Background. It has been described that aortic elastic properties are abnormal in patients with Marfan syndrome irrespective of the aortic diameter. The aim of our study was to investigate the potential value of transesophageal echocardiography combined with tissue Doppler imaging for the assessment of elastic properties of the thoracic aorta in patients with Marfan disease. Methods. Twentyone patients (pts) with Marfan syndrome (Gent criteria) aged 13 to 52 years were studied with multiplane transesophageal echocardiography (TEE). 7/21 pts had surgery for aortic dissection. Sixteen age- and gender-matched healthy subjects who had normal findings at TEE served as controls. The ascending and descending aorta were visualized in a TEE short axis view. Standard formulas and tissue Doppler imaging (TDI, Toshiba corp.) during TEE were used for the quantification of aortic elastic properties. Distensibility, stiffness index, and pulse wave velocity were calculated using M-mode data. TDI tracing displayed accelerated expansion of the aortic wall followed by a slow deceleration, a plateau and then a rapid deceleration into diastole. Acceleration time (AT, msec), maximum wall expansion velocity (Vmax, cm/sec), wall contraction E and A velocities (cm/sec), and peak systolic wall strain (e, %) were determined. Results. Ascending and descending thoracic aorta dilation (>40mm and >30mm) was present in 11/21 and 12/21 pts, respectively. Marfan patients had a lower distensibility and a higher stiffness index both in patients with dilated (p<.001) and normal aortas (p<.05). Highly significant differences were obtained between both groups for Vmax (2.8±1.6 vs 6.7±1.8 cm/sec, p<.0001), AT (68±7 vs 89±5msec, p<.0001) and strain (7.6±1.3% vs 24±2.9%, p<.0001). The indices derived from TDI were significantly decreased compared to controls both in patients with dilated (p<.0001) and normal aortas (p<.001). Significant and independent predictors of aortic dilatation were systolic blood pressure (F=19.2, p<.005), aortic stiffness index (F=21.3, p<.005), Vmax (F=31.2, p<.005), and strain (F=33.6, p<.005). Decreased aortic strain, Vmax and stiffness index were predictive of aortic dissection (Odds ratio = 3.9, p <.0001, 3.5, p <.0001, and 1.5, p<.005, respectively). Conclusion. Our results show that in Marfan syndrome elastic properties of the thoracic aorta are significantly different from normal controls, even in the absence of vessel dilatation. TDI assessment of aortic wall mechanics in Marfan patients is more accurate than standard M-mode measurements and is predictive of aortic dilatation and dissection
Assessment of aortic wall mechanics in Marfan syndrome by transesophageal echocardiography and tissue Doppler imaging / Vitarelli, Antonino; Y., Conde; D'Angeli, Ilaria; E., Cimino; D'Orazio, Simona; Stellato, Simona; V., Padella. - In: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. - ISSN 0735-1097. - STAMPA. - 43:A(2004), pp. 362A-363A. (Intervento presentato al convegno 54th Annual Scientific Session of the American-College-of-Cardiology tenutosi a New Orleans, LA nel MAR 07-10, 2004) [10.1016/s0735-1097(04)91533-1].
Assessment of aortic wall mechanics in Marfan syndrome by transesophageal echocardiography and tissue Doppler imaging
VITARELLI, Antonino;D'ANGELI, ILARIA;D'ORAZIO, SIMONA;STELLATO, SIMONA;
2004
Abstract
Background. It has been described that aortic elastic properties are abnormal in patients with Marfan syndrome irrespective of the aortic diameter. The aim of our study was to investigate the potential value of transesophageal echocardiography combined with tissue Doppler imaging for the assessment of elastic properties of the thoracic aorta in patients with Marfan disease. Methods. Twentyone patients (pts) with Marfan syndrome (Gent criteria) aged 13 to 52 years were studied with multiplane transesophageal echocardiography (TEE). 7/21 pts had surgery for aortic dissection. Sixteen age- and gender-matched healthy subjects who had normal findings at TEE served as controls. The ascending and descending aorta were visualized in a TEE short axis view. Standard formulas and tissue Doppler imaging (TDI, Toshiba corp.) during TEE were used for the quantification of aortic elastic properties. Distensibility, stiffness index, and pulse wave velocity were calculated using M-mode data. TDI tracing displayed accelerated expansion of the aortic wall followed by a slow deceleration, a plateau and then a rapid deceleration into diastole. Acceleration time (AT, msec), maximum wall expansion velocity (Vmax, cm/sec), wall contraction E and A velocities (cm/sec), and peak systolic wall strain (e, %) were determined. Results. Ascending and descending thoracic aorta dilation (>40mm and >30mm) was present in 11/21 and 12/21 pts, respectively. Marfan patients had a lower distensibility and a higher stiffness index both in patients with dilated (p<.001) and normal aortas (p<.05). Highly significant differences were obtained between both groups for Vmax (2.8±1.6 vs 6.7±1.8 cm/sec, p<.0001), AT (68±7 vs 89±5msec, p<.0001) and strain (7.6±1.3% vs 24±2.9%, p<.0001). The indices derived from TDI were significantly decreased compared to controls both in patients with dilated (p<.0001) and normal aortas (p<.001). Significant and independent predictors of aortic dilatation were systolic blood pressure (F=19.2, p<.005), aortic stiffness index (F=21.3, p<.005), Vmax (F=31.2, p<.005), and strain (F=33.6, p<.005). Decreased aortic strain, Vmax and stiffness index were predictive of aortic dissection (Odds ratio = 3.9, p <.0001, 3.5, p <.0001, and 1.5, p<.005, respectively). Conclusion. Our results show that in Marfan syndrome elastic properties of the thoracic aorta are significantly different from normal controls, even in the absence of vessel dilatation. TDI assessment of aortic wall mechanics in Marfan patients is more accurate than standard M-mode measurements and is predictive of aortic dilatation and dissectionI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
