Patients with blunt traumatic thoracic aortic injury treated with TEVAR present increased flow dynamics alterations and pulse wave velocity: a 4D flow CMR study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Guala ◽  
D Gil Sala ◽  
A Ruiz-Munoz ◽  
M.E Garcia Reyes ◽  
L Dux-Santoy ◽  
...  
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Aortic Injury ◽  
Flow Dynamics ◽  
Funding Source ◽  
4D Flow ◽  
4D Flow Cmr ◽  
Thoracic Aortic Injury

Abstract Background Thoracic endovascular aortic repair (TEVAR) is widely used for the treatment of blunt traumatic thoracic aortic injuries. Aortic flow dynamics and mechanical implications of this intervention are poorly investigated and may be of particular interest in the long-term follow-up of these mostly young patients. Purpose To assess whether the presence of TEVAR in a cohort of otherwise healthy subjects was related to dilation of the proximal aorta or increase in aortic stiffness and flow alterations. Methods Nineteen patients who underwent TEVAR implantation after a traumatic injury of the thoracic descending aorta (DAo) (10.0±6.1 years from intervention) and 44 healthy volunteers (HV) underwent 4D flow CMR to compute ascending aorta (AAo) pulse wave velocity (PWV), a marker of aortic stiffness, systolic flow reversal ratio (SFRR), quantifying backward flow during systole and in-plane rotational flow (IRF), measuring in-plane strength of helical flow. IRF and SFRR were assessed at 20 planes between the sinotubular junction and the mid thoracic DAo. Aortic diameters were measured using double-oblique cine CMR. Results Patients with TEVAR and HV did not differ in age, sex, body surface area, blood pressure and DAo diameter distal to TEVAR (Table). However, TEVAR patients presented larger diameters at the sinus of Valsalva and AAo, increased AAo PWV and strong flow alterations: IRF was reduced from the distal AAo to the proximal DAo, while SFRR was increased in the whole thoracic aorta (Figure). Conclusions In patients with blunt traumatic thoracic aortic injury treated with TEVAR the aorta proximal to TEVAR is dilated, stiffer and present potentially pathogenic flow conditions. Longitudinal studies are needed to assess whether these alterations have prognostic value and may improve clinical prevention and management of these patients. Figure 1. IRF and SFRR in healthy vs TEVAR Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study has been funded by Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation (PI19/01480). Guala A. received funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I).

Role of estimated aortic pulse wave velocity in the prediction of future thoracic aortic aneurysm expansion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Boczar ◽  
M Boodhwani ◽  
L Beauchesne ◽  
C Dennie ◽  
K.L Chan ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Linear Regression ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Aortic Stiffness ◽  
Thoracic Aortic Aneurysm ◽  
Pulse Wave ◽  
Aortic Pulse Wave Velocity ◽  
Funding Source

Abstract Background Thoracic aortic aneurysm (TAA) is a deadly disease in critical need of novel strategies for risk assessment and medical management. To address this need, we have previously shown that directly measured carotid-femoral pulse wave velocity (cfPWV), a marker of aortic stiffness and health, independently predicts future TAA expansion. Since aortic pulse wave velocity can be estimated from age and mean arterial pressure (MAP), in the present study we sought to determine whether estimated aortic pulse wave velocity (e-aPWV) also predicts TAA expansion. Methods One hundred and five consecutive, unoperated subjects with TAA were recruited. e-aPWV was estimated from validated equations based on age and MAP. cfPWV was measured with arterial tonometry according to guidelines. TAA size was measured at baseline and at the latest follow-up using available imaging modalities according to guidelines. Stepwise multivariable linear regression (P≤0.25 to enter, P≤0.10 to stay in the model) assessed independent associations of e-aPWV and cfPWV with future TAA growth. Variables considered in the models were: age, sex, BSA, MAP, TAA etiology and location, baseline TAA size, follow-up time, imaging modality, history of hypertension, diabetes and smoking. Results Seventy eight percent of subjects were men. Mean±SD age, baseline aneurysm size and follow-up time were 62.6±11.4 years, 46.2±3.8 mm and 3.0±1.0 years, respectively. e-aPWV and cfPWV were moderately correlated (Pearson's correlation coefficient = 0.61). Results of the linear regression analyses showed that both measured (cfPWV) and estimated (e-aPWV) independently predicted future TAA expansion (β±SE: 0.032±0.011, P=0.048 and 0.240±0.085, P=0.006, respectively). The base model's R-squared value of 0.39 was increased to 0.44 with addition of either cfPWV or e-aPWV to the model, confirming that each parameter of aortic stiffness enhances prediction of TAA growth. Conclusion Aortic stiffness is relevant for assessment of TAA disease activity. Similar to cfPWV, e-aPWV is also independently associated with future TAA expansion. Thus, e-aPWV represents a tool to improve TAA risk stratification that is simple, free of cost, and obviates the need for specialized equipment or dedicating training, which leads to excellent potential for widespread incorporation into clinical practice. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research

scholarly journals P.53 Ascending Aorta Diameter and Pulse Wave Velocity are Increased and Local Hemodynamic is Disrupted in Patients with Blunt Traumatic Thoracic Aortic Injury Treated by TEVAR

2020 ◽  
Vol 26 (Supplement 1) ◽  
pp. S74
Author(s):  
Andrea Guala ◽  
Daniel Gil Sala ◽  
Aroa Ruiz-Muñoz ◽  
Marvin Garcia-Reyes ◽  
Lydia Dux-Santoy ◽  
...  
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Aortic Injury ◽  
Ascending Aorta ◽  
Thoracic Aortic Injury ◽  
Aorta Diameter ◽  
P 53

A high ankle-brachial index is associated with increased aortic pulse wave velocity: the Czech post-MONICA study

2011 ◽  
Vol 18 (6) ◽  
pp. 790-796 ◽  
Author(s):  
Peter Wohlfahrt ◽  
Daniel Palouš ◽  
Michaela Ingrischová ◽  
Alena Krajčoviechová ◽  
Jitka Seidlerová ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Population Sample ◽  
Ankle Brachial Index ◽  
Aortic Pulse Wave Velocity ◽  
Left Ventricular ◽  
History Of

Background: Ankle brachial index (ABI) has been increasingly used in general practice to identify individuals with low ABI at high cardiovascular risk. However, there has been no consensus on the clinical significance of high ABI. The aim of our study was to compare aortic stiffness as a marker of cardiovascular risk in individuals with low (<1.0), normal (1.0–1.4), and high ABI (>1.4). Methods: A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, aged 54 ± 13.5 years, 47% of men) were examined. ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device. Results: Of the 911 individuals, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. There was a U-shaped association between aPWV and ABI. aPWV was significantly higher in individuals with low and high ABI compared with the normal ABI group (11.1 ± 2.8, 8.3 ± 2.3, p < 0.001; 10.8 ± 2.5, 8.3 ± 2.3 m/s, p < 0.001, respectively). In a model adjusted for age, sex, systolic, diastolic, mean blood pressure and examiner, aPWV remained increased in both extreme ABI groups compared with the normal ABI group. In logistic regression analysis, aPWV together with glucose level, male sex, and a history of deep venous thrombosis were independent predictors of high ABI, while cholesterol was not. Conclusion: This is the first study showing increased aortic stiffness in individuals with high ABI, presumably responsible for increased left ventricular mass described previously in this group. These findings suggest increased cardiovascular risk of high ABI individuals.

scholarly journals Biological Pathways in Adolescent Aortic Stiffness

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Justin P. Zachariah ◽  
Yunfei Wang ◽  
Jane W. Newburger ◽  
Sarah D. deFerranti ◽  
Gary F Mitchell ◽  
...  
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Normal Weight ◽  
Excess Weight ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol

Background Aortic stiffening begins in youth and antedates future hypertension. In adults, excess weight, systemic inflammation, dyslipidemia, insulin resistance, neurohormonal activation, and altered adipokines are implicated in the pathogenesis of increased aortic stiffness. In adolescents, we assessed the relations of comprehensive measures of aortic stiffness with body mass index (BMI) and related but distinct circulating biomarkers. Methods and Results A convenience sample of 246 adolescents (mean age, 16±2 years; 45% female, 24% Black, and 43% Hispanic) attending primary care or preventive cardiology clinics at 2 tertiary hospitals was grouped as normal weight (N=98) or excess weight (N=148, defined as BMI ≥age‐ and sex‐referenced 85th percentile). After an overnight fast, participants underwent anthropometry, noninvasive arterial tonometry, and assays for serum lipids, CRP (C‐reactive protein), glucose, insulin, renin, aldosterone, and leptin. We used multivariable linear regression to relate arterial stiffness markers (including carotid‐femoral pulse wave velocity) to BMI z score and a biomarker panel. Carotid‐femoral pulse wave velocity was higher in excess weight compared with normal weight group (5.0±0.7 versus 4.6±0.6 m/s; P <0.01). After multivariable adjustment, carotid‐femoral pulse wave velocity was associated with BMI z score (0.09 [95% CI, 0.01–0.18]; P =0.04) and with low‐density lipoprotein cholesterol (0.26 [95% CI, 0.03–0.50]; P =0.03). Conclusions Higher BMI and low‐density lipoprotein cholesterol were associated with greater aortic stiffness in adolescents. Maintaining optimal BMI and lipid levels may mitigate aortic stiffness.

Abstract WP265: Association Between Brachial-Ankle Pulse Wave Velocity and Aortic Atheroma in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jaewook Jeong ◽  
Jin Kyo Choi ◽  
Young Dae Kim ◽  
Ji Hoe Heo ◽  
Hyo Suk Nam
Keyword(s):  
Ischemic Stroke ◽  
Pulse Wave Velocity ◽  
Acute Ischemic Stroke ◽  
Wave Velocity ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Mean Value ◽  
Noninvasive Technique ◽  
Aortic Atheroma ◽  
Aortic Plaques

Background and Purpose: Aortic plaques are associated with both larger artery and small artery atherosclerosis. However, association between aortic plaque and aortic stiffness in ischemic stroke is unknown. Brachial-ankle pulse wave velocity (baPWV) is a noninvasive technique to measure aortic stiffness. In the present study, we hypothesized that presence of aortic plaques is associated with increased baPWV. Methods: We reviewed 1099 patients diagnosed with acute ischemic stroke, who had both transesophageal echocardiography (TEE) and brachial-ankle pulse wave velocity (baPWV) measurements. Aortic plaques were classified as complex aortic plaques (CAP) or simple aortic plaques (SAP). CAP were defined as plaques protruding into the lumen ≥4 mm and of mobile lesions located in the proximal aorta. SAP represented plaques <4 mm in the proximal aorta and plaques located in the descending aorta of any sizes. Patients were classified into 4 groups; patients who have CAP only, those who have SAP only, those who have both CAP and SAP, and those without aortic plaques. Results: Among the 1099 patients, aortic atheroma was found in 689 (62.7%) patients. Twenty one (1.9%) patients had only CAP, 142 (12.9%) patients had both SAP and CAP, while 526 (47.9%) patients had SAP without CAP. Mean value of baPWV was 1982±580 cm/sec. baPWV was significantly increased in patients with any aortic atheromas than those without atheromas (2095±577 cm/sec vs. 1793±535 cm/sec, p <0.001). Analysis of variance showed that baPWV was significantly increased in patients with SAP only (p<0.001) and SAP and CAP (p<0.001) compared to those without any aortic atheroma, whereas CAP only patients were not associated with baPWV (p = 0.131). Conclusion: We found that baPWV was associated with SAP but not CAP in acute ischemic stroke patients. These feature suggests that SAP represent generalized atherosclerosis and aortic stiffness, whereas CAP represent the sole mechanism of stroke.

scholarly journals P1830 Single-beat aortic arch pulse wave velocity by dual-gate simultaneous Doppler technique: a novel method for arterial stiffness evaluation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Antonini-Canterin ◽  
A Pepe ◽  
M Strazzanti ◽  
D Rivaben ◽  
E Nicolosi ◽  
...  
Keyword(s):  
Pulse Wave Velocity ◽  
Healthy Volunteers ◽  
Aortic Arch ◽  
Wave Velocity ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Surrogate Marker ◽  
Mri Studies ◽  
Pulsed Wave Doppler ◽  
Dual Gate

Abstract Background Guidelines recommend increased aortic stiffness as a negative prognostic factor to be considered in primary and secondary prevention. Pulse wave velocity (PWV) is a frequently employed surrogate marker of aortic stiffness. Carotid-femoral PWV is the most common index in research and clinical practice, but recently several velocity-encoded magnetic resonance imaging (MRI) techniques have been used for the evaluation of regional aortic arch PWV, where the stiffness seems to be particularly relevant from a prognostic point of view. Purposes. We developed a new ultrasound method for the assessment of aortic arch PWV, using a single-beat dual-gate simultaneous pulsed wave Doppler tracing. The aim of the study is to evaluate the feasibility of this new technique in a group of healthy volunteers. Methods We examined 126 healthy volunteers (81 females, 45 males, mean age 42 + 15 years, range 13-83 years) using a commercially available machine equipped with simultaneous dual-gate pulsed Doppler. Using the suprasternal approach, the first sample volume was placed in ascending aorta and the second one in descending aorta. The distance between the two sites was directly measured with a curvilinear tracing in the middle of the vessel, following the shape of the aortic arch. PWV was calculated as the ratio of distance (in millimiters) and the transit time (in milliseconds) measured using the "foot-to-foot" method. The results are then easily transformed, simplifying in the commonly unit of meters/second. Results Feasibility was 99%; in one case it was not possible to measure accurately the aortic arch PWV due to unfavorable suprasternal acustic window. The procedure time was very fast, requiring 2 + 1 minutes. Intraobserver and interobserver variability were 7% and 9% respectively. Aortic arch PWV, as expected, showed a strong correlation with age in males as well as in females (r= 0.71 and r = 0.60 respectively, p &lt; 0.001 for both); there was also a significant correlation with body mass index (r = 0.31; p &lt; 0.001). Aortic arch PWV values ranged from 3.1 to 8.5 m/s, showing a substantial overlap with normal values reported in MRI studies. Conclusions The direct measurement of aortic arch PWV is feasible and reproducible with ultrasound, using the novel single-beat dual-gate simultaneous pulsed wave Doppler tracing. This technique could be implemented in a standard echo examination, that is much more available than MRI studies. Further studies are needed to evaluate if Doppler-derived aortic arch PWV could provide additional prognostic information. Abstract P1830 Figure. Aortic Arch PWV

Aortic Stiffness Assessed by Global Pulse Wave Velocity in Postmenopausal Women: An Ultrasonographic Study

2012 ◽  
Vol 29 (10) ◽  
pp. 1233-1238 ◽  
Author(s):  
Pasquale Palmiero ◽  
Maria Maiello ◽  
David D. Daly ◽  
Marco Matteo Ciccone ◽  
Navin C. Nanda
Keyword(s):  
Pulse Wave Velocity ◽  
Postmenopausal Women ◽  
Wave Velocity ◽  
Aortic Stiffness ◽  
Pulse Wave

scholarly journals Normal and reference values for MRI-based pulse wave velocity in the middle-aged general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.J.P Van Hout ◽  
I.A Dekkers ◽  
J.J.M Westenberg ◽  
M.J Schalij ◽  
R De Mutsert ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Reference Values ◽  
Pulse Wave ◽  
Funding Source ◽  
Clinical Implementation ◽  
Research Profile ◽  
Cv Disease

Abstract Background Aortic stiffness, assessed through pulse wave velocity (PWV), is an independent predictor for cardiovascular (CV) risk. However, the scarce availability of normal and reference values for magnetic resonance imaging (MRI) based PWV is limiting clinical implementation. Purpose The aim of this study was to determine normal and reference values for MRI-PWV in the general population. Methods From the 2,484 participants of the NEO study that have available MRI-PWV data, we selected 1,639 participants that were free from CV disease or treatment for diabetes, hypertension or dyslipidaemia (age range 45–65 years, 51% male). Participants were categorized by sex, age and blood pressure (BP) subgroups. Normal values were specified for healthy (&lt;130/80 mmHg) and elevated BP (≥130/80 and &lt;140/90 mmHg) and reference values for high BP (≥140/90 mmHg) subgroups. Differences between groups were tested with either an independent samples t-test or ANOVA. Results Overall mean PWV was 6.5 m/s [95% CI 6.4–6.6]. PWV increased significantly with advancing age and BP categories (both p&lt;0.001). There was no difference in PWV between men and women, however a stronger increasing trend for women above 55 years old was observed (figure). The 95% CI's were smaller for participants &lt;55 years old as compared to participants &gt;55, indicating an increasing variability of PWV with age. The elevated PWV upper limits for the higher blood pressure subgroups are particularly evident in participants above 55 years old. Conclusion This study provides normal and reference values for MRI-assessed PWV per sex, age and blood pressure category. PWV percentiles (10, 25, 50, 75 and 90th) Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The NEO study is supported by the participating departments, the Division and the Board of Directors of the Leiden University Medical Centre, and by the Leiden University, Research Profile Area “Vascular and Regenerative Medicine”

scholarly journals Normal Pregnancy Is Associated with Changes in Central Hemodynamics and Enhanced Recruitable, but Not Resting, Endothelial Function

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Juan Torrado ◽  
Yanina Zócalo ◽  
Ignacio Farro ◽  
Federico Farro ◽  
Claudio Sosa ◽  
...  
Keyword(s):  
Pulse Wave Velocity ◽  
Endothelial Function ◽  
Wave Velocity ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Reactive Hyperemia ◽  
Intima Media Thickness ◽  
Normal Pregnancy ◽  
Low Flow ◽  
Central Hemodynamics

Introduction.Flow-mediated dilation (FMD), low flow-mediated constriction (L-FMC), and reactive hyperemia-related changes in carotid-to-radial pulse wave velocity (ΔPWVcr%) could offer complementary information about both “recruitability” and “resting” endothelial function (EF). Carotid-to-femoral pulse wave velocity (PWVcf) and pulse wave analysis-derived parameters (i.e., AIx@75) are the gold standard methods for noninvasive evaluation of aortic stiffness and central hemodynamics. If healthy pregnancy is associated with both changes in resting and recruitable EF, as well as in several arterial parameters, it remains unknown and/or controversial.Objectives.To simultaneously and noninvasively assess in healthy pregnant (HP) and nonpregnant (NP) women central parameters in conjunction with “basal and recruitable” EF, employing new complementary approaches.Methods.HP (n=11, 34.2 ± 3.3 weeks of gestation) and age- and cardiovascular risk factors-matched NP (n=22) were included. Aortic blood pressure (BP), AIx@75, PWVcf, common carotid stiffness, and intima-media thickness, as well as FMD, L-FMC, and ΔPWVcr %, were measured.Results.Aortic BP, stiffness, and AIx@75 were reduced in HP. ΔPWVcr% and FMD were enhanced in HP in comparison to NP. No differences were found in L-FMC between groups.Conclusion.HP is associated with reduced aortic stiffness, central BP, wave reflections, and enhanced recruitable, but not resting, EF.

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