Evaluation of the Aortic Root by MRI

Summers, Ronald M.; Andrasko-Bourgeois, Jonathan; Feuerstein, Irwin M.; Hill, Suvimol; Jones, Elizabeth; Busse, Mary K.; Wise, Betty; Bove, Karen E.; Rishforth, Beth A.; Tucker, Eben; Spray, Thomas L.; Hoeg, Jeffrey M.

doi:10.1161/01.cir.98.6.509

Cited by 81 publications

(6 citation statements)

References 30 publications

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“…For example, average end diastole CSA at the sinuses of Valsalva (534 ± 113 mm 2 ) agreed with manually measured values published by Summers et al (571 ± 141 mm 2 ) [8]. CSA in the distal aorta also compared well with published data from Mohiaddin et al with average CSA of 138 ± 23 mm 2 /m 2 compared to 140 ± 20 mm 2 /m 2 for patients ages 2(}-39 years [9].…”

Section: Discussionsupporting

confidence: 87%

Automated analysis of four-dimensional magnetic resonance images of the human aorta

Johnson

Premraj

Patel

et al. 2010

Int J Cardiovasc Imaging

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The purpose of the study was to demonstrate the accuracy and clinical utility of an automated method of image analysis of 4D (3D + time) magnetic resonance (MR) imaging of the human aorta. Serial MR images of the entire thoracic aorta were acquired on 32 healthy individuals. Graph theory based segmentation was applied to the images and cross sectional area (CSA) was determined for the entire length of thoracic aorta. Mean CSA was compared between the 3 years. CSA values at the level of sinuses of Valsalva and sino-lubular junction were used to calculate average diameters for comparison to Roman-Devereux norms. A robust automated segmentation method was developed that accurately reproduced CSA measurements for the entire length of thoracic aorta in serially acquired scans with a 1% error compared to expert tracing. Calculated aortic root diameters based on CSA correlated with Roman-Devereux norms. Mean CSA for the aortic root agreed well with previously published manually derived values. Automated analysis of 4D MR images of the thoracic aorta provides accurate and reproducible results for CSA in healthy human subjects. The ability to simultaneously analyze the entire length of thoracic aorta throughout the cardiac cycle opens the door to the calculation of novel indices of aortic biophysical properties. These novel indices may lead to earlier detection of patients at risk for adverse events.

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Section: Discussionsupporting

confidence: 87%

Automated analysis of four-dimensional magnetic resonance images of the human aorta

Johnson

Premraj

Patel

et al. 2010

Int J Cardiovasc Imaging

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“…Owing to concerns about the exposure of young individuals to radiation, CTCA must be performed in CT scanners with at least 64 and preferably 320 detectors or dual source scanners, with radiation exposure adapted for body weight. 28 The atherosclerotic burden of the aorta can be also evaluated by MRI 29 or trans-oesophageal echocardiography. 30 …”

Section: Cardiovascular Complications and Natural Historymentioning

confidence: 99%

Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society

Cuchel¹,

Bruckert²,

Descamps³

et al. 2014

European Heart Journal

918

1,021

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AimsHomozygous familial hypercholesterolaemia (HoFH) is a rare life-threatening condition characterized by markedly elevated circulating levels of low-density lipoprotein cholesterol (LDL-C) and accelerated, premature atherosclerotic cardiovascular disease (ACVD). Given recent insights into the heterogeneity of genetic defects and clinical phenotype of HoFH, and the availability of new therapeutic options, this Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society (EAS) critically reviewed available data with the aim of providing clinical guidance for the recognition and management of HoFH.Methods and resultsEarly diagnosis of HoFH and prompt initiation of diet and lipid-lowering therapy are critical. Genetic testing may provide a definitive diagnosis, but if unavailable, markedly elevated LDL-C levels together with cutaneous or tendon xanthomas before 10 years, or untreated elevated LDL-C levels consistent with heterozygous FH in both parents, are suggestive of HoFH. We recommend that patients with suspected HoFH are promptly referred to specialist centres for a comprehensive ACVD evaluation and clinical management. Lifestyle intervention and maximal statin therapy are the mainstays of treatment, ideally started in the first year of life or at an initial diagnosis, often with ezetimibe and other lipid-modifying therapy. As patients rarely achieve LDL-C targets, adjunctive lipoprotein apheresis is recommended where available, preferably started by age 5 and no later than 8 years. The number of therapeutic approaches has increased following approval of lomitapide and mipomersen for HoFH. Given the severity of ACVD, we recommend regular follow-up, including Doppler echocardiographic evaluation of the heart and aorta annually, stress testing and, if available, computed tomography coronary angiography every 5 years, or less if deemed necessary.ConclusionThis EAS Consensus Panel highlights the need for early identification of HoFH patients, prompt referral to specialized centres, and early initiation of appropriate treatment. These recommendations offer guidance for a wide spectrum of clinicians who are often the first to identify patients with suspected HoFH.

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“…Increased atherosclerosis in the aorta in patients with FH, as assessed by CMR in comparison to healthy controls, has already been well documented. Increased wall thickness of the ascending aorta was demonstrated in nine patients with homozygous familial hypercholesterolemia by Summers et al [20]. Schmitz et al studied 11 heterozygous, nonsmoking, nondiabetic, and nonhypertensive patients with heterozygous familial hypercholesterolemia.…”

Section: Discussionmentioning

confidence: 99%

Aortic Wall Thickness as a Surrogate for Subclinical Atherosclerosis in Familial and Nonfamilial Hypercholesterolemia: Quantitative 3D Magnetic Resonance Imaging Study and Interrelations with Computed Tomography Calcium Scores, and Carotid Ultrasonography

Gałąska,

Kulawiak-Gałąska,

Dorniak

et al. 2023

JCM

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We aimed to compare the extent of subclinical atherosclerosis in the ascending and descending aortas by measuring wall area and thickness using 3D cardiovascular magnetic resonance imaging (aAWAI and dAWAI) in patients with asymptomatic familial hypercholesterolemia (FH) and nonfamilial hypercholesterolemia (NFH). We also aimed to establish the interrelations of CMR parameters with other subclinical atherosclerosis measurements, such as calcium scores, obtained using computed tomography in coronary arteries (CCS) and ascending and descending aorta (TCSasc and TCSdsc), as well as the carotid intima-media thicknesses (cIMT) using ultrasonography. A total of 60 patients with FH (29 men and 31 women), with a mean age of 52.3 ± 9.6 years, were analyzed. A subclinical atherosclerosis assessment was also performed on a group consisting of 30 age- and gender-matched patients with NFH, with a mean age of 52.5 ± 7.9 years. We found the ascending and descending aortic wall areas and thicknesses in the FH group to be significantly increased than those of the NFH group. A multivariate logistic regression analysis showed that a positive FH mutation value was a strong predictor of high aAWAI and dAWAI independent of the LDL cholesterol level. Correlations across CMR atherosclerotic parameters, calcium scores, and cIMT in the FH and NFH groups, were significant but low. Most of the atherosclerosis tests with high results belonged to the FH group. We found that patients with documented heterozygous FH had a higher atherosclerosis burden in the aorta compared to patients with severe hypercholesterolemia without FH gene mutation. Atherosclerosis is not severe in asymptomatic patients with FH, but is more pronounced and also more diffuse than in patients with NFH. The etiology of hypercholesterolemia, and not just cholesterol levels, plays a significant role in determining the degree of subclinical atherosclerosis.

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Evaluation of the Aortic Root by MRI

Abstract: This study not only demonstrates the utility of MRI for detecting and characterizing aortic root atherosclerotic plaque and supravalvular aortic stenosis in HFH patients but also suggests that the LDL receptor plays a direct or indirect role in aortic mural development and vascular growth.

Cited by 81 publications

References 30 publications

Automated analysis of four-dimensional magnetic resonance images of the human aorta

Automated analysis of four-dimensional magnetic resonance images of the human aorta

Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society

Aortic Wall Thickness as a Surrogate for Subclinical Atherosclerosis in Familial and Nonfamilial Hypercholesterolemia: Quantitative 3D Magnetic Resonance Imaging Study and Interrelations with Computed Tomography Calcium Scores, and Carotid Ultrasonography

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