Numerical modeling of arterial pulse wave propagation to characterize aortic hemodynamic: Validation using magnetic resonance data

ObjectivesArterial stiffness, which is caused by aging and other cardiovascular risk factors and primarily affects the aorta, is associated with cardiac and cerebral morbidity and mortality. The objective of our study was to non-invasively estimate local biomechanical and hemodynamic biomarkers related to proximal aortic stiffness, by combining cardiovascular magnetic resonance (CMR) data and numerical simulations.Materials and methodsTo achieve this aim, we used a numerical 1D fluid-structure model to simulate blood flow in the descending aorta, and we combined this model with clinical data (areas and velocities in three levels of the descending aorta, carotid pressures) acquired in two healthy subjects using CMR and applanation tonometry.ResultsFirst, we studied the sensibility of our model on an idealized aorta and showed that our model was able to characterize age-related arterial alterations, when compared to established physiological knowledge. Furthermore, while comparisons of simulations against clinical data revealed low errors (< 20%) in terms of aortic areas and velocities for the two subjects, more important errors were found for pulse pressures (up to 20%). Importantly, errors in terms of velocity and area were lower than their variations occurring with aging.ConclusionsThus, our fast method could enable the non-invasive estimation of aortic functional parameters and a more realistic version of our numerical model could also provide a reliable estimation of central pressure.     

Cytomegalovirus Seropositivity Is Associated with Increased Arterial Stiffness in Patients with Chronic Kidney Disease

Background

Patients with chronic kidney disease have an increased cardiovascular risk that is not fully explained by traditional risk factors but appears to be related to increased arterial stiffness. Cytomegalovirus (CMV) infection is associated with increased cardiovascular risk although the mechanisms for this are unknown. We examined whether CMV seropositivity was associated with increased arterial stiffness in patients with chronic kidney disease.

Methodology and Principal Findings

In 215 non-diabetic patients with chronic kidney disease, CMV seropositivity was determined using an anti-CMV IgG ELISA. Pulse wave velocity was measured and aortic distensibility assessed in the ascending, proximal descending and distal descending thoracic aorta. Patients seropositive for CMV had a higher pulse wave velocity and lower aortic distensibility at all 3 levels. These differences (except for ascending aortic distensibility) persisted in a subcohort matched for age, gender and renal function, and when the whole cohort was divided into quartiles of age. In multivariable analyses, CMV seropositivity was an independent determinant of pulse wave velocity and proximal and distal descending aortic distensibility.

Conclusions

In patients with chronic kidney disease, CMV seropositivity is associated with increased arterial stiffness and decreased distensibility of the proximal descending and distal aorta. These findings suggest that further research is required to examine CMV as a possible cause of arterial disease and increased cardiovascular risk in patients with CKD and may be relevant more widely for CMV seropositive patients with normal renal function.     

Baroreceptor influence on a spinal cardiovascular reflex

A stretch of the walls of the thoracic aorta, performed in vagotomized cats without obstructing aortic flow, induces increases in heart rate, myocardial contractility, and arterial pressure. These reflex responses are still present after high spinal section. Cats under chloralose-urethane anesthesia were vagotomized and one carotid sinus was isolated and perfused with arterial blood at constant flow. The contralateral carotid sinus nerve and both aortic nerves were sectioned. A stretch of the walls of the thoracic aorta between the 7th and 10th intercostal arteries induced a reflex increase in mean arterial pressure 29 +/- 2 mmHg (mean +/- SE). Stepwise increases of carotid sinus pressure (CSP) or electrical stimulation of the carotid sinus nerve induced stepwise decreases of this reflex response. At maximal baroreceptor stimulation (CSP 212 +/- 9 mmHg) the reflex response to aortic stretch was reduced by 42%. These experiments show that this spinal cardiovascular reflex is at least partially under the inhibitory control of the baroreceptor input.     

Echocardiographic assessment of aortic elastic properties with automated border detection in an ICU: in vivo application of the arctangent Langewouters model

We studied whether combined pressure and transesophageal ultrasound monitoring is feasible in the intensive care unit (ICU) setting for global cardiovascular hemodynamic monitoring [systemic vascular resistance (SVR) and total arterial compliance (C(PPM))] and direct estimation of local ascending and descending aortic mechanical properties, i.e., distensibility and compliance coefficients (DC and CC). Pressure-area data were fitted to the arctangent Langewouters model, with aortic cross-sectional area obtained via automated border detection. Data were measured in 19 subjects at baseline, during infusion of sodium nitroprusside (SNP), and after washout. SNP infusion lowered SVR from 1.15 +/- 0.40 to 0.80 +/- 0.32 mmHg.ml(-1).s (P < 0.05), whereas C(PPM) increased from 0.87 +/- 0.46 to 1.02 +/- 0.42 ml/mmHg (P < 0.05). DC and CC increased from 0.0018 +/- 0.0007 to 0.0025 +/- 0.0009 l/mmHg (P < 0.05) and from 0.0066 +/- 0.0028 to 0.0083 +/- 0.0026 cm2/mmHg (P < 0.05), respectively, at the descending, but not ascending, aorta. The Langewouters model fitted the descending aorta data reasonably well. Assessment of local mechanical properties of the human ascending aorta in a clinical setting by automated border detection remains technically challenging.     

Age- and sex-dependent changes in pulse pressure in fowl aorta

Chickens (males more than females) have higher blood pressure (BP) than most mammals and spontaneously develop vascular neointimal plaques (NP) and diffuse subendothelial thickening in the lower segment of the abdominal aorta (AbA, referred to as 'NP-prone area') that partly resemble atherosclerotic lesions in mammals. NP areas, which are larger in males, have a causal relationship with incremental increases in BP during maturation. We hypothesize that decreased wall distensibility and altered hemodynamic forces at the NP-prone area may contribute to the NP formation. We measured pressure pulse wave (PW) and systolic and diastolic BP along the descending aorta in anesthetized chickens at different ages using an intravascular microtip transducer and calculated pulse pressure (PP) as an indicator for artery distensibility. At all ages examined and in both sexes, the PW showed a sharper peak at the more peripheral locations and the amplitude of the PW increased as it descended the aorta. PP, expressed as relative increases from the PP in the aortic arch (%), was 40.4+/-12.6 and 71.4+/-18.6 at the AbA and ischiadic artery, respectively, in young males (24-27 weeks); 23.5+/-8.6 and 43.8+/-16.2 in adults (72-75 weeks); and 5.4+/-3.4 and 9.1+/-4.9 in chicks (5-7 weeks). Location-dependent increases in PP were significantly higher in young males (P<0.05). The PP increases in females were not different among the three age groups. The contour of the PW in the proximal aorta changes in older birds, exhibiting steeper increases in the ascending and descending limbs, suggesting that faster wave reflection from the periphery augments peak systolic pressure. NP was most frequently seen in the lower segment of the abdominal aorta in older males. These results suggest that: (1) site-dependent increases in PP amplitude are marked in young males, possibly reflecting a reduction in arterial wall elasticity enhanced by incremental rises in BP, and (2) NP formation may contribute to the stiffness of aortic walls in the NP-prone area.     

Wave intensity in the ascending aorta: effects of arterial occlusion

We examine the effects of arterial occlusion on the pressure, velocity and the reflected waves in the ascending aorta using wave intensity analysis. In 11 anaesthetised, open-chested dogs, snares were used to produce total arterial occlusion at 4 sites: the upper descending aorta at the level of the aortic valve (thoracic); the lower thoracic aorta at the level of the diaphragm (diaphragm); the abdominal aorta between the renal arteries (abdominal) and the left iliac artery, 2 cm downstream from the aorta iliac bifurcation (iliac). Pressure and flow in the ascending aorta were measured, and data were collected before and during the occlusion. During thoracic and diaphragm occlusions a significant increase in mean aortic pressure (46% and 23%) and in wave speed (25% and 10%) was observed, while mean flow rate decreased significantly (23% and 17%). Also, the reflected compression wave arrived significantly earlier (45% and 15%) and its peak intensity was significantly greater (257% and 125%), all compared with control. Aortic occlusion distal to the renal arteries, however, caused an indiscernible change in the pressure and velocity waveforms, and in the intensities and timing of the waves in the forward and backward directions. The measured pressure and velocity waveforms are the result of the interaction between the heart and the arterial system. The separated pressure, velocity and wave intensity are required to provide information about arterial hemodynamic such as the timing and magnitude of the forward and backward waves. The net wave intensity is simpler to calculate but provides information only about the predominant direction of the waves and can be misleading when forward and backward waves of comparable magnitudes are present simultaneously.     

Evaluation of blood flow velocity waveform in common carotid artery using multi-branched arterial segment model of human arteries

Arteriosclerosis is considered to be a major cause of cardiovascular diseases, which account for approximately 30% of the causes of death in the world. We have recently demonstrated a strong correlation between arteriosclerosis (arterial elasticity) and two characteristics: maximum systolic velocity (S1) and systolic second peak velocity (S2) of the common carotid artery flow velocity waveform (CCFVW). The CCFVW can be measured by using a small portable measuring device. However, there is currently no theoretical evidence supporting the causes of the relation between CCFVW and arterial elasticity, or the origin of the CCFVW characteristics. In this study, the arterial blood flow was simulated using a one-dimensional systemic arterial segments model of human artery in order to conduct a qualitative evaluation of the relationship between arterial elasticity and the characteristics of CCFVW. The simulation was carried out based on the discretized segments with the physical properties of a viscoelastic tube (the cross-sectional area at the proximal and terminal ends, the length, and the compliance per unit area of the tube (C_S)). The findings obtained through this study revealed that the simulated CCFVW had shape similar characteristics to that of the measured CCFVW. Moreover, when the compliance C_S of the model was decreased, the first peak of the simulated-CCFVW decreased and the second peak increased. Further, by separating the anterograde pulse wave and the reflected pulse wave, which form the CCFVW, we found that the decrease in the first peak of the simulated CCFVW was due to the arrival of a reflected pulse wave from the head after the common carotid artery toward the arrival of a anterograde pulse wave ejected directly from the heart and that the increase in the second peak resulted from the arrival of the peak of the reflected pulse wave from the thoracic aorta. These results establish that the CCFVW characteristics contribute to the assessment of arterial elasticity.     

A novel servo-control system that imposes desired aortic input impedance on in situ rat heart

To clarify the pathophysiological role of dynamic arterial properties in cardiovascular diseases, we attempted to develop a new control system that imposes desired aortic impedance on in situ rat left ventricle. In 38 anesthetized open-chest rats, ascending aortic pressure and flow waveforms were continuously sampled (1,000 Hz). Desired flow waveforms were calculated from measured aortic pressure waveforms and target impedance. To minimize the difference between measured and desired aortic flow waveforms, the computer generated commands to the servo-pump, connected to a side branch of the aorta. By iterating the process, we could successfully control aortic impedance in such a way as to manipulate compliance and characteristic impedance between 60 and 160% of their respective native values. The error between desired and measured aortic flow waveforms was 70 +/- 34 microl/s (root mean square; 4.4 +/- 1.4% of peak flow), indicating reasonable accuracy in controlling aortic impedance. This system enables us to examine the importance of dynamic arterial properties independently of other hemodynamic and neurohumoral factors in physiological and clinical settings.     

Unloading arterial baroreceptors causes neurogenic hypertension

We developed a new model to examine the role of arterial baroreceptors in the long-term control of mean arterial pressure (MAP) in dogs. Baroreceptors in the aortic arch and one carotid sinus were denervated, and catheters were implanted in the descending aorta and common carotid arteries. MAP and carotid sinus pressure (CSP) averaged 104 +/- 2 and 102 +/- 2 mmHg (means +/- 1 SE), respectively, during a 5-day control period. Baroreceptor unloading was induced by ligation of the common carotid artery proximal to the innervated sinus (n = 6 dogs). MAP and CSP averaged 127 +/- 7 and 100 +/- 3 mmHg, respectively, during the 7-day period of baroreceptor unloading. MAP was significantly elevated (P < 0.01) compared to control, but CSP was unchanged. Heart rate and plasma renin activity increased significantly in response to baroreceptor unloading. Removal of the ligature to restore normal flow through the carotid resulted in normalization of all variables. Ligation of the carotid below a denervated sinus (n = 4) caused a significant decrease in CSP but no systemic hypertension. These results indicate that chronic unloading of carotid baroreceptors can produce neurogenic hypertension and provide strong evidence that arterial baroreceptors are involved in the long-term control of blood pressure.     

充胀犬胸部降主动脉所致的升压效应

在17只麻醉开胸犬,观察局部充胀胸部降主动脉(TDA)对心血管活动的影响。主要结果如下:1.充胀 TDA 引起心率、心肌收缩力、肾及股薄肌灌注压和全身动脉血压增加;TDA 局部去神经后反应消失,表明上述心血管效应系 TDA 受牵张刺激引起的正反馈性神经反射现象。2.切断动物两侧颈迷走神经和窦神经后,充胀 TDA 引起的心血管效应增大。3.用心得安(1mg/kg)消除心脏的β-效应后,充胀 TDA 引起的升压反应有所减小;用酚妥拉明(3mg/kg)阻断血管的α-受体效应后,多数动物即不再出现血压增高,从而提示充胀TDA 时的血压升高主要是反射性外周阻力增加所致。在缓冲神经完整的条件下,上述 TDA加压效应是存在的,但主动脉弓和颈动脉窦缓冲反射对其有对抗作用。     

Chemical activation of thin-fiber phrenic afferents. 2. Cardiovascular responses

To assess the effects of groups III and IV (thin-fiber) phrenic afferents on arterial pressure, heart rate, and distribution of cardiac output, we injected capsaicin into phrenic arteries of in situ isolated and innervated left diaphragms of dogs anesthetized with chloralose, vagotomized, and mechanically ventilated. Blood flow in the ascending aorta, common carotid, renal, superior mesenteric, and femoral arteries was measured by electromagnetic and Doppler flow probes. Injection of 1 mg capsaicin into the left phrenic artery produced congruent to 15% increase in mean arterial pressure and congruent to 7% increase in heart rate with no change in aortic flow. Phrenic arterial flow decreased by 64%, renal arterial flow by 16%, and superior mesenteric arterial flow by 10%, whereas carotid flow increased by 13% and flow to the right gastrocnemius muscle did not change. Mean arterial pressure, heart rate, and blood flow distribution (with the exception of the decline in phrenic blood flow) returned to baseline within 60 s of the injection. Injection of 1.5 mg capsaicin into the right isolated and innervated gastrocnemius produced congruent to 35% increase in mean arterial pressure, 17% rise in heart rate, and no change in aortic blood flow. Phrenic and carotid arterial flow rose by 240 and 41%, respectively, whereas renal and superior mesenteric flow declined by 50 and 20%, respectively. In conclusion, thin-fiber phrenic afferents have an excitatory effect on arterial pressure and heart rate. They redistribute blood flow away from the renal and intestinal vascular beds and toward the carotid vascular bed. On the other hand, the cardiovascular reflex from thin-fiber phrenic afferents seems less potent than that from limb muscle afferents.     

Topographical mapping of sites of enhanced HRP permeability in the normal rabbit aorta.

The spatial distribution of sites of enhanced permeability to the macromolecule horseradish peroxidase (HRP) in the normal rabbit aorta after one min circulation was studied using image analysis. These sites, referred to as "HRP spots," exhibit a nonuniform distribution that is qualitatively similar in all rabbits studied. The density of HRP spots is highest in the aortic arch, decreases distally, reaches a minimum in the lower descending thoracic aorta, and then increases again in the abdominal aorta. The region of highest spot density follows a clockwise helical pattern in the aortic arch and outside the arch occurs in streaks largely oriented in the bulk flow direction. The streaks in the abdominal aorta localize along the anatomical right lateral wall and occasionally along the left lateral wall proximal to the celiac artery and along the ventral wall between the celiac and superior mesenteric arteries. The density of spots is high in the immediate vicinity of aortic ostia with the most elevated density being distal to ostia in most cases. At a short distance from the ostium edge of the celiac and superior mesenteric branches the proximal density is comparably high, and no preferred spot orientation is observed around the brachiocephalic vessel. These results are consistent with an influence of localizing factors such as detailed hemodynamic phenomena and/or arterial wall structural and/or functional variations.     

Three-Dimensional Computational Modeling of an Extra-Descending Aortic Assist Device Using Fluid-Structure Interaction

BackgroundThe incidence of heart failure is anticipated to rise by 2030, resulting in more than 8 million adults with this condition in US. Despite the advancement in pharmacological and surgical treatments, some patients progress to severe forms of cardiac dysfunction requiring cardiac transplantation as a last-resort treatment. Cardiac assist devices play an essential role in the recovery of normal cardiac performance through reversible remodeling or in assisting the weak organ to prolong survival rate. However, these devices need to be monitored carefully, as prolonged use may lead to physiological maladaptation and further cardiac complications. The optimization of such devices has done through the development and use of numerical simulations that allow the analysis of in-vivo hemodynamic patterns of blood flow. This study aims to investigate the performance of a model of extra-aortic assist device surrounding the descending aorta through three-dimensional patient-specific modeling.MethodsA three-dimensional model of the aorta was constructed from patient-specific cardiac CT images of a 60-year-old male diagnosed with left ventricular failure at the Tehran Heart Center (THC). Numerical simulation was conducted for two complete cardiac cycles using fluid-structure interaction (FSI) analysis under the assumption that the balloon and the aortic vessel behave as linear elastic materials, and that blood is a Newtonian and incompressible fluid.ResultsThe numerical simulation demonstrated a high correlation between the FSI analysis and clinical data of the patient-specific anatomical and physiological conditions. Blood velocity, pressure, deformation, and strain contours were simulated and analyzed through three-dimensional modeling. Compared to the unassisted aorta, the device provided an increase in blood flow displacement of an additional 15 ml of blood in the descending aorta, brachiocephalic, carotid, and subclavian arteries. The maximum von Mises stress distribution across the aortic vessel was higher than the stress imposed on the system in the unassisted heart, with values of 3.3 MPa and 0.28 MPa, respectively. Numerical investigation of structural responses revealed that no remarkable force was exerted on the aortic valve by the device at the descending aorta.ConclusionWe present the numerical investigation of a counterpulsation device around the descending aorta that has not previously been tested on human or animal models. While this extra-aortic balloon pump (EABP) did not show a significant improvement in coronary perfusion, there is room for improvement in further studies to optimize the geometry of the balloon. Additional investigations are required to determine the efficacy of this device and its safety before in-vivo experimental studies are pursued. This simulation has clinical relevance when choosing an appropriate cardiac assist device to address patient-specific physiological and pathological conditions.     

Computational simulations of hemodynamic changes within thoracic, coronary, and cerebral arteries following early wall remodeling in response to distal aortic coarctation

Mounting evidence suggests that the pulsatile character of blood pressure and flow within large arteries plays a particularly important role as a mechano-biological stimulus for wall growth and remodeling. Nevertheless, understanding better the highly coupled interactions between evolving wall geometry, structure, and properties and the hemodynamics will require significantly more experimental data. Computational fluid–solid-growth models promise to aid in the design and interpretation of such experiments and to identify candidate mechanobiological mechanisms for the observed arterial adaptations. Motivated by recent aortic coarctation models in animals, we used a computational fluid–solid interaction model to study possible local and systemic effects on the hemodynamics within the thoracic aorta and coronary, carotid, and cerebral arteries due to a distal aortic coarctation and subsequent spatial variations in wall adaptation. In particular, we studied an initial stage of acute cardiac compensation (i.e., maintenance of cardiac output) followed by early arterial wall remodeling (i.e., spatially varying wall thickening and stiffening). Results suggested, for example, that while coarctation increased both the mean and pulse pressure in the proximal vessels, the locations nearest to the coarctation experienced the greatest changes in pulse pressure. In addition, after introducing a spatially varying wall adaptation, pressure, left ventricular work, and wave speed all increased. Finally, vessel wall strain similarly experienced spatial variations consistent with the degree of vascular wall adaptation.     

Transient analysis of cardiopulmonary interactions. I. Diastolic events

The etiology of the fall in left ventricular stroke volume (LVSV) with negative intrathoracic pressure (NITP) during inspiration has been ascribed to a reduction in LV preload. This study evaluated the effects of NITP with and without airway obstruction confined to early (ED), mid- (MD), or late diastole (LD) on the subsequent LVSV, anteroposterior (AP), and right-to-left (RL) aortic diameters (DAO) (series I, n = 6) as well as on phasic arterial blood flow out of the thorax (series II, n = 6) in anesthetized dogs. Transient NITP was obtained by electrocardiogram-triggered phrenic nerve stimulation. In series I, NITP applied for 60% of diastole with the airway obstructed caused decreases of LVSV during ED [-7.7 +/- 3.2% (SE) NS], MD (-11.7 +/- 3.9%, P less than 0.05), and LD (-14.6 +/- 1.5%, P less than 0.01) associated with significant increases of left ventricular end-diastolic pressures relative to both atmospheric and esophageal pressures during MD and LD. NITP increased DAO(AP) and DAO(RL), resulting in increases in diastolic aortic cross-sectional area by an average of 6.1-8.3% (P less than 0.01). Similar changes were seen with the airway unobstructed during NITP. In series II, NITP caused diminished diastolic antegrade carotid artery and/or descending aortic flow run off in all dogs. Transient retrograde arterial flows with NITP were observed in more than half of the animals consistent with increases in aortic diameters. We conclude that a decrease of intrathoracic pressure confined to diastole can 1) diminish the ensuing LVSV, presumptively reducing preload by ventricular interdependence; 2) distend the intrathoracic aorta; 3) diminish antegrade flow out of the thorax independent of effects on cardiac performance; and 4) cause transient retrograde carotid and aortic blood flow. The intrathoracic aorta and, presumably, the arterial intrathoracic vascular compartment can be viewed as an elastic container driven by changes in intrathoracic pressure.     

Estimating absolute aortic pressure using MRI and a one-dimensional model

Aortic blood pressure is a strong indicator to cardiovascular diseases and morbidity. Clinically, pressure measurements are done by inserting a catheter in the aorta. However, imaging techniques have been used to avoid the invasive procedure of catheterization. In this paper, we combined MRI measurements to a one-dimensional model in order to simulate blood flow in an aortic segment. Absolute pressure was estimated in the aorta by using MRI measured flow as boundary conditions and MRI measured compliance as a pressure law for solving the model. Model computed pressure was compared to catheter measured pressure in an aortic phantom. Furthermore, aortic pressure was estimated in vivo in three healthy volunteers.     

Morphological changes of the anterior spinal artery during aortic cross-clamping and effect of prostaglandin E1 with perfusion

This investigation was designed to evaluate the morphological changes of anterior spinal artery (ASA) and its reaction to prostaglandinE1 (PGE1) during aortic cross-clamping. ASA during 30 min cross-clamping was observed with charge-coupled device (CCD) and ASA diameter (ASAD) was measured. Group A: Infrarenal aorta was cross-clamped. Group B: Infrarenal aorta was cross-clamped and aorta above the bifurcation was snared. The aortic segment between clamp and snare was perfused with blood. Group C: PGE1 of 100 ng/kg/min was added to perfusate of Group B. The aortic segmental pressures in group B and C were about 30% of the proximal systolic arterial pressure and were significantly higher than distal pressure of group A. After cross-clamping, ASAD decreased about 80% of before cross-clamping in group A. By segmental perfusion of which pressure was about 30% of proximal systolic arterial pressure, ASAD remained almost 90% in group B. By administration of PGE1, ASAD was significantly increased in group C. The changes of ASAD were significantly different between group A and C, and between group B and C.     

Calcifications of the Thoracic Aorta on Extended Non-Contrast-Enhanced Cardiac CT

Background

The presence of calcified atherosclerosis in different vascular beds has been associated with a higher risk of mortality. Thoracic aorta calcium (TAC) can be assessed from computed tomography (CT) scans, originally aimed at coronary artery calcium (CAC) assessment. CAC screening improves cardiovascular risk prediction, beyond standard risk assessment, whereas TAC performance remains controversial. However, the curvilinear portion of the thoracic aorta (TA), that includes the aortic arch, is systematically excluded from TAC analysis. We investigated the prevalence and spatial distribution of TAC all along the TA, to see how those segments that remain invisible in standard TA evaluation were affected.

Methods and Results

A total of 970 patients (77% men) underwent extended non-contrast cardiac CT scans including the aortic arch. An automated algorithm was designed to extract the vessel centerline and to estimate the vessel diameter in perpendicular planes. Then, calcifications were quantified using the Agatston score and associated with the corresponding thoracic aorta segment. The aortic arch and the proximal descending aorta, “invisible” in routine CAC screening, appeared as two vulnerable sites concentrating 60% of almost 11000 calcifications. The aortic arch was the most affected segment per cm length. Using the extended measurement method, TAC prevalence doubled from 31% to 64%, meaning that 52% of patients would escape detection with a standard scan. In a stratified analysis for CAC and/or TAC assessment, 111 subjects (46% women) were exclusively identified with the enlarged scan.

Conclusions

Calcium screening in the TA revealed that the aortic arch and the proximal descending aorta, hidden in standard TA evaluations, concentrated most of the calcifications. Middle-aged women were more prone to have calcifications in those hidden portions and became candidates for reclassification.     

Beyond the aorta: partial transmission of reflected waves from aortic coarctation into supra-aortic branches modulates cerebral hemodynamics and left ventricular load

Wave reflection from the site of aortic coarctation produces a reflected backward compression wave (BCW) that raises left ventricular (LV) afterload. However, not all reflected wave power will propagate back to the LV. This study investigated the hypothesis that the BCW is partially transmitted into supra-aortic vessels as a forward wave and explored the consequences of this phenomenon for cerebral and LV haemodynamic load. In eight sheep, high fidelity pressure and flow were measured in the aortic trunk (AoT) and brachiocephalic trunk (BCT, the single supra-aortic vessel present in sheep) at baseline and during two levels of proximal descending aortic constriction. Wave power analysis showed that aortic constriction produced not only a BCW in the AoT, but also a second forward compression wave (\(\mathrm{FCW}_{2})\) in the BCT that augmented pressure and flow after the initial forward compression wave (\(\mathrm{FCW}_{1})\). Mathematical analysis and a one-dimensional model of the human systemic arteries and aortic coarctation suggested that the relative transmission of waves into supra-aortic vessels versus the aorta was determined by the relative admittances of these vessels. Reducing supra-aortic admittance (1) increased pressure and flow pulsatility in cerebral arteries, (2) produced carotid and middle cerebral arterial flow waveforms with an older adult phenotype, (3) promoted transmission of reflected wave power towards the LV and (4) substantially increased mid- to late-systolic myocardial stress, which may promote LV hypertrophy. These findings suggest that wave transmission into supra-aortic branches has an important impact on both cerebral hemodynamics and LV load in aortic coarctation.     

Measuring Ascending Aortic Stiffness In Vivo in Mice Using Ultrasound

We present a protocol for measuring in vivo aortic stiffness in mice using high-resolution ultrasound imaging. Aortic diameter is measured by ultrasound and aortic blood pressure is measured invasively with a solid-state pressure catheter. Blood pressure is raised then lowered incrementally by intravenous infusion of vasoactive drugs phenylephrine and sodium nitroprusside. Aortic diameter is measured for each pressure step to characterize the pressure-diameter relationship of the ascending aorta. Stiffness indices derived from the pressure-diameter relationship can be calculated from the data collected. Calculation of arterial compliance is described in this protocol.This technique can be used to investigate mechanisms underlying increased aortic stiffness associated with cardiovascular disease and aging. The technique produces a physiologically relevant measure of stiffness compared to ex vivo approaches because physiological influences on aortic stiffness are incorporated in the measurement. The primary limitation of this technique is the measurement error introduced from the movement of the aorta during the cardiac cycle. This motion can be compensated by adjusting the location of the probe with the aortic movement as well as making multiple measurements of the aortic pressure-diameter relationship and expanding the experimental group size.