Wong Dennis T L, Narayan Om, Leong Darryl P, Bertaso Angela G, Maia Murilo G, Ko Brian S H, Baillie Timothy, Seneviratne Sujith K, Worthley Matthew I, Meredith Ian T, Cameron James D
Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia,
Int J Cardiovasc Imaging. 2015 Jun;31(5):1053-62. doi: 10.1007/s10554-015-0640-z. Epub 2015 Apr 9.
Aortic distensibility (AD) decreases with age and increased aortic stiffness is independently associated with adverse cardiovascular outcomes. The association of severe aortic stenosis (AS) with AD in different aortic regions has not been evaluated. Elderly subjects with severe AS and a cohort of patients without AS of similar age were studied. Proximal aortic cross-sectional-area changes during the cardiac cycle were determined using retrospective-ECG-gating on 128-detector row computed-tomography. Using oscillometric-brachial-blood-pressure measurements, the AD at the ascending-aorta (AA), proximal-descending-aorta (PDA) and distal-descending-aorta (DDA) was determined. Linear mixed effects modelling was used to determine the association of age and aortic stenosis on regional AD. 102 patients were evaluated: 36 AS patients (70-85 years), 24 AS patients (>85 years) and 42 patients without AS (9 patients <50 years, 20 patients between 51-70 years and 13 patients 70-85 years). When comparing patients 70-85 years, AA distensibility was significantly lower in those with AS compared to those without AS (0.9 ± 0.9 vs. 1.4 ± 1.1, P = 0.03) while there was no difference in the PDA (1.0 ± 1.1 vs. 1.0 ± 1.2, P = 0.26) and DDA (1.1 ± 1.2 vs. 1.2 ± 0.8, P = 0.97). In patients without AS, AD decreased with age in all aortic regions (P < 0.001). The AA in patients <50 years were the most distensible compared to other aortic regions. There is regional variation in aortic distensibility with aging. Patients with aortic stenosis demonstrated regional differences in aortic distensibility with lower distensibility demonstrated in the proximal ascending aorta compared to an age-matched cohort.
主动脉扩张性（AD）随年龄增长而降低，主动脉僵硬度增加与不良心血管结局独立相关。严重主动脉瓣狭窄（AS）与不同主动脉区域AD之间的关联尚未得到评估。对患有严重AS的老年受试者以及一组年龄相仿的无AS患者进行了研究。在128排计算机断层扫描上使用回顾性心电图门控技术确定心动周期中主动脉近端横截面积的变化。通过示波法测量肱动脉血压，确定升主动脉（AA）、主动脉近端降部（PDA）和主动脉远端降部（DDA）的AD。采用线性混合效应模型确定年龄和主动脉瓣狭窄对区域AD的关联。共评估了102例患者：36例AS患者（70 - 85岁），24例AS患者（>85岁），42例无AS患者（9例<50岁，20例51 - 70岁，13例70 - 85岁）。在比较70 - 85岁的患者时，AS患者的AA扩张性显著低于无AS患者（0.9±0.9对1.4±1.1，P = 0.03），而PDA（1.0±1.1对1.0±1.2，P = 0.26）和DDA（1.1±1.2对1.2±0.8，P = 0.97）无差异。在无AS的患者中，所有主动脉区域的AD均随年龄下降（P < 0.001）。与其他主动脉区域相比，<50岁患者的AA最具扩张性。随着年龄增长，主动脉扩张性存在区域差异。与年龄匹配的队列相比，主动脉瓣狭窄患者的主动脉扩张性存在区域差异，升主动脉近端的扩张性较低。
