Background

The aim of this study is to evaluate the changes in aortic stiffness and cardiac function in young patientswho underwent thoracic endovascular aortic repair (TEVAR) after blunt injury of thoracic aorta.

Methods

We included 10 patients who underwent TEVAR between November 2012 and November 2016 and 10 healthy controls (matched for sex, age, height and body surface area). Patients with cardiovascular risk factors, comorbidities with potential impact on arterial stiffness, and prior aortic surgical or endovascular interventions were excluded.

Oscillometric measurement of pulse wave velocity (PWV) applying the Gesenius-Keller method of recording the echocardiogram-triggered pulse waves at different cuff pressures and comprehensive CMR examination including acquistion of isotropic 4D Flow dataset and myocardial mapping were performed in all controls and patients. The mean follow-up period after TEVAR at the time of CMR was 5.4 ± 1.8 years; mean age at the time of TEVAR: 30.3 ± 8.7 years.

CMR acquisitions were subsequently analyzed and data regarding global-, segmental aortic PWV, cardiac volumes, systolic- and diastolic function as well as native myocardial T1 and T2 values were collected.

Results

Four TEVAR patients developed arterial hypertension during follow up. Both oscillometric measurement (9.8 [8.4,12.2] vs. 7.0 [6.2,8.2] m/s, p = 0.001) and 4D Flow CMR based analysis (5.9 [5.7,6.7] vs. 4.8 [4.5,6.0] m/s, p = 0.012) demonstrated higher global PWV in TEVAR patients. The segmental analysis showed higher PWV in descending- and abdominal aorta (distal to the predominant position of the graft, 19.1 [8.4,24.0] vs. 6.2 [5.2,7.4] m/s, p = 0.003). The indexed diameter of ascending aorta was larger in TEVAR patients (16.1 ± 2.0 vs. 13.5 ± 1.9 mm/m², p = 0.007) with no significant difference in indexed diameter of aortic arch, descending- and abdominal aorta. The analysis of CINE acquisitions demonstrated increased left ventricular myocardial thickness (11.7 ± 1.2 vs. 9.7 ± 0.9, p < 0.001) and otherwise no significant difference in cardiac volumes and ejection fraction. Among surrogate parameters indicative of impaired relaxation, tissue-tracking derived 3D global diastolic strain rate (0.70 ± 0.17 vs. 0.89 ± 0.18, p = 0.026) and diastolic longitudinal velocity (e´, 0.59 ± 0.13 vs. 0.74 ± 0.10, p = 0.013) were decreased. Conversely, A-wave velocity (0.26 ± 0.07 vs. 0.19 ± 0.06, p = 0.012) derived from 4D Flow CMR was increased. Additionally, native myocardial T1 values showed to be significantly increased in TEVAR patients (1007.8 ± 26.7 vs. 982.1 ± 24.6 ms, p = 0.037).

Conclusion