Echocardiographic Evaluation of the Thoracic Aorta: Tips and Pitfalls

Upadhyaya, Krishna; Ugonabo, Ifeoma; Satam, Keyuree; Hull, Sarah C.

doi:10.1055/s-0041-1724005

Cited by 13 publications

(3 citation statements)

References 19 publications

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“…ECG-gated CTA is the most common imaging modality used for studying the AA due to superior spatial resolution. However, several authors report morphometric data using alternative imaging modalities like trans-esophageal echocardiography (TEE) and magnetic resonance (MR) (27)(28)(29). MR lacks spatial resolution but offers the advantage of decreased radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Sex-specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair

Katsarou

Mandigers

Berczeli

et al. 2023

Preprint

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Background: In many studies on aortic disease women are underrepresented. The present study aims to assess sex-specific morphometric differences and gain more insight into endovascular treatment of the AA and arch. Methods: Electrocardiogram-gated cardiac computed tomography scans of 116 patients who were evaluated for transcatheter aortic valve replacement were retrospectively reviewed. Measurements of the AA and aortic arch were made in multiplanar views, perpendicular to the semi-automatic centerline. Multiple linear regression analysis was performed to identify predictors affecting AA and aortic arch diameter in men and women. Propensity score matching was used to investigate whether sex influences aortic morphology. Results: In both sexes, body surface area (BSA) was identified as a positive predictor and diabetes as a negative predictor for aortic diameters. In men, age was identified as a positive predictor and smoking as a negative predictor for aortic diameters. Propensity score matching identified 40 pairs. Systolic and diastolic mean diameters and AA length were significantly wider in men. On average, male aortas were 7,4% wider compared to female aortas, both in systole and diastole. Conclusions: The present analysis demonstrates that, in women, increased BSA is associated with increased aortic arch diameters, while diabetes is associated to decreased AA and arch diameters. In men, increased body surface area and age are associated to increased AA and arch diameters, while smoking and diabetes are associated to decreased AA and arch diameters. Men were confirmed to have 7.4% greater AA and arch diameters than women.

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Section: Discussionmentioning

confidence: 99%

Sex-specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair

Katsarou

Mandigers

Berczeli

et al. 2023

Preprint

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“…The diameter of the ascending aorta was measured at the sinotubular junction from ventricular end diastole frames using the "leading edge to leading edge" methodology. 25 Aortic measurements were averaged over three consecutive, non-respiratory cardiac cycles.…”

Section: Echocardiographymentioning

confidence: 99%

Variants in the Kallikrein Gene Family and Hypermobile Ehlers-Danlos Syndrome

Gensemer,

Beck,

Guo

et al. 2024

Preprint

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Hypermobile Ehlers-Danlos syndrome (hEDS) is a common heritable connective tissue disorder that lacks a known genetic etiology. To identify genetic contributions to hEDS, whole exome sequencing was performed on families and a cohort of sporadic hEDS patients. A missense variant in Kallikrein-15 (KLK15 p. Gly226Asp), segregated with disease in two families and genetic burden analyses of 197 sporadic hEDS patients revealed enrichment of variants within the Kallikrein gene family. To validate pathogenicity, the variant identified in familial studies was used to generate knock-in mice. Consistent with our clinical cohort, Klk15G224D/+ mice displayed structural and functional connective tissue defects within multiple organ systems. These findings support Kallikrein gene variants in the pathogenesis of hEDS and represent an important step towards earlier diagnosis and better clinical outcomes.

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“…Anatomically, this corresponds most closely to a sinus-to-sinus image on CT or MRI. Not achieving an ECHO image with full sinuses will underestimate the true sinus-tosinus dimension [8].…”

Section: Introductionmentioning

confidence: 99%

Extended law of laplace for measurement of the cloverleaf anatomy of the aortic root

Ban

Kalogerakos²,

Khosravi

et al. 2023

Int J Cardiovasc Imaging

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The cross-sectional shape of the aortic root is cloverleaf, not circular, raising controversy regarding how best to measure its radiographic “diameter” for aortic event prediction. We mathematically extended the law of Laplace to estimate aortic wall stress within this cloverleaf region, simultaneously identifying a new metric of aortic root dimension that can be applied to clinical measurement of the aortic root and sinuses of Valsalva on clinical computerized tomographic scans. Enforcing equilibrium between blood pressure and wall stress, finite element computations were performed to evaluate the mathematical derivation. The resulting Laplace diameter was compared with existing methods of aortic root measurement across four patient groups: non-syndromic aneurysm, bicuspid aortic valve, Marfan syndrome, and non-dilated root patients (total 106 patients, 62 M, 44 F). (1) Wall stress: Mean wall stress at the depth of the sinuses followed this equation: Wall stress = BP × Circumscribing circle diameter/(2 × Aortic wall thickness). Therefore, the diameter of the circle enclosing the root cloverleaf, that is, twice the distance between the center, where the sinus-to-commissure lines coincide, and the depth of the sinuses, may replace diameter in the Laplace relation for a cloverleaf cross-section (or any shaped cross-section with two or more planes of symmetry). This mathematically derived result was verified by computational finite element analyses. (2) Diameters: CT scan measurements showed a significant difference between this new metric, the Laplace diameter, and the sinus-to-commissure, mid-sinus-to-mid-sinus, and coronal measurements in all four groups (p-value < 0.05). The average Laplace diameter measurements differed significantly from the other measurements in all patient groups. Among the various possible measurements within the aortic root, the diameter of the circumscribing circle, enclosing the cloverleaf, represents the diameter most closely related to wall stress. This diameter is larger than the other measurements, indicating an underestimation of wall stress by prior measurements, and otherwise provides an unbiased, convenient, consistent, physics-based measurement for clinical use. Graphical abstract “Diameter” applies to circles. Our mathematical derivation of an extension of the law of Laplace, from circular to cloverleaf cross-sectional geometries of the aortic root, has implications for measurement of aortic root “diameter.” The suggested method is as follows: (1) the “center” of the aortic root is identified by drawing three sinus-to-commissure lines. The intersection of these three lines identifies the “center” of the cloverleaf. (2) The largest radius from this center point to any of the sinuses is identified as the “radius” of the aortic root. (3) This radius is doubled to give the “diameter” of the aortic root. We find that this diameter best corresponds to maximal wall stress in the aortic root. Please note that this diameter defines the smallest circle that completely encloses the cloverleaf shape, touching the depths of all three sinuses.

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Echocardiographic Evaluation of the Thoracic Aorta: Tips and Pitfalls

Cited by 13 publications

References 19 publications

Sex-specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair

Sex-specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair

Variants in the Kallikrein Gene Family and Hypermobile Ehlers-Danlos Syndrome

Extended law of laplace for measurement of the cloverleaf anatomy of the aortic root

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