Abstract Introduction Echocardiography-derived septal strain patterns are valuable for predicting volumetric reverse remodelling and survival in patients undergoing cardiac resynchronization therapy (CRT). Nevertheless, presence of myocardial scarring in the left ventricle (LV) is known to attenuate CRT treatment response. Purpose This study aims to investigate the interplay between septal strain patterns and myocardial scarring in CRT candidates, and how they link to outcome after CRT. Methods In this prospective multicentre study, CRT candidates from five European institutions underwent pre-implantation assessments using speckle-tracking strain analysis on echocardiography and cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE). Dyssynchrony was graded through analysis of septal strain curves, categorizing patients into five distinct patterns, denoted as strain Stage-0 through strain Stage-4 (Fig. A). LGE of the LV wall was quantitatively assessed using CMR (as a percentage). The study endpoints were volumetric reverse remodelling (volume responder = more than 15% decrease LV end-systolic volume) after one year, and all-time all-cause mortality. Results A total of 267 patients, with a mean age of 66±11 years (69% males, 90% left bundle branch block [LBBB]) presented with an average LV ejection fraction (EF) of 30±7%. With each stepwise increase in strain stage, global LV scarring decreased (p<0.01; Fig. B) and the proportion of volume responders increased (all p<0.0001; Fig. C). ROC curves demonstrated that the predictive power of strain stages for CRT volumetric response was not significantly improved when scarring percentage was added (AUC 0.78 [95% CI: 0.69-0.83] vs. 0.81 [95% CI: 0.71-0.90]; p>0.05; Fig. D). In a multivariate cox regression model – including clinical characteristics that were significantly related to survival in univariate analysis – a patients’ strain stage was the only significant predictor of survival, also outperforming scar burden as determinant of outcome (HR 0.68; p=0.041; Fig. E). Conclusions Septal strain patterns show a strong association with the extent of reverse remodelling and outcome in CRT-treated patients. An inverse relationship is observed between pre-implant strain stages and the extent of myocardial scarring. However, scar burden did not provide incremental predictive value over the strain stages. Strain-pattern-based dyssynchrony assessment is a meaningful predictive marker which integrates information on myocardial dysfunction due to dyssynchrony as well as scar burden.

The presented study details the virtual deployment of a bifurcated stent graft (Medtronic Talent) in an Abdominal Aortic Aneurysm model, using the finite element method. The entire deployment procedure is modeled, with the stent graft being crimped and bent according to the vessel geometry, and subsequently released. The finite element results are validated in vitro with placement of the device in a silicone mock aneurysm, using high resolution CT scans to evaluate the result. The presented work confirms the capability of finite element computer simulations to predict the deformed configuration after endovascular aneurysm repair (EVAR). These simulations can be used to quantify mechanical parameters, such as neck dilations, radial forces and stresses in the device, that are difficult or impossible to obtain from medical imaging.

Recently an expert consensus group advised to measure carotid-femoral (cf) pulse wave velocity (PWV) on the right side of the body, using 80

Huybrechts, S.; Devos, D.; Vermeersch, S.; Mahieu, D.; Achten, E.; De Backer, T.; Segers, P.; Van Bortel, L. Author Information

Carotid-femoral pulse wave velocity (PWV) is the gold standard method for determination of arterial stiffness. Path lengths are commonly determined by tape measure, which may not correspond to anatomical path lengths. This study investigates the correspondence between the travelled arterial length obtained from magnetic resonance imaging (MRI) images with commonly used body-surface distances obtained by tape measure. 98 healthy males/females were included (50 In the present population sample the distance (CA-FA) x 0.8, which is the distance from the carotid artery to the femoral artery multiplied by 0.8, provides the best approximation of the real travelled aortic path length.

Objective: Carotid-femoral pulse wave velocity (PWV) is the gold standard method for determination of arterial stiffness. Correct PWV determination critically depends on the measurement of the arterial pathway travelled by the pulse during a certain transit time. Path lengths are commonly determined by tape measure, which may not correspond to anatomical path lengths. This study investigates the correspondence between the travelled arterial length obtained from magnetic resonance imaging (MRI) images with commonly used body-surface distances obtained by tape measure. Design and Method: MRI path lengths were obtained in 46 subjects (20 men; age 21 to 68) through centreline fitting of the artery lumen from ascending aorta (AA) to the femoral (FA) and carotid artery (CA) using a custom developed Matlab® interface. The MRI-measured (AA-FA) – (AA-CA) length (the arterial segment travelled in carotid-femoral PWV measurement) was compared to 4 commonly used tape-measures. Results: See table. Figure 1. No caption available. Conclusions: In the present population sample the distance from suprasternal notch over umbilicus to the femoral artery minus the distance between suprasternal notch and the carotid artery provides the best approximation of the real aortic path length.

Objective: Pulse wave velocity (PWV) is accepted as the standard technique to assess aortic stiffness. While the carotid-femoral transit time can be assessed with high accuracy, the measurement of the aortic length is, however, less accurate. Several approaches for measuring aortic length over the body-surface exist, all of which are measured with a tape measure, hence introducing errors over the curved body surface. Design and method: We compared eight different body-surface distances with the aortic path length as determined from Magnetic Resonance (MR)-images. 12 healthy volunteers (aged 23 to 39 years) were imaged from carotid to femoral artery. Body surface measurements were done with an antropometer and tape measure. Aortic path length along the luminal centreline was determined from MR-images using custom built Matlab-based software. Results: Only two body surface measurements were close to the MR-derived aortic path length. Total distance between carotid and femoral artery minus the distance between carotid artery and sternal notch was 2.1±3.7cm (5.3±8.9 %) larger than the MR-derived aortic path length. The distance between the suprasternal notch and the femoral artery minus the distance between the carotid artery and the suprasternal notch was 1.1±2.7cm (2.4±6.0 %) smaller than the MR-derived aortic path length. Conclusions: For assessment of PWV, aortic length can be estimated by the total distance between carotid and femoral artery minus the distance between carotid artery and sternal notch or by the distance between the suprasternal notch and the femoral artery minus the distance between the carotid artery and the suprasternal notch.

Severe renal artery stenosis is responsible for 5

Marfan’s syndrome (MFS) is an autosomal dominant connective tissue disorder, with clinical manifestations in the skeletal, ocular, and cardiovascular organ systems, caused by mutations in the fibrillin 1 gene ( FBN1 ). MFS shows full penetrance but with considerable clinical variability both between and within families. More than 500 different mutations have been identified so far, scattered throughout the gene and usually unique to individual families. Prognosis in MFS is mainly determined by progressive dilatation of the aorta, potentially leading to aortic dissection and death at young age. Recently, we have shown that increased aortic stiffness is an independent predictor of progressive aortic dilatation.1 It has been suggested that genetic variation in FBN1 as assessed by analysis of an intragenic polymorphism (variable number tandem repeat (VNTR) polymorphism in intron 28) is an important factor contributing to risk associated with pulse pressure and aortic stiffness in healthy middle aged men and in patients with coronary artery disease.2,3 In patients with MFS the association between aortic stiffness and the FBN1 genotype or FBN1 mutations has not been investigated previously. Our purpose was to investigate the association between aortic stiffness parameters and the FBN1 genotype in patients with MFS. The genotype was characterised by the mutation on the one hand and by a specific intragenic FBN1 polymorphism on the other. A cohort of 67 patients with MFS (31 men, mean (SD) age 32 (10) years) representing 51 families with …

Early return of reflected pressure waves increases the load on central arteries and may increase the risk of aortic rupture in patients with Marfan's syndrome (MFS). To assess whether wave reflection is elevated in MFS, we used ultrasound and MRI to measure central pressure and flow waveforms in 26 patients (13-54 yr of age) and 26 age- and gender-matched controls. Aortic systolic and diastolic cross-sectional areas were measured at the ascending and descending aorta (AA and DA), diaphragm (DIA), and lower abdominal aorta (AB). From these measurements, local characteristic impedance (Z(0-xx)) and local reflection coefficients (Gamma(xx-yy)) were calculated. Calculated global wave reflection indexes were the augmentation index (AIx) and the ratio of backward to forward pressure wave (P(b)/P(f)). The aorta was wider in MFS patients at AA (P < 0.01) and DA (P < 0.01). Aortic pulse wave velocity was 42 cm/s higher in MFS patients (P < 0.05). Z(0-xx) was not different between groups, except at DA, where it was lower in MFS patients. In controls, Gamma(AA-DA) was 0.31 +/- 0.08, Gamma(DA-DIA) was 0.00 +/- 0.11, and Gamma(DIA-AB) was 0.31 +/- 0.16. Mean values of Gamma(xx-yy) were not different between MFS patients and controls. In controls, aging diminished Gamma(AA-DA) but increased Gamma(DIA-AB). Clear age-related patterns were absent in MFS patients. AIx or P(b)/P(f) was not higher in MFS patients than in controls. There were indications for enhanced wave reflection in young MFS patients. Our data demonstrated that the major determinants of AIx were pulse wave velocity and the effective length of the arterial system and, to a lesser degree, HR and P(b)/P(f).