MRI detects increased aortic stiffening and myocardial dysfunction after TEVAR of blunt injury in young patients

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Tamer Ghazy - , University Hospital Gießen and Marburg (Author)
  • Bettina Kirstein - , University Hospital Schleswig-Holstein - Campus Lübeck (Author)
  • Jakub Tomala - , Department of Internal Medicine and Cardiology (at Dresden Heart Centre), Heart Center Dresden University Hospital (Author)
  • Igli Kalaja - , University Medical Center Mainz (Author)
  • Jörg Herold - , Darmstadt Clinics (Author)
  • Marc Irqsusi - , University Hospital Gießen and Marburg (Author)
  • Ardawan Rastan - , University Hospital Gießen and Marburg (Author)
  • Helmut Karl Lackner - , Medical University of Graz (Author)
  • Norbert Weiss - , Department of Internal Medicine III (Author)
  • Adrian Mahlmann - , Catholic Hospital Hagen (Author)

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) is a well-established technique for the management of blunt thoracic aortic injury (BTAI). Despite improvements in vascular imaging, graft material properties, and implant techniques, stent-graft deployment artificially induces aortic stiffening. This study aimed to evaluate the midterm effect of thoracic endovascular aortic repair after blunt thoracic aortic injury on aortic stiffness and cardiac function in young patients using cardiovascular magnetic resonance (CMR) imaging. Patients and methods: From all patients who underwent TEVAR for BTAI between 2009 and 2019 in a single institution, 10 patients with no other comorbidities affecting arterial stiffness were sex-, age-, height-, and body surface area-matched to 10 healthy controls. Comprehensive CMR examination was performed in all controls and patients. The mean follow-up period was 5.4±1.8 years; the mean age at the time of TEVAR was 30.3±8.7 years. Results: Four patients who underwent TEVAR developed arterial hypertension. 4D flow CMR-based analysis demonstrated higher global pulse wave velocity (PWV) in TEVAR patients than in controls (p=0.012). Segmental analysis showed a higher PWV in the descending and abdominal aorta. The indexed diameter of the ascending aorta was larger in TEVAR patients than in controls (p=0.007). The CINE acquisitions demonstrated increased left ventricular myocardial thickness (p<0.001). The 3D global diastolic strain rate and diastolic longitudinal velocity (e') decreased, and the A-wave velocity increased. Native myocardial T1 values were significantly higher in TEVAR patients (p=0.037). Conclusions: Young patients with TEVAR after BTAI are at an increased risk of developing vascular and myocardial dysfunction due to increased aortic stiffness. CMR follow-up allows for a comprehensive and radiation-free evaluation of vascular stiffness and associated myocardial changes, especially at the early and subclinical stages.

Details

Original languageEnglish
Pages (from-to)317-324
Number of pages8
JournalVasa - European Journal of Vascular Medicine
Volume52
Issue number5
Publication statusPublished - Sept 2023
Peer-reviewedYes

External IDs

Scopus 85165453627

Keywords

Keywords

  • 4D flow, Aortic stiffness, blunt thoracic aortic injury, diastolic function, magnetic resonance imaging, thoracic endovascular aortic repair