Determination of aortic stiffness using 4D flow cardiovascular magnetic resonance - a population-based study

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Abstract

Background

Increased aortic stiffness is an independent predictor of cardiovascular disease. Optimal measurement is highly beneficial for the detection of atherosclerosis and the management of patients at risk. Thus, it was our purpose to selectively measure aortic stiffness using a novel imaging method and to provide reference values from a population-based study.

Methods

One hundred twenty six inhabitants of Freiburg, Germany, between 20 and 80 years prospectively underwent 3 Tesla cardiovascular magnetic resonance (CMR) of the thoracic aorta. 4D flow CMR (spatial/temporal resolution 2mm ³/20ms) was executed to calculate aortic pulse wave velocity (PWV) in m/s using dedicated software. In addition, we calculated distensibility coefficients (DC) using 2D CINE CMR imaging of the ascending (AAo) and descending aorta (DAo). Segmental aortic diameter and thickness of aortic plaques were determined by 3D T1 weighted CMR (spatial resolution 1mm ³).

Results

PWV increased from 4.93 ± 0.54 m/s in 20–30 year-old to 8.06 ± 1.03 m/s in 70–80 year-old subjects. PWV was significantly lower in women compared to men ( p < 0.0001). Increased blood pressure (systolic r = 0.36, p < 0.0001; diastolic r = 0.33, p = 0.0001; mean arterial pressure r = 0.37, p < 0.0001) correlated with PWV after adjustment for age and gender. Finally, PWV increased with increasing diameter of the aorta (ascending aorta r = 0.20, p = 0.026; aortic arch r = 0.24, p = 0.009; descending aorta r = 0.26, p = 0.004). Correlation of PWV and DC of the AAo and DAo or the mean of both was high ( r = 0.69, r = 0.68, r = 0.73; p < 0.001).

Conclusions

4D flow CMR was successfully applied to calculate aortic PWV and thus aortic stiffness. Findings showed a high correlation with distensibility coefficients representing local compliance of the aorta. Our novel method and reference data for PWV may provide a reliable biomarker for the identification of patients with underlying cardiovascular disease and optimal guidance of future treatment in studies or clinical routine.

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Most cited references 20

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The relationship of age with regional aortic stiffness and diameter.

Lucas Hickson, Mark Butlin, Mark I. Wilkinson … (2010)

The purpose of this study was to determine the impact of age on regional aortic pulse wave velocity (aPWV). aPWV is an independent predictor of cardiovascular risk and increases exponentially with age. However, it is unclear whether such changes occur uniformly along the length of the aorta or vary by region. A total of 162 subjects, aged 18 to 77 years and free of cardiovascular disease and medication, were recruited from the Anglo-Cardiff Collaborative Trial. Cine phase contrast magnetic resonance imaging was performed at 5 aortic levels. Systolic diameter and average blood flow were measured at each level and regional aPWV (regional aPWV measured by cine phase contrast magnetic resonance imaging) determined in 4 aortic segments: the arch (R1), the thoracic-descending aorta (R2), mid-descending aorta (R3), and the abdominal aorta (R4) and across the entire aorta. Regional PWV measured by cine phase contrast magnetic resonance imaging values increased from the valve to the bifurcation in the 4 segments (PWV-R1- PWV-R4: 4.6 ± 1.5 m/s, 5.5 ± 2.0 m/s, 5.7 ± 2.3 m/s, 6.1 ± 2.9 m/s, respectively) and did not differ between genders. The greatest age-related difference in stiffness occurred in the abdominal aorta (+0.9 m/s per decade, p < 0.001) followed by the thoracic-descending region (+0.7 m/s, p < 0.001), the mid-descending region (+0.6 m/s, p < 0.001) and aortic arch (+0.4 m/s, p < 0.001). The average systolic diameters decreased moving distally (L1-5: 3.1 ± 0.4 cm, 2.3 ± 0.3 cm, 2.1 ± 0.3 cm, 1.9 ± 0.2 cm, and 1.7 ± 0.2 cm, respectively). The greatest variation in systolic diameter as a function of age occurred in the ascending region (+0.96 mm/decade, p < 0.001). Values of aPWV measured across the entire aorta were strongly correlated with PWV-tonometry (R = 0.71, p < 0.001), although they were significantly lower (mean difference 1.7 ± 1.6 m/s, p < 0.001). The greatest difference in aortic stiffness occurs in the abdominal region, whereas the greatest difference in diameter occurs in the ascending aorta, which may help offset an increase in wall stiffness. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study.

Alban Redheuil (2014)

The predictive value of ascending aortic distensibility (AAD) for mortality and hard cardiovascular disease (CVD) events has not been fully established.

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Normal values of aortic dimensions, distensibility, and pulse wave velocity in children and young adults: a cross-sectional study

Inga Voges, Michael Jerosch-Herold, Jürgen Hedderich … (2012)

Background Aortic enlargement and impaired bioelasticity are of interest in several cardiac and non-cardiac diseases as they can lead to cardiovascular complications. Cardiovascular magnetic resonance (CMR) is increasingly accepted as a noninvasive tool in cardiovascular evaluation. Assessment of aortic anatomy and bioelasticity, namely aortic distensibility and pulse wave velocity (PWV), by CMR is accurate and reproducible and could help to identify anatomical and bioelastic abnormalities of the aorta. However, normal CMR values for healthy children and young adults are lacking. Methods Seventy-one heart-healthy subjects (age 16.4 ± 7.6 years, range 2.3 - 28.3 years) were examined using a 3.0 Tesla CMR scanner. Aortic cross-sectional areas and aortic distensibility were measured at four positions of the ascending and descending thoracic aorta. PWV was assessed from aortic blood flow velocity measurements in a aortic segment between the ascending aorta and the proximal descending aorta. The Lambda-Mu-Sigma (LMS) method was used to obtain percentile curves for aortic cross-sectional areas, aortic distensibility and PWV according to age. Results Aortic areas, PWV and aortic distensibility (aortic cross-sectional areas: r = 0.8 to 0.9, p < 0.001; PWV: r = 0.25 to 0.32, p = 0.047 to 0.009; aortic distensibility r = -0.43 to -0.62, p < 0.001) correlated with height, weight, body surface area, and age. There were no significant sex differences. Conclusions This study provides percentile curves for cross-sectional areas, distensibility and pulse wave velocity of the thoracic aorta in children and young adolescents between their 3rd and 29th year of life. These data may serve as a reference for the detection of pathological changes of the aorta in cardiovascular disease.

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Author and article information

Contributors

Andreas Harloff:

ORCID: http://orcid.org/0000-0002-3252-7910

+49 761 270 53240 , andreas.harloff@uniklinik-freiburg.de

Hanieh Mirzaee: hanieh.mirzaee@mevis.fraunhofer.de

Thomas Lodemann: tlodemann@googlemail.com

Paul Hagenlocher: paul-hagenlocher@web.de

Thomas Wehrum: thomas.wehrum@uniklinik-freiburg.de

Judith Stuplich: judith.stuplich@universitaets-herzzentrum.de

Anja Hennemuth: anja.hennemuth@charite.de

Jürgen Hennig: juergen.hennig@uniklinik-freiburg.de

Sebastian Grundmann: sebastian.grundmann@universitaets-herzzentrum.de

Werner Vach: wv@imbi.uni-freiburg.de

Journal

Journal ID (nlm-ta): J Cardiovasc Magn Reson

Journal ID (iso-abbrev): J Cardiovasc Magn Reson

Title: Journal of Cardiovascular Magnetic Resonance

Publisher: BioMed Central (London )

ISSN (Print): 1097-6647

ISSN (Electronic): 1532-429X

Publication date (Electronic): 21 June 2018

Publication date PMC-release: 21 June 2018

Publication date Collection: 2018

Volume: 20

Electronic Location Identifier: 43

Affiliations

[1 ]ISNI 0000 0000 9428 7911, GRID grid.7708.8, Department of Neurology, , Medical Center – University of Freiburg, ; 79106 Freiburg, Germany

[2 ]GRID grid.5963.9, Faculty of Medicine, University of Freiburg, ; Freiburg im Breisgau, Germany

[3 ]ISNI 0000 0004 0496 8246, GRID grid.428590.2, Fraunhofer MEVIS, ; Bremen, Germany

[4 ]GRID grid.5963.9, Department of Cardiology and Angiology I, Heart Center Freiburg University, , University of Freiburg, ; Freiburg im Breisgau, Germany

[5 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Charité-Universitätsmedizin Berlin, ; Berlin, Germany

[6 ]ISNI 0000 0000 9428 7911, GRID grid.7708.8, Department of Diagnostic Radiology – MR Physics, , Medical Center - University of Freiburg, ; Freiburg im Breisgau, Germany

[7 ]GRID grid.5963.9, Institute for Medical Biometry and Statistics, , University of Freiburg, ; Freiburg im Breisgau, Germany

[8 ]GRID grid.410567.1, Department of Orthopedics & Traumatology, , University Hospital Basel, ; Basel, Switzerland

Author information

Andreas Harloff http://orcid.org/0000-0002-3252-7910

Article

Publisher ID: 461

DOI: 10.1186/s12968-018-0461-z

PMC ID: 6011486

PubMed ID: 29925388

SO-VID: 39f2332d-bac2-49eb-bc7a-ff95fb2b0cab

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 November 2017

Date accepted : 22 May 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001659, Deutsche Forschungsgemeinschaft;

Award ID: grant #HA5399/3-1

Award Recipient : Andreas Harloff

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: aorta,stiffness,population-based study,4d flow mri,pulse wave velocity

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: aorta, stiffness, population-based study, 4d flow mri, pulse wave velocity

Determination of aortic stiffness using 4D flow cardiovascular magnetic resonance - a population-based study

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Most cited references 20

The relationship of age with regional aortic stiffness and diameter.

Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study.

Normal values of aortic dimensions, distensibility, and pulse wave velocity in children and young adults: a cross-sectional study

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