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CC BY 4.0 · Aorta (Stamford) 2013; 01(05): 235-243
DOI: 10.12945/j.aorta.2013.13-034
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Influence of Cardiovascular Risk Factors on Aortic Wall Motion After Repair of Type A Aortic Dissection

An Electrocardiography-Gated Computed Tomography Study
Mariagrazia Croccia
1   Department of Cardiac Surgery, Heart Transplantation Division, University of Siena, Siena, Italy
,
Maurizio Levantino
2   Section of Cardiac Surgery, University Hospital, Pisa, Italy
,
Paolo Marraccini
3   Division of Radiology, University Hospital, Pisa, Italy
,
Federico Franchi
4   Department of Anesthesia and Intensive Care, University of Siena, Siena, Italy
,
Uberto Bortolotti
2   Section of Cardiac Surgery, University Hospital, Pisa, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf

19. Juli 2013

21. Oktober 2013

Publikationsdatum:
28. September 2018 (online)

   Lizenzen und Reprints

Abstract

Background: We aimed to evaluate size changes of the thoracic aorta during the cardiac cycle with dynamic computed tomographic angiography (CTA) at specific anatomic landmarks in patients who previously underwent ascending aorta repair because of type A dissection, and to correlate aortic wall motion with several cardiovascular risk factors.

Methods: From December 2008 to December 2010, 18 patients (14 men and 4 women, mean age 64 ± 12 years) with previous aortic repair underwent electrocardiography-gated CTA follow-up. Aortic systolic and diastolic diameter and cross-sectional area were measured at 4 levels: 1 cm proximal (level A) and 1 (B), 3 (C), and 10 cm (D) distal to the origin of the left subclavian artery. Results were assessed according to age and presence of diabetes, hypertension, and smoking.

Results: This morpho-functional evaluation of aortic wall motion demonstrated a significant influence (P < 0.05) of hypertension at level A and D and diabetes at level D. Smoking had a borderline significance at level C and D. No significant correlation with age was evident, with results not significantly different in patients ≤ 55 and > 55 years.

Conclusions: Smoking, diabetes, and hypertension play a role in impairing aortic size variations. These variations might predict wall structural alterations due to cardiovascular risk factors before they become morphologically evident. This might influence timing of surveillance following repair of acute dissection, allowing it to be specifically tailored for any single subject.

Key Words

Aortic dissection - Repair of aortic dissection - Computed tomography
 

  • References

  • 1 Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L. , et al. Epidemiology and clinicopathology of aortic dissection. Chest 2000; 117: 1271-1278 . 10.1378/chest.117.5.1271
    CrossrefPubMedGoogle Scholar
  • 2 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey Jr DE. , et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/ SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke. Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121: e266-e369 . 10.1161/CIR.0b013e3181d4739e
    PubMedGoogle Scholar
  • 3 McEniery CM, Wilkinson IB, Avolio AP. Age, hypertension and arterial function. Clin Exp Pharmacol Physiol 2007; 34: 665-671 . 10.1111/j.1440-1681.2007.04657.x
    CrossrefPubMedGoogle Scholar
  • 4 Lalande A, Khau Van Kien P, Walker PM, Zhu L, Legrand L, Claustres M. , et al. Compliance and pulse wave velocity assessed by MRI detect early aortic impairment in young patients with mutation of the smooth muscle myosin heavy chain. J Magn Reson Imaging 2008; 28: 1180-1187 . 10.1002/jmri.21565
    CrossrefPubMedGoogle Scholar
  • 5 van Herwaarden JA, Bartels LW, Muhs BE, Vincken KL, Lindeboom MY, Teutelink A. , et al. Dynamic magnetic resonance angiography of the aneurysm neck: conformational changes during the cardiac cycle with possible consequences for endograft sizing and future design. J Vasc Surg 2006; 44: 22-28 . 10.1016/j.jvs.2006.03.028
    CrossrefPubMedGoogle Scholar
  • 6 Muhs BE, Vincken KL, van Prehn J, Stone MK, Bartels LW, Prokop M. , et al. Dynamic cine-CT angiography for the evaluation of the thoracic aorta; insight in dynamic changes with implication for thoracic endograft treatment. Eur J Vasc Endovasc Surg 2006; 32: 532-536 . 10.1016/j.ejvs.2006.05.009
    CrossrefPubMedGoogle Scholar
  • 7 Liga R, Marini C, Coceani M, Filidei E, Schlueter M, Bianchi M. , et al. Structural abnormalities of the coronary arterial wall–in addition to luminal narrowing–affect myocardial blood flow reserve. J Nucl Med 2011; 52: 1704-1712 . 10.2967/jnumed.111.091009
    CrossrefPubMedGoogle Scholar
  • 8 Altman DG, Bland JM. Measurement in medicine: the analysis of method comparison studies. Statisticians 1983; 32: 307-317 . 10.2307/2987937
    PubMedGoogle Scholar
  • 9 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310
    PubMedGoogle Scholar
  • 10 Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B. , et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003; 34: 1203-1206 . 10.1161/01.STR.0000065428.03209.64
    CrossrefPubMedGoogle Scholar
  • 11 Ganten M, Krautter U, Hosch W, Hansmann J, von Tengg-Kobligk H, Delorme S. , et al. Age related changes of human aortic distensibility: evaluation with ECG-gated CT. Eur Radiol 2007; 17: 701-708 . 10.1007/s00330-006-0309-z
    CrossrefPubMedGoogle Scholar
  • 12 Blacher J, Safar ME, Guerin AP, Pannier B, Marchais SJ, London GM. Aortic pulse wave velocity index and mortality in end-stage renal disease. Kidney Int 2003; 63: 1852-1860 . 10.1046/j.1523-1755.2003.00932.x
    CrossrefPubMedGoogle Scholar
  • 13 Herrington DM, Kesler K, Reiber Jh, Davis W, Brown WV, Helms R. , et al. Arterial compliance adds to conventional risk factors for prediction of angiographic coronary artery disease. Am Heart J 2003; 146: 662-667 . 10.1016/S0002-8703(03)00254-0
    CrossrefPubMedGoogle Scholar
  • 14 van Prehn J, Vincken KL, Muhs BE, Barwegen GK, Bartels LW, Prokop M. , et al. Toward endografting of the ascending aorta: insight into dynamics using dynamic cine-CTA. J Endovasc Ther 2007; 14: 551-560 . 10.1583/1545-1550(2007)14[551:TEOTAA]2.0.CO;2
    CrossrefPubMedGoogle Scholar
  • 15 van Prehn J, Bartels LW, Mestres G, Vincken KL, Prokop M, Verhagen HJ. , et al. Dynamic aortic changes in patients with thoracic aortic aneurysms evaluated with electrocardiography-triggered computed tomographic angiography before and after thoracic endovascular aneurysm repair: preliminary results. Ann Vasc Surg 2009; 23: 291-297 . 10.1016/j.avsg.2008.08.007
    CrossrefPubMedGoogle Scholar
  • 16 Arko FR, Murphy EH, Davis 3rd CM, Johnson ED, Smith ST, Zarins CK. Dynamic geometry and wall thickness of the aortic neck of abdominal aortic aneurysms with intravascular ultrasonography. J Vasc Surg 2007; 46: 891-897 . 10.1016/j.jvs.2007.06.030
    CrossrefPubMedGoogle Scholar
  • 17 Goergen CJ, Johnson BL, Greve JM, Taylor CA, Zarins CK. Increased anterior abdominal aortic wall motion: possible role in aneurysm pathogenesis and design of endovascular devices. J Endovasc Ther 2007; 14: 574-584 . 10.1583/1545-1550(2007)14[574:IAAAWM]2.0.CO;2
    CrossrefPubMedGoogle Scholar
  • 18 Celermajer DS, Sorensen KE, Georgakopoulos D, Bull C, Thomas O, Robinson J. , et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation 1993; 88: 2149-2155 . 10.1161/01.CIR.88.5.2149
    CrossrefPubMedGoogle Scholar
  • 19 Metafratzi ZM, Efremidis SC, Scopelitou AS, De Roos A. The clinical significance of aortic compliance and its assessment with magnetic resonance imaging. J Cardiovasc Magn Reson 2002; 4: 481-491 . 10.1081/JCMR-120016386
    PubMedGoogle Scholar
  • 20 Shores J, Berger KR, Murphy EA, Pyeritz RE. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome. N Engl J Med 1994; 330: 1335-1341 . 10.1056/NEJM199405123301902
    CrossrefPubMedGoogle Scholar
  • 21 Suzuki T, Isselbacher EM, Nienaber CA, Pyeritz RE, Eagle KA, Tsai TT. , et al. Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD]). Am J Cardiol 2012; 109: 122-127 . 10.1016/j.amjcard.2011.08.012
    CrossrefPubMedGoogle Scholar
  • 22 Li N, Beck T, Chen J, Biermann C, Guo L, Sun H. , et al. Assessment of thoracic aortic elasticity: a preliminary study using electrocardiographically gated dual-source CT. Eur Radiol 2011; 21: 1564-1572 . 10.1007/s00330-011-2077-7
    CrossrefPubMedGoogle Scholar
  • 23 Duvernoy O, Coulden R, Ytterberg C. Aortic motion: a potential pitfall in CT imaging of dissection in the ascending aorta. J Comput Assist Tomogr 1995; 19: 569-572 . 10.1097/00004728-199507000-00012
    CrossrefPubMedGoogle Scholar
  • 24 Markl M, Wallis W, Strecker C, Gladstone BP, Vach W, Harloff A. Analysis of pulse wave velocity in the thoracic aorta by flow-sensitive four-dimensional MRI: reproducibility and correlation with characteristics in patients with aortic atherosclerosis. J Magn Reson Imaging 2012; 35: 1162-1168 . 10.1002/jmri.22856
    CrossrefPubMedGoogle Scholar
  • 25 Nollen GJ, Westerhof BE, Groenink M, Osnabrugge A, van der Wall EE, Mulder BJ. Aortic pressure-area relation in Marfan patients with and without beta blocking agents: a new non-invasive approach. Heart 2004; 90: 314-318 . 10.1136/hrt.2003.010702
    CrossrefPubMedGoogle Scholar