Evaluation of aortic stiffness by a new simplified 2D speckle tracking analysis

Abstract

Arterial stiffness is a marker of cardiovascular damage and an independent predictor of major cardiovascular events, usually assessed via Carotid-Femoral Pulse Wave Velocity (cfPWV). The aim of this study was to test the feasibility and usefulness of aortic strain analysis using a simplified transthoracic echocardiography (TTE) speckle-tracking (ST) based method. 60 consecutive patients with normal blood pressure and aortic dimensions underwent TTE and cfPWV evaluation. Strain analysis was performed on the largest section of the ascending aorta (aA) with a dedicated software; three couples of speckles were identified within the anterior and posterior aortic wall and transverse segments connecting each couple traced. Peak ascending Aorta Strain (PaAS) was defined as the averaged peak percentage deformation of these segments during the cardiac cycle; aortic stiffness index β was defined as 100 × Ln(SBP/DBP)/PaAS. 17 patients were excluded for suboptimal TTE images. In the 43 analyzed individuals (male 58%, age 63 years) PaAS was 5.5 [3.7-8.6] % with excellent inter and intra observer reproducibility (ICC 95% for both). PaAS showed significant correlation with age (r = - 0.64), aA diameter (r = - 0.45), cfPWV (r = - 0.41), stroke volume (r = - 0.41) and heart rate (r = - 0.49). Age remained the only independent determinant of PaAS in a multivariate analysis. β (10.8 [5.9-15.0]) showed significant direct correlation with age, Pulse pressure, aA diameter and cfPWV. A simplified strain analysis of the ascending aorta is technically feasible with good reproducibility; PaAS and β index correlate well with established parameters of arterial stiffness and might represent a new index in evaluating vascular biomechanics.

Local transversal aortic strain is impaired in ascending aorta dilatation

“…Our data show that, in hypertensive patients, ascending aorta dilatation is associated with increased local aortic stiffness – as measured by transversal aortic strain by speckle tracking analysis. Abnormal Beta-SI, an indicator of reduced elastic function of the ascending aorta [8], was much more prevalent in patients with ascending aorta dilatation than in those with normal ascending aorta diameter. The association between aortic dimensions and local aortic stiffness was even more apparent in patients with ascending aorta more than 45 mm.…”

“…Aortic strain analysis with different imaging modalities has been studied and proposed as a technique to assess functional properties of the aorta [6,7]. A simplified, transthoracic echocardiography (TTE)-based approach evaluating transverse ascending aorta strain, has been recently proposed as a useful noninvasive imaging technique to evaluate ascending aorta elasticity [8]. In particular, b 2 -stiffness index (Beta-SI), which may be derived from strain analysis, describes aortic stiffness, reflects the biomechanical properties of the ascending aorta and may represent a new marker of cardiovascular damage.…”

The Evaluation of Longitudinal Strain of Large and Small Abdominal Aortic Aneurysm by Two‐Dimensional Speckle‐Tracking Ultrasound

“…As a simple and reproducible method, US can be used to measure the vascular deformation of abdominal aorta that indirectly reflects wall stress and also provides the aortic mechanical properties. 23,24 2D STI was an available and angleindependent assessment of the regional vascular strain, and the malformation could be obtained by semi-automatic calculation of the displacement between two points. However, previous studies only concentrated on the role of CS in AAA patients.…”

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“…However, the availability of appropriate equipment and experienced operators is essential to assess cfPWV. In addition, considering the required exposure of the inguinal area and the extended examination time, this method is mostly used in research settings rather than daily clinical practice 34. Echocardiography-based analysis of aortic deformation may be a widely available and relatively low-cost option to investigate the biomechanical properties of the ascending aorta.…”

“…The image quality is the most important factor for capturing a sufficient sequence of digital images over a cardiac cycle and may vary depending on the patient, operator and device. A good parasternal view clearly depicting the ascending aorta may be considered pivotal and insufficient image quality may adversely affect the results of this analysis 34…”