Aortic Atherosclerotic Disease and Stroke

The aim of this study was to determine the value of flow-sensitive four-dimensional MRI for the assessment of pulse wave velocity as a measure of vessel compliance in the thoracic aorta. Findings in 12 young healthy volunteers were compared with those in 25 stroke patients with aortic atherosclerosis and an age-matched normal control group (n 5 9). Results from pulse wave velocity calculations incorporated velocity data from the entire aorta and were compared to those of standard methods based on flow waveforms at only two specific anatomic landmarks. Global aortic pulse wave velocity was higher in patients with atherosclerosis (7.03 6 0.24 m/ sec) compared to age-matched controls (6.40 6 0.32 m/sec). Both were significantly (P < 0.001) increased compared to younger volunteers (4.39 6 0.32 m/sec). Global aortic pulse wave velocity in young volunteers was in good agreement with previously reported MRI studies and catheter measurements. Estimation of measurement inaccuracies and error propagation analysis demonstrated only minor uncertainties in measured flow waveforms and moderate relative errors below 16% for aortic compliance in all 46 subjects. These results demonstrate the feasibility of pulse wave velocity calculation based on fourdimensional MRI data by exploiting its full volumetric coverage, which may also be an advantage over standard two-dimensional techniques in the often-distorted route of the aorta in patients with atherosclerosis. Magn Reson Med 63:1575-1582, 2010. V C 2010 Wiley-Liss, Inc. Key words: pulse wave velocity; compliance; phase contrast; atherosclerosis; aorta Increased pulse wave velocity (PWV) as a measure of aortic stiffness is an important marker for both agerelated changes in aortic compliance and the presence of atherosclerosis (1,2) and is an independent predictor of cardiovascular mortality and stroke (3,4). Reliable measurement of PWV is of particular interest for monitoring the progression or regression of vessel compliance during therapy (5,6).Pressure catheter measurements can be considered the gold standard for the assessment of the development of aortic pressure wave, but their use is limited due to the invasiveness of the procedure (7). To provide a noninvasive estimate of PWV, phase contrast (PC) MRI has been applied in a number of in vivo studies determining blood flow based on flow waveform measurements in single two-dimensional (2D) planes transecting the aorta (8-10). For PWV estimation, typically transit-time methods are employed estimating temporal differences of specific features of blood flow waveforms, e.g., time from foot to foot or peak to peak, between two locations of the vessel with known distance (11-24). However, the precision of this method highly depends on the exact calculation of flow difference and distance between only two measuring points (16,25,26).Methodological improvements include a more continuous evaluation along a vessel center line and cross-correlation (XCor) analysis for the estimation of waveform delays, which improved the accuracy of PWV...

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“…Reliable measurement of PWV is of particular interest for monitoring the progression or regression of vessel compliance during therapy (5,6).…”

mentioning

confidence: 99%

Estimation of global aortic pulse wave velocity by flow‐sensitive 4D MRI

Markl

Wallis

Brendecke

et al. 2010

Magnetic Resonance in Med

108

102

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“…Lastly, several studies have shown that mobile plaques ( Figure 2) represent an extremely high-risk lesion and may increase the likelihood of stroke several-fold compared with nonmobile plaques. 13 …”

Section: Atheroma Characteristicsmentioning

confidence: 99%

“…Aspirin therapy administered within 48 hours of CABG surgery was shown to reduce the rate of stroke in a large, prospective study. 19 A small number of retrospective studies also found benefit to oral anticoagulation with warfarin in patients with mobile aortic plaques, 13 although these findings have not been replicated or reproduced uniformly in patients undergoing heart surgery.…”

Section: Stroke Prevention In the Perioperative Settingmentioning

confidence: 99%

Atheromatous disease of the aorta and perioperative stroke

Andersen

Hart

Devendra

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Some prospective studies have demonstrated TEE finding of large atheromas (4-5 mm) with mobile attachments are strongly correlated with future embolic disease. 13) 14) In addition to looking for embolic sources like thoracic atheromas, it is clinically important to evaluate atherosis and sclerosis of the thoracic aorta using TEE. In general, atherosis is evaluated based on intima-media complex thickness (IMT), and sclerosis is evaluated based on arterial stiffness.…”

Section: Evaluation Of Thoracic Aortic Atherosclerosismentioning

confidence: 99%

Transesophageal Echocardiographic Evaluation of Atherosclerosis

Nishino

Tanouchi

2008

Korean Circ J

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Transesophageal echocardiography (TEE) is a promising method for evaluating thoracic aortic atherosclerosis and coronary atherosclerosis. The highest impact of TEE as a clinical tool is in searching for cardiac embolic sources in patients with stroke and atrial fibrillation and in conducting detailed evaluations in patients with valvular disease, especially those with mitral valvular disease. However, it is also clinically useful in the evaluation of thoracic aortic atherosclerosis and coronary atherosclerosis. TEE is capable of evaluating thoracic aortic atherosis (intima-media complex thickness) and sclerosis (stiffness parameter β) simultaneously. In addition, TEE can evaluate coronary atherosclerosis by non-invasively revealing narrowing or occlusion of the coronary arteries and providing information about coronary flow reserve. TEE imaging has improved with the advent of harmonic imaging, multiplane probes, contrast agents, and three-dimensional TEE. Future technology, including integrated backscatter (IBS), tissue Doppler, and strain imaging, will lead to further improvements in TEE. Thoracic aortic atherosclerosis and coronary atherosclerosis assessment should be performed in any patient undergoing TEE.

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Aortic Atherosclerotic Disease and Stroke

Cited by 253 publications

References 111 publications

Estimation of global aortic pulse wave velocity by flow‐sensitive 4D MRI

Estimation of global aortic pulse wave velocity by flow‐sensitive 4D MRI

Atheromatous disease of the aorta and perioperative stroke

Transesophageal Echocardiographic Evaluation of Atherosclerosis

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