Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm
Objectives: Current diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surfa...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906724000411 |
| _version_ | 1797217077319172096 |
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| author | Siavash Zamirpour Yue Xuan Zhongjie Wang Axel Gomez Joseph R. Leach Dimitrios Mitsouras David A. Saloner Julius M. Guccione Liang Ge Elaine E. Tseng |
| author_facet | Siavash Zamirpour Yue Xuan Zhongjie Wang Axel Gomez Joseph R. Leach Dimitrios Mitsouras David A. Saloner Julius M. Guccione Liang Ge Elaine E. Tseng |
| author_sort | Siavash Zamirpour |
| collection | DOAJ |
| description | Objectives: Current diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surface area (BSA) is unknown. Our objective was to compare aTAA wall stresses with indexed diameters in relation to all-cause mortality at 3.75 years follow-up. Methods: Finite element analyses were performed in a veteran population with aortas ≥ 4.0 cm. Three-dimensional geometries were reconstructed from computed tomography with models accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain wall stress distributions under systolic pressure. Peak wall stresses were compared across guideline thresholds for diameter/BSA and diameter/height. Hazard ratios for all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models. Results: Of 253 veterans, 54 (21 %) had aneurysm repair at 3.75 years. Indexed diameter alone would have prompted repair at baseline in 17/253 (6.7 %) patients, including only 4/230 (1.7 %) with diameter < 5.5 cm. Peak wall stresses did not significantly differ across guideline thresholds for diameter/BSA (circumferential: p = 0.15; longitudinal: p = 0.18), but did differ for diameter/height (circumferential: p = 0.003; longitudinal: p = 0.048). All-cause mortality was independently associated with peak longitudinal stresses (p = 0.04). Peak longitudinal stresses were best predicted by diameter (c-statistic = 0.66), followed by diameter/height (c-statistic = 0.59), and diameter/BSA (c-statistic = 0.55). Conclusions: Diameter/height improved stratification of peak wall stresses compared to diameter/BSA. Peak longitudinal stresses predicted all-cause mortality independent of age and indexed diameter and may aid risk stratification for aTAA adverse events. |
| first_indexed | 2024-03-07T19:41:13Z |
| format | Article |
| id | doaj.art-0b2cdcb97f254aab8a5bda9d4d7af1a3 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-04-24T11:56:07Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-0b2cdcb97f254aab8a5bda9d4d7af1a32024-04-09T04:13:17ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672024-04-0151101375Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysmSiavash Zamirpour0Yue Xuan1Zhongjie Wang2Axel Gomez3Joseph R. Leach4Dimitrios Mitsouras5David A. Saloner6Julius M. Guccione7Liang Ge8Elaine E. Tseng9Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA; School of Medicine, University of California, San Francisco, USADepartment of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USADepartment of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USADepartment of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USADepartment of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USADepartment of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USADepartment of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USADepartment of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USADepartment of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USADepartment of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA; Corresponding author at: Professor of Surgery, Division of Cardiothoracic Surgery, UCSF Medical Center, 500 Parnassus Ave., Suite 405W, Box 0118, San Francisco, CA 94143-0118, USAObjectives: Current diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surface area (BSA) is unknown. Our objective was to compare aTAA wall stresses with indexed diameters in relation to all-cause mortality at 3.75 years follow-up. Methods: Finite element analyses were performed in a veteran population with aortas ≥ 4.0 cm. Three-dimensional geometries were reconstructed from computed tomography with models accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain wall stress distributions under systolic pressure. Peak wall stresses were compared across guideline thresholds for diameter/BSA and diameter/height. Hazard ratios for all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models. Results: Of 253 veterans, 54 (21 %) had aneurysm repair at 3.75 years. Indexed diameter alone would have prompted repair at baseline in 17/253 (6.7 %) patients, including only 4/230 (1.7 %) with diameter < 5.5 cm. Peak wall stresses did not significantly differ across guideline thresholds for diameter/BSA (circumferential: p = 0.15; longitudinal: p = 0.18), but did differ for diameter/height (circumferential: p = 0.003; longitudinal: p = 0.048). All-cause mortality was independently associated with peak longitudinal stresses (p = 0.04). Peak longitudinal stresses were best predicted by diameter (c-statistic = 0.66), followed by diameter/height (c-statistic = 0.59), and diameter/BSA (c-statistic = 0.55). Conclusions: Diameter/height improved stratification of peak wall stresses compared to diameter/BSA. Peak longitudinal stresses predicted all-cause mortality independent of age and indexed diameter and may aid risk stratification for aTAA adverse events.http://www.sciencedirect.com/science/article/pii/S2352906724000411Ascending aortic aneurysmBiomechanicsComputed tomographyFinite element analysisOutcomesRisk factors |
| spellingShingle | Siavash Zamirpour Yue Xuan Zhongjie Wang Axel Gomez Joseph R. Leach Dimitrios Mitsouras David A. Saloner Julius M. Guccione Liang Ge Elaine E. Tseng Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm International Journal of Cardiology: Heart & Vasculature Ascending aortic aneurysm Biomechanics Computed tomography Finite element analysis Outcomes Risk factors |
| title | Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm |
| title_full | Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm |
| title_fullStr | Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm |
| title_full_unstemmed | Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm |
| title_short | Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm |
| title_sort | height and body surface area versus wall stress for stratification of mid term outcomes in ascending aortic aneurysm |
| topic | Ascending aortic aneurysm Biomechanics Computed tomography Finite element analysis Outcomes Risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S2352906724000411 |
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