Glasgow Computational Engineering Centre, James Watt School of Engineering, University of Glasgow, Glasgow, Scotland, UK.
Institute of Cardiovascular Science, University College London, London, England, UK.
Biomech Model Mechanobiol. 2024 Dec;23(6):2043-2061. doi: 10.1007/s10237-024-01881-z. Epub 2024 Jul 29.
Although tissue stiffness is known to play an important role in aortic dilatation, the current guidelines for offering preventative surgery in patients with Marfan syndrome rely solely on the aortic diameter. In this systematic review and meta-analysis, we analyze and compare literature on in vivo aortic stiffness measures in Marfan patients. Our aim is to assess the potential of these measurements as early indicators of aortic dilatation. Following the PRISMA guidelines, we collected literature on diameter and three in vivo stiffness measures: Pulse wave velocity (PWV), -stiffness index (SI) and distensibility, at five different aortic locations in patients with Marfan syndrome. Results were reviewed and compared against each other. For meta-analysis, an augmented dataset was created by combining data from the literature. Regression with respect to age and statistical comparisons were performed. Thirty articles reporting data from 1925 patients with Marfan and 836 patients without Marfan were reviewed. PWV was found to be higher in Marfan, but only in dilated aortas. Distensibility was found to be lower even in non-dilated aortas, and its decrease was associated with higher chances of developing aortic dilatation. -SI was higher in Marfan patients and was positively correlated with the rate of aortic dilatation, emphasizing its role as a valuable indicator. In our meta-analysis, all stiffness measures showed a significant variation with age. Distensibility and -stiffness index were different in Marfan patients at all locations, and the difference was more pronounced after accounting for age-related variation. From the literature, -SI and distensibility emerge as the best predictors of future aortic dilatation. Our meta-analysis quantifies age-related changes in aortic stiffness and highlights the importance of accounting for age in comparing these measurements. Missing diameter values in the literature limited our analysis. Further investigation of criteria combining stiffness and diameter is recommended to better assist clinical decisions for prophylactic surgery.
虽然组织硬度已知在主动脉扩张中起着重要作用，但目前马凡综合征患者预防性手术的指南仅依赖于主动脉直径。在这项系统评价和荟萃分析中，我们分析和比较了马凡综合征患者体内主动脉硬度测量的文献。我们的目的是评估这些测量作为主动脉扩张早期指标的潜力。根据 PRISMA 指南，我们收集了关于马凡综合征患者五个不同主动脉位置的直径和三种体内硬度测量值（脉搏波速度 (PWV)、- 僵硬度指数 (SI) 和可扩展性）的文献。对结果进行了回顾和相互比较。为了进行荟萃分析，通过合并文献中的数据创建了一个扩充数据集。进行了年龄相关回归和统计学比较。对 30 篇报告马凡综合征患者 1925 例和无马凡综合征患者 836 例数据的文章进行了回顾。发现马凡综合征患者的 PWV 较高，但仅在扩张的主动脉中。即使在非扩张的主动脉中，也发现可扩展性较低，其降低与发生主动脉扩张的几率增加相关。- SI 在马凡综合征患者中较高，与主动脉扩张率呈正相关，强调了其作为有价值指标的作用。在我们的荟萃分析中，所有硬度测量值均显示出与年龄的显著变化。在所有位置，马凡综合征患者的可扩展性和 - 僵硬度指数均不同，并且在考虑与年龄相关的变化后，差异更为明显。从文献中可以看出，- SI 和可扩展性是未来主动脉扩张的最佳预测指标。我们的荟萃分析量化了主动脉硬度与年龄相关的变化，并强调了在比较这些测量值时考虑年龄的重要性。文献中缺少直径值限制了我们的分析。建议进一步研究结合硬度和直径的标准，以更好地为预防性手术的临床决策提供帮助。
