Screening for Proximal Aortic Aneurysm by Using Noninvasive Pulse Wave Velocity as Surrogate Marker: Are We There Yet?

Background: Proximal aortic aneurysm is an asymptomatic disease often unrecognized until occurrence of aortic catastrophe (e.g., acute dissection type A or aortic rupture). To date no preventive screening focusing on proximal aortic aneurysm detection is established in Germany leading to diagnosis being an incidental finding in most of the patients due to other imaging modalities. It is known that during course of aneurysm development changes in aortic distensibility occur. Noninvasive testing of aortic distensibility could be an easy, cost-effective method for aneurysm screening. This clinical study investigates the feasibility of bed-side evaluation of pulse wave velocity in aortic aneurysm patient as screening method.

Methods: We prospectively enrolled 185 patients with/ without know proximal aortic aneurysm and/or aortic valve disease. Pulse wave velocity and several other markers for aortic distensibility were recorded using two different devices: SphygmoCor and Mobil-O-Graph. All patients gave their informed consent and were measured either when visiting the aortic day clinic or the night before surgery in the same way.

Results: Mean age of all 185 patients was 59 ± 14 years, with a high proportion of male patients (81%). Hemodynamics were similar between the groups with no significant differences in heart rate (74 ± 15 vs. 70 ± 12, p = 0.2) was well as systolic (128 ± 15 vs. 124 ± 16, p = 0.3) and diastolic (81 ± 13 vs. 80 ± 13, p = 0.5) blood pressure at time of data acquisition. Pulse wave velocity was significantly higher in patients without aortic aneurysm in both utilized techniques (SphygmoCor: 8.9 m/s ±3.6 vs. 7.3 m/s ± 2.5, p = 0.01, Mobil-O-Graph: 9.5 m/s ± 1.7 vs. 8.7 m/s ± 2.0, p = 0.01). Furthermore, augmentation index, another parameter relevant for aortic stiffness was also significantly higher in patients without proximal aortic aneurysm (SphygmoCor: 36.7 ± 16.3 vs. 30.4 ± 30.4, p = 0.02, Mobil-O-Graph: 28.9 ± 11.7 vs. 23.5 ± 10.9, p = 0.02).

Conclusion: Noninvasive measurement of pulse wave velocity and augmentation index is an easy tool for determination of cardiovascular risk with a possible implication for screening for proximal aortic aneurysm. However, further studies need to correlate the results to other (more precise) imaging methods (MRI elastography) and follow patients over the course of aneurysm development. For the individual patients measurement over several years, especially considering changes in pulse wave velocity, could be highly useful.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024