Current evidence in predictors of aortic growth and events in acute type B aortic dissection

Spinelli, Domenico; Benedetto, Filippo; Donato, Rocco; Piffaretti, Gabriele; Marrocco-Trischitta, Massimiliano M.; Patel, Himanshu J.; Eagle, Kim A.; Trimarchi, Santi

doi:10.1016/j.jvs.2018.05.232

Cited by 80 publications

(66 citation statements)

References 62 publications

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“…Current treatment protocols and surgical criteria are largely based on anatomic variables, the most important of which is maximum aortic diameter [ 7 ]. Aortic diameter is a simple metric, and has a direct relationship with tensile wall stress (i.e., Law of Laplace).…”

Section: Discussionmentioning

confidence: 99%

“…Aortic diameter is a simple metric, and has a direct relationship with tensile wall stress (i.e., Law of Laplace). However, in a recent systematic review of growth in TBAD, maximal aortic diameter was associated with growth in only ~ 50% of studies, highlighting the need for better risk stratification tools [ 7 ]. While our results support the association between baseline diameter and aortic growth we also found that FLEF and FL ΔP max provided additional predictive value over baseline diameter alone.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Current methods for predicting growth in TBAD are based on anatomic features, most commonly maximal aortic diameter [ 7 ]. However, such evaluation does not include assessment of abnormal blood flow [ 7 – 9 ], which is believed to play an important role in driving aortic growth. An increasing body of experimental evidence [ 10 – 17 ] has demonstrated that an excess of FL inflow relative to outflow leads to increasing pressurization of the FL, which promotes growth due to elevated stresses on the weakened aortic wall.…”

Section: Introductionmentioning

confidence: 99%

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False lumen pressure estimation in type B aortic dissection using 4D flow cardiovascular magnetic resonance: comparisons with aortic growth

Marlevi

Sotelo

Grogan-Kaylor

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Chronic type B aortic dissection (TBAD) is associated with poor long-term outcome, and accurate risk stratification tools remain lacking. Pressurization of the false lumen (FL) has been recognized as central in promoting aortic growth. Several surrogate imaging-based metrics have been proposed to assess FL hemodynamics; however, their relationship to enlarging aortic dimensions remains unclear. We investigated the association between aortic growth and three cardiovascular magnetic resonance (CMR)-derived metrics of FL pressurization: false lumen ejection fraction (FLEF), maximum systolic deceleration rate (MSDR), and FL relative pressure (FL ΔPmax). Methods CMR/CMR angiography was performed in 12 patients with chronic dissection of the descending thoracoabdominal aorta, including contrast-enhanced CMR angiography and time-resolved three-dimensional phase-contrast CMR (4D Flow CMR). Aortic growth rate was calculated as the change in maximal aortic diameter between baseline and follow-up imaging studies over the time interval, with patients categorized as having either ‘stable’ (< 3 mm/year) or ‘enlarging’ (≥ 3 mm/year) growth. Three metrics relating to FL pressurization were defined as: (1) FLEF: the ratio between retrograde and antegrade flow at the TBAD entry tear, (2) MSDR: the absolute difference between maximum and minimum systolic acceleration in the proximal FL, and (3) FL ΔPmax: the difference in absolute pressure between aortic root and distal FL. Results FLEF was higher in enlarging TBAD (49.0 ± 17.9% vs. 10.0 ± 11.9%, p = 0.002), whereas FL ΔPmax was lower (32.2 ± 10.8 vs. 57.2 ± 12.5 mmHg/m, p = 0.017). MSDR and conventional anatomic variables did not differ significantly between groups. FLEF showed positive (r = 0.78, p = 0.003) correlation with aortic growth rate whereas FL ΔPmax showed negative correlation (r = − 0.64, p = 0.026). FLEF and FL ΔPmax remained as independent predictors of aortic growth rate after adjusting for baseline aortic diameter. Conclusion Comparative analysis of three 4D flow CMR metrics of TBAD FL pressurization demonstrated that those that focusing on retrograde flow (FLEF) and relative pressure (FL ΔPmax) independently correlated with growth and differentiated patients with enlarging and stable descending aortic dissections. These results emphasize the highly variable nature of aortic hemodynamics in TBAD patients, and suggest that 4D Flow CMR derived metrics of FL pressurization may be useful to separate patients at highest and lowest risk for progressive aortic growth and complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

False lumen pressure estimation in type B aortic dissection using 4D flow cardiovascular magnetic resonance: comparisons with aortic growth

Marlevi

Sotelo

Grogan-Kaylor

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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“…Review of type B dissections suggests that the size of the aorta at presentation, the size of the false lumen compared with true lumen, and the number of branches arising from the false lumen may be indicators of poor outcome if untreated. 5,6 To approach the treatment of the descending aorta, we must consider conditions at the time of presentation. The modified frozen elephant trunk has appeal when the stent can be placed to exclude any entry within the arch.…”

mentioning

confidence: 99%

Commentary: The proximal descending aorta is a “cruel mistress” and should not be ignored

Carpenter

2022

The Journal of Thoracic and Cardiovascular Surgery

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Using a reduced‐order model to investigate the effect of the heart rate on the aortic dissection

Keramati

Birgersson

Kim

et al. 2022

Numer Methods Biomed Eng

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The computational cost of a three‐dimensional (3D) fluid–structure interaction (FSI) simulation of a dissected aorta has prevented researchers from investigating the effect of a wide range of the heart rate on the hemodynamic quantities in the disease. We have presented a systematic procedure to develop a zero‐dimensional (0D) model for a dissected aorta. A series of numerical experiments were used to calculate the values for the resistance, inertance, and compliance of each lumen with irregular geometries. Having validated the results from the 0D model against those from the 3D model for one heart rate, we used the 0D model to investigate the effect of the heart rate of 50–150 bpm on the flow rates and the pressures in an idealized geometry of an aortic dissection. The 0D model showed acceptable accuracy when compared with the 3D FSI simulation. For instance, at peak systole, 7.18% relative error in the flow rate in the true lumen was observed for 0D and 3D simulations. The flow rate in the true lumen showed a stronger dependency on the heart rate, that is, 300% for the true lumen and 1.5% for the false lumen. The pressure difference between the lumina increased non‐monotonically as the heart beats faster. Because of its efficiency, the reported procedure can be used for uncertainty and sensitivity analysis of the hemodynamic quantities in a diseased aorta with complex geometries such as that of the aortic dissection.

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Current evidence in predictors of aortic growth and events in acute type B aortic dissection

Cited by 80 publications

References 62 publications

False lumen pressure estimation in type B aortic dissection using 4D flow cardiovascular magnetic resonance: comparisons with aortic growth

False lumen pressure estimation in type B aortic dissection using 4D flow cardiovascular magnetic resonance: comparisons with aortic growth

Commentary: The proximal descending aorta is a “cruel mistress” and should not be ignored

Using a reduced‐order model to investigate the effect of the heart rate on the aortic dissection

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