1. Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm
- Author
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Zamirpour, Siavash, Xuan, Yue, Wang, Zhongjie, Gomez, Axel, Leach, Joseph R, Mitsouras, Dimitrios, Saloner, David A, Guccione, Julius M, Ge, Liang, and Tseng, Elaine E
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Good Health and Well Being ,Ascending aortic aneurysm ,Biomechanics ,Computed tomography ,Finite element analysis ,Outcomes ,Risk factors ,Cardiorespiratory Medicine and Haematology ,Cardiovascular medicine and haematology - Abstract
ObjectivesCurrent diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surface area (BSA) is unknown. Our objective was to compare aTAA wall stresses with indexed diameters in relation to all-cause mortality at 3.75 years follow-up.MethodsFinite element analyses were performed in a veteran population with aortas ≥ 4.0 cm. Three-dimensional geometries were reconstructed from computed tomography with models accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain wall stress distributions under systolic pressure. Peak wall stresses were compared across guideline thresholds for diameter/BSA and diameter/height. Hazard ratios for all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models.ResultsOf 253 veterans, 54 (21 %) had aneurysm repair at 3.75 years. Indexed diameter alone would have prompted repair at baseline in 17/253 (6.7 %) patients, including only 4/230 (1.7 %) with diameter
- Published
- 2024