Combining Aortic Size With Arterial Hemodynamics Enhances Assessment of Future Thoracic Aortic Aneurysm Expansion

• Published in: Canadian journal of cardiology 2023-01, Vol.39 (1), p.40-48
• Main Authors: Zhu, Tina, Mian, Owais, Boodhwani, Munir, Beauchesne, Luc, Dennie, Carole, Chan, Kwan, Wells, George A., Rubens, Fraser, Coutinho, Thais
• Format: Article
• Language: English
• Subjects: Aged; Aorta; Aortic Aneurysm, Thoracic - diagnosis; Arteries; Blood Pressure - physiology; Female; Hemodynamics - physiology; Humans; Male; Middle Aged
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2022.09.010

Thoracic aortic aneurysm (TAA) is a deadly disease whose current method for risk stratification (aneurysm size) is imperfect. We sought to evaluate whether combining aortic size with hemodynamic measures that reflect the aorta’s function was superior to aortic size alone in the assessment of TAA expansion. One hundred thirty-seven nonoperated participants with TAA were followed prospectively. Aortic stiffness and pulsatile hemodynamics were noninvasively assessed at baseline with a combination of arterial tonometry with echocardiography using validated methodology. Aneurysm growth was calculated from standard imaging modalities. Multivariable linear regression models adjusted for potential confounders evaluated the association of aneurysm size and arterial hemodynamics, alone and in combination, with TAA growth. Sixty-nine percent of participants were male. Mean ± SD age, baseline aneurysm size, follow-up, and aneurysm expansion were, respectively, 62.2 ± 11.4 years, 45.9 ± 4.0 mm, 4.5 ± 1.9 years, and 0.41 ± 0.46 mm/year. In the linear regression models, the standardised β (β∗) for the association of aneurysm size with aneurysm expansion was 0.178 (P = 0.044). This was improved by combining aortic size with most measures of aortic function, with β∗ ranging from 0.192 (for aneurysm size combined with central diastolic blood pressure) to 0.484 (for aneurysm size combined with carotid-femoral pulse-wave velocity) (P ≤ 0.05 for each). Combining aneurysm size with measures of arterial function improves assessment of aneurysm growth over TAA size alone, which is the standard for clinical decisions in TAA. Thus, combining aneurysm size with measures of aortic function provides a clinical advantage in the assessment of TAA disease activity. L’anévrisme de l’aorte thoracique (AAT) est une maladie mortelle pour laquelle la méthode actuelle de stratification du risque (la taille de l’anévrisme) demeure imparfaite. Nous avons entrepris d’évaluer si l’on pouvait mieux mesurer la dilatation de l’AAT en utilisant, en plus de la taille de l’aorte, des mesures hémodynamiques reflétant la fonction aortique. Cent trente-sept patients présentant un AAT et n’ayant pas subi d’opération ont été l’objet d’un suivi prospectif. Une évaluation initiale non invasive de la rigidité aortique et de la pulsatilité hémodynamique a été réalisée en conjuguant la tonométrie artérielle et l’échocardiographie, selon une méthodologie validée. La dilatation de l’anévrisme a été calculée à parti