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Canadian Journal of Cardiology

Estimated Aortic Pulse Wave Velocity Is Associated With Faster Thoracic Aortic Aneurysm Growth: A Prospective Cohort Study With Sex-Specific Analyses

  • Kevin E. Boczar
    Affiliations
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

    School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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  • Munir Boodhwani
    Affiliations
    Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Luc Beauchesne
    Affiliations
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Carole Dennie
    Affiliations
    Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada

    Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Kwan Chan
    Affiliations
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • George A. Wells
    Affiliations
    School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada

    Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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  • Thais Coutinho
    Correspondence
    Corresponding author: Dr Thais Coutinho, Division of Cardiac Prevention and Rehabilitation, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada. Tel.: +1-613-696-7397; fax: +1-613-696-7133.
    Affiliations
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

    School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada

    Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

    Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Published:August 07, 2022DOI:https://doi.org/10.1016/j.cjca.2022.07.013

      Abstract

      Background

      Thoracic aortic aneurysm (TAA) is associated with high morbidity and mortality, and there is a critical need for improved tools for risk assessment and prognostication. We have previously shown that aortic stiffness, measured from arterial tonometry (carotid-femoral pulse wave velocity [cfPWV]), is independently associated with TAA expansion. To increase clinical applicability, we sought to determine the association of mathematically estimated aortic pulse wave velocity (e-PWV) with TAA expansion.

      Methods

      One-hundred and five consecutive unoperated subjects with TAA were recruited. We used arterial tonometry to measure cfPWV and used mean arterial pressure and age to calculate e-PWV according to validated equations. Multivariable linear regression assessed associations of baseline e-PWV with future aneurysm growth. Given sex differences in TAA outcomes, sex-stratified analyses were performed.

      Results

      Seventy-eight percent of subjects were men. Mean ± standard deviation (SD) age, baseline aneurysm size, and follow-up time were 62.6 ± 11.4 years, 46.2 ± 3.8 mm, and 2.9 ± 1.0 years, respectively. Aneurysm growth was 0.43 ± 0.37 mm per year; e-PWV was independently associated with future aneurysm expansion (β ± SE: 0.240 ± 0.085, P = 0.006). In sex-specific analyses, e-PWV was associated with aneurysm growth in both men (β ± standard error (SE) : 0.076 ± 0.022, P = 0.001) and women (β ± SE : 0.145 ± 0.050, P = 0.012), but the strength of association nearly twice as strong in women as in men.

      Conclusions

      Greater aortic stiffness reflects worse aortic health and provides novel insights into disease activity; e-PWV is independently associated with TAA growth. This finding increases clinical applicability, as e-PWV can be estimated simply, quickly, and free of cost without the need for specialized equipment.

      Résumé

      Contexte

      L’anévrisme de l’aorte thoracique (AAT) est associé à un taux élevé de morbidité et de mortalité, et il est urgent d’améliorer les outils d’évaluation du risque et d’établissement du pronostic. Nous avons déjà démontré que la rigidité aortique, mesurée par tonométrie artérielle (vitesse de l’onde de pouls carotido-fémorale [VOPcf]), est indépendamment associée à la dilatation de l’AAT. Pour accroître l’utilité clinique, nous avons cherché à mesurer l’association entre la vitesse de l’onde de pouls aortique estimée mathématiquement (VOP-e) et la dilatation de l’AAT.

      Méthodologie

      Nous avons recruté cent cinq sujets consécutifs présentant un AAT et n’ayant pas subi d’opération. Nous avons mesuré la VOPcf par tonométrie artérielle, puis calculé la VOP-e selon la pression artérielle moyenne et l’âge, à partir d’équations validées. Une régression linéaire multiple a permis d’évaluer l’association entre la VOP-e de référence et la dilatation ultérieure de l’anévrisme. En raison des différences liées au sexe quant aux données sur l’AAT, nous avons également mené des analyses stratifiées selon le sexe.

      Résultats

      Soixante-dix-huit pour cent des sujets étaient de sexe masculin. Les valeurs moyennes ± l’écart-type pour l’âge, la taille initiale de l’anévrisme et la durée de suivi étaient respectivement de 62,6 ± 11,4 ans, 46,2 ± 3,8 mm et 2,9 ± 1,0 ans. La dilatation de l’anévrisme était de 0,43 ± 0,37 mm par année; la VOP-e a été indépendamment associée à la dilatation ultérieure de l’anévrisme (β ± erreur type : 0,240 ± 0,085, P = 0,006). Dans les analyses spécifiques au sexe, la VOP-e a été associée à une dilatation de l’anévrisme tant chez les hommes (β ± erreur type : 0,076 ± 0,022, P = 0,001) que chez les femmes (β ± erreur type : 0,145 ± 0,050, P = 0,012), mais l’association était presque deux fois plus importante chez les femmes que chez les hommes.

      Conclusions

      Une rigidité aortique accrue est un signe de mauvaise santé aortique et jette un nouveau regard sur l’activité de la maladie, puisque la VOP-e est indépendamment associée à la dilatation de l’anévrisme. Ces résultats mettent en évidence l’utilité clinique de la VOP-e, car elle se mesure simplement, rapidement et gratuitement, sans nécessiter d’équipement spécialisé.

      Graphical abstract

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      References

        • Elefteriades J.A.
        Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks.
        Ann Thorac Surg. 2002; 74 (discussion S1892-8): S1877-S1880
        • Meszaros I.
        • Morocz J.
        • Szlavi J.
        • et al.
        Epidemiology and clinicopathology of aortic dissection.
        Chest. 2000; 117: 1271-1278
        • Kuzmik G.A.
        • Sang A.X.
        • Elefteriades J.A.
        Natural history of thoracic aortic aneurysms.
        J Vasc Surg. 2012; 56: 565-571
        • Boczar K.E.
        • Boodhwani M.
        • Beauchesne L.
        • et al.
        Aortic stiffness, central blood pressure, and pulsatile arterial load predict future thoracic aortic aneurysm expansion.
        Hypertension. 2021; 77: 126-134
        • Hiratzka L.F.
        • Bakris G.L.
        • Beckman J.A.
        • et al.
        2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.
        Anesth Analg. 2010; 111: 279-315
        • Pape L.A.
        • Tsai T.T.
        • Isselbacher E.M.
        • et al.
        Aortic diameter > or = 5.5 cm is not a good predictor of type a aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD).
        Circulation. 2007; 116: 1120-1127
        • Kim E.K.
        • Choi S.H.
        • Sung K.
        • et al.
        Aortic diameter predicts acute type a aortic dissection in patients with marfan syndrome but not in patients without marfan syndrome.
        J Thorac Cardiovasc Surg. 2014; 147: 1505-1510
        • Sharples L.
        • Sastry P.
        • Freeman C.
        • et al.
        Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: the effective treatments for thoracic aortic aneurysms study.
        Eur Heart J. 2022; 43: 2356-2369
        • Chung J.C.
        • Wong E.
        • Tang M.
        • et al.
        Biomechanics of aortic dissection: a comparison of aortas associated with bicuspid and tricuspid aortic valves.
        J Am Heart Assoc. 2020; 9e016715
        • Chung J.
        • Lachapelle K.
        • Wener E.
        • et al.
        Energy loss, a novel biomechanical parameter, correlates with aortic aneurysm size and histopathologic findings.
        J Thorac Cardiovasc Surg. 2014; 148 (discussion 1088-9): 1082-1088
        • Guala A.
        • Teixido-Tura G.
        • Rodriguez-Palomares J.
        • et al.
        Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in marfan syndrome.
        Eur Heart J. 2019; 40: 2047-2055
        • Vlachopoulos C.
        • Aznaouridis K.
        • Stefanadis C.
        Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.
        J Am Coll Cardiol. 2010; 55: 1318-1327
        • Greve S.V.
        • Blicher M.K.
        • Kruger R.
        • et al.
        Estimated carotid-femoral pulse wave velocity has similar predictive value as measured carotid-femoral pulse wave velocity.
        J Hypertens. 2016; 34: 1279-1289
        • Mattace-Raso F.U.S.
        • Hofman A.
        • Verwoert G.C.
        • et al.
        Reference Values for Arterial Stiffness' Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values.
        Eur Heart J. 2010; 31: 2338-2350
        • Coutinho T.
        • Borlaug B.A.
        • Pellikka P.A.
        • Turner S.T.
        • Kullo I.J.
        Sex differences in arterial stiffness and ventricular-arterial interactions.
        J Am Coll Cardiol. 2013; 61: 96-103
        • Laurent S.
        • Cockcroft J.
        • Van Bortel L.
        • et al.
        Expert consensus document on arterial stiffness: methodological issues and clinical applications.
        Eur Heart J. 2006; 27: 2588-2605
        • Kullo I.J.
        • Bielak L.F.
        • Turner S.T.
        • Sheedy 2nd, P.F.
        • Peyser P.A.
        Aortic pulse wave velocity is associated with the presence and quantity of coronary artery calcium: a community-based study.
        Hypertension. 2006; 47: 174-179
        • Cheung K.
        • Boodhwani M.
        • Chan K.L.
        • Beauchesne L.
        • Dick A.
        • Coutinho T.
        Thoracic aortic aneurysm growth: role of sex and aneurysm etiology.
        J Am Heart Assoc. 2017; 6
        • McClure R.S.
        • Brogly S.B.
        • Lajkosz K.
        • Payne D.
        • Hall S.F.
        • Johnson A.P.
        Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms in Ontario, Canada: a population-based study.
        J Thorac Cardiovasc Surg. 2018; 155: 2254-2264.e2254
        • Khaled I.
        • Priego P.
        • Soliman H.
        • Faisal M.
        • Saad Ahmed I.
        Oncological outcomes of laparoscopic versus open gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer: a retrospective multicenter study.
        World J Surg Oncol. 2021; 19: 206
        • Loh J.C.
        • Creaser J.
        • Rourke D.A.
        • et al.
        Temporal trends in treatment and outcomes for advanced heart failure with reduced ejection fraction from 1993-2010: findings from a university referral center.
        Circ Heart Fail. 2013; 6: 411-419
        • Humphrey J.D.
        • Tellides G.
        Central artery stiffness and thoracic aortopathy.
        Am J Physiol Heart Circ Physiol. 2019; 316: H169-H182
        • Arribas S.M.
        • Hinek A.
        • Gonzalez M.C.
        Elastic fibres and vascular structure in hypertension.
        Pharmacol Ther. 2006; 111: 771-791
        • Mitchell G.F.
        • Wang N.
        • Palmisano J.N.
        • et al.
        Hemodynamic correlates of blood pressure across the adult age spectrum: noninvasive evaluation in the Framingham Heart Study.
        Circulation. 2010; 122: 1379-1386
        • Jae S.Y.
        • Heffernan K.S.
        • Kurl S.
        • Kunutsor S.K.
        • Laukkanen J.A.
        Association between estimated pulse wave velocity and the risk of stroke in middle-aged men.
        Int J Stroke. 2021; 16: 551-555
        • Vlachopoulos C.
        • Terentes-Printzios D.
        • Laurent S.
        • et al.
        Association of estimated pulse wave velocity with survival: a secondary analysis of sprint.
        JAMA Netw Open. 2019; 2e1912831
        • Boczar K.E.
        • Cheung K.
        • Boodhwani M.
        • et al.
        Sex differences in thoracic aortic aneurysm growth.
        Hypertension. 2019; 73: 190-196
        • Regnault V.
        • Thomas F.
        • Safar M.E.
        • et al.
        Sex difference in cardiovascular risk: role of pulse pressure amplification.
        J Am Coll Cardiol. 2012; 59: 1771-1777
        • Makrygiannis G.
        • Courtois A.
        • Drion P.
        • Defraigne J.O.
        • Kuivaniemi H.
        • Sakalihasan N.
        Sex differences in abdominal aortic aneurysm: the role of sex hormones.
        Ann Vasc Surg. 2014; 28: 1946-1958

      Linked Article

      • The Aortic Wall Conundrum: Predicting Thoracic Aortic Disease Behaviour
        Canadian Journal of CardiologyVol. 38Issue 11
        • Preview
          Most thoracic aortic aneurysms (TAAs) are benign throughout a lifetime or can be operated in a scheduled manner with relative safety when detected in time.1 However, TAAs with unfavourable biomechanical characteristics remain associated with high morbidity and mortality, particularly as a result of aortic dissection.2 Traditionally, size thresholds have been used to determine the risk of TAAs and guide the timing of intervention3; however, these thresholds have been found to be poor predictors of dissection, as half or more of dissections occur at aortic diameters below the thresholds.
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