Aortic Stiffness in Heritable Aortopathies: Relationship to Aneurysm Growth Rate
Aortic Stiffness in Heritable Aortopathies: Relationship to Aneurysm Growth Rate
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DOI：
10.1016/j.hlc.2012.08.049
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发表时间：
2013-01-01
影响因子：
2.6
通讯作者：
Jeremy, Richmond W.
中科院分区：
文献类型：
--
作者：
de Wit, Aletta;Vis, Kelly;Jeremy, Richmond W.
目的：本研究比较了不同遗传性主动脉病综合征的主动脉生物力学，并检验了主动脉硬度测量的临床实用性。方法和结果：在 218 名患者（55 名马凡氏症患者、47 名二叶主动脉瓣 (BAV)、47 名孤立性家族性胸动脉瘤 (FTAD) 和 69 名匹配对照）中，通过超声心动图同时测量血压来测量主动脉生物力学。患者按年龄分层为 40 岁。主动脉僵硬度随着年龄的增长而增加，所有主动脉病的主动脉生物力学均异常，特别是 BAV 和 FTAD。两个年龄组的 BAV 和 FTAD 的硬度和脉搏波速度均增加 (p < 0.001)，并且均比 Marf 患者更僵硬 (p < 0.01)。 40 岁的 Marfan 患者与对照组相似。多变量回归确定年龄是与硬度增加以及主动脉直径和平均血压增加的主要相关性（R-2 = 0.64；p < 0.001）。硬度指数 > 16 的主动脉病患者的主动脉直径增加率 (0.25 +/- 0.30 毫米/年) 低于硬度正常的患者 (0.68 +/- 0.39 毫米/年, p < 0.001)。虽然硬度增加对于检测主动脉病变的阳性预测价值较高（40 岁年龄组为 93%），但阴性预测准确性较低（分别为 55% 和 34%）。结论：生物力学异常对于所有主动脉病变来说都很常见，BAV 和 FTAD 的异常程度高于马凡。主动脉僵硬度增加与动脉瘤进展速度减慢相关。 （心脏、肺和循环 2013 年；22:3-11） (C) 2012 年澳大利亚和新西兰心脏和胸外科医师协会 (ANZSCTS) 以及澳大利亚和新西兰心脏协会 (CSANZ)。由爱思唯尔公司出版。保留所有权利。
Objective: This study compared aortic biomechanics in different heritable aortopathy syndromes and examined the clinical utility of aortic stiffness measurements.Methods and results: In 218 patients (55 Marfan, 47 bicuspid aortic valve (BAV), 47 isolated familial thoracic aneurysm (FTAD) and 69 matched controls) aortic biomechanics were measured by echocardiography with simultaneous blood pressure measurements. Patients were stratified by age as 40 years.Aortic stiffness increased with age and aortic biomechanics were abnormal in all aortopathies, particularly in BAV and FTAD. Increased stiffness and pulse wave velocity were seen in BAV and FTAD in both age cohorts (p < 0.001) and both were stiffer than Marf an patients (p < 0.01). Marfan patients aged 40 years were similar to controls. Multivariate regression identified age as the dominant correlate with increased stiffness, and also aortic diameter and mean blood pressure (R-2 = 0.64; p < 0.001). Aortopathy patients with stiffness index > 16 had lower rate of increase in aortic diameter (0.25 +/- 0.30 mm/year) than those with normal stiffness (0.68 +/- 0.39 mm/year, p < 0.001). Whilst positive predictive value of increased stiffness for detection of aortopathy was high (93% in age 40 years), negative predictive accuracy was low (55% and 34% respectively).Conclusion: Abnormal biomechanics are common to all aortopathies, with greater abnormality in BAV and FTAD than in Marfan. Increased aortic stiffness is associated with slower rate of aneurysm progression. (Heart, Lung and Circulation 2013;22:3-11) (C) 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.