Cosentino Federica, Raffa Giuseppe M, Gentile Giovanni, Agnese Valentina, Bellavia Diego, Pilato Michele, Pasta Salvatore
Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", Piazza delle Cliniche, University of Palermo, n.2, 90128 Palermo, Italy.
Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, via Tricomi n.5, 90127 Palermo, Italy.
J Pers Med. 2020 Apr 22;10(2):28. doi: 10.3390/jpm10020028.
An ascending thoracic aortic aneurysm (ATAA) is a heterogeneous disease showing different patterns of aortic dilatation and valve morphologies, each with distinct clinical course. This study aimed to explore the aortic morphology and the associations between shape and function in a population of ATAA, while further assessing novel risk models of aortic surgery not based on aortic size. Shape variability of = 106 patients with ATAA and different valve morphologies (i.e., bicuspid versus tricuspid aortic valve) was estimated by statistical shape analysis (SSA) to compute a mean aortic shape and its deformation. Once the computational atlas was built, principal component analysis (PCA) allowed to reduce the complex ATAA anatomy to a few shape modes, which were correlated to shear stress and aortic strain, as determined by computational analysis. Findings demonstrated that shape modes are associated to specific morphological features of aneurysmal aorta as the vessel tortuosity and local bulging of the ATAA. A predictive model, built with principal shape modes of the ATAA wall, achieved better performance in stratifying surgically operated ATAAs versus monitored ATAAs, with respect to a baseline model using the maximum aortic diameter. Using current imaging resources, this study demonstrated the potential of SSA to investigate the association between shape and function in ATAAs, with the goal of developing a personalized approach for the treatment of the severity of aneurysmal aorta.
升主动脉瘤（ATAA）是一种异质性疾病，表现出不同的主动脉扩张模式和瓣膜形态，每种模式都有独特的临床病程。本研究旨在探讨ATAA患者群体的主动脉形态以及形状与功能之间的关联，同时进一步评估不基于主动脉大小的主动脉手术新风险模型。通过统计形状分析（SSA）估计了106例ATAA患者和不同瓣膜形态（即二叶式与三叶式主动脉瓣）的形状变异性，以计算平均主动脉形状及其变形。一旦构建了计算图谱，主成分分析（PCA）就可以将复杂的ATAA解剖结构简化为几种形状模式，这些模式与通过计算分析确定的剪切应力和主动脉应变相关。研究结果表明，形状模式与动脉瘤性主动脉的特定形态特征相关，如血管迂曲和ATAA的局部膨出。与使用最大主动脉直径的基线模型相比，基于ATAA壁的主要形状模式构建的预测模型在区分接受手术治疗的ATAA与接受监测的ATAA方面表现更好。利用当前的成像资源，本研究证明了SSA在研究ATAA形状与功能之间关联方面的潜力，目标是开发一种针对动脉瘤性主动脉严重程度的个性化治疗方法。
