The use of ultrasound to assess aortic biomechanics: Implications for aneurysm and dissection

Abstract

Arterial stiffening, which occurs when conduit arteries thicken and lose elasticity, has been associated with cardiovascular disease and increased risk for future cardiovascular events. Specifically, aortic stiffening plays a large role in the pathogenesis of vascular diseases, such as aneurysm formation and dissection. Current parameters used to assess risk of aortic rupture include absolute diameter and growth rate. However, these properties lack the reliability required to accurately risk‐stratify patients. As with any elastic conduit, it is important to assess the biomechanical properties of the aorta in order to assess cardiovascular risk and prevent disease progression. There are several invasive and noninvasive methods by which stiffness of the large arteries can be assessed. Of particular interest are ultrasound‐based methods, such as tissue Doppler imaging and speckle‐tracking echocardiography, due to their noninvasive and feasible nature. In this review, we summarize studies demonstrating utility of noninvasive ultrasound imaging methods for measuring aortic biomechanics for the assessment and management of aortic aneurysms.

Assessment of the Global and Regional Circumferential Strain of Abdominal Aortic Aneurysm with Different Size by Speckle‐Tracking Echocardiography

“…Several limitations should be summarized. First, STE relied on good acoustic windows in order to adequately analyze all segments of the aorta 30 . Therefore, speckle‐tracking method could not be performed properly in the patients with a limited echogenicity due to AAA depth, bowel gas or aortic wall calcification.…”

“…First, STE relied on good acoustic windows in order to adequately analyze all segments of the aorta. 30 Therefore, speckle-tracking method could not be performed properly in the patients with a limited echogenicity due to AAA depth, bowel gas or aortic wall calcification. Second, the sample size was relatively small, and aneurysm asymmetry and presence of thrombus in each wall were not analyzed.…”

Biventricular interaction and aortic function in adult patients with repaired tetralogy of Fallot: a two-dimensional–three-dimensional speckle-tracking echocardiographic study

“…To assess aortic distensibility echocardiographic tracings were obtained using a 2D guided M-mode evaluation of systolic and diastolic aortic diameter, 3 cm above the aortic valve. The elastic properties of the aorta were indexed by calculation 19–21 of aortic distensibility ( D ) and stiffness index (SI) as D = 2( A s − A d )/[ A d ( P s − P d )], and SI = ln( P s / P d )/( A s − A d )/ A d , respectively, where A s is the aortic diameter at end-systole, A d is the aortic diameter at end-diastole, P s is the systolic blood pressure, P d is the diastolic blood pressure, and ln is the natural logarithm. Aortic wall TDI velocities were obtained by marking a region of interest on the 2D image in the anterior aspect of the ascending aorta at the same point as in M-mode measurements.…”

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

“…However, PWS was inconvenient to obtain in clinical practice due to complex techniques and calculations. As one convenient method, ultrasound (US) has exhibited its feasibility in the measurement of AAA diameters and biomechanical properties 11 . Conventional aortic stiffness parameters, such as aortic strain, stiffness index β, elastic modulus, and distensibility derived from M‐Mode US, can predict the alterations of elasticity in AAA 12 .…”

“…As one convenient method, ultrasound (US) has exhibited its feasibility in the measurement of AAA diameters and biomechanical properties. 11 Conventional aortic stiffness parameters, such as aortic strain, stiffness index β, elastic modulus, and distensibility derived from M-Mode US, can predict the alterations of elasticity in AAA. 12 However, M-Mode US is angle-dependent and influenced by a field of view and depth, and its application in evaluating diameter changes in cases with complex anatomy is limited.…”