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A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress.

Abstract：

OBJECTIVES:The aim of this study was to evaluate whether the orientation of the heart, measured as an angle between the long axis of the heart and ascending aorta midline (heart-aorta-angle, HAA), associates with ascending aortic (AA) dilatation. Furthermore, the association between HAA and wall shear stress (WSS) was studied. METHODS:HAA was retrospectively measured in 1000 consecutive coronary artery computed tomographic angiography (CCTA) images in patients with low-to-moderate pretest probability for coronary artery disease (CAD). To evaluate the effects of HAA on AA flow, 4D flow MRI was performed for 28 patients with AA dilatation (> 40 mm) and WSS was analyzed. RESULTS:The mean age of patients undergoing CCTA was 52.9 ± 9.8 years; 66.5% were women. Their median HAA was 128.7° and interquartile range 123.3-134.1°. HAA was significantly smaller in patients with dilated AA (median 126.7° [121.3-130.8°]) compared with the patients with normal AA (median 129.5° [124.3-135.3°], p < 0.001). HAA was smaller in males (p < 0.001) and in patients with diabetes (p = 0.016), hypertension (p = 0.001), CAD (p = 0.003), hypercholesterolemia (p < 0.001), and bicuspid aortic valve (p = 0.025) than without these factors. In a subpopulation without any of these underlying diseases (n = 233), HAA was still significantly smaller in the patients with dilated AA (median 127.9° [124.3-134.3°]) compared with patients with normal AA (median 131.9° [127.6-136.9°], p = 0.013). In 4D flow MRI, a smaller HAA correlated with increased total WSS in the outer curvature of the proximal AA (r = - 0.510, p = 0.006). CONCLUSION:A smaller HAA associates with AA dilatation and affects the blood flow in the proximal AA. KEY POINTS:• A smaller angle between the long axis of the heart and ascending aorta midline associated with ascending aortic dilatation. • A smaller heart-aorta-angle correlated with increased total wall shear stress in the outer curvature of the proximal ascending aorta.

journal_name

Eur Radiol

journal_title

European radiology

authors

Kauhanen SP,Liimatainen T,Kariniemi E,Korhonen M,Parkkonen J,Vienonen J,Vanninen R,Hedman M

doi

10.1007/s00330-020-06852-3

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

5149-5157

issue

eissn

0938-7994

issn

1432-1084

pii

10.1007/s00330-020-06852-3

journal_volume

pub_type

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A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress.