Intermediate pressure-normalized principal wall strain values are associated with increased abdominal aortic aneurysmal growth rates.

Autor:	Zottola ZR; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States., Kong DS; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States., Medhekar AN; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States., Frye LE; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States., Hao SB; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States., Gonring DW; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States., Hirad AA; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States., Stoner MC; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States., Richards MS; Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States., Mix DS; Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2023 Aug 31; Vol. 10, pp. 1232844. Date of Electronic Publication: 2023 Aug 31 (Print Publication: 2023).
DOI:	10.3389/fcvm.2023.1232844
Abstrakt:	Introduction: Current abdominal aortic aneurysm (AAA) assessment relies on analysis of AAA diameter and growth rate. However, evidence demonstrates that AAA pathology varies among patients and morphometric analysis alone is insufficient to precisely predict individual rupture risk. Biomechanical parameters, such as pressure-normalized AAA principal wall strain ( ε ρ + ¯ /PP, %/mmHg), can provide useful information for AAA assessment. Therefore, this study utilized a previously validated ultrasound elastography (USE) technique to correlate ε ρ + ¯ /PP with the current AAA assessment methods of maximal diameter and growth rate. Methods: Our USE algorithm utilizes a finite element mesh, overlaid a 2D cross-sectional view of the user-defined AAA wall, at the location of maximum diameter, to track two-dimensional, frame-to-frame displacements over a full cardiac cycle, using a custom image registration algorithm to produce ε ρ + ¯ /PP. This metric was compared between patients with healthy aortas and AAAs (≥3 cm) and compared between small and large AAAs (≥5 cm). AAAs were then separated into terciles based on ε ρ + ¯ /PP values to further assess differences in our metric across maximal diameter and prospective growth rate. Non-parametric tests of hypotheses were used to assess statistical significance as appropriate. Results: USE analysis was conducted on 129 patients, 16 healthy aortas and 113 AAAs, of which 86 were classified as small AAAs and 27 as large. Non-aneurysmal aortas showed higher ε ρ + ¯ /PP compared to AAAs (0.044 ± 0.015 vs. 0.034 ± 0.017%/mmHg, p  = 0.01) indicating AAA walls to be stiffer. Small and large AAAs showed no difference in ε ρ + ¯ /PP. When divided into terciles based on ε ρ + ¯ /PP cutoffs of 0.0251 and 0.038%/mmHg, there was no difference in AAA diameter. There was a statistically significant difference in prospective growth rate between the intermediate tercile and the outer two terciles (1.46 ± 2.48 vs. 3.59 ± 3.83 vs. 1.78 ± 1.64 mm/yr, p  = 0.014). Discussion: There was no correlation between AAA diameter and ε ρ + ¯ /PP, indicating biomechanical markers of AAA pathology are likely independent of diameter. AAAs in the intermediate tercile of ε ρ + ¯ /PP values were found to have nearly double the growth rates than the highest or lowest tercile, indicating an intermediate range of ε ρ + ¯ /PP values for which patients are at risk for increased AAA expansion, likely necessitating more frequent imaging follow-up. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Zottola, Kong, Medhekar, Frye, Hao, Gonring, Hirad, Stoner, Richards and Mix.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu