Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

Bu, Zhaohui; Ma, Jun; Fan, Yibo; Qiao, Zhiqing; Kang, Yu; Zheng, Ying; Wang, Wei; Du, Yiqin; Zhang, Zheng; Shen, Xuedong; He, Ben; Pu, Jun

doi:10.1161/jaha.118.008802

Cited by 11 publications

(10 citation statements)

References 42 publications

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“…Increased afterload, reduced coronary perfusion, and LV hypertrophy have been reported proximal to, and increased aortic impedance distal to, prosthetic grafts. 6,22 Increased energy propagation has been hypothesised to be a contributor to pseudoaneurysm formations and distal aortic adverse remodelling. 7 Animal models have linked compliance mismatch between prosthetic endovascular grafts and the native descending aorta to postprocedure complications such as dissection, aneurysmal dilatation, and rupture distal to the repair.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…18 Likewise, a decrease in ascending aortic strain is an independent predictor of significant coronary artery disease in patients with coronary artery stenosis ≥70%. 19 Given the interdependence of systemic and renal hemodynamics, it is tempting to speculate that aortic stiffening is expected to have deleterious consequences on the renal vasculature. Renal resistive index (RRI) measured with intrarenal Doppler ultrasound is influenced by complex interactions between vascular wall properties and systemic factors and can be used to identify vascular dysfunction.…”

Section: Introductionmentioning

confidence: 99%

<p>Aortic Stiffness and Diastolic Dysfunction in Sprague Dawley Rats Consuming Short-Term Fructose Plus High Salt Diet</p>

Komnenov¹,

Levanovich²,

Perecki³

et al. 2020

IBPC

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Introduction: High fructose and salt consumption continues to be prevalent in western society. Existing studies show that a rat model reflecting a diet of fructose and salt consumed by the upper 20th percentile of the human population results in salt-sensitive hypertension mitigated by treatment with an antioxidant. We hypothesized that dietary fructose, rather than glucose, combined with high salt leads to aortic stiffening and decreased renal artery compliance. We also expect that daily supplementation with the antioxidant, 4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl (+T; Tempol), will ameliorate the increase in mean arterial pressure (MAP) and vascular changes. Methods: Male Sprague Dawley rats were studied with either 20% fructose or 20% glucose in the drinking water and normal salt (0.4%) or high salt (4%) in the chow resulting in four dietary groups: fructose normal Fru+NS or high salt (Fru+HS) or glucose with normal (Glu +NS) or high salt (Glu+HS). Tempol (+T) was added to the drinking water in half of the rats in each group for 3 weeks. Results: MAP was significantly elevated and the glucose:insulin ratio was depressed in the Fru+HS. Both parameters were normalized in Fru+HS+T. Plasma renin activity (PRA) and kidney tissue angiotensin II (Ang II) were not suppressed in the high salt groups. Pulse wave velocity (PWV), radial ascending strain, and distensibility coefficient of the ascending aorta were significantly decreased in Fru+HS rats and improved in the Fru+HS+T rats. No differences occurred in left ventricular systolic function, but the ratio of early (E) to late (A) transmitral filling velocities was decreased and renal resistive index (RRI) was higher in Fru+HS rats; antioxidant treatment did not change these indices. Discussion: Thus, short-term consumption of high fructose plus high salt diet by rats results in modest hypertension, insulin resistance, diminished aortic and renal artery compliance, and left ventricular diastolic dysfunction. Antioxidant treatment ameliorates the blood pressure, insulin resistance and aortic stiffness, but not renal artery stiffness and left ventricular diastolic dysfunction.

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“…In linear models adjusted for age, sex, and the first five principal components of ancestry, hypertension diagnosed prior to imaging was associated with lower strain and distensibility ( Figure 2 left panel ). The presence of coronary artery disease (CAD) was associated with increased strain and distensibility, contrary to expectation 16 . The strongest CAD association was with descending aortic strain, which was 0.24 standard deviation (SD) higher in those with a history of CAD (P = 1.6E-26).…”

Section: Resultsmentioning

confidence: 75%

The Genetic Determinants of Aortic Distension

Choi

Chaffin

Nekoui

et al. 2021

Preprint

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As the largest conduit vessel, the aorta is responsible for the conversion of phasic systolic inflow from ventricular ejection into more continuous blood delivery to peripheral arteries. Distension during systole and recoil during diastole conserves ventricular energy and is enabled by the specialized composition of the aortic extracellular matrix. Aortic distensibility decreases with age and prematurely in vascular disease. To discover genetic determinants of aortic distensibility we trained a deep learning model to quantify aortic size throughout the cardiac cycle and calculate aortic distensibility and aortic strain in 42,342 participants in the UK Biobank with available cardiac magnetic resonance imaging. In up to 40,028 participants with genetic data, common variant analysis identified 12 and 26 loci for ascending and 11 and 21 loci for descending aortic distensibility and strain, respectively. Of the newly identified loci, 22 were specific to strain or distensibility and were not identified in a thoracic aortic diameter GWAS within the same samples. Loci associated with both aortic diameter and aortic strain or distensibility demonstrated a consistent, inverse directionality. Transcriptome-wide analyses, rare-variant burden tests, and analyses of gene expression in single nucleus RNA sequencing of human aorta were performed to prioritize genes at individual loci. Loci highlighted multiple genes involved in elastogenesis, matrix degradation, and extracellular polysaccharide generation. Characterization of the genetic determinants of aortic function may provide novel targets for medical intervention in aortic disease.

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Ascending Aortic Strain Analysis Using 2‐Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris

Cited by 11 publications

References 42 publications

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

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

<p>Aortic Stiffness and Diastolic Dysfunction in Sprague Dawley Rats Consuming Short-Term Fructose Plus High Salt Diet</p>

The Genetic Determinants of Aortic Distension

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