Flow displacement and decreased wall shear stress might be associated with the growth rate of an ascending aortic dilatation

Korpela, Tarmo; Kauhanen, S. Petteri; Kariniemi, Elina; Saari, Petri; Liimatainen, Timo; Jaakkola, Pekka; Vanninen, Ritva; Hedman, Marja

doi:10.1093/ejcts/ezab483

Cited by 14 publications

(7 citation statements)

References 21 publications

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“…Our recent work demonstrated association of decreased WSS with significant growth of TAA and suggested 4-dimensional flow magnetic resonance imaging as useful in assessing risk for AA diameter growth. 77 We and others [62][63][64] have also studied how WSS induces changes in the biomechanical properties and cellular heterogeneity of the aorta in patients with TAA and shown high region-specificity. It remains to be seen whether WSS is also able to contribute to reprogramming of SMCs, immune cells, and ECs in aortic aneurysms, how these relate to aortic expansion, and how different genetic factors affect growth rate of the aneurysms in human.…”

Section: Management and Future Prospectsmentioning

confidence: 99%

Large Vessel Cell Heterogeneity and Plasticity: Focus in Aortic Aneurysms

Jauhiainen

Kiema

Hedman

et al. 2022

ATVB

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Smooth muscle cells and endothelial cells have a remarkable level of plasticity in vascular pathologies. In thoracic and abdominal aortic aneurysms, smooth muscle cells have been suggested to undergo phenotypic switching and to contribute to degradation of the aortic wall structure in response to, for example, inflammatory mediators, dysregulation of growth factor signaling or oxidative stress. Recently, endothelial-to-mesenchymal transition, and a clonal expansion of degradative smooth muscle cells and immune cells, as well as mesenchymal stem–like cells have been suggested to contribute to the progression of aortic aneurysms. What are the factors driving the aortic cell phenotype changes and how vascular flow, known to affect aortic wall structure and to be altered in aortic aneurysms, could affect aortic cell remodeling? In this review, we summarize the current literature on aortic cell heterogeneity and phenotypic switching in relation to changes in vascular flow and aortic wall structure in aortic aneurysms in clinical samples with special focus on smooth muscle and endothelial cells. The differences between thoracic and abdominal aortic aneurysms are discussed.

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Section: Management and Future Prospectsmentioning

confidence: 99%

Large Vessel Cell Heterogeneity and Plasticity: Focus in Aortic Aneurysms

Jauhiainen

Kiema

Hedman

et al. 2022

ATVB

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“…Focal increases in wall shear stress (WSS) ( Barker et al, 2012 ) and higher circumferential WSS ( Rodríguez-Palomares et al, 2018 ) have been detected in BAV patients with TAA compared to healthy subjects. We have also reported flow displacement and increased circumferential WSS in patients with tricuspid aortic valve (TAV) with TAA ( Kauhanen et al, 2019 ; Korpela et al, 2022 ). Higher shear forces have been suggested to explain the higher prevalence of TAA in patients with BAV in comparison to TAV ( Barker et al, 2012 ; Meierhofer et al, 2013 ; Mahadevia et al, 2014 ; van Ooij et al, 2017 ).…”

Section: Introductionmentioning

confidence: 90%

Wall Shear Stress Predicts Media Degeneration and Biomechanical Changes in Thoracic Aorta

et al. 2022

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Objectives: In thoracic aortic aneurysm (TAA) of the ascending aorta (AA), AA is progressively dilating due to the weakening of the aortic wall. Predicting and preventing aortic dissections and ruptures in TAA continues to be challenging, and more accurate assessment of the AA dilatation, identification of high-risk patients, and timing of repair surgery are required. We investigated whether wall shear stress (WSS) predicts pathological and biomechanical changes in the aortic wall in TAA.Methods: The study included 12 patients with bicuspid (BAV) and 20 patients with the tricuspid aortic valve (TAV). 4D flow magnetic resonance imaging (MRI) was performed a day before aortic replacement surgery. Biomechanical and histological parameters, including assessing of wall strength, media degeneration, elastin, and cell content were analyzed from the resected AA samples.Results: WSSs were greater in the outer curves of the AA compared to the inner curves in all TAA patients. WSSs correlated with media degeneration of the aortic wall (ρ = -0.48, p < 0.01), elastin content (ρ = 0.47, p < 0.01), and aortic wall strength (ρ = -0.49, p = 0.029). Subsequently, the media of the outer curves was thinner, more rigid, and tolerated lower failure strains. Failure values were shown to correlate with smooth muscle cell (SMC) density (ρ = -0.45, p < 0.02), and indicated the more MYH10+ SMCs the lower the strength of the aortic wall structure. More macrophages were detected in patients with severe media degeneration and the areas with lower WSSs.Conclusion: The findings indicate that MRI-derived WSS predicts pathological and biomechanical changes in the aortic wall in patients with TAA and could be used for identification of high-risk patients.

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“…The latter has been associated with increased FL pressurisation. Regions of high oscillatory shear index (OSI) and low time-averaged WSS (TAWSS) have been linked with aneurysmal growth and rupture 12,41 in TBAD and other aortic diseases 12,33,18,21 , creating a feedback loop of degradation as growth further exacerbates these effects 41 .…”

Section: Introductionmentioning

confidence: 99%

Aneurysmal Growth in Type-B Aortic Dissection: Assessing the Impact of Patient-Specific Inlet Conditions on Key Haemodynamic Indices

Stokes

Lind

Haupt

et al. 2023

Preprint

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Type-B Aortic Dissection (TBAD) is cardiovascular disease in which a tear develops in the intimal layer of the descending aorta, allowing pressurised blood to delaminate the intimal and medial layers to form a true and false lumen. In medically managed patients, long-term aneurysmal dilatation of the false lumen is considered virtually inevitable and is associated with poorer disease outcomes. The pathophysiological mechanisms driving false lumen dilatation are not yet understood, though haemodynamic factors are believed to play a key role. Recent analysis via Computational Fluid Dynamics (CFD) and 4D-Flow MRI have demonstrated links between flow helicity, oscillatory wall shear stress and aneurysmal dilatation of the false lumen. In this study, we compare simulations using the gold-standard three-dimensional, three-component inlet velocity profile (3D IVP) extracted from 4DMR data with flow-matched flat and through-plane profiles that remain widely used in the absence of 4DMR. Furthermore, we assess the impact of 4DMR imaging errors on the flow solution by scaling the 3D IVP components to the degree of imaging error observed in previous studies. We demonstrate that secondary inlet flows affect the distribution of oscillatory shear and helicity throughout the FL, and that even the 3D IVP exhibited notable differences in helicity and oscillatory shear when modulated to account for imaging errors. These results illustrate that the quality of inlet velocity conditions in simulations of TBAD may greatly affect their clinical value, and efforts to further enhance their patient-specific accuracy are warranted.

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Flow displacement and decreased wall shear stress might be associated with the growth rate of an ascending aortic dilatation

Cited by 14 publications

References 21 publications

Large Vessel Cell Heterogeneity and Plasticity: Focus in Aortic Aneurysms

Large Vessel Cell Heterogeneity and Plasticity: Focus in Aortic Aneurysms

Wall Shear Stress Predicts Media Degeneration and Biomechanical Changes in Thoracic Aorta

Aneurysmal Growth in Type-B Aortic Dissection: Assessing the Impact of Patient-Specific Inlet Conditions on Key Haemodynamic Indices

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