The Influence of Wall Stress on AAA Growth and Biomarkers

Speelman, Lambert; Hellenthal, F.A.M.V.I.; Pulinx, B.; Bosboom, Emh Mariëlle; Breeuwer, Marcel; Sambeek, M.R. van; Vosse, F.N. van de; Jacobs, Michael J.; Wodzig, Will K. W. H.; Schurink, Geert Willem H.

doi:10.1016/j.ejvs.2009.12.021

Cited by 64 publications

(40 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Significant correlations with expansion were found in 2 studies (1 low and 1 medium bias risk; r =0.55 and r =0.42) with 61 follow‐up patients in total,10, 39 whereas 2 studies (1 low and 1 medium bias risk) could not reproduce such significant correlations in 66 follow‐up patients 18, 40. Pulinx et al, however, did reach significance when initial AAA diameter was included in their multivariate model 40…”

Section: Resultsmentioning

confidence: 88%

“…Complement reactive protein was examined as marker for expansion in 5 studies17, 18, 19, 20, 21 and in 2 as marker for rupture 22, 23. De Haro et al and Wiernicki et al were the only groups to demonstrate significant correlations with expansion.…”

Section: Resultsmentioning

confidence: 99%

“…Speelman et al18 (n=18) and Flondell‐Sité et al32 (n=163) investigated tissue inhibitor metalloproteinase 1 as marker for expansion. Their studies had, respectively, low and medium bias risk.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Groeneveld

Meekel

Rubinstein

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThe natural course of abdominal aortic aneurysms (AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture.Methods and ResultsPotential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty‐two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S‐elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta‐analysis was conducted because of clinical and methodological heterogeneity.ConclusionsWe identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.

show abstract

Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Groeneveld

Meekel

Rubinstein

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…Tables 1 and 2 illustrate some of the marker investigated for the association with small AAA growth. [55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] Of the marker examined, only 2, namely D-dimer and plasmin-antiplasmin complex, have been associated with AAA growth after adjusting for initial AAA diameter in at least 2 distinct studies ( Table 1). [55][56][57] In the largest of these studies, in which 299 patients with small AAAs were included, it was reported that the use of plasma D-dimer plus initial aortic diameter enable the identification of groups of patients with AAA growth as disparate as 0.4 and 2.5 mm/y.…”

Section: Current Research To Identify Circulating Markers Of Aaa Progmentioning

confidence: 99%

Surrogate Markers of Abdominal Aortic Aneurysm Progression

Wanhainen

Mani

Golledge

2016

ATVB

View full text Add to dashboard Cite

Abstract-The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Wanhainen et al Surrogate Markers of Aneurysm Progression 237in all studies when a standardized protocol is used. 7,8 One of the challenging aspects to assessing maximum AAA diameter is the variety of methods that can potentially be used and the lack of reporting of the exact techniques used in individual studies. Variations may occur in the plane of acquisition (eg, coronal or sagittal), the axis of measurement (eg, axial or orthogonal), the position of the measuring calipers (eg, inner to inner or outer to outer), the relationship with the cardiac cycle (systole versus diastole), and the selected region of the AAA. 9 It has been suggested that diameters measured perpendicular to the aorta centerline (orthogonal), rather than within the axial plane, are more representative of the true AAA diameter. 4,6 With ultrasound, measurements within the anteroposterior, rather than the transverse plane, have been reported to be more reproducible. 4 There is no current consensus on how to place the calipers when measuring the diameter with ultrasound. Methods used include the outer-to-outer method, where calipers are placed on the outer layer of the aortic wall; the inner-to-inner method, where calipers are placed on the inner layer of the aortic wall; and the leading edge-to-leading edge method, where calipers are placed on the outer layer of the anterior wall and the inner layer of the posterior wall ( Figure 1). Much of the reported variation in ultrasound measured AAA diameter is likely because of the variation in caliper placement. 5,10 The UK Small Aneurysm Trial 11 is based on the measurement of AAA diameter on the outer-to-outer method, and this method has been adopted into the current UK intervention criteria. 12 The inner-to-inner method was used in the Multicentre Aneurysm Screening Study, 13 and consequently it is used in the current UK National Health Service AAA screening programme.14 The leading edgeto-leading edge method is used in the current Swedish AAA screening programme.15 Studies comparing these methods show there is a significant difference in diameters measured with the different methods, which has an impact on the reported prevalence rates of AAA. 5,10 In a Swedish AAA screening study, the difference in mean diameter was 4 mm between inner-toinner and outer-to-outer, which resulted in an astonishing 77% difference in AAA prevalence (ie, 1.3% compared with 2.3%). 5A systematic review of 15 studies reported considerable variation in small AAA growth rates (mean, −0.3 to +4.0 mm/y). 15 The variation could not be explained by differences in initial AAA diameter alone. 16 The authors suggested that methodological issues, such as differences in imaging modalities, variation ...

show abstract

“…Since the work of Vorp and others, who found that mechanical properties and stress are important factors in AAA rupture, many researchers have worked toward a non-invasive, clinical method to determine patient-specific aortic mechanical metrics (Doyle et al 2009, 2014; Fillinger et al 2003; Helderman et al 2008; Li et al 2008; Raghavan et al 2000; Speelman et al 2010; Vorp et al 1998; Wang et al 2002). US elastography techniques offer a clinically accessible tool for potentially providing these metrics.…”

Section: Discussionmentioning

confidence: 99%

Detecting Regional Stiffness Changes in Aortic Aneurysmal Geometries Using Pressure-Normalized Strain

Mix

Yang

Johnson

et al. 2017

Ultrasound in Medicine & Biology

View full text Add to dashboard Cite

Transabdominal ultrasound elasticity imaging could improve the assessment of rupture risk for abdominal aortic aneurysms by providing information on the mechanical properties and stress or strain states of vessel walls. We implemented a non-rigid image registration method to visualize the pressure-normalized strain within vascular tissues and adapted it to measure total strain over an entire cardiac cycle. We validated the algorithm’s performance with both simulated ultrasound images with known principal strains and anatomically accurate heterogeneous polyvinyl alcohol cryogel vessel phantoms. Patient images of abdominal aortic aneurysm were also used to illustrate the clinical feasibility of our imaging algorithm and the potential value of pressure-normalized strain as a clinical metric. Our results indicated that pressure-normalized strain could be used to identify spatial variations in vessel tissue stiffness. The results of this investigation were sufficiently encouraging to warrant a clinical study measuring abdominal aortic pressure-normalized strain in a patient population with aneurysmal disease.

show abstract

The Influence of Wall Stress on AAA Growth and Biomarkers

Abstract: Although lower relative wall stress was associated to a lower AAA growth rate, no relation was found between biomarker concentrations and wall stress. Future research may focus on more and extensive biomarker measurements in relation to AAA wall stress.

Cited by 64 publications

References 24 publications

Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Surrogate Markers of Abdominal Aortic Aneurysm Progression

Detecting Regional Stiffness Changes in Aortic Aneurysmal Geometries Using Pressure-Normalized Strain

Contact Info

Product

Resources

About