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Objectives: Hypertension leads to aortic stiffening and dilatation but unexpected data from the Framingham Heart Study showed an inverse relationship between brachial pulse pressure and aortic diameter. Aortic dilatation would not only lead to lower pulse pressure but also to a worse prognosis (cardiac events, heart failure). Invasive pressure may be more informative but data are lacking., Aim: This study evaluated the relationship between invasively measured central blood pressure and proximal aortic diameter., Methods: In 71 consecutive patients referred to invasive haemodynamic study, proximal aortic remodelling was evaluated in terms of Z-score, comparing diameters measured at the sinus of Valsalva to the diameter expected according to patients' age, sex and body height. Pressures were recorded directly in the proximal aorta by means of a catheter before coronary assessment., Results: The mean invasive aortic SBPs and DBPs were 146 ± 23 and 78 ± 13 mmHg, respectively, giving a central pulse pressure (cPP inv) of 68 ± 21 mmHg. Proximal aortic diameter was 34.9 ± 19.4 mm, whereas Z-score was -0.3 ± 1.7. Patients with higher cPPinv showed a significantly lower Z-score (-0.789 vs. 0.155, P = 0.001). cPPinv was inversely related to Z-score (R = -0.271, P = 0.022) independently from age, mean blood pressure and heart rate (β = -0.241, P = 0.011)., Conclusion: Aortic root Z-score is inversely associated with invasively measured central pulse pressure in a cohort of patients undergoing invasive coronary assessment. Remodelling at the sinuses of Valsalva may be a compensatory mechanism to limit pulse pressure., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Aortic dilatation is common in hypertensive patients and is associated with higher risk of cardiovascular events. Parameters predicting further dilatation during lifetime are poorly understood., Aim: To predict the midterm aortic diameter evolution in a cohort of hypertensive patients with known aortic dilatation at Sinus of Valsalva (SOV) level., Methods: We prospectively analyzed a cohort of essential hypertensive outpatients without any other known risk factor for aortic dilatation. They underwent serial echocardiographic evaluations from 2003 to 2016., Results: Two hundred and forty-two hypertensive outpatients with a mild-to-moderate (37-53 mm) aortic dilatation were followed up for at least 5 years. Mean growth rate was 0.08 ± 0.35 mm/year. No clinical or anthropometric parameters were significantly different in patients with and without aortic diameter increase. Aortic z score (number of standard deviations from the average value observed in the general population) at baseline was inversely associated with growth rate (R 0.04, P < 0.05). Aortic diameter at first visit, demographic and echocardiographic variables were major determinants of aortic diameter at second visit, accounting for about 90% of its total variability., Conclusion: Mean growth rate of proximal aorta in hypertensive patients with known aortic dilatation was of about 0.1 mm/year. Dilatation over time is slower in patients with increased rather than normal aortic z score. Eventually, it could be possible to reliably predict aortic diameter at few months from first visit.

Arterial stiffness is a marker of cardiovascular damage and an independent predictor of major cardiovascular events, usually assessed via Carotid-Femoral Pulse Wave Velocity (cfPWV). The aim of this study was to test the feasibility and usefulness of aortic strain analysis using a simplified transthoracic echocardiography (TTE) speckle-tracking (ST) based method. 60 consecutive patients with normal blood pressure and aortic dimensions underwent TTE and cfPWV evaluation. Strain analysis was performed on the largest section of the ascending aorta (aA) with a dedicated software; three couples of speckles were identified within the anterior and posterior aortic wall and transverse segments connecting each couple traced. Peak ascending Aorta Strain (PaAS) was defined as the averaged peak percentage deformation of these segments during the cardiac cycle; aortic stiffness index β 2 was defined as 100 × Ln(SBP/DBP)/PaAS. 17 patients were excluded for suboptimal TTE images. In the 43 analyzed individuals (male 58%, age 63 years) PaAS was 5.5 [3.7-8.6] % with excellent inter and intra observer reproducibility (ICC 95% for both). PaAS showed significant correlation with age (r = - 0.64), aA diameter (r = - 0.45), cfPWV (r = - 0.41), stroke volume (r = - 0.41) and heart rate (r = - 0.49). Age remained the only independent determinant of PaAS in a multivariate analysis. β 2 (10.8 [5.9-15.0]) showed significant direct correlation with age, Pulse pressure, aA diameter and cfPWV. A simplified strain analysis of the ascending aorta is technically feasible with good reproducibility; PaAS and β 2 index correlate well with established parameters of arterial stiffness and might represent a new index in evaluating vascular biomechanics.

Background: Accurate and reproducible measurements of proximal thoracic aorta diameters are essential in the diagnosis and follow-up of patients with aortic dilatation, a condition particularly common in hypertensive patients., Aim: to evaluate the accuracy of transthoracic echocardiography (TTE) in comparison with cardiac magnetic resonance (CMR) for the assessment of proximal thoracic aorta diameters in a cohort of hypertensive patients., Methods: A total of 75 essential hypertensive outpatients previously evaluated by TTE and than by CMR were included in the study. We specifically compared the two techniques at the level of sinuses of Valsalva (SoV) and ascending aorta (Asc) diameter. For the TTE images, the inner edge-to-inner edge and leading edge-to-leading edge conventions were compared., Results: TTE and CMR diameters were significantly related (SoV: r 0.931, P < 0.001; Asc: r 0.949, P < 0.001) when the leading edge-to-leading edge convention was used. Mean difference between CMR and TTE diameters was 2.49 ± 2.01 mm at the level of SoV and 1.13 ± 1.77 mm at the level of Asc. Correlation was good also for the TEE diameters measured by inner edge-to-inner edge convention (SoV: r 0.936, P < 0.001; Asc: r 0.947, P < 0.001). Comparing the two approaches in the evaluation of Asc, inner edge-to-inner edge showed a trend to a better correlation with CMR measurements than leading edge-to-leading edge, with a good interobserver and intraobserver agreement., Conclusion: The results of the current study suggest that TTE could be a reliable tool to assess proximal aorta diameters in hypertensive patients.

Objectives: The objectives of this study were to evaluate the prevalence of dilatation of proximal ascending aorta (pAA) in essential hypertensive patients and the association between pAA dilatation, arterial stiffness and left ventricular hypertrophy., Background: Few data are available regarding patients with pAA dilatation in arterial hypertension. It is not known whether pAA dilatation may be related to increased left ventricular mass and what the relation with central hemodynamics and arterial stiffness would be., Methods: A total of 345 untreated and treated essential hypertensive patients (mean age, 54.3 ± 11 years) were considered for this analysis. We measured pulsatile hemodynamic parameters directly using tonometry, and the proximal aortic diameters through ultrasound imaging (echocardiography)., Results: Prevalence of pAA dilatation was 17%. Peripheral hemodynamic parameters were similar in patients with and without ascending aorta dilatation. We observed a slight increase of central systolic (129.81 ± 15.4 vs. 125.02 ± 14.7 mmHg; P = 0.02) and pulse pressure (45.02 ± 10.4 vs. 42 ± 9.54 mmHg; P = 0.02) in patients with pAA dilatation. Pulse wave velocity (9.26 ± 2.33 vs. 7.70 ± 1.69 m/s; P < 0.0001), as well as the augmentation index (25.86 ± 10.2 vs. 19.41 ± 9.52%; P < 0.0001), was significantly greater in patients with pAA dilatation. Finally, left ventricular hypertrophy was thrice as frequent (32.8 vs. 13.4%; P < 0.0001) compared to hypertensive patients without aortic dilatation., Conclusion: This study shows a high prevalence (17%) of ascending aortic dilatation in patients affected by essential hypertension, without further complications. Dilatation of the ascending aorta is associated both to an increased left ventricular mass and arterial stiffness.

Introduction: Current evidence suggests that aortic blood pressure has a superior prognostic value with respect to brachial pressure for cardiovascular events, but direct measurement is not feasible in daily clinical practice. Aim: The aim of the present study is the clinical validation of a multiscale mathematical model for non-invasive appraisal of central blood pressure from subject-specific characteristics. Methods: A total of 51 young male were selected for the present study. Aortic systolic and diastolic pressure were estimated with a mathematical model and were compared to the most-used non-invasive validated technique (SphygmoCor device, AtCor Medical, Australia). SphygmoCor was calibrated through diastolic and systolic brachial pressure obtained with a sphygmomanometer, while model inputs consist of brachial pressure, height, weight, age, left-ventricular end-systolic and end-diastolic volumes, and data from a pulse wave velocity study. Results: Model-estimated systolic and diastolic central blood pressures resulted to be significantly related to SphygmoCor-assessed central systolic (r = 0.65 p <0.0001) and diastolic (r = 0.84 p<0.0001) blood pressures. The model showed a significant overestimation of systolic pressure (+7.8 (-2.2;14) mmHg, p = 0.0003) and a significant underestimation of diastolic values (-3.2(-7.5;1.6), p = 0.004), which imply a significant overestimation of central pulse pressure. Interestingly, model prediction errors mirror the mean errors reported in large meta-analysis characterizing the use of the SphygmoCor when non-invasive calibration is performed. Conclusion: In conclusion, multi-scale mathematical model predictions result to be significantly related to SphygmoCor ones. Model-predicted systolic and diastolic aortic pressure resulted in difference of less than 10 mmHg in the 51% and 84% of the subjects, respectively, when compared with SphygmoCor-obtained pressures. [ABSTRACT FROM AUTHOR]