Local transversal aortic strain is impaired in ascending aorta dilatation.
Journal
Journal of hypertension
ISSN: 1473-5598
Titre abrégé: J Hypertens
Pays: Netherlands
ID NLM: 8306882
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
pubmed:
6
1
2021
medline:
16
10
2021
entrez:
5
1
2021
Statut:
ppublish
Résumé
Ascending aorta dilatation is found in 13% of hypertensive patients. Little is known about elastic properties of ascending aorta in such patients. Echo-based transverse aortic strain analysis can describe mechanical properties of ascending aorta but has never been applied to patients with ascending aorta dilatation. To assess mechanical properties of ascending aorta by transverse aortic strain analysis (as β2-stiffness index) in hypertensive patients with ascending aorta dilatation and association between mechanical properties of ascending aorta and cardiovascular damage. A total of 100 hypertensive outpatients underwent transthoracic echocardiography and assessment of pulse wave velocity (PWV). Strain analysis of ascending aorta was performed with echocardiographic speckle-tracking software. Patients were divided in three groups based on ascending aorta diameter: less than 40, 40-45, and at least 45 mm. Beta-SI increased exponentially with ascending aorta dimensions (P < 0.001). Patients with ascending aorta dilatation had Beta-SI significantly higher than those with normal ascending aorta diameter. A greater proportion of patient with impaired (i.e., elevated) Beta-SI was present in groups with larger ascending aorta (18.2 vs. 48.4 vs. 80%, respectively, P < 0.05). On multivariate logistic regression only impaired Beta-SI predicted ascending aorta dilatation (P < 0.001). Beta-SI was related to cardiovascular damage in terms of left ventricular (LV) mass (LV mass indexed to BSA, P = 0.030) and PWV (P = 0.028). Patients with high Beta-SI had greater LV mass indexed to BSA (117 ± 47 vs. 94 ± 24 g/m2; P = 0.010) and PWV (10.20 ± 2.99 vs. 8.63 ± 1.88 m/s; P = 0.013). Ascending aorta dilatation is associated with increased local aortic stiffness in hypertensive patients. Strain analysis adds functional information to the mere morphological evaluation of aortic diameter and could be a useful tool to better define cardiovascular risk in this population.
Sections du résumé
BACKGROUND
Ascending aorta dilatation is found in 13% of hypertensive patients. Little is known about elastic properties of ascending aorta in such patients. Echo-based transverse aortic strain analysis can describe mechanical properties of ascending aorta but has never been applied to patients with ascending aorta dilatation.
AIM
To assess mechanical properties of ascending aorta by transverse aortic strain analysis (as β2-stiffness index) in hypertensive patients with ascending aorta dilatation and association between mechanical properties of ascending aorta and cardiovascular damage.
METHODS
A total of 100 hypertensive outpatients underwent transthoracic echocardiography and assessment of pulse wave velocity (PWV). Strain analysis of ascending aorta was performed with echocardiographic speckle-tracking software. Patients were divided in three groups based on ascending aorta diameter: less than 40, 40-45, and at least 45 mm.
RESULTS
Beta-SI increased exponentially with ascending aorta dimensions (P < 0.001). Patients with ascending aorta dilatation had Beta-SI significantly higher than those with normal ascending aorta diameter. A greater proportion of patient with impaired (i.e., elevated) Beta-SI was present in groups with larger ascending aorta (18.2 vs. 48.4 vs. 80%, respectively, P < 0.05). On multivariate logistic regression only impaired Beta-SI predicted ascending aorta dilatation (P < 0.001). Beta-SI was related to cardiovascular damage in terms of left ventricular (LV) mass (LV mass indexed to BSA, P = 0.030) and PWV (P = 0.028). Patients with high Beta-SI had greater LV mass indexed to BSA (117 ± 47 vs. 94 ± 24 g/m2; P = 0.010) and PWV (10.20 ± 2.99 vs. 8.63 ± 1.88 m/s; P = 0.013).
CONCLUSION
Ascending aorta dilatation is associated with increased local aortic stiffness in hypertensive patients. Strain analysis adds functional information to the mere morphological evaluation of aortic diameter and could be a useful tool to better define cardiovascular risk in this population.
Identifiants
pubmed: 33399306
doi: 10.1097/HJH.0000000000002757
pii: 00004872-202107000-00023
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1402-1411Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021–3104.
Milan A, Degli Esposti D, Salvetti M, Izzo R, Moreo A, Pucci G, et al. Prevalence of proximal ascending aorta and target organ damage in hypertensive patients: the multicentric ARGO-SIIA project (Aortic RemodellinG in hypertensiOn of the Italian Society of Hypertension). J Hypertens 2019; 37:57–64.
Milan A, Tosello F, Naso D, Avenatti E, Leone D, Magnino C, et al. Ascending aortic dilatation, arterial stiffness and cardiac organ damage in essential hypertension. J Hypertens 2013; 31:109–116.
Cuspidi C, Facchetti R, Bombelli M, Re A, Cairoa M, Sala C, et al. Aortic root diameter and risk of cardiovascular events in a general population: data from the PAMELA study. J Hypertens 2014; 32:1879–1887.
Canciello G, Mancusi C, Losi MA, Izzo R, Trimarco B, de Simone G, et al. Aortic root dilatation is associated with incident cardiovascular events in a population of treated hypertensive patients: the Campania Salute Network. Am J Hypertens 2018; 31:1317–1323.
Bell V, Mitchell WA, Sigurethsson S, Westenberg JJ, Gotal JD, Torjesen AA, et al. Longitudinal and circumferential strain of the proximal aorta. J Am Heart Assoc 2014; 3:e001536.
Cho JY, Kim KH. Evaluation of arterial stiffness by echocardiography: methodological aspects. Chonnam Med J 2016; 52:101–106.
Sabia L, Avenatti E, Cesareo M, Leone D, Tosello F, Veglio F, et al. Evaluation of aortic stiffness by a new simplified 2D speckle tracking analysis. Int J Cardiovasc Imaging 2018; 34:1753–1760.
Guala A, Teixido-Tura G, Rodriguez-Palomares J, Ruiz-Munoz A, Dux-Santoy L, Villalva N, et al. Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome. Eur Heart J 2019; 40:2047–2055.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1–39.e14.
Muraru D, Maffessanti F, Kocabay G, Peluso D, Dal Bianco L, Piasentini E, et al. Ascending aorta diameters measured by echocardiography using both leading edge-to-leading edge and inner edge-to-inner edge conventions in healthy volunteers. Eur Heart J Cardiovasc Imaging 2014; 15:415–422.
Leone D, Cina A, Tosello F, Sabia L, Vallelonga F, Avenatti E, et al. Proximal aortic diameter evolution in hypertensive patients with mild-to-moderate aortic dilatation: a 5-year follow-up experience. J Hypertens 2019; 38:716–722.
Townsend RR. Arterial stiffness: recommendations and standardization. Pulse (Basel) 2017; 4: (Suppl 1): 3–7.
Cavalcante JL, Lima JA, Redheuil A, Al-Mallah MH. Aortic stiffness: current understanding and future directions. J Am Coll Cardiol 2011; 57:1511–1522.
Nichols WW. Clinical measurement of arterial stiffness obtained from noninvasive pressure waveforms. Am J Hypertens 2005; 18 (1 Pt 2):3S–10S.
Biswas M, Sudhakar S, Nanda NC, Buckberg G, Pradhan M, Roomi AU, et al. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography 2013; 30:88–105.
Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women. Hypertension 2004; 43:1239–1245.
Kim JB, Spotnitz M, Lindsay ME, MacGillivray TE, Isselbacher EM, Sundt TM 3rd. Risk of aortic dissection in the moderately dilated ascending aorta. J Am Coll Cardiol 2016; 68:1209–1219.
Pape LA, Tsai TT, Isselbacher EM, Oh JK, O’Gara PT, Evangelista A, et al. Aortic diameter >or =5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation 2007; 116:1120–1127.
Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55:1318–1327.
Milan A, Tosello F, Fabbri A, Vairo A, Leone D, Chiarlo M, et al. Arterial stiffness: from physiology to clinical implications. High Blood Press Cardiovasc Prev 2011; 18:1–12.
Tosello F, Leone D, Laurent S, Veglio F, Milan A. Out of proportion proximal aortic remodeling: a subclinical marker of early vascular ageing? A systematic review. Int J Cardiol 2016; 223:999–1006.
Laurent S, Marais L, Boutouyrie P. The noninvasive assessment of vascular aging. Can J Cardiol 2016; 32:669–679.
Nollen GJ, Groenink M, Tijssen JG, Van Der Wall EE, Mulder BJ. Aortic stiffness and diameter predict progressive aortic dilatation in patients with Marfan syndrome. Eur Heart J 2004; 25:1146–1152.
Kroner ES, Scholte AJ, de Koning PJ, van den Boogaard PJ, Kroft LJ, van der Geest RJ, et al. MRI-assessed regional pulse wave velocity for predicting absence of regional aorta luminal growth in marfan syndrome. Int J Cardiol 2013; 167:2977–2982.
Milan A, Zocaro G, Leone D, Tosello F, Buraioli I, Schiavone D, et al. Current assessment of pulse wave velocity: comprehensive review of validation studies. J Hypertens 2019; 37:1547–1557.
Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27:2588–2605.
Nemes A, Geleijnse ML, Forster T, Soliman OI, Ten Cate FJ, Csanady M. Echocardiographic evaluation and clinical implications of aortic stiffness and coronary flow reserve and their relation. Clin Cardiol 2008; 31:304–309.
Kawasaki T, Sasayama S, Yagi S, Asakawa T, Hirai T. Noninvasive assessment of the age related changes in stiffness of major branches of the human arteries. Cardiovasc Res 1987; 21:678–687.
Hirai T, Sasayama S, Kawasaki T, Yagi S. Stiffness of systemic arteries in patients with myocardial infarction. A noninvasive method to predict severity of coronary atherosclerosis. Circulation 1989; 80:78–86.
Dernellis J, Panaretou M. Aortic stiffness is an independent predictor of progression to hypertension in nonhypertensive subjects. Hypertension 2005; 45:426–431.