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CC BY 4.0 · Aorta (Stamford) 2020; 08(05): 132-140
DOI: 10.1055/s-0040-1715609
Original Research Article

Aortic Thickness: A Forgotten Paradigm in Risk Stratification of Aortic Disease

Ashutosh Hardikar
1   Menzies Institute for Medical Research, University of Tasmania, Australia
2   Department of Cardiothoracic Surgery, Royal Hobart Hospital, Hobart, Australia
,
Robin Harle
3   Department of Radiology, Royal Hobart Hospital, Hobart, Australia
,
Thomas H. Marwick
1   Menzies Institute for Medical Research, University of Tasmania, Australia
4   Baker Heart and Diabetes Institute, Melbourne, Australia
› Author Affiliations Funding None.
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Abstract

Background This study aimed at risk-stratifying aortic dilatation using aortic wall thickness (AWT) and comparing methods of AWT assessment.

Methods Demographic, epidemiological, and perioperative data on 72 consecutive aortic surgeries (age = 62 years[standard deviation (SD) = 12] years) performed by a single surgeon were collected from hospital database. Aortic thickness was measured on computed tomography scans, as well as intraoperatively in four quadrants, at the level of aortic sinuses, as well as midascending aorta, using calipers. Aortic wall stress was calculated using standard mathematical formulae.

Results The ascending aorta was 48.2 (SD = 8) mm and the mean thickness at ascending aorta level was 1.9 (SD = 0.3) mm. There was congruence between imaging and intraoperative measurements of thickness, as well as between the radiologist and surgeon. Preoperatively, 16 patients had multiple imaging studies showing an average rate of growth of 1.2 mm per year without significant difference in thickness. The wider the aorta, the thinner was the lateral or convex wall. Aortic stenosis (p = 0.01), lateral to medial wall thickness ratio (p = 0.04), and history of hypertension (p = 0.00), all had protective effect on aortic root stress. The ascending aortic stress was directly affected by age (p = 0.03) and inversely related to lateral to medial wall thickness ratio (p = 0.03).

Conclusion Aortic thickness can be measured preoperatively and easily confirmed intraoperatively. Risk stratification based on both aortic thickness and diameter (stress calculations) would better predict acute aortic events in dilated aortas and define aortic resection criteria more objectively.

Keywords

aortic wall thickness - aortic dilatation - aortopathy - aortic stress


Publication History

Received: 15 July 2019

Accepted: 20 June 2020

Article published online:
23 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Duprey A, Khanafer K, Schlicht M, Avril S, Williams D, Berguer R. In vitro characterisation of physiological and maximum elastic modulus of ascending thoracic aortic aneurysms using uniaxial tensile testing. Eur J Vasc Endovasc Surg 2010; 39 (06) 700-707
    CrossrefPubMedGoogle Scholar
  • 2 Erbel R, Eggebrecht H. Aortic dimensions and the risk of dissection. Heart 2006; 92 (01) 137-142
    CrossrefPubMedGoogle Scholar
  • 3 Coady MARJ, Rizzo JA, Hammond GL. et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms?. J Thorac Cardiovasc Surg 1997; 113 (03) 476-491 , discussion 489–491
    CrossrefPubMedGoogle Scholar
  • 4 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease Representative Members; Hiratzka LFCMA, Isselbacher EM. et al. Surgery for Aortic dilatation in Patients with Bicuspid Aortic valves: a statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2016; 133 (07) 680-686
    CrossrefPubMedGoogle Scholar
  • 5 Chau KH, Elefteriades JA. Natural history of thoracic aortic aneurysms: size matters, plus moving beyond size. Prog Cardiovasc Dis 2013; 56 (01) 74-80
    CrossrefPubMedGoogle Scholar
  • 6 Van Puyvelde J, Verbeken E, Verbrugghe P, Herijgers P, Meuris B. Aortic wall thickness in patients with ascending aortic aneurysm versus acute aortic dissection. Eur J Cardiothorac Surg 2016; 49 (03) 756-762
    CrossrefPubMedGoogle Scholar
  • 7 Svensson LG, Adams DH, Bonow RO. et al. Aortic valve and ascending aorta guidelines for management and quality measures: executive summary. Ann Thorac Surg 2013; 95 (04) 1491-1505
    CrossrefPubMedGoogle Scholar
  • 8 Elefteriades JA, Sang A, Kuzmik G, Hornick M. Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm). Open Heart 2015; 2 (01) e000169
    CrossrefPubMedGoogle Scholar
  • 9 Flack D. Measurement good practice guide no. 40: callipers and micrometers. Accessed July 8, 2020 at: https://docplayer.net/21009990-Good-practice-guide-no-40-callipers-and-micrometers-david-flack-issue-2.html
    PubMedGoogle Scholar
  • 10 Nishimura RA, Otto CM, Bonow RO. et al; ACC/AHA Task Force Members. 2014 AHA/ACC Guideline for the Management of Patients WithValvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129 (23) e521-e643
    PubMedGoogle Scholar
  • 11 Neri E, Barabesi L, Buklas D. et al. Limited role of aortic size in the genesis of acute type A aortic dissection. Eur J Cardiothorac Surg 2005; 28 (06) 857-863
    CrossrefPubMedGoogle Scholar
  • 12 Li AEKI, Kamel I, Rando F. et al. Using MRI to assess aortic wall thickness in the multiethnic study of atherosclerosis: distribution by race, sex, and age. Am J Roentgenol 2004; 182 (03) 593-597
    CrossrefPubMedGoogle Scholar
  • 13 Malayeri AA, Natori S, Bahrami H. et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2008; 102 (04) 491-496
    CrossrefPubMedGoogle Scholar
  • 14 Gupta S, Berry JD, Ayers CR. et al. Left ventricular hypertrophy, aortic wall thickness, and lifetime predicted risk of cardiovascular disease:the Dallas Heart Study. JACC Cardiovasc Imaging 2010; 3 (06) 605-613
    CrossrefPubMedGoogle Scholar
  • 15 Rosero EB, Peshock RM, Khera A, Clagett P, Lo H, Timaran CH. Sex, race, and age distributions of mean aortic wall thickness in a multiethnic population-based sample. J Vasc Surg 2011; 53 (04) 950-957
    CrossrefPubMedGoogle Scholar
  • 16 Shakeri A, Hafez Quran F, Javadrashid R, Abdekarimi MH, Ghojazadeh M, AbolghassemiFakhree MB. Correlation between aortic wall thickness and coronary artery disease by 64 slice multidetector computed tomography. J Cardiovasc Thorac Res 2013; 5 (03) 91-95
    PubMedGoogle Scholar
  • 17 Ittermann T, Lorbeer R, Dörr M. et al. High levels of thyroid-stimulating hormone are associated with aortic wall thickness in the general population. Eur Radiol 2016; 26 (12) 4490-4496
    CrossrefPubMedGoogle Scholar
  • 18 Tresoldi S, Di Leo G, Zoffoli E. et al. Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events. Acta Radiol 2014; 55 (09) 1040-1049
    CrossrefPubMedGoogle Scholar
  • 19 Slobodin G, Nakhleh A, Rimar D, Wolfson V, Rosner I, Odeh M. Increased aortic wall thickness for the diagnosis of aortitis: a computed tomography-based study. Int J Rheum Dis 2016; 19 (01) 82-86
    CrossrefPubMedGoogle Scholar
  • 20 Van Puyvelde J, Verbeken E, Verbrugghe P, Herijgers P, Meuris B. Aortic wall thickness in patients with ascending aortic aneurysm versus acute aortic dissection. Eur J Cardiothorac Surg 2016; 49 (03) 756-762
    CrossrefPubMedGoogle Scholar
  • 21 Nathan DP, Xu C, Gorman III JH. et al. Pathogenesis of acute aortic dissection: a finite element stress analysis. Ann Thorac Surg 2011; 91 (02) 458-463
    CrossrefPubMedGoogle Scholar
  • 22 Elefteriades JA, Farkas EA. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. J Am Coll Cardiol 2010; 55 (09) 841-857
    CrossrefPubMedGoogle Scholar
  • 23 Koullias G, Modak R, Tranquilli M, Korkolis DP, Barash P, Elefteriades JA. Mechanical deterioration underlies malignant behavior of aneurysmal human ascending aorta. J Thorac Cardiovasc Surg 2005; 130 (03) 677-683
    CrossrefPubMedGoogle Scholar
  • 24 Muraru D, Maffessanti F, Kocabay G. et al. Ascending aorta diameters measured by echocardiography using both leading edge-to-leading edge and inner edge-to-inner edge conventions in healthy volunteers. Eur Heart J Cardiovasc Imaging 2014; 15 (04) 415-422
    CrossrefPubMedGoogle Scholar
  • 25 Mensel B, Quadrat A, Schneider T. et al. MRI-based determination of reference values of thoracic aortic wall thickness in a general population. Eur Radiol 2014; 24 (09) 2038-2044
    CrossrefPubMedGoogle Scholar
  • 26 Scotti CM, Shkolnik AD, Muluk SC, Finol EA. Fluid-structure interaction in abdominal aortic aneurysms: effects of asymmetry and wall thickness. Biomed Eng Online 2005; 4: 64
    CrossrefPubMedGoogle Scholar
  • 27 Goldstein SA, Evangelista A, Abbara S. et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the american society of echocardiography and the European association of cardiovascular imaging: endorsed by the society of cardiovascular computed tomography and society for cardiovascular magnetic resonance. J Am Soc Echocardiogr 2015; 28 (02) 119-182
    CrossrefPubMedGoogle Scholar
  • 28 Bauer M, Pasic M, Schaffarzyk R. et al. Ann Thorac Surg 2002; 73: 720-724
    CrossrefPubMed
  • 29 Shang EK, Lai E, Pouch AM. et al. Validation of semiautomated and locally resolved aortic wall thickness measurements from computed tomography. J Vasc Surg 2015; 61 (04) 1034-1040
    CrossrefPubMedGoogle Scholar
  • 30 Okuma H, Gonoi W, Ishida M. et al. Greater thickness of the aortic wall on postmortem computed tomography compared with antemortem computed tomography: the first longitudinal study. Int J Legal Med 2014; 128 (06) 987-993
    CrossrefPubMedGoogle Scholar
  • 31 Kuralay E, Demirkilic U, Ozal E. et al. Surgical approach to ascending aorta in bicuspid aortic valve. J Card Surg 2003; 18 (02) 173-180
    CrossrefPubMedGoogle Scholar
  • 32 Yasuda H, Nakatani S, Stugaard M. et al. Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve. Circulation 2003; 108 (Suppl. 01) II291-II294
    PubMedGoogle Scholar
  • 33 Forsell C, Björck HM, Eriksson P, Franco-Cereceda A, Gasser TC. Biomechanical properties of the thoracic aneurysmal wall: differences between bicuspid aortic valve and tricuspid aortic valve patients. Ann Thorac Surg 2014; 98 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 34 Patel K, Zafar MA, Ziganshin BA, Elefteriades JA. Diabetes mellitus: is it protective against aneurysm? A narrative review. Cardiology 2018; 141 (02) 107-122
    CrossrefPubMedGoogle Scholar
  • 35 Pape LA, Tsai TT, Isselbacher EM. et al; International Registry of Acute Aortic Dissection (IRAD) Investigators. 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 (10) 1120-1127
    CrossrefPubMedGoogle Scholar