Central pulse pressure is inversely associated with proximal aortic remodelling

Tosello, F.; Guala, Andrea; D’Ascenzo, Fabrizio; Bollati, Martina; Leone, Dario; Sabia, Luca; Bruno, Giulia; Mingrone, Giulia; Astarita, Anna; Vallelonga, Fabrizio; Avenatti, Eleonora; Moretti, Claudio; Veglio, Franco; Ridolfi, Luca; Milan, Alberto

doi:10.1097/hjh.0000000000002730

Cited by 12 publications

(12 citation statements)

References 33 publications

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“…[19] A 20-year follow-up study discovered that aortic diameter was positively associated with LV mass. [8] Our study also demonstrated a strong and stable positive association between AoR and LVMI. Yet, it seems contradictory that aortic dilatation can reduce arterial load, which is positively correlated with LVH.…”

Section: Discussionsupporting

confidence: 71%

“…A study demonstrated that the group with the normal aorta and higher PWV had the highest risk of cardiovascular disease in the community population, especially males. [10] Aortic dilatation is related to LV remodeling, impaired diastolic function, and cardiovascular events; [8,18] however, the exact role ascending aortic dilatation has in regulating LV afterload remains debatable. PP is used clinically as the surrogate of arterial pulsatile pressure load.…”

Section: Discussionmentioning

confidence: 99%

“…Both aortic diameter and PP were reported to be positively correlated with the left ventricular mass index (LVMI). [7,8] Interestingly, the aortic diameter was found to be inversely associated with PP. [7,9] The above findings seem to be contradictory.…”

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confidence: 98%

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Ascending aorta dilatation reduces the influence of elevated pulse pressure on left ventricular hypertrophy: findings from a Chinese elderly hypertensive population

Jiang

Zhang

Liu

et al. 2023

Journal of Geriatric Cardiology

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OBJECTIVETo determine the role of ascending aorta dilatation in the relationship between pulse pressure (PP) and left ventricular (LV) hypertrophy.METHODS A total of 1556 Chinese elderly hypertensive patients were retrospectively studied. Transthoracic echocardiography was used to obtain the aortic and cardiac structure measurements. In addition, brachial blood pressure was measured, and total arterial compliance, systemic vascular resistance, arterial elastance, and end-systolic LV elastance were calculated. The participants were divided into four groups according to the status of ascending aortic diameter and PP. RESULTSLV mass index increased in succession in the four groups, i.e., the group with the normal aorta and lower PP, with the normal aorta and higher PP, with aortic dilatation and lower PP, and with aortic dilatation and higher PP (P trend < 0.001). Total arterial compliance −1 , arterial elastance, and end-systolic LV elastance were slightly higher in the individuals with normal aorta compared to those with aortic dilatation, regardless of PP being lower or higher (P < 0.01). Compared to the group with the normal aorta and lower PP, individuals with aortic dilatation had a significantly increased multivariable adjusted risk of LV hypertrophy, and higher PP further exacerbated this risk [aortic dilatation with lower PP (OR = 1.75, 95% CI: 1.01-3.04) and aortic dilatation with higher PP (OR = 3.42, 95% CI: 2.03-5.77)]. In the relation between PP and LV mass index (β = 0.095, P < 0.001), -41.3% of the total effect was attributable to mediation by ascending aortic diameter (P < 0.0001). CONCLUSIONSIn Chinese elderly patients with hypertension, ascending aorta dilatation could reduce the influence of elevated PP on LV hypertrophy.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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Ascending aorta dilatation reduces the influence of elevated pulse pressure on left ventricular hypertrophy: findings from a Chinese elderly hypertensive population

Jiang

Zhang

Liu

et al. 2023

Journal of Geriatric Cardiology

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“…We based on the hypothesis that the descending aorta does not appear to have an acute dilatation before aortic dissection, but as a matter of fact, it is difficult to validate the hypothesis as we can barely obtain the data just before aortic dissection happens. In terms of research design, the sample size is still not enough, and the features we take into account are not comprehensive, such as NT-ProBNP, C-reaction protein, hereditary background, central pulse pressure ( 22 , 27 – 29 ), etc. In addition, the model we established requires too many parameters to be used conveniently in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

A machine learning approach for predicting descending thoracic aortic diameter

Jin

Wang

et al. 2023

Front. Cardiovasc. Med.

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BackgroundTo establish models for predicting descending thoracic aortic diameters and provide evidence for selecting the size of the stent graft for TBAD patients.MethodsA total of 200 candidates without severe deformation of aorta were included. CTA information was collected and 3D reconstructed. In the reconstructed CTA, a total of 12 cross-sections of peripheral vessels were made perpendicular to the axis of flow of the aorta. Parameters of the cross sections and basic clinical characteristics were used for prediction. The data was randomly split into the training set and the test set in an 8:2 ratio. To fully describe diameters of descending thoracic aorta, three predicted points were set based quadrisection, and a total of 12 models at three predicted points were established using four algorithms included linear regression (LR), support vector machine (SVM), Extra-Tree regression (ETR) and random forest regression (RFR). The performance of models was evaluated by mean square error (MSE) of the prediction value, and the ranking of feature importance was given by Shapley value. After modeling, prognosis of five TEVAR cases and stent oversizing were compared.ResultsWe identified a series of parameters which affect the diameter of descending thoracic aorta, including age, hypertension, the area of proximal edge of superior mesenteric artery, etc. Among four predictive models, all the MSEs of SVM models at three different predicted position were less than 2 mm2, with approximately 90% predicted diameters error less than 2 mm in the test sets. In patients with dSINE, stent oversizing was about 3 mm, while only 1 mm in patients without complications.ConclusionThe predictive models established by machine learning revealed the relationship between basic characteristics and diameters of different segment of descending aorta, which help to provide evidence for selecting the matching distal size of the stent for TBAD patients, thereby reducing the incidence of TEVAR complications.

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“…In a previous study, we presented a numerical investigation of the effects of the computational model’s inlet and outlet boundary conditions on computed CT-FFR. The mean pressure calculated by the “physiological formula” differed from the real aortic pressure wave ( Tosello et al, 2021 ). However, the calculation model was not sensitive to the boundary conditions of the inlet pressure, i.e., the true aortic pressure could be replaced by the mean pressure calculated by the “physiological formula.” The findings revealed that distal boundary conditions (hyperemic vasodilation response of coronary micro-vessels) have a significant impact on FFR.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Quantification of Fraction Flow Reserve Based on Steady-State Geometric Multiscale Models

Liu

Wang

et al. 2022

Front. Physiol.

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Background: The underuse of invasive fraction flow reserve (FFR) in clinical practice has motivated research towards its non-invasive prediction. The early attempts relied on solving the incompressible three-dimensional Navier–Stokes equations in segmented coronary arteries. However, transient boundary condition has a high resource intensity in terms of computational time. Herein, a method for calculating FFR based on steady-state geometric multiscale (FFRSS) is proposed.Methods: A total of 154 moderately stenotic vessels (40–80% diameter stenosis) from 136 patients with stable angina were included in this study to validate the clinical diagnostic performance of FFRSS. The method was based on the coronary artery model segmented from the patient’s coronary CTA image. The average pressure was used as the boundary condition for the inlet, and the microcirculation resistance calculated by the coronary flow was used as the boundary condition for the outlet to calculate the patient-specific coronary hyperemia. Then, the flow velocity and pressure distribution and the FFRss of each coronary artery branch were calculated to evaluate the degree of myocardial ischemia caused by coronary stenosis. Also, the FFRSS and FFRCT of all patients were calculated, and the clinically measured FFR was used as the “gold standard” to verify the diagnostic performance of FFRSS and to compare the correlation between FFRSS and FFRCT.Results: According to the FFRSS calculation results of all patients, FFRSS and FFR have a good correlation (r = 0.68, p < 0.001). Similarly, the correlation of FFRSS and FFRCT demonstrated an r of 0.75 (95%CI: 0.67–0.72) (p < 0.001). On receiver-operating characteristic analysis, the optimal FFRSS cut point for FFR≤0.80 was 0.80 (AUC:0.85 [95% confidence interval: 0.79 to 0.90]; overall accuracy:88.3%). The overall sensitivity, specificity, PPV, and NPV for FFRSS ≤0.80 versus FFR ≤0.80 was 68.18% (95% CI: 52.4–81.4), 93.64% (95% CI: 87.3–97.4), 82.9%, and 91.1%, respectively.Conclusion: FFRSS is a reliable diagnostic index for myocardial ischemia. This method was similar to the closed-loop geometric multiscale calculation of FFR accuracy but improved the calculation efficiency. It also improved the clinical applicability of the non-invasive computational FFR model, helped the clinicians diagnose myocardial ischemia, and guided percutaneous coronary intervention.

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Central pulse pressure is inversely associated with proximal aortic remodelling

Abstract: Supplemental Digital Content is available in the text

Cited by 12 publications

References 33 publications

Ascending aorta dilatation reduces the influence of elevated pulse pressure on left ventricular hypertrophy: findings from a Chinese elderly hypertensive population

Ascending aorta dilatation reduces the influence of elevated pulse pressure on left ventricular hypertrophy: findings from a Chinese elderly hypertensive population

A machine learning approach for predicting descending thoracic aortic diameter

Non-Invasive Quantification of Fraction Flow Reserve Based on Steady-State Geometric Multiscale Models

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