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Zeijen VJ, Feyz L, Kardys I, Geleijnse ML, Van Mieghem NM, Zijlstra F, Lafeber M, Van Der Geest RJ, Hirsch A, Daemen J. Association between renal sympathetic denervation and arterial stiffness: the ASORAS study. J Hypertens 2023; 41:476-485. [PMID: 36655697 PMCID: PMC9894147 DOI: 10.1097/hjh.0000000000003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Renal sympathetic denervation (RDN) reduces blood pressure (BP). However, one out of three patients does not exhibit a significant BP response to the therapy. This study investigates the association between noninvasive vascular stiffness indices and RDN-mediated BP reduction. METHODS In this prospective, single-arm pilot study, patients with systolic office BP at least 140 mmHg, mean 24-h systolic ambulatory blood pressure (ABP) at least 130 mmHg and at least three prescribed antihypertensive drugs underwent radiofrequency RDN. The primary efficacy endpoint was temporal evolution of mean 24-h systolic ABP throughout 1-year post RDN (measured at baseline and 3-6-12 months). Effect modification was studied for baseline ultrasound carotid-femoral and magnetic resonance (MR) pulse wave velocity (PWV), MR aortic distensibility, cardiac MR left ventricular parameters and clinical variables. Statistical analyses were performed using linear mixed-effects models, and effect modification was assessed using interaction terms. RESULTS Thirty patients (mean age 62.5 ± 10.7 years, 50% women) with mean 24-h ABP 146.7/80.8 ± 13.7/12.0 mmHg were enrolled. Following RDN, mean 24-h systolic ABP changed with -8.4 (95% CI: -14.5 to -2.3) mmHg/year ( P = 0.007). Independent effect modifiers were CF-PWV [+2.7 (0.3 to 5.1) mmHg/year change in outcome for every m/s increase in CF-PWV; P = 0.03], daytime diastolic ABP [-0.4 (-0.8 to 0.0) mmHg/year per mmHg; P = 0.03], age [+0.6 (0.2 to 1.0) mmHg/year per year of age; P = 0.006], female sex [-14.0 (-23.1 to -5.0) mmHg/year as compared with men; P = 0.003] and BMI [+1.2 (0.1 to 2.2) mmHg/year per kg/m 2 ; P = 0.04]. CONCLUSION Higher CF-PWV at baseline was associated with a smaller reduction in systolic ABP following RDN. These findings could contribute to improve identification of RDN responders.
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Affiliation(s)
| | | | | | | | | | | | - Melvin Lafeber
- Department of Internal and Vascular Medicine, Erasmus University Medical Center, Rotterdam
| | | | - Alexander Hirsch
- Department of Cardiology
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Meccanici F, de Bruijn JWC, Dommisse JS, Takkenberg JJM, van den Bosch AE, Roos-Hesselink JW. Prevalence and development of aortic dilation and dissection in women with Turner syndrome: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2023; 21:133-144. [PMID: 36688313 DOI: 10.1080/14779072.2023.2172403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Women with Turner syndrome (TS) have an increased risk of aortic disease, reducing life-expectancy. This study aimed to systematically review the prevalence of thoracic aortic dilatation, aortic dimensions and growth, and the incidence of aortic dissection. METHODS A systematic literature search was conducted up to July 2022. Observational studies with an adult TS population were included, and studies including children aged <15 years old or specific TS populations were excluded. RESULTS In total 21 studies were included. The pooled prevalence of ascending aortic dilatation was 23% (95% CI 19-26) at a mean pooled age of 29 years (95% CI 26-32), while the incidence of aortic dissection was 164 per 100.000 patient-years (95% CI 95-284). Three reporting studies showed aortic growth over time to be limited. Risk factors for aortic dilation or dissection were older age, bicuspid aortic valve, aortic coarctation, and hypertension. CONCLUSION In adult TS women, ascending aortic dilatation is common and the hazard of aortic dissection increased compared to the general population, whereas aortic growth is limited. Conventional risk markers do not explain all aortic dissection cases; therefore, new imaging parameters and blood biomarkers are needed to improve prediction, allowing for patient-tailored follow-up and surgical decision-making.
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Affiliation(s)
- F Meccanici
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J W C de Bruijn
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J S Dommisse
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A E van den Bosch
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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3
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Abstract
Turner syndrome (TS) is a condition in females missing the second sex chromosome (45,X) or parts thereof. It is considered a rare genetic condition and is associated with a wide range of clinical stigmata, such as short stature, ovarian dysgenesis, delayed puberty and infertility, congenital malformations, endocrine disorders, including a range of autoimmune conditions and type 2 diabetes, and neurocognitive deficits. Morbidity and mortality are clearly increased compared with the general population and the average age at diagnosis is quite delayed. During recent years it has become clear that a multidisciplinary approach is necessary toward the patient with TS. A number of clinical advances has been implemented, and these are reviewed. Our understanding of the genomic architecture of TS is advancing rapidly, and these latest developments are reviewed and discussed. Several candidate genes, genomic pathways and mechanisms, including an altered transcriptome and epigenome, are also presented.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Mette Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Jesper Just
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Kristian Sandahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Sara Brun
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Janielle van der Velden
- Department of Pediatrics, Radboud University Medical Centre, Amalia Children's Hospital, 6525 Nijmegen, the Netherlands
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg 9000, Denmark
| | - Anne Skakkebaek
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus 8200 N, Denmark
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Meccanici F, Schotte MH, Snoeren M, Bons LR, van den Hoven AT, Kardys I, Budde RPJ, van den Bosch AE, Duijnhouwer AL, Roos-Hesselink JW. Aortic dilation and growth in women with Turner syndrome. Heart 2022; 109:102-110. [PMID: 35705330 DOI: 10.1136/heartjnl-2022-320922] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Women with Turner syndrome (TS) are at increased risk of aortic dissection, which is a life-threatening event associated with aortic dilation. Knowledge on the development of aortic dilation over time remains limited. This study aims to describe the prevalence of aortic dilation, to find associated factors and to study aortic growth in women with TS. METHODS In this prospective multicentre cohort study, consecutive adult women with genetically proven TS included between 2014 and 2016 underwent ECG-triggered multiphase CT angiography at baseline and after 3 years. Aortic diameters were measured at seven levels of the thoracic aorta using double oblique reconstruction and indexed for body surface area. Ascending aortic dilation was defined as an aortic size index >20 mm/m2. Aorta-related and cardiovascular events were collected. Statistical analysis included linear and logistic regression and linear mixed effects models. RESULTS The cohort consisted of 89 women with a median age of 34 years (IQR: 24-44). Ascending aortic dilation was found in 38.2% at baseline. At baseline, age (OR: 1.08 (95% CI 1.03 to 1.13), p<0.001), presence of bicuspid aortic valve (BAV) (OR: 7.09 (95% CI 2.22 to 25.9), p=0.002) and systolic blood pressure (OR: 1.06 (95% CI 1.02 to 1.11), p=0.004) were independently associated with ascending aortic dilation. During a median follow-up of 3.0 (2.4-3.6) years (n=77), significant aortic growth was found only at the sinotubular junction (0.20±1.92 mm, p=0.021). No aortic dissection occurred, one patient underwent aortic surgery and one woman died. CONCLUSIONS In women with TS, ascending aortic dilation is common and associated with age, BAV and systolic blood pressure. Aortic diameters were stable during a 3-year follow-up, apart from a significant yet not clinically relevant increase at the sinotubular junction, which may suggest a more benign course of progression than previously reported.
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Affiliation(s)
| | | | - Miranda Snoeren
- Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Lidia R Bons
- Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Isabella Kardys
- Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Chongthammakun V, Pan AY, Earing MG, Damluji AA, Goot BH, Cava JR, Gerardin JF. The association between cardiac magnetic resonance-derived aortic stiffness parameters and aortic dilation in young adults with bicuspid aortic valve: With and without coarctation of aorta. Am Heart J Plus 2022; 20:100194. [PMID: 38560418 PMCID: PMC10978397 DOI: 10.1016/j.ahjo.2022.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 04/04/2024]
Abstract
Background Bicuspid aortic valve (BAV) is associated with progressive aortic dilation. Studies in aortopathies have shown a correlation between increased aortic stiffness and aortic dilation. We aimed to evaluate aortic stiffness measures as predictors of progressive aortic dilation by cardiac magnetic resonance (CMR) in BAV patients. Methods This is a retrospective study of 49 patients with BAV (median age 21.1 years at first CMR visit) with ≥2 CMR at the Wisconsin Adult Congenital Heart Disease Program (WAtCH). Circumferential aortic strain, distensibility, and β-stiffness index were obtained from CMR-derived aortic root cine imaging, and aortic dimensions were measured at aortic root and ascending aorta. A linear mixed-model and logistic regression were used to identify important predictors of progressive aortic dilation. Results Over a median of 3.8 years follow-up, the annual growth rates of aortic root and ascending aorta dimensions were 0.25 and 0.16 mm/year, respectively. Aortic strain and distensibility decreased while β-stiffness index increased with age. Aortic root strain and distensibility were associated with progressive dilation of the ascending aorta. Baseline aortic root diameter was an independent predictor of >1 mm/year growth rate of the aortic root (adjusted OR 1.34, 95 % CI 1.03-1.74, p = 0.028). Most patients (61 %) had coexisting coarctation of aorta. Despite the higher prevalence of hypertension in patients with aortic coarctation, hypertension or coarctation had no effect on baseline aorta dimensions, stiffness, or progressive aortic dilation. Conclusion Some CMR-derived aortic stiffness parameters correlated with progressive aortic dilation in BAV and should be further investigated in larger and older BAV cohorts.
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Affiliation(s)
- Vasutakarn Chongthammakun
- Adult Congenital Heart Disease Program, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States of America
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Amy Y. Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Michael G. Earing
- Sections of Cardiology and Pediatric Cardiology, University of Chicago, Chicago, IL, United States of America
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA, United States of America
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Benjamin H. Goot
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Joseph R. Cava
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jennifer F. Gerardin
- Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
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Peppa M, Pavlidis G, Mavroeidi I, Katogiannis K, Varoudi M, Thymis J, Kostelli G, Vlastos D, Plotas P, Bamias A, Parissis J, Ikonomidis I. Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome. J Hypertens 2021; 39:2051-2057. [PMID: 34102661 DOI: 10.1097/hjh.0000000000002903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS. METHODS Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes - namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep) - and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group. RESULTS Compared to controls, women with TS on HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5 m/s), cSBP (130 ± 15 vs. 121 ± 6 mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05 mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2 ± 4 vs. 10.5 ± 2.3%), Ao strain, Ao distensibility and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 ± 6 vs. 7.2 ± 4%) and reduced PWV (7.8 ± 1.7 vs. 9.1 ± 2.4 m/s) and cSBP (123 ± 14 vs. 130 ± 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = -0.57; P < 0.05 for all comparisons). CONCLUSIONS HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.
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Affiliation(s)
- Melpomeni Peppa
- Endocrine Unit, 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center
| | | | - Ioanna Mavroeidi
- Endocrine Unit, 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center
| | | | | | | | | | | | | | - Aristotelis Bamias
- 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Creamer TJ, Bramel EE, MacFarlane EG. Insights on the Pathogenesis of Aneurysm through the Study of Hereditary Aortopathies. Genes (Basel) 2021; 12:genes12020183. [PMID: 33514025 PMCID: PMC7912671 DOI: 10.3390/genes12020183] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
Thoracic aortic aneurysms (TAA) are permanent and localized dilations of the aorta that predispose patients to a life-threatening risk of aortic dissection or rupture. The identification of pathogenic variants that cause hereditary forms of TAA has delineated fundamental molecular processes required to maintain aortic homeostasis. Vascular smooth muscle cells (VSMCs) elaborate and remodel the extracellular matrix (ECM) in response to mechanical and biochemical cues from their environment. Causal variants for hereditary forms of aneurysm compromise the function of gene products involved in the transmission or interpretation of these signals, initiating processes that eventually lead to degeneration and mechanical failure of the vessel. These include mutations that interfere with transduction of stimuli from the matrix to the actin-myosin cytoskeleton through integrins, and those that impair signaling pathways activated by transforming growth factor-β (TGF-β). In this review, we summarize the features of the healthy aortic wall, the major pathways involved in the modulation of VSMC phenotypes, and the basic molecular functions impaired by TAA-associated mutations. We also discuss how the heterogeneity and balance of adaptive and maladaptive responses to the initial genetic insult might contribute to disease.
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Affiliation(s)
- Tyler J. Creamer
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Emily E. Bramel
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Predoctoral Training in Human Genetics and Molecular Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Elena Gallo MacFarlane
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Correspondence:
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Bons LR, Van Den Hoven AT, Malik M, Van Den Bosch AE, McGhie JS, Duijnhouwer AL, Siebelink HMJ, Hirsch A, Devos DH, Rietzschel E, von der Thüsen JH, van de Laar IMBH, Verhagen JMA, van der Pluijm I, Budde RPJ, Roos-Hesselink JW. Abnormal Aortic Wall Properties in Women with Turner Syndrome. Aorta (Stamford) 2020; 8:121-131. [PMID: 33368097 PMCID: PMC7758113 DOI: 10.1055/s-0040-1714384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Turner syndrome (TS) is associated with aortic dilatation and dissection, but the underlying process is unclear. The aim of this study was to investigate the elastic properties and composition of the aortic wall in women with TS.
Methods
In this cross-sectional study, 52 women with TS aged 35 ± 13 years (50% monosomy, 12 with bicuspid aortic valve [BAV] and 4 with coarctation) were investigated using carotid-femoral pulse wave velocity (CF-PWV) by echocardiography and ascending aortic distensibility (AAD) and aortic arch pulse wave velocity (AA-PWV) by magnetic resonance imaging (MRI). As control group, 13 women with BAV without TS and 48 healthy patients were included.
Results
Women with TS showed a higher AA-PWV (β = 1.08, confidence interval [CI]: 0.54–1.62) after correcting for age and comorbidities compared with controls. We found no significant difference in AAD and CF-PWV. In women with TS, the presence of BAV, coarctation of the aorta, or monosomy (45, X) was not associated with aortic stiffness. In addition, aortic tissue samples were investigated with routine and immunohistochemical stains in five additional women with TS who were operated. The tissue showed more compact smooth muscle cell layers with abnormal deposition and structure of elastin and diminished or absent expression of contractile proteins desmin, actin, and caldesmon, as well as the progesterone receptor.
Conclusion
Both aortic arch stiffness measurements on MRI and histomorphological changes point toward an inherent abnormal thoracic aortic wall in women with TS.
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Affiliation(s)
- Lidia R Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Allard T Van Den Hoven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maira Malik
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E Van Den Bosch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacky S McGhie
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Alexander Hirsch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daniel H Devos
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Ernst Rietzschel
- Department of Cardiology, Ghent University Hospital, Gent, Belgium
| | - Jan H von der Thüsen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid M B H van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith M A Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid van der Pluijm
- Department of Vascular Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Molecular Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Soulat G, Millasseau S, Stroer S, Tavolaro S, Kachenoura N, Khettab H, Boutouyrie P, Laurent S, Mousseaux E. Impact of simultaneous measurement of central blood pressure with the SphygmoCor Xcel during MRI acquisition to better estimate aortic distensibility. J Hypertens 2019; 37:1448-54. [PMID: 31145713 DOI: 10.1097/HJH.0000000000002061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Aortic distensibility estimation of local aortic stiffness is based on local aortic strains and central pulse pressure (cPP) measurements. Most MRI studies used either brachial PP (bPP) despite differences with cPP, or direct cPP estimates obtained after MRI examination, assuming no major pressure variations. We evaluated the feasibility of assessment of cPP with a specific device fitted with a 6 m long hose (study1) and looked at the influence of using such cPP within the magnet instead of bPP on aortic distensibility in a control population (study 2). METHODS Brachial and central pressures values were recorded with the SphygmoCor XCEL system fitted with 2 and 6 m long tubing randomly assigned on arms. A 6 m long tubing was used in the second study to measure aortic distensibility with MRI. Aortic distensibility was calculated using either bPP (bAD) or cPP (cAD). RESULTS Study1, performed on 38 patients (mean age: 43 ± 17 years), showed no statistical difference between bPP and cPP measured with 2 or 6 m long tubing (0.41 ± 4.45 and 0.78 ± 3.18 mmHg, respectively, both P = ns). In study 2, cAD provided statistically higher values than bAD (1.87 ± 1.43 10 · mmHg, P < 0.001) especially in younger individuals (3.28 ± 0.86 10 · mmHg). The correlation between age and aortic distensibility was stronger with cAD (r = -0.92; P < 0,001) than with bAD (r = -0.88; P < 0.001). CONCLUSION cPP can be estimated with reasonable accuracy during MRI acquisition using a 6 m long tube. Using either cPP or bPP greatly influences aortic distensibility values, especially in young individuals in whom an accurate detection of early or accelerated vascular aging can be of major importance.
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Soulat G, Gencer U, Kachenoura N, Villemain O, Messas E, Boutouyrie P, Laurent S, Mousseaux E. Changes in segmental pulse wave velocity of the thoracic aorta with age and left ventricular remodelling. An MRI 4D flow study. J Hypertens 2020; 38:118-26. [DOI: 10.1097/hjh.0000000000002224] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Abstract
There were 89 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 76 original research papers, 4 reviews, 5 technical notes, 1 guideline, and 3 corrections. The volume was down slightly from 2017 with a corresponding 15% decrease in manuscript submissions from 405 to 346 and thus reflects a slight increase in the acceptance rate from 25 to 26%. The decrease in submissions for the year followed the initiation of the increased author processing charge (APC) for Society for Cardiovascular Magnetic Resonance (SCMR) members for manuscripts submitted after June 30, 2018. The quality of the submissions continues to be high. The 2018 JCMR Impact Factor (which is published in June 2019) was slightly lower at 5.1 (vs. 5.46 for 2017; as published in June 2018. The 2018 impact factor means that on average, each JCMR published in 2016 and 2017 was cited 5.1 times in 2018. Our 5 year impact factor was 5.82.In accordance with Open-Access publishing guidelines of BMC, the JCMR articles are published on-line in a continuus fashion in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful for the JCMR audience to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and contemporaneous JCMR publications. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, as in the past two years, I have used this publication to also convey information regarding the editorial process and as a "State of our JCMR."This is the 12th year of JCMR as an open-access publication with BMC (formerly known as Biomed Central). The timing of the JCMR transition to the open access platform was "ahead of the curve" and a tribute to the vision of Dr. Matthias Friedrich, the SCMR Publications Committee Chair and Dr. Dudley Pennell, the JCMR editor-in-chief at the time. The open-access system has dramatically increased the reading and citation of JCMR publications and I hope that you, our authors, will continue to send your very best, high quality manuscripts to JCMR for consideration. It takes a village to run a journal and I thank our very dedicated Associate Editors, Guest Editors, Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. This entire process would also not be possible without the dedication and efforts of our managing editor, Diana Gethers. Finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 4th year as your editor-in-chief. It has been a tremendous experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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12
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Abstract
Turner syndrome is a rare condition in women that is associated with either complete or partial loss of one X chromosome, often in mosaic karyotypes. Turner syndrome is associated with short stature, delayed puberty, ovarian dysgenesis, hypergonadotropic hypogonadism, infertility, congenital malformations of the heart, endocrine disorders such as type 1 and type 2 diabetes mellitus, osteoporosis and autoimmune disorders. Morbidity and mortality are increased in women with Turner syndrome compared with the general population and the involvement of multiple organs through all stages of life necessitates a multidisciplinary approach to care. Despite an often conspicuous phenotype, the diagnostic delay can be substantial and the average age at diagnosis is around 15 years of age. However, numerous important clinical advances have been achieved, covering all specialty fields involved in the care of girls and women with Turner syndrome. Here, we present an updated Review of Turner syndrome, covering advances in genetic and genomic mechanisms of disease, associated disorders and multidisciplinary approaches to patient management, including growth hormone therapy and hormone replacement therapy.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Mette H Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Brun
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Schäfer M, Browne LP, Truong U, Jaggers JJ, Mitchell MB, Malone L, Morgan G, Chatfield K, McLennan D, Turbendian H, Vargas D, Fonseca B, DiMaria M, Shah A, Ivy MP, Barker AJ, Hunter KS, Wilson N, Ivy DD, Campbell DN. Aortic stiffness in adolescent Turner and Marfan syndrome patients. Eur J Cardiothorac Surg 2019; 54:926-932. [PMID: 29684119 DOI: 10.1093/ejcts/ezy168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/25/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Turner syndrome (TS) and Marfan syndrome (MFS) are partially characterized by aortopathies with a risk of developing severe aortic dilation, stiffness and consequent dissection and aneurysm formation. The incidence of a bicuspid aortic valve (BAV) is also increased in TS. We investigated aortic stiffness in teenage TS and MFS patients and evaluated to what degree stiffness in TS patients is augmented by the presence of a BAV. METHODS Fifty-seven patients with TS (n = 37) and MFS (n = 20), as well as 22 controls with similar age and size distribution underwent evaluation of thoracic aortic stiffness using phase-contrast magnetic resonance imaging. Calculated stiffness indices including pulse wave velocity (PWV), distensibility and relative area change (RAC) were collected to characterize the ascending aorta and descending aorta. PWV was also determined to evaluate global aortic arch stiffness. RESULTS Patients with TS had reduced distensibility (0.43 vs 0.58%/mmHg, P < 0.05) and RAC (21 vs 29%, P < 0.01) in the ascending aorta when compared with normal controls. Similarly, patients with MFS had reduced ascending aortic distensibility (0.39 vs 0.58%/mmHg, P < 0.05) and RAC (22 vs 29%, P < 0.05). There were no differences in measured PWV in the ascending aorta. Patients with TS had significantly elevated PWV measured in the aortic arch when compared with controls (2.7 vs 1.9 m/s, P < 0.05). Patients with MFS had more prominent elevation in aortic arch PWV (4.2 vs 1.9 m/s, P < 0.01). The descending aortas had decreased distensibility (0.36 vs 0.55%/mmHg, P < 0.05) and RAC (18 vs 25%, P < 0.01) only in MFS patients. Additionally, 18 TS patients with a BAV were compared with 19 TS patients with a trileaflet aortic valve, without significant differences observed in any of the considered stiffness indices. CONCLUSIONS TS and MFS teenage patients display evidence of increased aortic stiffness. In TS patients, this is focused in the ascending aorta and is independent of the presence of a BAV. MFS patients display a generalized reduction in compliance of the entire aorta.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Lorna P Browne
- Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Uyen Truong
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - James J Jaggers
- Division of Congenital Heart Surgery, Department of Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Max B Mitchell
- Division of Congenital Heart Surgery, Department of Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Ladonna Malone
- Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Gareth Morgan
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn Chatfield
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel McLennan
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Harma Turbendian
- Division of Congenital Heart Surgery, Department of Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Danial Vargas
- Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Brian Fonseca
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Michael DiMaria
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Anar Shah
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Margaret P Ivy
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kendall S Hunter
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Neil Wilson
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - D Dunbar Ivy
- Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - David N Campbell
- Division of Congenital Heart Surgery, Department of Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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Fox DA, Kang KT, Potts JE, Bradley TJ, Stewart LL, Dionne JM, Sandor GGS. Non-invasive assessment of aortic stiffness and blood pressure in young Turner syndrome patients. J Pediatr Endocrinol Metab 2019; 32:489-498. [PMID: 31042642 DOI: 10.1515/jpem-2018-0346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 03/14/2019] [Indexed: 01/15/2023]
Abstract
Background Females with Turner syndrome (TS) carry an elevated risk of aortic dissection. The objective of the study was to assess the biophysical properties of the aorta and ambulatory blood pressure (BP) in females with TS and compare these findings to those in healthy female age-matched controls. Methods This was a prospective cohort study including subjects aged 8-25 years. Utilizing two-dimensional (2D) echocardiography and Doppler, proximal aortic dimensions were measured and biophysical properties of the aorta were calculated including pulse wave velocity (PWV), arterial pressure-strain elastic modulus and stiffness index. Resting BP was measured and ambulatory blood pressure monitoring (ABPM) was performed. Results Of 23 TS patients and 46 controls (median age 16.3 years), aortic annulus, sinus of Valsalva and sinotubular (ST) junction diameters, as well as left ventricular (LV) mass, were significantly greater in TS patients compared with controls when scaled for height2.7, but not for body surface area (BSA), although ascending aorta diameter was greater when scaled for both. Median PWV was faster in TS patients compared to controls (451 vs. 360 cm/s) while arterial pressure-strain elastic modulus and stiffness index were similar. Resting BP was abnormal in seven out of 22 patients and ABPM was abnormal in 16 out of 21 patients. Conclusions Young patients with TS had dilated proximal aortas when scaled for height2.7 and stiffer aortas when compared with healthy female age-matched controls. Moreover, resting BP underdiagnosed pre-hypertension and hypertension compared to ABPM. These findings are consistent with the presence of a primary aortopathy in TS.
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Affiliation(s)
- Danya A Fox
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of British Columbia, Vancouver, BC, Canada
| | - Kristopher T Kang
- Department of Pediatrics, Division of General Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - James E Potts
- Department of Pediatrics, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Timothy J Bradley
- Department of Pediatrics, Division of Cardiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Laura L Stewart
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of British Columbia, Vancouver, BC, Canada
| | - Janis M Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - George G S Sandor
- Department of Pediatrics, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
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15
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Brun S, Cleemann L, Holm K, Salskov G, Erlandsen M, Berglund A, Andersen NH, Gravholt CH. Five-Year Randomized Study Demonstrates Blood Pressure Increases in Young Women With Turner Syndrome Regardless of Estradiol Dose. Hypertension 2019; 73:242-248. [DOI: 10.1161/hypertensionaha.118.11742] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sara Brun
- From the Department of Pediatrics, Nordsjællands Hospital, Copenhagen University Hospital, Hillerød, Denmark (S.B., L.C., K.H., G.S.)
- Department of Endocrinology and Internal Medicine and the Medical Research Laboratories (S.B., A.B., C.H.G.), Aarhus University Hospital, Denmark
| | - Line Cleemann
- From the Department of Pediatrics, Nordsjællands Hospital, Copenhagen University Hospital, Hillerød, Denmark (S.B., L.C., K.H., G.S.)
| | - Kirsten Holm
- From the Department of Pediatrics, Nordsjællands Hospital, Copenhagen University Hospital, Hillerød, Denmark (S.B., L.C., K.H., G.S.)
| | - Gitte Salskov
- From the Department of Pediatrics, Nordsjællands Hospital, Copenhagen University Hospital, Hillerød, Denmark (S.B., L.C., K.H., G.S.)
| | - Mogens Erlandsen
- Section for Biostatistics, Department of Public Health, Aarhus University, Denmark (M.E.)
| | - Agnethe Berglund
- Department of Endocrinology and Internal Medicine and the Medical Research Laboratories (S.B., A.B., C.H.G.), Aarhus University Hospital, Denmark
- Department of Molecular Medicine (A.B., C.H.G.), Aarhus University Hospital, Denmark
| | - Niels H. Andersen
- Department of Cardiology, Aalborg University Hospital, Denmark (N.H.A.)
| | - Claus H. Gravholt
- Department of Endocrinology and Internal Medicine and the Medical Research Laboratories (S.B., A.B., C.H.G.), Aarhus University Hospital, Denmark
- Department of Molecular Medicine (A.B., C.H.G.), Aarhus University Hospital, Denmark
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Abstract
There were 106 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 92 original research papers, 3 reviews, 9 technical notes, and 1 Position paper, 1 erratum and 1 correction. The volume was similar to 2016 despite an increase in manuscript submissions to 405 and thus reflects a slight decrease in the acceptance rate to 26.7%. The quality of the submissions continues to be high. The 2017 JCMR Impact Factor (which is published in June 2018) was minimally lower at 5.46 (vs. 5.71 for 2016; as published in June 2017), which is the second highest impact factor ever recorded for JCMR. The 2017 impact factor means that an average, each JCMR paper that were published in 2015 and 2016 was cited 5.46 times in 2017.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in continuus fashion and in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or theme, so that readers can view areas of interest in a single article in relation to each other and other contemporary JCMR articles. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, I have elected to use this format to convey information regarding the editorial process to the readership.I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your very best, high quality manuscripts to JCMR for consideration. I thank our very dedicated Associate Editors, Guest Editors, and Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the forefront journal of our field. And finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 3rd year as your editor-in-chief. It has been a tremendous learning experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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Wen J, Trolle C, Viuff MH, Ringgaard S, Laugesen E, Gutmark EJ, Subramaniam DR, Backeljauw P, Gutmark-Little I, Andersen NH, Mortensen KH, Gravholt CH. Impaired aortic distensibility and elevated central blood pressure in Turner Syndrome: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2018; 20:80. [PMID: 30541571 PMCID: PMC6292015 DOI: 10.1186/s12968-018-0497-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/23/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Women with Turner Syndrome have an increased risk for aortic dissection. Arterial stiffening is a risk factor for aortic dilatation and dissection. Here we investigate if arterial stiffening can be observed in Turner Syndrome patients and is an initial step in the development of aortic dilatation and subsequent dissection. METHODS Fifty-seven women with Turner Syndrome (48 years [29-66]) and thirty-six age- and sex-matched controls (49 years [26-68]) were included. Distensibility, blood pressure, carotid-femoral pulse wave velocity (PWV), the augmentation index (Aix) and central blood pressure were determined using cardiovascular magnetic resonance, a 24-h blood pressure measurement and applanation tonometry. Aortic distensibility was determined at three locations: ascending aorta, transverse aortic arch, and descending aorta. RESULTS Mean aortic distensibility in the descending aorta was significantly lower in Turner Syndrome compared to healthy controls (P = 0.02), however, this was due to a much lower distensibility among Turner Syndrome with coarctation, while Turner Syndrome without coarctation had similar distensibility as controls. Both the mean heart rate adjusted Aix (31.4% vs. 24.4%; P = 0.02) and central diastolic blood pressure (78.8 mmHg vs. 73.7 mmHg; P = 0.02) were higher in Turner Syndrome compared to controls, and these indices correlated significantly with ambulatory night-time diastolic blood pressure. The presence of aortic coarctation (r = - 0.44, P = 0.005) and a higher central systolic blood pressure (r = - 0.34, P = 0.03), age and presence of diabetes were inversely correlated with aortic distensibility in TS. CONCLUSION Aortic wall function in the descending aorta is impaired in Turner Syndrome with lower distensibility among those with coarctation of the aorta, and among all Turner Syndrome higher Aix, and elevated central diastolic blood pressure when compared to sex- and age-matched controls. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov ( #NCT01678274 ) on September 3, 2012.
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Affiliation(s)
- Jan Wen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Christian Trolle
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Mette H. Viuff
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Steffen Ringgaard
- Department of Clinical Medicine, MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Ephraim J. Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH USA
- UC Department of Otolaryngology – Head and Neck Surgery, Cincinnati, OH USA
| | | | - Philippe Backeljauw
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Niels H. Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian H. Mortensen
- Cardiovascular Imaging Department, Cardio-respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH UK
| | - Claus H. Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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Mortensen KH, Young L, De Backer J, Silberbach M, Collins RT, Duijnhouwer AL, Pandya B, Gravholt CH, Lopez L, Roos-Hesselink JW. Cardiovascular imaging in Turner syndrome: state-of-the-art practice across the lifespan. Heart 2018; 104:1823-1831. [DOI: 10.1136/heartjnl-2017-312658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/29/2018] [Accepted: 06/29/2018] [Indexed: 01/15/2023] Open
Abstract
Cardiovascular imaging is essential to providing excellent clinical care for girls and women with Turner syndrome (TS). Congenital and acquired cardiovascular diseases are leading causes of the lifelong increased risk of premature death in TS. Non-invasive cardiovascular imaging is crucial for timely diagnosis and treatment planning, and a systematic and targeted imaging approach should combine echocardiography, cardiovascular magnetic resonance and, in select cases, cardiac CT. In recent decades, evidence has mounted for the need to perform cardiovascular imaging in all females with TS irrespective of karyotype and phenotype. This is due to the high incidence of outcome-determining lesions that often remain subclinical and occur in patterns specific to TS. This review provides an overview of state-of-the-art cardiovascular imaging practice in TS, by means of a review of the most recent literature, in the context of a recent consensus statement that has highlighted the role of cardiovascular diseases in these females.
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Pees C, Heno JA, Häusler G, Ertl DA, Gulesserian T, Michel-Behnke I. Aortic elasticity deterioration proves intrinsic abnormality of the ascending aorta in pediatric Turner syndrome unrelated to the aortic valve morphology. Heart Vessels 2018; 33:1350-1357. [PMID: 29777298 PMCID: PMC6208677 DOI: 10.1007/s00380-018-1187-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/11/2018] [Indexed: 01/15/2023]
Abstract
Turner syndrome (TS) is a common genetic disorder in females with high incidence of ascending aortic dilatation and even dissection occurring as early as in the second decade. Known risk factors (RF) are bicuspid aortic valves (BAV), coarctation of the aorta (CoA), and arterial hypertension. Since 10% of dissections occur in patients without RF, an intrinsic aortic wall abnormality has been postulated. This study aimed to investigate the elasticity of the ascending aorta as a surrogate marker of aortic wall texture. Forty-six pediatric patients with genetically proven TS were prospectively examined for the morphology of their aortic valve, and size and elasticity indices of the adjacent aorta. Cohorts of 46 female subjects with tricuspid aortic valves (TAV) and ten non-syndromic females with BAV were investigated as separate control groups. Comparison of healthy controls with TS patients revealed significantly deteriorated elasticity indices in those with TS. Furthermore, normalized aortic dimensions were greater in TS patients, but dilatations of the ascending aorta with z-score levels above two were restricted to those with BAV (14/46). Deteriorated elasticity indices were measured in TS patients, independent of aortic dilatation, BAV, and CoA, and were comparable to those of patients with isolated, non-syndromic BAVs. By measuring elasticity levels as a surrogate for aortic wall texture, we were able to gather evidence that TS presents with an intrinsic abnormality of the ascending aorta even in patients without concomitant BAV, CoA or dilatations as early as in childhood.
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Affiliation(s)
- Christiane Pees
- Pediatric Heart Center Vienna/Division of Pediatric Cardiology, University Children's Hospital Vienna, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Julian A Heno
- Pediatric Heart Center Vienna/Division of Pediatric Cardiology, University Children's Hospital Vienna, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gabriele Häusler
- Division of Pediatric Pulmonology, University Children's Hospital Vienna, Vienna, Austria
| | - Diana-Alexandra Ertl
- Division of Pediatric Pulmonology, University Children's Hospital Vienna, Vienna, Austria
| | - Talin Gulesserian
- Pediatric Heart Center Vienna/Division of Pediatric Cardiology, University Children's Hospital Vienna, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ina Michel-Behnke
- Pediatric Heart Center Vienna/Division of Pediatric Cardiology, University Children's Hospital Vienna, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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20
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Allen BD, Syed AA, Bollache E, Keller EJ, Barker AJ, Rose MJ, Jarvis KB, Schnell S, Markl M, Carr JC, Collins JD. Cardiovascular MRI in Thoracic Aortopathy: A Focused Review of Recent Literature Updates. Curr Radiol Rep 2017; 5:50. [DOI: 10.1007/s40134-017-0246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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