Aortopathies: From Etiology to the Role of Arterial Stiffness

Abstract

The aorta and aortic wall have a complex biological system of structural, biochemical, biomolecular, and hemodynamic elements. Arterial stiffness could be considered a manifestation of wall structural and functional variations, and it has been revealed to have a strong connection with aortopathies and be a predictor of cardiovascular risk, especially in patients affected by hypertension, diabetes mellitus, and nephropathy. Stiffness affects the function of different organs, especially the brain, kidneys, and heart, promoting remodeling of small arteries and endothelial dysfunction. This parameter could be easily evaluated using different methods, but pulse-wave velocity (PWV), the speed of transmission of arterial pressure waves, is considered the gold standard for a good and precise assessment. An increased PWV value indicates an elevated level of aortic stiffness because of the decline in elastin synthesis and activation of proteolysis and the increase in fibrosis that contributes to parietal rigidity. Higher values of PWV could also be found in some genetic diseases, such as Marfan syndrome (MFS) or Loeys-Dietz syndrome (LDS). Aortic stiffness has emerged as a major new cardiovascular disease (CVD) risk factor, and its evaluation using PWV could be very useful to identify patients with a high cardiovascular risk, giving some important prognostic information but also being used to value the benefits of therapeutic strategies.

Clinical Characteristics and Outcomes of Aortic Arch Emergencies: Takayasu Disease, Fibromuscular Dysplasia, and Aortic Arch Pathologies: A Retrospective Study and Review of the Literature

“…There are many different mechanisms behind aortopathies, like the bicuspid aortic valve, inflammatory diseases, FMD, and heritable connective tissue disorders (e.g., Ehlers–Danlos syndrome) [ 56 , 57 ]. It has been reported that bovine arch variation is associated with the occurrence of aneurysms or type B aortic dissection [ 57 ], as well as with an early age at stroke presentation (on average, 53 years old), compared to normal branching pattern (61 years) [ 18 ].…”

“…Furthermore, type B dissections, such as the one in our present study, often occur in patients with normal-sized or only mildly enlarged aortae, and, therefore, are unpredictable [ 46 ]. Malformative pathology of the aorta is often associated with congenital and/or valve diseases [ 56 , 57 ]. Aortic dissection and rupture are often consequences of disturbed shear stress.…”

Effects of 12-week Circuit Exercise Intervention on Blood Pressure, Vascular Function, and Inflammatory Cytokines in Obese Older Women with Sarcopenia

“…Additionally, aging brings about various changes in the blood vessels, including increased arterial diameter, hypertrophy of the arterial wall, increased arterial stiffness, and endothelial dysfunction [ 12 , 13 , 14 , 15 , 16 ]. Furthermore, inflammation is described as a key mechanism in the development of atherosclerosis, with C-reactive protein (CRP), interleukins, tumor necrosis factor-alpha (TNF- ), and transforming growth factor-beta (TGF- 1) identified as risk factors [ 17 , 18 , 19 ].…”