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Quantification of aortic stiffness in stroke patients using 4D flow MRI in comparison with transesophageal echocardiography

  • Thomas Wehrum
  • Felix Günther
  • Miriam Kams
  • Sarah Wendel
  • Christoph Strecker
  • Hanieh Mirzaee
  • Andreas Harloff
Original Paper

Abstract

To quantify stiffness of the descending aorta (DAo) in stroke patients using 4D flow MRI and compare results with transesophageal echocardiography (TEE). 48 acute stroke patients undergoing 4D flow MRI and TEE were included. Intima-media-thickness (IMT) was measured in the DAo and the aorta was scrutinized for atherosclerotic plaques using TEE. Stiffness of the DAo was determined by (a) 4D flow MRI at 3 T by calculating pulse wave velocity (PWV) and by (b) TEE calculating arterial strain, stiffness index, and distensibility coefficient. Mean IMT was 1.43 ± 1.75. 7 (14.6%) subjects had no sign of atherosclerosis, 10 (20.8%) had IMT-thickening or plaques < 4 mm, and 31 (66.7%) had at least one large and/or complex plaque in the aorta. Increased IMT significantly correlated (p < 0.001) with increased DAo stiffness in MRI (PWV r = 0.66) and in TEE (strain r = 0.57, stiffness index r = 0.64, distensibility coefficient r = 0.57). Patients with at least IMT-thickening had significantly higher stiffness values compared to patients without atherosclerosis. However, no difference was observed between patients with plaques < 4 mm and patients with plaques ≥ 4 mm. PWV and TEE parameters of stiffness correlated significantly [strain (r = − 0.36; p = 0.011), stiffness index (r = 0.51; p = 0.002), and distensibility coefficient (r = − 0.59; p < 0.001)]. 4D flow MRI and TEE-based parameters of aortic stiffness were associated with markers of atherosclerosis such as IMT-thickness and presence of plaques. We believe that 4D flow MRI is a promising tool for future studies of aortic atherosclerosis, due to its longer coverage of the aorta and non-invasiveness.

Keywords

Aorta Stiffness Compliance PWV TEE 4D flow MRI 

Notes

Funding

This study was funded by Deutsche Forschungsgemeinschaft (DFG) (Grant #HA5399/3-1).

Compliance with ethical standards

Conflict of interest

None of the authors has financial disclosures related to the performance or content of this study and to the submission of this paper.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Mozaffarian D, Benjamin EJ, Go AS et al (2016) Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 133:447–454CrossRefPubMedGoogle Scholar
  2. 2.
    Strong JP, Malcom GT, McMahan CA et al (1999) Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA 281:727–735CrossRefPubMedGoogle Scholar
  3. 3.
    Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55:1318–1327CrossRefPubMedGoogle Scholar
  4. 4.
    Ohyama Y, Ambale-Venkatesh B, Noda C et al (2016) Association of aortic stiffness with left ventricular remodeling and reduced left ventricular function measured by magnetic resonance imaging: the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging.  https://doi.org/10.1161/CIRCIMAGING.115.004426 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Yambe M, Tomiyama H, Koji Y et al (2006) B-type natriuretic peptide and arterial stiffness in healthy Japanese men. Am J Hypertens 19:443–447CrossRefPubMedGoogle Scholar
  6. 6.
    Rodilla E, Millasseau S, Costa JA, Pascual JM (2017) Arterial destiffening in previously untreated mild hypertensives after 1 year of routine clinical management. Am J Hypertens 30:510–517PubMedGoogle Scholar
  7. 7.
    Safar ME (2010) Arterial aging—hemodynamic changes and therapeutic options. Nat Rev Cardiol 7:442–449CrossRefPubMedGoogle Scholar
  8. 8.
    Dawson JD, Sonka M, Blecha MB et al (2009) Risk factors associated with aortic and carotid intimal medial thickness in adolescents and young adults: the Muscatine Offspring Study. J Am Coll Cardiol 53:2273–2279CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Wentland AL, Grist TM, Wieben O (2014) Review of MRI-based measurements of pulse wave velocity: a biomarker of arterial stiffness. Cardiovasc Diagn Ther 4:193–206PubMedPubMedCentralGoogle Scholar
  10. 10.
    Cho JY, Kim KH (2016) Evaluation of arterial stiffness by echocardiography: methodological aspects. Chonnam Med J 52:101–106CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wehrum T, Kams M, Schroeder L et al (2014) Accelerated analysis of three-dimensional blood flow of the thoracic aorta in stroke patients. Int J Cardiovasc Imaging 30:1571–1577CrossRefPubMedGoogle Scholar
  12. 12.
    Kröner ESJ, van der Geest RJ, Scholte AJHA. et al (2012) Evaluation of sampling density on the accuracy of aortic pulse wave velocity from velocity-encoded MRI in patients with Marfan syndrome. J Magn Reson Imaging 36:1470–1476CrossRefPubMedGoogle Scholar
  13. 13.
    Ibrahim E-SH, Johnson KR, Miller AB et al (2010) Measuring aortic pulse wave velocity using high-field cardiovascular magnetic resonance: comparison of techniques. J Cardiovasc Magn Reson 12:26CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Kim KH, Park JC, Yoon HJ et al (2009) Usefulness of aortic strain analysis by velocity vector imaging as a new echocardiographic measure of arterial stiffness. J Am Soc Echocardiogr 22:1382–1388CrossRefPubMedGoogle Scholar
  15. 15.
    Markl M, Wallis W, Strecker C et al (2012) Analysis of pulse wave velocity in the thoracic aorta by flow-sensitive four-dimensional MRI: reproducibility and correlation with characteristics in patients with aortic atherosclerosis. J Magn Reson Imaging 35:1162–1168CrossRefPubMedGoogle Scholar
  16. 16.
    Kaneko K, Takahashi T, Saito H et al (2014) Assessment of aortic arch stiffness using pulse-wave tissue Doppler imaging: a transesophageal echocardiographic comparison study of acute ischemic stroke patients and stroke-free patients. Echocardiography 31:1113–1121CrossRefPubMedGoogle Scholar
  17. 17.
    Stefanadis C, Stratos C, Boudoulas H et al (1990) Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J 11:990–996CrossRefPubMedGoogle Scholar
  18. 18.
    Yoon HJ, Kim KH, Lee SH et al (2013) Differences of aortic stiffness and aortic intima-media thickness according to the type of initial presentation in patients with ischemic stroke. J Cardiovasc Ultrasound 21:12–17CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Voges I, Jerosch-Herold M, Hedderich J et al (2012) Normal values of aortic dimensions, distensibility, and pulse wave velocity in children and young adults: a cross-sectional study. J Cardiovasc Magn Reson 14:77CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kondo K, Nemoto M, Harada N et al (2017) Comparison between quantitative stiffness measurements and ultrasonographic findings of fresh carotid plaques. Ultrasound Med Biol 43:138–144CrossRefPubMedGoogle Scholar
  21. 21.
    Wehrum T, Dragonu I, Strecker C et al (2017) Multi-contrast and three-dimensional assessment of the aortic wall using 3 T MRI. Eur J Radiol 91:148–154CrossRefPubMedGoogle Scholar
  22. 22.
    Mitsiou E, Boutari C, Kotsis V et al (2017) Effect of low (5 mg) vs high (20–40 mg) rosuvastatin dose on 24 h arterial stiffness, central haemodynamics, and non-alcoholic fatty liver disease in patients with optimally controlled arterial hypertension. Curr Vasc Pharmacol.  https://doi.org/10.2174/1570161115666170630122833 CrossRefGoogle Scholar
  23. 23.
    Ahmadi-Abhari S, Sabia S, Shipley MJ et al (2017) Physical activity, sedentary behavior, and long-term changes in aortic stiffness: the Whitehall II Study. J Am Heart Assoc.  https://doi.org/10.1161/JAHA.117.005974 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kobayashi R, Hashimoto Y, Hatakeyama H, Okamoto T (2016) Acute effects of aerobic exercise intensity on arterial stiffness after glucose ingestion in young men. Clin Physiol Funct Imaging.  https://doi.org/10.1111/cpf.12395 CrossRefPubMedGoogle Scholar
  25. 25.
    Kang SJ, Kim EH, Ko KJ (2016) Effects of aerobic exercise on the resting heart rate, physical fitness, and arterial stiffness of female patients with metabolic syndrome. J Phys Ther Sci 28:1764–1768CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurology and Clinical Neurophysiology, Medical Center – University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  2. 2.Department of Cardiology and Angiology, Medical Center – University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  3. 3.Fraunhofer MevisBremenGermany

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