Department of Neurological Surgery Washington University School of Medicine St. Louis MO USA.
Department of Biomedical Engineering Washington University in St. Louis St. Louis MO USA.
J Am Heart Assoc. 2024 Jul 2;13(13):e035171. doi: 10.1161/JAHA.124.035171. Epub 2024 Jun 21.
Cervical arterial tortuosity is associated with adverse outcomes in Loeys-Dietz syndrome and other heritable aortopathies.
A method to assess tortuosity based on curvature of the vessel centerline in 3-dimensional space was developed. We measured cervical carotid tortuosity in 65 patients with Loeys-Dietz syndrome from baseline computed tomography angiogram/magnetic resonance angiogram and all serial images during follow-up. Relations between baseline carotid tortuosity, age, aortic root diameter, and its change over time were compared. Patients with unoperated aortic roots were assessed for clinical end point (type A aortic dissection or aortic root surgery during 4 years of follow-up). Logistic regression was performed to assess the likelihood of clinical end point according to baseline carotid tortuosity. Total absolute curvature at baseline was 11.13±5.76 and was relatively unchanged at 8 to 10 years (fold change: 0.026±0.298, =1.00), whereas tortuosity index at baseline was 0.262±0.131, with greater variability at 8 to 10 years (fold change: 0.302±0.656, =0.818). Baseline total absolute curvature correlated with aortic root diameter (=0.456, =0.004) and was independently associated with aortic events during the 4-year follow-up (adjusted odds ratio [OR], 2.64 [95% CI, 1.02-6.85]). Baseline tortuosity index correlated with age (=0.532, <0.001) and was not associated with events (adjusted OR, 1.88 [95% CI, 0.79-4.51]). Finally, baseline total absolute curvature had good discrimination of 4-year outcomes (area under the curve=0.724, =0.014), which may be prognostic or predictive.
Here we introduce cervical carotid tortuosity as a promising quantitative biomarker with validated, standardized characteristics. Specifically, we recommend the adoption of a curvature-based measure, total absolute curvature, for early detection or monitoring of disease progression in Loeys-Dietz syndrome.
颈总动脉迂曲与 Loeys-Dietz 综合征和其他遗传性主动脉病变的不良结局相关。
我们开发了一种基于三维空间中血管中心线曲率来评估迂曲的方法。我们从基线计算机断层血管造影/磁共振血管造影和所有连续随访图像中测量了 65 例 Loeys-Dietz 综合征患者的颈总动脉迂曲。比较了基线颈动脉迂曲与年龄、主动脉根部直径及其随时间的变化之间的关系。评估未行主动脉根部手术的患者在 4 年随访期间的临床终点（A型主动脉夹层或主动脉根部手术）。采用逻辑回归评估根据基线颈动脉迂曲发生临床终点的可能性。基线时总绝对曲率为 11.13±5.76，8 至 10 年时相对不变（变化倍数：0.026±0.298，=1.00），而基线时迂曲指数为 0.262±0.131，8 至 10 年时变化更大（变化倍数：0.302±0.656，=0.818）。基线时总绝对曲率与主动脉根部直径相关（=0.456，=0.004），并与 4 年随访期间的主动脉事件独立相关（调整后的比值比[OR]，2.64[95%可信区间，1.02-6.85]）。基线迂曲指数与年龄相关（=0.532，<0.001），与事件无关（调整后的 OR，1.88[95%可信区间，0.79-4.51]）。最后，基线总绝对曲率对 4 年结局有较好的区分能力（曲线下面积=0.724，=0.014），可能具有预后或预测价值。
在此，我们提出颈总动脉迂曲是一种有前景的定量生物标志物，具有已验证的标准化特征。具体而言，我们建议采用基于曲率的测量方法，即总绝对曲率，用于早期检测或监测 Loeys-Dietz 综合征的疾病进展。
