify these risks prior to market, and continued use of similar drugs, reaffirms the need to improve preclinical evaluation of drug-induced VHD. Here, we present two complimentary assays to measure stiffness and contractile stresses generated by engineered valvular tissues in vitro. As a case study, we measured the effects of acute (24 hr) pergolide exposure to engineered porcine aortic valve interstitial cell (AVIC) tissues. Pergolide exposure led to increased tissue stiffness but it decreased both basal and active contractile tone stresses generated by AVIC tissues. Pergolide exposure also disrupted AVIC tissue organization (i.e., tissue anisotropy), suggesting that the mechanical properties and contractile functionality of these tissues are governed by their ability to maintain their structure. We expect further use of these assays to identify off-target drug effects that alter the phenotypic balance of AVICs, disrupt their ability to maintain mechanical homeostasis, and lead to VHD.

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Assessment of Aortic Stiffness by Transesophageal Echocardiography

Cited by 10 publications

References 32 publications

Combining in vivo and in vitro biomechanical data reveals key roles of perivascular tethering in central artery function

Combining in vivo and in vitro biomechanical data reveals key roles of perivascular tethering in central artery function

Proximal Aortic Distensibility Is an Independent Predictor of All-Cause Mortality and Incident CV Events

Acute pergolide exposure stiffens engineered valve interstitial cell tissues and reduces contractility in vitro

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