Abstract
Background
Thoracic aortic aneurysm (TAA) is a highly morbid disease. We have previously shown
that baseline hemodynamic measures reflecting aortic function are associated with
future TAA expansion. However, whether serial arterial hemodynamic assessment further
improves TAA growth assessment remains unknown. Therefore, we aimed to compare single
vs serial arterial hemodynamic assessments in the evaluation of future TAA growth.
Methods
Eighty-six unoperated participants with TAA underwent noninvasive arterial hemodynamic
assessment using arterial tonometry and echocardiography at baseline and after 1 year.
Aortic diameter was measured serially with the use of standard imaging modalities.
Stepwise multivariable linear regression was used to assess associations of baseline
and 1-year change (Δ) in arterial hemodynamic measures with TAA growth.
Results
Mean age was 62.7 ± 11.0 years; 79% were male. Mean aneurysm growth was 0.48 ± 0.54
mm/year after a follow-up of 2.96 ± 1.03 years. Yearly changes in arterial hemodynamic
measures ranged from −3.2% to +4.2%. Linear regression results showed that while baseline
arterial hemodynamic measures were independently associated with aneurysm growth (carotid-femoral
pulse wave velocity: β ± SE = 0.038 ± 0.013; aortic characteristic impedance: β ±
SE = 0.002 ± 0.001; proximal aortic compliance: β ± SE = −0.011 ± 0.006; forward pressure
wave amplitude: β ± SE 0.009 ± 0.002; reflected pressure wave amplitude: β ± SE =
0.017 ± 0.006; P < 0.05 for each), the 1-year Δ in these measures did not incrementally add to aneurysm
growth assessment (P > 0.05 for each Δ).
Conclusions
Although baseline measures of aortic function independently predict TAA expansion,
1-year changes in these measures do not improve this prediction. Thus, for TAA risk
assessment purposes, a baseline assessment of aortic function may suffice, which simplifies
its use for potential predictive algorithms.
Résumé
Contexte
L'anévrisme de l'aorte thoracique (AAT) est une maladie à morbidité élevée. Nous avons
précédemment montré que les mesures hémodynamiques de base qui reflètent la fonction
aortique sont associées à l'expansion ultérieure de l'AAT. Toutefois, on ne sait pas
encore si une série d'évaluations hémodynamiques artérielles améliore l'évaluation
de la progression de l'AAT. Nous avons donc cherché à comparer les évaluations hémodynamiques
artérielles, unitaires ou réalisées en série, dans l'évaluation de l'essor de l'AAT.
Méthodes
Quatre-vingt-six participants présentant un AAT, non opérés, ont subi une évaluation
hémodynamique artérielle non invasive à l'aide d'une tonométrie artérielle et d'une
échocardiographie, au début de l'étude et après un an. Le diamètre aortique a été
mesuré périodiquement, en utilisant les modalités d'imagerie standard. Une régression
linéaire multiple et séquentielle a été utilisée pour évaluer les associations entre
la variation (Δ) des mesures hémodynamiques artérielles au départ et après un an durant
la progression de l'AAT.
Résultats
L'âge moyen était de 62,7 ± 11,0 ans; 79 % étaient des hommes. La croissance moyenne
de l'anévrisme était de 0,48 ± 0,54 mm/an après un suivi de 2,96 ± 1,03 ans. Les changements
annuels des mesures hémodynamiques artérielles allaient de −3,2 % à +4,2 %. La résultante
de la régression linéaire a montré que si les mesures hémodynamiques artérielles de
base étaient indépendamment associées au développement de l'anévrisme (vitesse de
l'onde de pouls carotido-fémorale: β ± ES = 0,038 ± 0,013; impédance caractéristique
de l'aorte: β ± ES = 0,002 ± 0,001; compliance aortique proximale: β ± ES = −0,011
± 0,006; amplitude de l'onde de pression incidente: β ± ES = 0,009 ± 0,002; amplitude
de l'onde de pression réfléchie: β ± ES = 0,017 ± 0,006; P < 0,05 pour chacune), le Δ à un an de ces mesures n'a pas immensément contribué à
l'évaluation de la progression de l'anévrisme (P > 0,05 pour chaque Δ).
Conclusions
Bien que les mesures de base de la fonction aortique permettent de prédire l'essor
de l'AAT de façon indépendante, les changements à un an de ces mesures n'améliorent
pas cette prédiction. Ainsi, à des fins d'évaluation du risque d'AAT, une évaluation
de base de la fonction aortique peut suffire, ce qui simplifie son utilisation au
sein d'algorithmes prédictifs potentiels.
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Article info
Publication history
Published online: August 09, 2021
Accepted:
July 26,
2021
Received:
March 11,
2021
Footnotes
See page 1788 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
