Ascending aorta in tetralogy of Fallot: Beyond echocardiographic dimensions

Cruz, Cristina; Pinho, Teresa; Sousa, Carla; Dias, Cláudia Camila; Silva-Cardoso, José; Maciel, Maria Júlia

doi:10.1111/echo.14046

Cited by 13 publications

(10 citation statements)

References 29 publications

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“…Aortic dilation is also a known abnormality in cTOF, which is associated with higher ASI (3). This was confirmed by both M-mode (15). Our results confirm previous studies describing that cTOF is associated with impaired LV deformations (16,17).…”

Section: Discussionsupporting

confidence: 92%

Left ventricular strains correlate with aortic elastic properties in adult patients with corrected tetralogy of Fallot (Results from the CSONGRAD Registry and MAGYAR-Path Study)

Rácz¹,

Kormányos²,

Domsik³

et al. 2021

Cardiovasc Diagn Ther

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Background: Aortopathy is a common phenomenon in tetralogy of Fallot (TOF). The current study was designed to detect left ventricular (LV) deformation abnormalities and its relation to aortic stiffness in corrected TOF (cTOF) using the novel three-dimensional (3D) speckle-tracking echocardiography (3DSTE).Detailed comparative analysis between patients with early palliation-late correction (pcTOF) and early total reconstruction (etrTOF) was also performed.Methods: The present study consisted of 28 cTOF patients (35.0±15.7 years, 11 males) from which 15 and 13 proved to be pcTOF and etrTOF, respectively. Their clinical parameters were compared to those of 39 matched healthy adults (35.5±6.0 years, 16 males).Results: cTOF patients showed significantly lower global LV longitudinal, circumferential and area strains as compared to controls. In etrTOF patients, global LV 3D strain was higher than in controls. In pcTOF patients, all LV strains proved to be significantly lower as compared to those of etrTOF patients and controls. In all cTOF patients, several moderate correlations could be detected between LV strain parameters and aortic elastic properties.Conclusions: Significant LV deformational abnormalities could be demonstrated in cTOF patients. etrTOF patients have beneficial LV strain parameters as compared to those of pcTOF patients. LV strains show correlations with aortic elastic properties.

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Section: Discussionsupporting

confidence: 92%

Left ventricular strains correlate with aortic elastic properties in adult patients with corrected tetralogy of Fallot (Results from the CSONGRAD Registry and MAGYAR-Path Study)

Rácz¹,

Kormányos²,

Domsik³

et al. 2021

Cardiovasc Diagn Ther

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“…Consistent with prior studies for which strain has been employed to assess vascular physiology, 15,16 the aortic circumference was partitioned into six, 60 segments, with the segmental results averaged to derive the following global indices of aortic mechanics: circumferential aortic strain (CAS) e peak circumferential deformation of the aortic wall between systole and diastole (measured as the relative (%) aortic area difference between these two time points; ([end systole e end diastole]/end diastole) Â 100 pulse pressure adjusted CAS e CAS normalised for pulse pressure (PP): (CAS/PP) 18 time to peak (TTP) strain e calculated as time interval between minimum and maximum circumferential aortic strain.…”

Section: Image Analysismentioning

confidence: 71%

Immediate Impact of Prosthetic Graft Replacement of the Ascending Aorta on Circumferential Strain in the Descending Aorta

Rong

Palumbo

Rahouma

et al. 2019

European Journal of Vascular and Endovascular Surgery

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The results of this study demonstrate graft induced increases in circumferential deformation and distensibility in the native descending aorta in the presence of unchanged haemodynamics and stroke volume after proximal aortic graft replacement, suggesting that replacing native aorta with a graft increases pulse pressure and energy propagation downstream to the graft. This observation may have important clinical implications and may be a mechanism contributing to the reported risk of aneurysm formation or expansion, dissection, or rupture of the aorta distal to graft. Objectives: Prosthetic replacement of the ascending aorta (AA) can potentially modify energy propagation to the distal aorta and contribute to adverse aortic remodelling. This preliminary study employed intra-operative transoesophageal echocardiography (TOE) to assess the immediate impact of prosthetic graft replacement of the AA on circumferential strain in the descending aorta. Methods: Intra-operative TOEs in patients undergoing AA graft replacement were analysed for circumferential strain, fractional area change (FAC), dimensions (end diastolic area [EDA], and end systolic area [ESA]) in the descending aorta immediately before and after graft replacement. Deformation was assessed via global peak circumferential aortic strain (CAS), together with pulse pressure corrected strain, time to peak strain (TTP), and aortic distensibility. Results: Forty-five patients undergoing AA replacement with prosthetic graft (91% elective) were studied. Following grafting, descending thoracic aortic circumferential strain increased (6.3 AE 2.8% vs. 8.9 AE 3.4%, p ¼ .001) paralleling distensibility (5.7 [3.7e8.6] 10 À3 mmHg vs. 8.5 [6.4e12.4] 10 À3 mmHg, p < .001). Despite slight increments in post graft left ventricular ejection fraction (LVEF) (52.3 AE 10.8% vs. 55.0 AE 11.9, p < .001), stroke volume was similar (p ¼ .41), and magnitude of increased strain did not correlate with change in stroke volume (r ¼ À.03, p ¼ .86), LVEF (r ¼ .18, p ¼ .28), or pulse pressure (r ¼ .28, p ¼ .06). Descending aortic size (EDA 4 [2.7e4.6] cm 2 vs. 3.7 [2.5e5] cm 2 , p ¼ .89; ESA 4.3 [3.2e5.3] cm 2 vs. 4.5 [3.3e5.8] cm 2 , p ¼ .14) was similar pre-and post graft. In subgroup analysis, patients with cystic medial necrosis had a significantly higher post procedure CAS than patients with atherosclerotic aneurysms (9.7 AE 3.5% vs. 7.0 AE 2.3%, p ¼ .03). Conclusions: Prosthetic graft replacement of the AA increases immediate aortic circumferential strain of the descending aorta, particularly in patients with cystic medial necrosis. Our findings suggest that grafts augment energy transfer to the distal aorta, a potential mechanism for progressive distal aortic dilation and/or dissection.

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“…Consistent with previous literature by our group and others, 5,7‐9 the following global indices of aortic biomechanics were considered for both TEE and CMR analysis: Global circumferential aortic strain (GCS)—peak circumferential deformation of the aortic wall between systole and diastole (measured as the relative (%) difference between these two time points; [end‐systole−end‐diastole]/end‐diastole × 100). Pulse pressure–adjusted GCS—GCS normalized for pulse pressure (PP): (GCS/PP) 9 Time‐to‐peak (TTP) strain—calculated as time interval between initial LV systolic contraction (R wave) and maximal circumferential aortic strain. …”

Section: Methodsmentioning

confidence: 99%

Descending aortic strain quantification by intra‐operative transesophageal echocardiography: Multimodality validation via cardiovascular magnetic resonance

et al. 2020

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Background Whereas cardiac magnetic resonance (CMR) imaging provides high temporal resolution imaging of aortic distensibility (strain), transesophageal echocardiography (TEE) is widely used for intra‐operative aortic imaging and provides a clinical alternative for aortic assessment. We tested intra‐operative global circumferential aortic strain (GCS) measured on TEE in relation to the reference of CMR‐derived strain among patients undergoing surgical graft repair of ascending aortic aneurysms. Methods CMR (3T) was prospectively performed in patients scheduled for aortic repair. TEE was performed intra‐operatively; images were co‐localized with MRI. GCS on CMR and TEE was quantified independently, blinded to results of the other modality. Results 25 patients (54 ± 10 year‐old, 88% male) were studied, inclusive of 13 genetically mediated and 12 degenerative aneurysms: CMR and TEE were performed within 12 ± 9 days. Pulse pressure (PP)–adjusted descending aortic TEE‐derived GCS strongly correlated with cine‐CMR‐derived GCS (r = .75, P = .002) though absolute GCS and PP‐adjusted values were slightly lower (5.40 ± 1.11 vs 6.49 ± 1.43% and 11.55 ± 3.04 vs 13.99 ± 4.53%, respectively). Similarly, TEE yielded slightly lower end‐diastolic area (EDA [5.1 ± 1.7 cm2 vs 5.8 ± 1.3 cm2, P = .004]) and end‐systolic area (ESA [6.1 ± 1.9 cm2 vs 6.5 ± 1.7 cm2, P = .10]), with significant correlations between the two modalities (r = .73, .76, P < .05 for all). Conclusions This exploratory study supports feasibility of TEE for assessing aortic GCS in a surgical at‐risk population, as well as magnitude of agreement between intra‐operative TEE and preoperative CMR. We found that there is a significant correlation between GCS and EDA and ESA aortic areas, but that TEE‐derived parameters underestimated CMR values by a small but significant amount.

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Ascending aorta in tetralogy of Fallot: Beyond echocardiographic dimensions

Abstract: TOF patients have a larger and stiffer AAo compared to controls. CAAS derived from 2D-STE allows a routine noninvasive method for assessing AAo stiffness, with advantages over M-mode strain, and may be used as predictor of major aortic or cardiovascular events.

Cited by 13 publications

References 29 publications

Left ventricular strains correlate with aortic elastic properties in adult patients with corrected tetralogy of Fallot (Results from the CSONGRAD Registry and MAGYAR-Path Study)

Left ventricular strains correlate with aortic elastic properties in adult patients with corrected tetralogy of Fallot (Results from the CSONGRAD Registry and MAGYAR-Path Study)

Immediate Impact of Prosthetic Graft Replacement of the Ascending Aorta on Circumferential Strain in the Descending Aorta

Descending aortic strain quantification by intra‐operative transesophageal echocardiography: Multimodality validation via cardiovascular magnetic resonance

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