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


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.


Aorta Stiffness Compliance PWV TEE 4D flow MRI 



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.


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© 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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