Consistency of aortic distensibility and pulse wave velocity estimates with respect to the Bramwell-Hill theoretical model: a cardiovascular magnetic resonance study

<p>Abstract</p> <p>Background</p> <p>Arterial stiffness is considered as an independent predictor of cardiovascular mortality, and is increasingly used in clinical practice. This study aimed at evaluating the consistency of the automated estimation of regional and local aortic stiffness indices from cardiovascular magnetic resonance (CMR) data.</p> <p>Results</p> <p>Forty-six healthy subjects underwent carotid-femoral pulse wave velocity measurements (<it>CF_PWV</it>) by applanation tonometry and CMR with steady-state free-precession and phase contrast acquisitions at the level of the aortic arch. These data were used for the automated evaluation of the aortic arch pulse wave velocity (<it>Arch_PWV</it>), and the ascending aorta distensibility (<it>AA_Distc, AA_Distb)</it>, which were estimated from ascending aorta strain (<it>AA_Strain</it>) combined with either carotid or brachial pulse pressure. The local ascending aorta pulse wave velocity <it>AA_PWVc </it>and <it>AA_PWVb </it>were estimated respectively from these carotid and brachial derived distensibility indices according to the Bramwell-Hill theoretical model, and were compared with the <it>Arch_PWV</it>. In addition, a reproducibility analysis of <it>AA_PWV </it>measurement and its comparison with the standard <it>CF_PWV </it>was performed. Characterization according to the Bramwell-Hill equation resulted in good correlations between <it>Arch_PWV </it>and both local distensibility indices <it>AA_Distc </it>(r = 0.71, p < 0.001) and <it>AA_Distb </it>(r = 0.60, p < 0.001); and between <it>Arch_PWV </it>and both theoretical local indices <it>AA_PWVc </it>(r = 0.78, p < 0.001) and <it>AA_PWVb </it>(r = 0.78, p < 0.001). Furthermore, the <it>Arch_PWV </it>was well related to <it>CF_PWV </it>(r = 0.69, p < 0.001) and its estimation was highly reproducible (inter-operator variability: 7.1%).</p> <p>Conclusions</p> <p>The present work confirmed the consistency and robustness of the regional index <it>Arch_PWV </it>and the local indices <it>AA_Distc and AA_Distb </it>according to the theoretical model, as well as to the well established measurement of <it>CF_PWV</it>, demonstrating the relevance of the regional and local CMR indices.</p

Evaluation of the oartic stiffness in MRI : assesment of the distensibility and the pulse wave velocity

Elle peut être estimée par deux indices : la distensibilité de la paroi aortique et la vitessede propagation de l'onde de pouls (VOP) le long de l'artère. Ces marqueurs peuvent êtreobtenus dans l'aorte proximale grâce à l'imagerie de résonance magnétique (IRM) et sontreliés entre eux par le modèle de Bramwell-Hill. L'objectif de cette thèse est, d'une part, deproposer et de valider cliniquement des méthodes d'estimation de la distensibilité et de laVOP aortique, et, d'autre part, d'étudier le modèle théorique de Bramwell-Hill, au regarddes données cliniques. Nous avons dans un premier temps comparé différentes méthodesd'estimation de la distensibilité de l'aorte. Cette étude a permis d'identifier l'approche quifournit la meilleure description physiologique de l'aorte ascendante et descendante. Ensuite,nous avons proposé une nouvelle méthode de mesure de la VOP proximale. Celle-cia été validée par comparaison avec les méthodes proposées dans la littérature en termesde reproductibilité et de corrélations des mesures avec : 1) l'âge : facteur de risque "naturel " de la rigidité aortique chez des sujets sains, et 2) la VOP carotido-fémoralemesurée par tonométrie, méthode de référence utilisée en routine clinique pour estimer larigidité globale de l'aorte. Enfin, nous avons validé le modèle théorique de Bramwell-Hillau niveau des sections de l'aorte ascendante et descendante. En conclusion, nous avonsproposé des approches locale et régionale d'évaluation de la rigidité de l'aorte proximaleet nous en avons validé la robustesse, notamment dans le cadre du vieillissement artériel.The aortic stiffness is recognized as a major factor of cardiovascular risk, and is characterizedby distensibility and pulse wave velocity (PWV) measurements. These aorticindices are related according to the Bramwell-Hill model and can be assessed in the proximalaorta with magnetic resonance imaging (MRI). The aims of this thesis were : 1) topropose and validate clinical methods for estimating the distensibility and aortic PWVfrom MRI data, and 2) to study the theoretical model of Bramwell-Hill in the light ofclinical data. First, we compared different methods for estimating the distensibility ofthe aorta. This study permitted to identify the approach which provides the best physiologicaldescription of the ascending and descending aorta. Then we proposed a newmethod for estimating the PWV in the proximal aorta, which was validated by comparisonwith previously described methods in terms of reproducibility and correlation ofaortic PWV with : 1) age : major risk factor of aortic stiffness in healthy subjects, and 2)carotid-femoral PWV measured by tonometry, gold standard method in clinical routinefor estimating the overall stiffness of the aorta. Finally, we validated the theoretical modelof Bramwell-Hill at the sections of the ascending and descending aorta. In conclusion, weproposed local and regional approaches to assess the stiffness of the proximal aorta, andwe validated its robustness, particularly in the context of aging

Développement de méthodes pour l'évaluation de la rigidité aortique en IRM (mesure de la distensibilité et de la vitesse d'onde de pouls)

Elle peut être estimée par deux indices : la distensibilité de la paroi aortique et la vitessede propagation de l'onde de pouls (VOP) le long de l'artère. Ces marqueurs peuvent êtreobtenus dans l'aorte proximale grâce à l'imagerie de résonance magnétique (IRM) et sontreliés entre eux par le modèle de Bramwell-Hill. L'objectif de cette thèse est, d'une part, deproposer et de valider cliniquement des méthodes d'estimation de la distensibilité et de laVOP aortique, et, d'autre part, d'étudier le modèle théorique de Bramwell-Hill, au regarddes données cliniques. Nous avons dans un premier temps comparé différentes méthodesd'estimation de la distensibilité de l'aorte. Cette étude a permis d'identifier l'approche quifournit la meilleure description physiologique de l'aorte ascendante et descendante. Ensuite,nous avons proposé une nouvelle méthode de mesure de la VOP proximale. Celle-cia été validée par comparaison avec les méthodes proposées dans la littérature en termesde reproductibilité et de corrélations des mesures avec : 1) l'âge : facteur de risque "naturel " de la rigidité aortique chez des sujets sains, et 2) la VOP carotido-fémoralemesurée par tonométrie, méthode de référence utilisée en routine clinique pour estimer larigidité globale de l'aorte. Enfin, nous avons validé le modèle théorique de Bramwell-Hillau niveau des sections de l'aorte ascendante et descendante. En conclusion, nous avonsproposé des approches locale et régionale d'évaluation de la rigidité de l'aorte proximaleet nous en avons validé la robustesse, notamment dans le cadre du vieillissement artériel.The aortic stiffness is recognized as a major factor of cardiovascular risk, and is characterizedby distensibility and pulse wave velocity (PWV) measurements. These aorticindices are related according to the Bramwell-Hill model and can be assessed in the proximalaorta with magnetic resonance imaging (MRI). The aims of this thesis were : 1) topropose and validate clinical methods for estimating the distensibility and aortic PWVfrom MRI data, and 2) to study the theoretical model of Bramwell-Hill in the light ofclinical data. First, we compared different methods for estimating the distensibility ofthe aorta. This study permitted to identify the approach which provides the best physiologicaldescription of the ascending and descending aorta. Then we proposed a newmethod for estimating the PWV in the proximal aorta, which was validated by comparisonwith previously described methods in terms of reproducibility and correlation ofaortic PWV with : 1) age : major risk factor of aortic stiffness in healthy subjects, and 2)carotid-femoral PWV measured by tonometry, gold standard method in clinical routinefor estimating the overall stiffness of the aorta. Finally, we validated the theoretical modelof Bramwell-Hill at the sections of the ascending and descending aorta. In conclusion, weproposed local and regional approaches to assess the stiffness of the proximal aorta, andwe validated its robustness, particularly in the context of aging.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Measurement of aortic arch pulse wave velocity in cardiovascular MR: Comparison of transit time estimators and description of a new approach

International audiencePurpose: To investigate the efficiency of a new method (TT-Upslope) for transit time (Δt) estimation from cardiovascular MR (CMR) velocity curves.Materials and methods: Fifty healthy volunteers (40 ± 15 years) underwent applanation tonometry to estimate carotid-femoral pulse wave velocity (cf-PWV) and carotid pressure measurements, and CMR to estimate aortic arch-PWV and ascending aorta distensibility (AAD). The Δt was calculated with TT-Upslope by minimizing the area delimited by two sigmoid curves fitted to the systolic upslope of the ascending (AAC) and descending (DAC) aorta velocity curves, and compared with previously described methods: TT-Point using the half maximum of AAC and DAC, TT-Foot using AAC and DAC feet, and TT-Wave by minimizing the area between AAC and DAC curves using cross correlation.Results: All the Δt methods provided a high reproducibility of arch-PWV. However, TT-Upslope and TT-Wave resulted in better correlations with aging (r = 0.83/r = 0.83 versus r = 0.47/r = 0.72), cf-PWV (r = 0.69/r = 0.70 versus r = 0.34/r = 0.59), and AAD (r = 0.81/r = 0.71 versus r = 0.61/r = 0.60). Furthermore, TT-Upslope resulted in stronger relationship between arch-PWV and AAD according to a theoretical model and provided better characterization of older subjects compared with TT-Wave.Conclusion: Arch-PWV estimated with CMR using the TT-Upslope method was found to be reproducible and accurate, providing strong correlations with age and aortic stiffness indices

Automated segmentation of the aorta from phase contrast MR images: Validation against expert tracing in healthy volunteers and in patients with a dilated aorta

International audiencePurpose: To assess if segmentation of the aorta can be accurately achieved using the modulus image of phase contrast (PC) magnetic resonance (MR) acquisitions.Materials and methods: PC image sequences containing both the ascending and descending aorta of 52 subjects were acquired using three different MR scanners. An automated segmentation technique, based on a 2D+t deformable surface that takes into account the features of PC aortic images, such as flow-related effects, was developed. The study was designed to: 1) assess the variability of our approach and its robustness to the type of MR scanner, and 2) determine its sensitivity to aortic dilation and its accuracy against an expert manual tracing.Results: Interobserver variability in the lumen area was 0.59 +/- 0.92% for the automated approach versus 10.09 +/- 8.29% for manual segmentation. The mean Dice overlap measure was 0.945 +/- 0.014. The method was robust to the aortic size and highly correlated (r = 0.99) with the manual tracing in terms of aortic area and diameter.Conclusion: A fast and robust automated segmentation of the aortic lumen was developed and successfully tested on images provided by various MR scanners and acquired on healthy volunteers as well as on patients with a dilated aorta