Skip to main content
Erschienen in: The International Journal of Cardiovascular Imaging 4/2017

24.11.2016 | Original Paper

Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study

verfasst von: Rogério Teixeira, Ricardo Monteiro, Paulo Dinis, Maria José Santos, Ana Botelho, Nuno Quintal, Nuno Cardim, Lino Gonçalves

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Vascular mechanics assessed with two-dimensional speckle tracking echocardiography (2D-STE) could be used as a new imaging surrogate of vascular stiffening. The CHA2DS2-VASc score is considered accurate as an estimate of stroke risk in non-valvular AF, although many potential stroke risk factors have not been included in this scoring method. The purpose of this research is to study the feasibility of evaluating vascular mechanics at the descending aorta in non-valvular AF patients using transesophageal 2D-STE and to analyze the association between descending aortic mechanics and stroke. We prospectively recruited a group of 44 patients referred for a transesophageal echocardiogram (TEE) in the context of cardioversion for non-valvular AF. A short-axis view of the descending aorta, one to two centimeters after the aortic arch was selected for the vascular mechanics assessment with the 2D-STE methodology. The vascular mechanics parameters analyzed were circumferential aortic strain (CAS) and early circumferential aortic strain rate (CASR). A clinical assessment was performed with focus on the past stroke history and the CHA2DS2-VASc score. The mean age of our cohort was 65 ± 13 years and 75% were men; AF was known for 2.8 ± 2.5 years and it was considered paroxystic in 41% of cases. Waveforms adequate for measuring 2D-STE were present in 85% of the 264 descending aortic wall segments. The mean CAS was 3.5 ± 1.2% and the mean CASR was 0.7 ± 0.3 s−1. The inter- and intra-observer variability for aortic mechanics was considered adequate. The median CHA2DS2VASc score was 2 (2–3). As the score increased we noted that both the CAS (r = −0.38, P = 0.01) and the CASR (r = −0.42, P < 0.01) decreased. Over 16% of the AF patients had a past history of stroke. These patients had lower values of both descending aortic strain [2.2 (1.8–2.6) vs. 3.9 (3.3–4.9)%, P < 0.01] and strain rate [0.4 (0.3–0.4) vs. 0.7 (0.6–1.1) s−1, P < 0.01]. CAS remained independently associated with a past history of stroke after adjustment for the CHA2DS2VASc score. Our data showed that non-valvular AF patients with a past history of stroke had lower values of aortic mechanics assessed with transesophageal 2D-STE.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Teixeira R, Vieira MJ, Goncalves A, Cardim N, Goncalves L (2016) Ultrasonographic vascular mechanics to assess arterial stiffness: a review. Eur Heart J Cardiovasc Imaging 17(3):233–246CrossRefPubMed Teixeira R, Vieira MJ, Goncalves A, Cardim N, Goncalves L (2016) Ultrasonographic vascular mechanics to assess arterial stiffness: a review. Eur Heart J Cardiovasc Imaging 17(3):233–246CrossRefPubMed
2.
Zurück zum Zitat Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: American Society Echocardiography/European Association of Echocardiography consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 24(3):277–313CrossRefPubMed Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: American Society Echocardiography/European Association of Echocardiography consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 24(3):277–313CrossRefPubMed
3.
Zurück zum Zitat Larsson M, Verbrugghe P, Smoljkic M, Verhoeven J, Heyde B, Famaey N et al (2015) Strain assessment in the carotid artery wall using ultrasound speckle tracking: validation in a sheep model. Phys Med Biol 60(3):1107–1123CrossRefPubMed Larsson M, Verbrugghe P, Smoljkic M, Verhoeven J, Heyde B, Famaey N et al (2015) Strain assessment in the carotid artery wall using ultrasound speckle tracking: validation in a sheep model. Phys Med Biol 60(3):1107–1123CrossRefPubMed
4.
Zurück zum Zitat Larsson M, Heyde B, Kremer F, Brodin LA, D’Hooge J (2015) Ultrasound speckle tracking for radial, longitudinal and circumferential strain estimation of the carotid artery—an in vitro validation via sonomicrometry using clinical and high-frequency ultrasound. Ultrasonics 56:399–408CrossRefPubMed Larsson M, Heyde B, Kremer F, Brodin LA, D’Hooge J (2015) Ultrasound speckle tracking for radial, longitudinal and circumferential strain estimation of the carotid artery—an in vitro validation via sonomicrometry using clinical and high-frequency ultrasound. Ultrasonics 56:399–408CrossRefPubMed
5.
Zurück zum Zitat Kim SA, Lee KH, Won HY, Park S, Chung JH, Jang Y et al (2013) Quantitative assessment of aortic elasticity with aging using velocity-vector imaging and its histologic correlation. Arterioscler Thromb Vasc Biol 33(6):1306–1312CrossRefPubMed Kim SA, Lee KH, Won HY, Park S, Chung JH, Jang Y et al (2013) Quantitative assessment of aortic elasticity with aging using velocity-vector imaging and its histologic correlation. Arterioscler Thromb Vasc Biol 33(6):1306–1312CrossRefPubMed
6.
Zurück zum Zitat Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH et al (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33(21):2719–2747CrossRefPubMed Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH et al (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33(21):2719–2747CrossRefPubMed
7.
Zurück zum Zitat Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31(19):2369–2429CrossRefPubMed Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31(19):2369–2429CrossRefPubMed
8.
Zurück zum Zitat Lip GY (2011) Stroke in atrial fibrillation: epidemiology and thromboprophylaxis. J Thromb Haemost 9(Suppl 1):344–351CrossRefPubMed Lip GY (2011) Stroke in atrial fibrillation: epidemiology and thromboprophylaxis. J Thromb Haemost 9(Suppl 1):344–351CrossRefPubMed
9.
Zurück zum Zitat Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137(2):263–272CrossRefPubMed Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137(2):263–272CrossRefPubMed
10.
Zurück zum Zitat Dubois D, Dubois E (1916) A formula to extimate the approximate surface area if height and weight are know. Arch Inter Med 17:863–871CrossRef Dubois D, Dubois E (1916) A formula to extimate the approximate surface area if height and weight are know. Arch Inter Med 17:863–871CrossRef
11.
Zurück zum Zitat McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33(14):1787–1847CrossRefPubMed McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33(14):1787–1847CrossRefPubMed
12.
Zurück zum Zitat Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monaghan M et al (2008) European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 9(4):438–448CrossRefPubMed Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monaghan M et al (2008) European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 9(4):438–448CrossRefPubMed
13.
Zurück zum Zitat Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39CrossRefPubMed Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39CrossRefPubMed
14.
Zurück zum Zitat Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463CrossRefPubMed Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463CrossRefPubMed
15.
Zurück zum Zitat Sohn DW, Song JM, Zo JH, Chai IH, Kim HS, Chun HG et al (1999 Nov) Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation. J Am Soc Echocardiogr 12(11):927–931CrossRefPubMed Sohn DW, Song JM, Zo JH, Chai IH, Kim HS, Chun HG et al (1999 Nov) Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation. J Am Soc Echocardiogr 12(11):927–931CrossRefPubMed
16.
Zurück zum Zitat Flachskampf FA, Badano L, Daniel WG, Feneck RO, Fox KF, Fraser AG et al (2010) Recommendations for transoesophageal echocardiography: update 2010. Eur J Echocardiogr 11(7):557–576CrossRefPubMed Flachskampf FA, Badano L, Daniel WG, Feneck RO, Fox KF, Fraser AG et al (2010) Recommendations for transoesophageal echocardiography: update 2010. Eur J Echocardiogr 11(7):557–576CrossRefPubMed
17.
Zurück zum Zitat Ito T, Suwa M, Hirota Y, Otake Y, Moriguchi A, Kawamura K (1996) Influence of left atrial function on Doppler transmitral and pulmonary venous flow patterns in dilated and hypertrophic cardiomyopathy: evaluation of left atrial appendage function by transesophageal echocardiography. Am Heart J 131(1):122–130CrossRefPubMed Ito T, Suwa M, Hirota Y, Otake Y, Moriguchi A, Kawamura K (1996) Influence of left atrial function on Doppler transmitral and pulmonary venous flow patterns in dilated and hypertrophic cardiomyopathy: evaluation of left atrial appendage function by transesophageal echocardiography. Am Heart J 131(1):122–130CrossRefPubMed
18.
Zurück zum Zitat Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P (1990) Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J 11(11):990–996CrossRefPubMed Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P (1990) Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J 11(11):990–996CrossRefPubMed
19.
Zurück zum Zitat Kim KH, Park JC, Yoon HJ, Yoon NS, Hong YJ, Park HW et al (2009) Usefulness of aortic strain analysis by velocity vector imaging as a new echocardiographic measure of arterial stiffness. J Am Soc Echocardiogr 22(12):1382–1388CrossRefPubMed Kim KH, Park JC, Yoon HJ, Yoon NS, Hong YJ, Park HW et al (2009) Usefulness of aortic strain analysis by velocity vector imaging as a new echocardiographic measure of arterial stiffness. J Am Soc Echocardiogr 22(12):1382–1388CrossRefPubMed
20.
Zurück zum Zitat Yuda S, Kaneko R, Muranaka A, Hashimoto A, Tsuchihashi K, Miura T et al (2011) Quantitative measurement of circumferential carotid arterial strain by two-dimensional speckle tracking imaging in healthy subjects. Echocardiography 28(8):899–906CrossRefPubMed Yuda S, Kaneko R, Muranaka A, Hashimoto A, Tsuchihashi K, Miura T et al (2011) Quantitative measurement of circumferential carotid arterial strain by two-dimensional speckle tracking imaging in healthy subjects. Echocardiography 28(8):899–906CrossRefPubMed
21.
Zurück zum Zitat Teixeira R, Moreira N, Baptista R, Barbosa A, Martins R, Castro G et al (2013) Circumferential ascending aortic strain and aortic stenosis. Eur Heart J Cardiovasc Imaging 14(7):631–641CrossRefPubMed Teixeira R, Moreira N, Baptista R, Barbosa A, Martins R, Castro G et al (2013) Circumferential ascending aortic strain and aortic stenosis. Eur Heart J Cardiovasc Imaging 14(7):631–641CrossRefPubMed
22.
Zurück zum Zitat Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476): 307–310CrossRefPubMed Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476): 307–310CrossRefPubMed
23.
Zurück zum Zitat Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428CrossRefPubMed Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428CrossRefPubMed
24.
Zurück zum Zitat Petrini J, Yousry M, Rickenlund A, Liska J, Hamsten A, Eriksson P et al (2010) The feasibility of velocity vector imaging by transesophageal echocardiography for assessment of elastic properties of the descending aorta in aortic valve disease. J Am Soc Echocardiogr 23(9):985–992CrossRefPubMed Petrini J, Yousry M, Rickenlund A, Liska J, Hamsten A, Eriksson P et al (2010) The feasibility of velocity vector imaging by transesophageal echocardiography for assessment of elastic properties of the descending aorta in aortic valve disease. J Am Soc Echocardiogr 23(9):985–992CrossRefPubMed
25.
Zurück zum Zitat Tsai WC, Sun YT, Liu YW, Ho CS, Chen JY, Wang MC et al (2013) Usefulness of vascular wall deformation for assessment of carotid arterial stiffness and association with previous stroke in elderly. Am J Hypertens 26(6):770–777CrossRefPubMed Tsai WC, Sun YT, Liu YW, Ho CS, Chen JY, Wang MC et al (2013) Usefulness of vascular wall deformation for assessment of carotid arterial stiffness and association with previous stroke in elderly. Am J Hypertens 26(6):770–777CrossRefPubMed
26.
Zurück zum Zitat Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B et al (2003) Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 34(5):1203–1206CrossRefPubMed Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B et al (2003) Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 34(5):1203–1206CrossRefPubMed
27.
Zurück zum Zitat Masawa N, Yoshida Y, Yamada T, Joshita T, Sato S, Mihara B (1994) Morphometry of structural preservation of tunica media in aged and hypertensive human intracerebral arteries. Stroke 25(1):122–127CrossRefPubMed Masawa N, Yoshida Y, Yamada T, Joshita T, Sato S, Mihara B (1994) Morphometry of structural preservation of tunica media in aged and hypertensive human intracerebral arteries. Stroke 25(1):122–127CrossRefPubMed
28.
Zurück zum Zitat Heistad DD, Armstrong ML, Baumbach GL, Faraci FM (1995) Sick vessel syndrome. Recovery of atherosclerotic and hypertensive vessels. Hypertension 26(3):509–513CrossRefPubMed Heistad DD, Armstrong ML, Baumbach GL, Faraci FM (1995) Sick vessel syndrome. Recovery of atherosclerotic and hypertensive vessels. Hypertension 26(3):509–513CrossRefPubMed
29.
Zurück zum Zitat Bernhardt P, Schmidt H, Hammerstingl C, Luderitz B, Omran H (2006) Atrial thrombi-a prospective follow-up study over 3 years with transesophageal echocardiography and cranial magnetic resonance imaging. Echocardiography 23(5):388–394CrossRefPubMed Bernhardt P, Schmidt H, Hammerstingl C, Luderitz B, Omran H (2006) Atrial thrombi-a prospective follow-up study over 3 years with transesophageal echocardiography and cranial magnetic resonance imaging. Echocardiography 23(5):388–394CrossRefPubMed
30.
Zurück zum Zitat Leung DY, Black IW, Cranney GB, Hopkins AP, Walsh WF (1994) Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation. J Am Coll Cardiol 24(3):755–762CrossRefPubMed Leung DY, Black IW, Cranney GB, Hopkins AP, Walsh WF (1994) Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation. J Am Coll Cardiol 24(3):755–762CrossRefPubMed
31.
Zurück zum Zitat Zabalgoitia M, Halperin JL, Pearce LA, Blackshear JL, Asinger RW, Hart RG (1998) Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. Stroke Prevention in Atrial Fibrillation III Investigators. J Am Coll Cardiol 31(7):1622–1626CrossRefPubMed Zabalgoitia M, Halperin JL, Pearce LA, Blackshear JL, Asinger RW, Hart RG (1998) Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. Stroke Prevention in Atrial Fibrillation III Investigators. J Am Coll Cardiol 31(7):1622–1626CrossRefPubMed
32.
Zurück zum Zitat O’Rourke MF (2001) Diastolic heart failure, diastolic left ventricular dysfunction and exercise intolerance. J Am Coll Cardiol 38(3):803–805CrossRefPubMed O’Rourke MF (2001) Diastolic heart failure, diastolic left ventricular dysfunction and exercise intolerance. J Am Coll Cardiol 38(3):803–805CrossRefPubMed
Metadaten
Titel
Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study
verfasst von
Rogério Teixeira
Ricardo Monteiro
Paulo Dinis
Maria José Santos
Ana Botelho
Nuno Quintal
Nuno Cardim
Lino Gonçalves
Publikationsdatum
24.11.2016
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 4/2017
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-016-1028-4

Weitere Artikel der Ausgabe 4/2017

The International Journal of Cardiovascular Imaging 4/2017 Zur Ausgabe

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.