Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia; BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK; Australian Research Council Centre for Personalised Therapeutics Technologies, Australia. Electronic address: https://twitter.com/vasclab_uwa.
Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia.
Eur J Vasc Endovasc Surg. 2020 Sep;60(3):365-373. doi: 10.1016/j.ejvs.2020.02.023. Epub 2020 Apr 4.
To test whether aneurysm biomechanical ratio (ABR; a dimensionless ratio of wall stress and wall strength) can predict aneurysm related events.
In a prospective multicentre clinical study of 295 patients with an abdominal aortic aneurysm (AAA; diameter ≥ 40 mm), three dimensional reconstruction and computational biomechanical analyses were used to compute ABR at baseline. Participants were followed for at least two years and the primary end point was the composite of aneurysm rupture or repair.
The majority were male (87%), current or former smokers (86%), most (72%) had hypertension (mean ± standard deviation [SD] systolic blood pressure 140 ± 22 mmHg), and mean ± SD baseline diameter was 49.0 ± 6.9 mm. Mean ± SD ABR was 0.49 ± 0.27. Participants were followed up for a mean ± SD of 848 ± 379 days and rupture (n = 13) or repair (n = 102) occurred in 115 (39%) cases. The number of repairs increased across tertiles of ABR: low (n = 24), medium (n = 34), and high ABR (n = 44) (p = .010). Rupture or repair occurred more frequently in those with higher ABR (log rank p = .009) and ABR was independently predictive of this outcome after adjusting for diameter and other clinical risk factors, including sex and smoking (hazard ratio 1.41; 95% confidence interval 1.09-1.83 [p = .010]).
It has been shown that biomechanical ABR is a strong independent predictor of AAA rupture or repair in a model incorporating known risk factors, including diameter. Determining ABR at baseline could help guide the management of patients with AAA.
测试动脉瘤力学比（ABR；壁应力与壁强度的无因次比值）是否可预测与动脉瘤相关的事件。
在一项针对 295 例腹主动脉瘤（AAA；直径≥40mm）患者的前瞻性多中心临床研究中，使用三维重建和计算生物力学分析在基线时计算 ABR。对参与者进行至少两年的随访，主要终点是动脉瘤破裂或修复的复合终点。
大多数患者为男性（87%）、现吸烟者或曾经吸烟者（86%）、大多数（72%）患有高血压（平均±标准差[SD]收缩压 140±22mmHg），平均±SD 基线直径为 49.0±6.9mm。平均±SD ABR 为 0.49±0.27。参与者平均随访 848±379 天，115 例（39%）发生破裂（n=13）或修复（n=102）。ABR 三分位的修复数量增加：低（n=24）、中（n=34）和高 ABR（n=44）（p=0.010）。ABR 较高的患者发生破裂或修复的频率更高（对数秩检验 p=0.009），并且在调整直径和其他临床危险因素（包括性别和吸烟）后，ABR 是该结局的独立预测因素（风险比 1.41；95%置信区间 1.09-1.83 [p=0.010]）。
在包含已知危险因素（包括直径）的模型中，已经表明力学 ABR 是 AAA 破裂或修复的强有力独立预测因子。在基线时确定 ABR 可以帮助指导 AAA 患者的管理。
