Aortic size in acute type A dissection: implications for preventive ascending aortic replacement

Parish, Landi M.; Gorman, Joseph H.; Kahn, S.; Plappert, Theodore; John-Sutton, Martin G. St.; Bavaria, Joseph E.; Gorman, Robert C.

doi:10.1016/j.ejcts.2008.12.047

Cited by 104 publications

(81 citation statements)

References 25 publications

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“…Thoracic aortic aneurysms (TAAs) predispose patients to catastrophic aortic complications such as aortic dissection or rupture (1)(2)(3). The past decade has witnessed advances in surgical management and pharmacotherapy; however, out of hospital mortality remains high whereby approximately 40% of patients still die in the field, highlighting the importance of more effective risk stratification to prevent aortic complications (4).…”

Section: Introductionmentioning

confidence: 99%

Cine-CMR partial voxel segmentation demonstrates increased aortic stiffness among patients with Marfan syndrome

Singh

Almarzooq

Codell³

et al. 2017

J. Thorac. Dis.

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Background: Standard cine-cardiac magnetic resonance (CMR) imaging is commonly used to evaluate cardiac structure, geometry and function. Prior studies have shown that automated segmentation via partial voxel interpolation (PVI) accurately quantifies phantom-based cardiac chamber volumes and necropsy left ventricular myocardial mass. Despite this, the applicability and usefulness of PVI in the determination of physiologic parameters of the aorta such as aortic stiffness has yet to be investigated. Methods: Routine CMR was conducted with a 1.5T (GE) scanner with pulse sequences similar to that of standard CMR (parameters: TR 3.4 msec, TE 1.14 msec, flip angle 60°, temporal resolution ~30-40 msec). Views were obtained in standard cardiac-oriented longitudinal or axial views (2, 3 and 4 chambers). Within non-dilated regions of the descending thoracic aorta, aortic area was quantified via a novel PVI automated process (LV-METRIC), which discerns relative amounts of blood pool in each voxel. Aortic stiffness, as calculated from brachial artery pulse pressure and aortic area at maximal and minimal dimensions, was evaluated in 60 total segments (one segment per patient). All segments were in the descending aorta and were not aneurysmal. Results: Sixty patients in total were studied, including 50 that had genetically-related aortic disorder [35 bicuspid aortic valve (BAV), 15 Marfan syndrome (MFS)]. Ten normal controls without aortic disease were included for comparison purposes. All patients (n=60) had evaluable CMR images for assessment of the descending aorta with use of automated segmentation. Patients with BAV and MFS were similar to controls in age, systolic blood pressure, brachial artery pulse pressure, smoking status or hypercholesterolemia (all P=NS). There were more women (P<0.001), lower body mass index (P=0.008), and greater height (P<0.001) in the MFS cohort compared to BAV and controls. Descending aortic area in either systole (maximal) or diastole (minimal) was similar among all three cohorts. However, change in aortic area (ΔArea) throughout the cardiac cycle was substantially lower in MFS than control subjects (P<0.001). In contrast, change in aortic area throughout the cardiac cycle was not significantly different between BAV vs. controls (P=0.62). Aortic stiffness was increased among MFS patients versus control subjects (P=0.014). When comparing MFS to BAV subjects, a comparable trend was observed (P=0.09). No statistical difference was evident in aortic stiffness in patients with BAV versus control subjects (P=0.29). Conclusions: The application of PVI to standard CMR imaging can assess abnormal descending aorta functional indices in normal caliber segments in MFS subjects. Future prospective studies with larger subject populations are warranted to further determine the overall utility of automated aortic segmentation as a possible early biomarker of aortic dysfunction before overt dilatation.

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Section: Introductionmentioning

confidence: 99%

Cine-CMR partial voxel segmentation demonstrates increased aortic stiffness among patients with Marfan syndrome

Singh

Almarzooq

Codell³

et al. 2017

J. Thorac. Dis.

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“…Approximately 95% of TAAs are asymptomatic before the occurrence of often fatal acute complications, such as aortic dissection or rupture (3)(4)(5). Although prophylactic surgical correction is guided by anatomic measures of aortic size, diameter alone poorly predicts the risk for life-threatening complications (6,7).…”

Section: Clinical Problemmentioning

confidence: 99%

Role of molecular imaging with positron emission tomographic in aortic aneurysms

et al. 2017

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Aortic aneurysms (AA) are often asymptomatic before the occurrence of acute, potentially fatal complications including dissection and/or rupture. Beyond aortic size, the ability to assess aortic wall characteristics and processes contributing to aneurysm development may allow improved selection of patients who may benefit from prophylactic surgical intervention. Current risk stratification for aneurysms relies upon routine noninvasive imaging of aortic size without assessing the underlying pathophysiologic processes, including features such as inflammation, which may be associated with aneurysm development and progression. The use of molecular imaging modalities with positron emission tomographic (PET) scan allows characterization of aortic wall inflammatory activity. Elevated uptake of Fuorine-2-deoxy-D-glucose (FDG), a radiotracer with elevated avidity in highly-metabolic cells, has been correlated with the development and progression of both abdominal and thoracic AA in a number of animal models and clinical studies. Other novel PET radiotracers targeting matrix metalloproteinases (MMPs), mitochondrial translocator proteins (TSPO) and endothelial cell adhesion molecules are being investigated for clinical utility in identifying progression of disease in AA. By further defining the activation of molecular pathways in assessing aortic regions at risk for dilatation, this imaging modality can be integrated into future clinical decision-making models.

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“…Furthermore, 12% of women had a dissection at an aortic diameter <40 mm. 23 Similarly, in the International Registry of Acute Aortic Dissection, 40% of acute type A dissections occurred with aortic diameters <50 mm. 24 There is no evidence that β-blockers, angiotensin receptor blockers, or angiotensin-converting enzyme inhibitors protect athletes from aortic dissection or rupture during intense competitive sports.…”

Section: Outcome and Risk Of Aortic Dissection And Rupturementioning

confidence: 99%

“…21-22a However, some patients with acute aortic dissection do not have a markedly dilated aorta at the time of dissection. 23,24 In a series of 177 patients without the Marfan syndrome phenotype or BAV who incurred an acute type A dissection, aortic diameter was <50 mm in 42% and <45 mm in 21% at the time of dissection. Furthermore, 12% of women had a dissection at an aortic diameter <40 mm.…”

Section: Outcome and Risk Of Aortic Dissection And Rupturementioning

confidence: 99%

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome

Braverman¹,

Harris²,

Kovacs³

et al. 2015

Circulation

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Aortic size in acute type A dissection: implications for preventive ascending aortic replacement

Cited by 104 publications

References 25 publications

Cine-CMR partial voxel segmentation demonstrates increased aortic stiffness among patients with Marfan syndrome

Cine-CMR partial voxel segmentation demonstrates increased aortic stiffness among patients with Marfan syndrome

Role of molecular imaging with positron emission tomographic in aortic aneurysms

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome

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