A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress
A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress
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DOI：
10.1007/s00330-020-06852-3
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发表时间：
2020-04-22
影响因子：
5.9
通讯作者：
Hedman, Marja
中科院分区：
文献类型：
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作者：
Kauhanen, S. Petteri;Liimatainen, Timo;Hedman, Marja
目的探讨心脏长轴与升主动脉中线夹角（heart-aorta-angle，HAA）是否与升主动脉扩张有关。此外，HAA和壁面切应力（WSS）之间的关系进行了研究。方法回顾性分析1000例冠心病患者的冠状动脉CT血管造影（CCTA）图像，并对HAA进行分析。为评价HAA对AA血流的影响，对28例AA扩张（> 40 mm）的患者进行了4D flow MRI，并分析了WSS。结果接受CCTA的患者平均年龄为52.9 ± 9.8岁; 66.5%为女性。他们的中位HAA为128.7度，四分位距为123.3-134.1度。与正常AA患者（中位数129.5度[124.3 - 135.3度]，p < 0.001）相比，扩张AA患者的HAA（中位数126.7度[121.3 - 130.8度]）明显更小。男性（p < 0.001）、糖尿病（p = 0.016）、高血压（p = 0.001）、CAD（p = 0.003）、高胆固醇血症（p < 0.001）和二叶主动脉瓣（p = 0.025）患者的HAA小于无这些因素的患者。在没有任何这些基础疾病的亚群（n = 233）中，与正常AA患者（中位数131.9度[127.6-136.9度]，p = 0.013）相比，扩张AA患者（中位数127.9度[124.3-134.3度]）的HAA仍然显著较小。在4D flow MRI中，较小的HAA与近端AA外曲率中的总WSS增加相关（r = -0. 510，p = 0. 006）。结论腹主动脉狭窄与腹主动脉扩张有关，并影响腹主动脉近端血流。
Objectives The aim of this study was to evaluate whether the orientation of the heart, measured as an angle between the long axis of the heart and ascending aorta midline (heart-aorta-angle, HAA), associates with ascending aortic (AA) dilatation. Furthermore, the association between HAA and wall shear stress (WSS) was studied. Methods HAA was retrospectively measured in 1000 consecutive coronary artery computed tomographic angiography (CCTA) images in patients with low-to-moderate pretest probability for coronary artery disease (CAD). To evaluate the effects of HAA on AA flow, 4D flow MRI was performed for 28 patients with AA dilatation (> 40 mm) and WSS was analyzed. Results The mean age of patients undergoing CCTA was 52.9 +/- 9.8 years; 66.5% were women. Their median HAA was 128.7 degrees and interquartile range 123.3-134.1 degrees. HAA was significantly smaller in patients with dilated AA (median 126.7 degrees [121.3-130.8 degrees]) compared with the patients with normal AA (median 129.5 degrees [124.3-135.3 degrees], p < 0.001). HAA was smaller in males (p < 0.001) and in patients with diabetes (p = 0.016), hypertension (p = 0.001), CAD (p = 0.003), hypercholesterolemia (p < 0.001), and bicuspid aortic valve (p = 0.025) than without these factors. In a subpopulation without any of these underlying diseases (n = 233), HAA was still significantly smaller in the patients with dilated AA (median 127.9 degrees [124.3-134.3 degrees]) compared with patients with normal AA (median 131.9 degrees [127.6-136.9 degrees], p = 0.013). In 4D flow MRI, a smaller HAA correlated with increased total WSS in the outer curvature of the proximal AA (r = - 0.510, p = 0.006). Conclusion A smaller HAA associates with AA dilatation and affects the blood flow in the proximal AA.