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Open AccessArticle

Aortic Stiffness Measured from Either 2D/4D Flow and Cine MRI or Applanation Tonometry in Coronary Artery Disease: A Case–Control Study

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Lan-Anh Nguyen

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Sophia Houriez-Gombaud-Saintonge

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J. Clin. Med. 2023, 12(11), 3643; https://doi.org/10.3390/jcm12113643 - 24 May 2023

Viewed by 296

Abstract

Background and objective: Aortic stiffness can be evaluated by aortic distensibility or pulse wave velocity (PWV) using applanation tonometry, 2D phase contrast (PC) MRI and the emerging 4D flow MRI. However, such MRI tools may reach their technical limitations in populations with cardiovascular [...] Read more.

Background and objective: Aortic stiffness can be evaluated by aortic distensibility or pulse wave velocity (PWV) using applanation tonometry, 2D phase contrast (PC) MRI and the emerging 4D flow MRI. However, such MRI tools may reach their technical limitations in populations with cardiovascular disease. Accordingly, this work focuses on the diagnostic value of aortic stiffness evaluated either by applanation tonometry or MRI in high-risk coronary artery disease (CAD) patients. Methods: 35 patients with a multivessel CAD and a myocardial infarction treated 1 year before were prospectively recruited and compared with 18 controls with equivalent age and sex distribution. Ascending aorta distensibility and aortic arch 2D PWV were estimated along with 4D PWV. Furthermore, applanation tonometry carotid-to-femoral PWV (cf PWV) was recorded immediately after MRI. Results: While no significant changes were found for aortic distensibility; cf PWV, 2D PWV and 4D PWV were significantly higher in CAD patients than controls (12.7 ± 2.9 vs. 9.6 ± 1.1; 11.0 ± 3.4 vs. 8.0 ± 2.05 and 17.3 ± 4.0 vs. 8.7 ± 2.5 m·s⁻¹ respectively, p < 0.001). The receiver operating characteristic (ROC) analysis performed to assess the ability of stiffness indices to separate CAD subjects from controls revealed the highest area under the curve (AUC) for 4D PWV (0.97) with an optimal threshold of 12.9 m·s⁻¹ (sensitivity of 88.6% and specificity of 94.4%). Conclusions: PWV estimated from 4D flow MRI showed the best diagnostic performances in identifying severe stable CAD patients from age and sex-matched controls, as compared to 2D flow MRI PWV, cf PWV and aortic distensibility. Full article

(This article belongs to the Special Issue Advances in Multimodality Aortic Imaging)

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Open AccessArticle

Comparison of In-Vivo and Ex-Vivo Ascending Aorta Elastic Properties through Automatic Deep Learning Segmentation of Cine-MRI and Biomechanical Testing

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Emmanouil Markodimitrakis

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Siyu Lin

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Emmanouil Koutoulakis

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Diana Marcela Marín-Castrillón

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Francisco Aarón Tovar Sáez

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Marie-Catherine Morgant

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Alain Lalande

J. Clin. Med. 2023, 12(2), 402; https://doi.org/10.3390/jcm12020402 - 04 Jan 2023

Viewed by 1548

Abstract

Ascending aortic aneurysm is a pathology that is important to be supervised and treated. During the years the aorta dilates, it becomes stiff, and its elastic properties decrease. In some cases, the aortic wall can rupture leading to aortic dissection with a high [...] Read more.

Ascending aortic aneurysm is a pathology that is important to be supervised and treated. During the years the aorta dilates, it becomes stiff, and its elastic properties decrease. In some cases, the aortic wall can rupture leading to aortic dissection with a high mortality rate. The main reference standard to measure when the patient needs to undertake surgery is the aortic diameter. However, the aortic diameter was shown not to be sufficient to predict aortic dissection, implying other characteristics should be considered. Therefore, the main objective of this work is to assess in-vivo the elastic properties of four different quadrants of the ascending aorta and compare the results with equivalent properties obtained ex-vivo. The database consists of 73 cine-MRI sequences of thoracic aorta acquired in axial orientation at the level of the pulmonary trunk. All the patients have dilated aorta and surgery is required. The exams were acquired just prior to surgery, each consisting of 30 slices on average across the cardiac cycle. Multiple deep learning architectures have been explored with different hyperparameters and settings to automatically segment the contour of the aorta on each image and then automatically calculate the aortic compliance. A semantic segmentation U-Net network outperforms the rest explored networks with a Dice score of 98.09% (±0.96%) and a Hausdorff distance of 4.88 mm (±1.70 mm). Local aortic compliance and local aortic wall strain were calculated from the segmented surfaces for each quadrant and then compared with elastic properties obtained ex-vivo. Good agreement was observed between Young’s modulus and in-vivo strain. Our results suggest that the lateral and posterior quadrants are the stiffest. In contrast, the medial and anterior quadrants have the lowest aortic stiffness. The in-vivo stiffness tendency agrees with the values obtained ex-vivo. We can conclude that our automatic segmentation method is robust and compatible with clinical practice (thanks to a graphical user interface), while the in-vivo elastic properties are reliable and compatible with the ex-vivo ones. Full article

(This article belongs to the Special Issue Advances in Multimodality Aortic Imaging)

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Open AccessArticle

What Are the Biomechanical Properties of an Aortic Aneurysm Associated with Quadricuspid Aortic Valve?

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Siyu Lin

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Marie-Catherine Morgant

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Diana M. Marín-Castrillón

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J. Clin. Med. 2022, 11(16), 4897; https://doi.org/10.3390/jcm11164897 - 20 Aug 2022

Viewed by 652

Abstract

Association of quadricuspid aortic valve (QAV) with ascending aortic aneurysms (AsAA) is rare. A 63-year-old female with hypertension was found (on MRI) to have an ascending aortic aneurysm (52 mm in maximum diameter) and dilatation at the level of the sinotubular junction (38 [...] Read more.

Association of quadricuspid aortic valve (QAV) with ascending aortic aneurysms (AsAA) is rare. A 63-year-old female with hypertension was found (on MRI) to have an ascending aortic aneurysm (52 mm in maximum diameter) and dilatation at the level of the sinotubular junction (38 mm in diameter) associated with quadricuspid aortic valve. An ascending aortic wall replacement surgery was performed. In this study, we focus on the behavior of the aorta associated with QAV considering the in vitro biomechanical characteristics and histology. The properties of QAV are closer to bicuspid aortic valve than tricuspid aortic valve, but with higher wall thickness. Full article

(This article belongs to the Special Issue Advances in Multimodality Aortic Imaging)

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