Circumferential ascending aortic strain and aortic stenosis

Teixeira, Rogério; Moreira, Nádia; Baptista, Rui; Barbosa, António; Martins, Rui; Castro, Graça; Providência, Luí­s A.

doi:10.1093/ehjci/jes221

Cited by 37 publications

(33 citation statements)

References 30 publications

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“…In agreement with previous studies,15, 16 CAAS measurement using 2D‐ST echocardiography in the present study demonstrated the heterogeneous motion pattern and local variations in compliance of different segments of the ascending aortic wall (Figure 1B and 1C). According to previous investigators,14, 15 we divided the ascending aortic wall into 6 equally sized segments. A global CAAS was calculated as the mean value of peak CAAS of the 6 segments.…”

Section: Discussionsupporting

confidence: 93%

“…Bjällmark et al reported that the possible heterogeneity of the deformation pattern may be further accentuated by atherosclerotic plaque and plaque calcification 16. In agreement with previous studies,15, 16 CAAS measurement using 2D‐ST echocardiography in the present study demonstrated the heterogeneous motion pattern and local variations in compliance of different segments of the ascending aortic wall (Figure 1B and 1C). According to previous investigators,14, 15 we divided the ascending aortic wall into 6 equally sized segments.…”

Section: Discussionsupporting

confidence: 91%

“…Güngör et al demonstrated that the early diastolic velocity of the anterior wall of the ascending aorta measured with pulse‐wave tissue Doppler imaging echocardiography correlates with arterial stiffening and is decreased in patients with premature CAD 36. However, the tissue Doppler imaging technique is angle dependent and is influenced by tethering or translational motion 15. The 2D‐ST technique not only avoids the limitations mentioned above, but also allows the measurement of deformation in all segments of the vessel.…”

Section: Discussionmentioning

confidence: 99%

“…Circumferential deformation of the descending thoracic aorta,11 abdominal aorta,12, 13 or carotid arteries14 can be measured using 2D speckle tracking (2D‐ST), allowing a simple and accurate determination of aortic stiffness 15. An association between circumferential strain and the progression of vascular stiffness with age has been reported by Bjällmark et al 16.…”

Section: Introductionmentioning

confidence: 99%

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Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

Fan

et al. 2018

JAHA

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BackgroundArterial stiffening and atherosclerosis tend to coexist. Strain imaging, using a 2‐dimensional speckle tracking (2D‐ST) method, has been used for arterial stiffness assessment and early identification of atherosclerosis. We investigated whether the ascending aortic strain assessed by 2D‐ST echocardiography at rest can predict the presence of coronary artery disease (CAD).Methods and ResultsTwo hundred seventy‐one consecutive patients with suspected stable angina pectoris sequentially underwent exercise treadmill testing, 2‐dimensional echocardiography, M‐mode echocardiography, 2D‐ST echocardiography, and coronary angiography. Circumferential ascending aortic strain (CAAS) and radial ascending aortic strain were assessed by 2D‐ST echocardiography. Ninety‐two patients with coronary lumen area stenosis ≥70% were categorized as having significant CAD. Global CAAS was significantly lower in patients with significant CAD (7.41±2.30% versus 11.54±4.03%; P<0.001) and remained an independent predictor of significant CAD (odds ratio, 0.64 [0.54–0.75]; P<0.001) after multivariate regression. Based on the receiver operating characteristic curve for diagnosing significant CAD, the optimal cut‐off value of global CAAS was ≤9.22% (sensitivity, 86%; specificity, 70%; area under curve=0.82; P<0.001). Global CAAS decreased with increasing severity of CAD and was significantly associated with 3‐vessel disease (odds ratio, 0.58 [0.42–0.79]; P<0.001). Diagnostics for significant CAD were remarkably better for global CAAS combined with exercise treadmill testing than for exercise treadmill testing alone (area under curve=0.88 versus 0.78; P<0.001).ConclusionsGlobal CAAS assessed by 2D‐ST echocardiography at rest was able to predict the presence of significant CAD and identify multivessel disease. In addition, global CAAS combined with exercise treadmill testing remarkably improved the diagnostics for significant CAD.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

Fan

et al. 2018

JAHA

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“…Over time, the effect of the baroreflex dissipates as mean pressure becomes primarily regulated by renal control of blood volume. Yet the initial changes in pulse pressure due to sustained changes in peripheral resistance (25,76), cardiac output (21,26,32,44,72,81), or aortic stenosis (2,8,15,27,70,71,74) tend to ameliorate with time. In each case, pulse pressure appears to be chronically regulated independently of mean pressure by modulation of a key mechanical property: arterial compliance.…”

mentioning

confidence: 99%

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

Nguyen

Tüzün²,

Quick

2016

American Journal of Physiology-Regulatory, Integrative and Comp

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Nguyen PH, Tuzun E, Quick CM. Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses. Am J Physiol Regul Integr Comp Physiol 311: R522-R531, 2016. First published June 15, 2016 doi:10.1152/ajpregu.00402.2015.-Aortic pulse pressure arises from the interaction of the heart, the systemic arterial system, and peripheral microcirculations. The complex interaction between hemodynamics and arterial remodeling precludes the ability to experimentally ascribe changes in aortic pulse pressure to particular adaptive responses. Therefore, the purpose of the present work was to use a human systemic arterial system model to test the hypothesis that pulse pressure homeostasis can emerge from physiological adaptation of systemic arteries to local mechanical stresses. First, we assumed a systemic arterial system that had a realistic topology consisting of 121 arterial segments. Then the relationships of pulsatile blood pressures and flows in arterial segments were characterized by standard pulse transmission equations. Finally, each arterial segment was assumed to remodel to local stresses following three simple rules: 1) increases in endothelial shear stress increases radius, 2) increases in wall circumferential stress increases wall thickness, and 3) increases in wall circumferential stress decreases wall stiffness. Simulation of adaptation by iteratively calculating pulsatile hemodynamics, mechanical stresses, and vascular remodeling led to a general behavior in response to mechanical perturbations: initial increases in pulse pressure led to increased arterial compliances, and decreases in pulse pressure led to decreased compliances. Consequently, vascular adaptation returned pulse pressures back toward baseline conditions. This behavior manifested when modeling physiological adaptive responses to changes in cardiac output, changes in peripheral resistances, and changes in local arterial radii. The present work, thus, revealed that pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses. vascular adaptation; compliance resetting; pulsatile hemodynamics; multiscale modeling AORTIC PULSE PRESSURE APPEARS to be homeostatic despite the lack of global regulatory mechanisms affecting elastic arteries. Cardiac output, peripheral resistances, and arterial compliances are the primary mechanical determinants of aortic pressures (40,47). Whereas mean pressure is predominantly determined by cardiac output and peripheral resistance, pulse pressure (systolic-diastolic) is also affected by compliance (the change in volume per change in transmural pressure) of the large elastic arteries (69). As arterial compliances decrease, pulse pressures tend to increase (40,41,47,48). Acutely, mean pressure and pulse pressure are physiologically coupled by feedback mechanisms: when pulse pressure rises, stretch-sensitive baroreceptors lower peripheral resistance, i.e., the baroreflex, which, in turn, lowers mean pressure. Furthe...

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In Vivo Strain Analysis of Dilated Ascending Thoracic Aorta by ECG-Gated CT Angiographic Imaging

et al. 2017

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Accurate assessment of aortic extensibility is a requisite first step for elucidating the pathophysiology of an ascending thoracic aortic aneurysm (ATAA). This study aimed to develop a framework for the in vivo evaluation of the full-field distribution of the aortic wall strain by imaging analysis of electrocardiographic- (ECG) gated thoracic data of 34 patients with ATAA. Seven healthy controls (i.e., non-aneurysmal aorta) from patients who underwent ECG-gated CT angiography for coronary artery diseases were included for comparison. To evaluate the systolic function, ECG-gated computed tomography (CT) angiography was used to generate patient-specific geometric meshes of the ascending aorta, and then to estimate both the displacement and strain fields using a mathematical algorithm. Results evidenced stiff behavior for the aneurysmal aorta compared with that of the healthy ascending aorta of the controls, with patients over 55 years of age displaying significantly lower extensibility. Moreover, the patient risk as quantified by the ratio of in vivo strain to the ruptured one increased significantly with increased systolic blood pressure, older age, and higher pressure-strain modulus. Statistical analysis also indicated that an increased pressure-strain modulus is a risk factor for ATAAs with bicuspid aortic valve, suggesting a different mechanism of failure in these patients. The approach here proposed for the in vivo evaluation of the aortic wall strain is simple and fast, with promising applicability in routine clinical imaging, and could be used to develop a rupture potential criterion on the basis of the aortic aneurysm extensibility.

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Circumferential ascending aortic strain and aortic stenosis

Abstract: In patients with moderate-to-severe aortic stenosis, SVI and LV afterload-related variables were the most important determinants of 2S-ST global CAAS.

Cited by 37 publications

References 30 publications

Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

Aortic pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses

In Vivo Strain Analysis of Dilated Ascending Thoracic Aorta by ECG-Gated CT Angiographic Imaging

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