Gisela Teixido-Tura1, Alban Redheuil2, Jose Rodríguez-Palomares3, Laura Gutiérrez3, Violeta Sánchez4, Alberto Forteza5, Joao A C Lima6, David García-Dorado3, Artur Evangelista3. 1. Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain. Electronic address: gisela.tt@gmail.com. 2. University of Paris-Descartes, Georges-Pompidou-European-Hospital, APHP and INSERM U678, Paris, France. 3. Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain. 4. Department of Cardiology, Hospital Doce de Octubre, Madrid, Spain. 5. Department of Cardiovascular Surgery, Hospital Doce de Octubre, Madrid, Spain. 6. Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States.
Abstract
BACKGROUND: Previous studies demonstrated the usefulness of MRI in the evaluation of aortic biomechanics in Marfan patients with aortic dilatation. However, these parameters have not been well studied in earlier stages of aortic disease. The present work aimed to study aortic biomechanics: aortic distensibility (AD) and pulse wave velocity (PWV), by MRI in Marfan patients without advanced aortic disease. METHODS: Eighty consecutive Marfan patients were compared with 36 age- and sex-matched controls. MRI images at the level of ascending, descending and abdominal aorta were used to determine AD and PWV. RESULTS: Marfan patients (27 men; age: 32.0 ± 10.5 years; mean aortic root diameter: 37.2 ± 4.6mm) had lower AD at all levels (ascending 2.6 ± 2.1 vs. 6.2 ± 3.7 mm Hg(-1)·10(-3), p<0.001; descending 3.1 ± 2.0 vs. 8.3 ± 4.2, p<0.001; and abdominal 4.5 ± 2.2 vs. 14.0 ± 5.2, p<0.001), higher aortic arch PWV (8.1 ± 6.5 vs. 4.3 ± 1.8m/s, p<0.01) and ascending-to-abdominal PWV (6.1 ± 3.0 vs. 4.7 ± 1.5m/s, p<0.01) compared with controls. Thirty-five Marfan patients had a non-dilated aortic root (mean aortic root diameter: 34.5 ± 3.8 mm). In multivariable analyses, after adjustment for age, pulse pressure and aortic dimensions, AD remained lower and PWV higher in Marfan patients; even Marfan patients with non-dilated aortic root showed impaired aortic biomechanics compared with controls. Z-score for ascending AD<-3.5 distinguished Marfan patients from controls with 82.5% sensitivity and 86.1% specificity. CONCLUSIONS: Aortic biomechanics by MRI were abnormal in the entire aorta in Marfan patients. Moreover, Marfan patients without dilated aortic root showed clear impairment of aortic biomechanics, which suggests that they may be used as early markers of aortic involvement in these patients.
BACKGROUND: Previous studies demonstrated the usefulness of MRI in the evaluation of aortic biomechanics in Marfan patients with aortic dilatation. However, these parameters have not been well studied in earlier stages of aortic disease. The present work aimed to study aortic biomechanics: aortic distensibility (AD) and pulse wave velocity (PWV), by MRI in Marfan patients without advanced aortic disease. METHODS: Eighty consecutive Marfan patients were compared with 36 age- and sex-matched controls. MRI images at the level of ascending, descending and abdominal aorta were used to determine AD and PWV. RESULTS: Marfan patients (27 men; age: 32.0 ± 10.5 years; mean aortic root diameter: 37.2 ± 4.6mm) had lower AD at all levels (ascending 2.6 ± 2.1 vs. 6.2 ± 3.7 mm Hg(-1)·10(-3), p<0.001; descending 3.1 ± 2.0 vs. 8.3 ± 4.2, p<0.001; and abdominal 4.5 ± 2.2 vs. 14.0 ± 5.2, p<0.001), higher aortic arch PWV (8.1 ± 6.5 vs. 4.3 ± 1.8m/s, p<0.01) and ascending-to-abdominal PWV (6.1 ± 3.0 vs. 4.7 ± 1.5m/s, p<0.01) compared with controls. Thirty-five Marfan patients had a non-dilated aortic root (mean aortic root diameter: 34.5 ± 3.8 mm). In multivariable analyses, after adjustment for age, pulse pressure and aortic dimensions, AD remained lower and PWV higher in Marfan patients; even Marfan patients with non-dilated aortic root showed impaired aortic biomechanics compared with controls. Z-score for ascending AD<-3.5 distinguished Marfan patients from controls with 82.5% sensitivity and 86.1% specificity. CONCLUSIONS: Aortic biomechanics by MRI were abnormal in the entire aorta in Marfan patients. Moreover, Marfan patients without dilated aortic root showed clear impairment of aortic biomechanics, which suggests that they may be used as early markers of aortic involvement in these patients.
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