Elastic properties of aorta with respect to its dilatation vs aneurysm according to ECG-synchronized CT-angiography

Purpose: to compare the indicators of elasticity of the thoracic aorta, determined by ECG-Gated-CT angiography, in patients with ascending aortic aneurysm and dilatation.

Materials and methods. The study included 20 patients with dilatation of the ascending aorta (40 mm ≤ maximum aortic diameter (D_max) < 50 mm) (group 1a), 30 patients with non-syndromic aneurysms of the ascending aorta (n = 30, D_max ≥ 50 mm) (group 1b), as well as 19 patients with normal aortic sizes (D_max < 40 mm) as controls (group 2). All patients underwent multispiral computed tomography angiography of the aorta in ECG-Gated mode (ECG-Gated -CT). Maximum systolic and diastolic aortic diameters (D_max) were measured at different levels of the thoracic aorta, followed by calculation of the difference between them and calculation of the circular deformation (CS), compliance, stiffness (Stiff), wall distensibility, longitudinal deformation (LS).

Results. Moderate negative correlation between the age of the patients and CS at all levels of the thoracic aorta (r_maximum = –0.33, r_minimum = –0.41) was revealed. Groups 1a and 1b did not differ significantly in all parameters. Group 1a differed from the control group (p < 0.05) in Stiff at the level of the aortic annulus (AA) (0.07 [–0.14; 0.15] vs –0.04 [–0.1; 0.06]), as well as CS at the level of AA and sinuses of Valsalva (SV ) (0.49 [–2.94; 3.36] vs –1.18 [–4.51; 3.87]), and group 1b – in CS at the level of SV (3.73 [0.24; 6.56] vs 0.13 [–1.42; 3.04]) and proximal part of the descending aorta (distal to the left subclavian artery) (5.48 [1.27; 8.40] vs 1.97 [–0.32; 6.08]), also in LS (5.96 [–8.98; 9.25] vs –2.58 [–7.75; 1.89]) at the level of the aortic arch.

Conclusion. According to ECG-Gated-CT angiography, the indicators of elasticity of the thoracic aorta in patients with ascending aortic aneurysm and dilatation did not differ. Compared with the control group, patients with aneurysm of the ascending aorta showed an increased pulse deformity of the non-dilated aortic arch.

1. Isselbacher E.M. Thoracic and abdominal aortic aneurysms. Circulation. 2005; 111: 816–828. http://doi.org/10.1161/01.CIR.0000154569.08857.7A

2. Davis F.M., Luo Y., Avril S. et al. Local mechanical properties of human ascending thoracic aneurysms. J. Mech. Behav. Biomed. Mater. 2016; 61: 235–249. http://doi.org/10.1016/j.jmbbm.2016.03.025

3. Emerel L., Thunes J., Kickliter T. et al. Predissection-derived geometric and distensibility indices reveal increased peak longitudinal stress and stiffness in patients sustaining acute type A aortic dissection: Implications for predicting dissection. J. Thorac. Cardiovasc. Surg. 2019; 158 (2): 355–363. http://doi.org/10.1016/j.jtcvs.2018.10.116

4. Isselbacher E.M., Cardenas C.L.L., Lindsay M.E. Hereditary influence in thoracic aortic aneurysm and dissection. Circulation. 2016; 133 (24): 2516–2528. http://doi.org/10.1161/CIRCULATIONAHA.116.009762

5. Ilyushenkova J.N., Panfilov D.S., Saushkin V.V., Sonduev E.L., Kozlov B.N., Sazonova S.I. Scintigraphic imaging of inflammation in the aortic wall using 99m Tc-pyrophosphate. Sovremennye tehnologii v medicine = Modern Technologies in Medicine. 2021; 13 (6): 65–71. https://doi.org/10.17691/stm2021.13.6.07 (In Russian)

6. Hiratzka L.F., Bakris G.L., Beckman J.A. 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. 2014; 35 (41): 2873–2926. http://doi.org/10.1161/CIR.0b013e3181d4739e

7. Abugov S.A., Averina T.B., Akchurin R.S., Alekyan B.G., Arakelyan V.S., Vachev A.N., Gordeev M.L. et al. Clinical guidelines. guidelines for the diagnosis and treatment of aortic diseases (2017). The Russian Journal of Cardiology & Cardiovascular Surgery. 2018: 11 (1): 7–67. (In Russian)

8. Adriaans B.P., Wildberger J.E., Westenberg J.J.M. et al. Predictive imaging for thoracic aortic dissection and rupture: moving beyond diameters. Eur. Radiol. 2019; 29 (12): 6396–6404. http://doi.org/10.1007/s00330-019-06320-7

9. Koechlin L., Macius E., Kaufmann J. et al. Aortic root and ascending aorta dimensions in acute aortic dissection. Perfusion. 2020; 35 (2): 131–137. http://doi.org/10.1177/0267659119858848

10. Iddawela S., Ravendren A., Harky A. Bio-chemomechanics of the thoracic aorta. Vasc. Biol. 2021; 12; 3 (1): 25–33. http://doi.org/10.1530/VB-20-0015. eCollection 2021.

11. Pasta S., Agnese V., Giuseppe M.D. et al. In Vivo Strain Analysis of Dilated Ascending Thoracic Aorta by ECG-Gated CT Angiographic Imaging. Ann. Biomed. Eng. 2017; 45 (12): 2911–2920. http://doi.org/10.1007/s10439-017-1915-4

12. Skripnik A.Yu., Fokin V.A., Mironchuk R.R., Uspenskiy V.E., Irtyuga O.B., Kushnareva E.A., Rud S.D., Lepekhina A.S., Moiseeva O.M., Trufanov G.E. Assessment of the elastic properties of the ascending aorta using electro cardiographic synchronized computed tomography angiography with advanced data processing. Russian Journal of Cardiology. 2019; 12: 48–54. https://doi.org/10.15829/1560-4071-2019-12-48-54 (In Russian)

13. Morrison T.M., Choi G., Zarins C.K., Taylor C.A. Circumferential and longitudinal cyclic strain of the human thoracic aorta: Age-related changes. J. Vasc. Surg. 2009; 49 (4): 1029–1036. http://doi.org/10.1016/j.jvs.2008.11.056

14. Vatner S.F., Zhang J, Vyzas C. et al. Vascular Stiffness in Aging and Disease. Front. Physiol. 2021; 12: 762437. http://doi.org/10.3389/fphys.2021.762437

15. Zubair M.M., de Beaufort H.W.L., Belvroy V.M. et al. Impact of Cardiac Cycle on Thoracic Aortic Geometry – Morphometric Analysis of Ecg Gated Computed Tomography. Ann. Vasc. Surg. 2020; 65: 174–182. http://doi.org/10.1016/j.avsg.2019.10.072

16. de Beaufort H.W., Nauta F.J., Conti M. et al. Extensibility and Distensibility of the Thoracic Aorta in Patients with Aneurysm. Eur. J. Vasc. Endovasc. Surg. 2017; 53 (2): 199–205. http://doi.org/10.1016/j.ejvs.2016.11.018

17. Mitéran J., Bouchot O., Cochet A., Lalande A. Automatic determination of aortic compliance based on MRI and adapted curvilinear detector. Biomed. Signal Process Control. 2018; 40: 295–311. http://doi.org/10.1016/j.bspc.2017.09.002