Association Between Aortic Peak Wall Stress and Rupture Index with Abdominal Aortic Aneurysm-related Events

Overview

Journal Eur Radiol

Specialty Radiology

Date 2023 Mar 10

PMID 36897345

Authors

Tejas P Singh

Joseph V Moxon

T Christian Gasser

Jason Jenkins

Michael Bourke

Benard Bourke

Jonathan Golledge

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of this study was to assess whether aortic peak wall stress (PWS) and peak wall rupture index (PWRI) were associated with the risk of abdominal aortic aneurysm (AAA) rupture or repair (defined as AAA events) among participants with small AAAs.

Methods: PWS and PWRI were estimated from computed tomography angiography (CTA) scans of 210 participants with small AAAs (≥ 30 and ≤ 50 mm) prospectively recruited between 2002 and 2016 from two existing databases. Participants were followed for a median of 2.0 (inter-quartile range 1.9, 2.8) years to record the incidence of AAA events. The associations between PWS and PWRI with AAA events were assessed using Cox proportional hazard analyses. The ability of PWS and PWRI to reclassify the risk of AAA events compared to the initial AAA diameter was examined using net reclassification index (NRI) and classification and regression tree (CART) analysis.

Results: After adjusting for other risk factors, one standard deviation increase in PWS (hazard ratio, HR, 1.56, 95% confidence intervals, CI 1.19, 2.06; p = 0.001) and PWRI (HR 1.74, 95% CI 1.29, 2.34; p < 0.001) were associated with significantly higher risks of AAA events. In the CART analysis, PWRI was identified as the best single predictor of AAA events at a cut-off value of > 0.562. PWRI, but not PWS, significantly improved the classification of risk of AAA events compared to the initial AAA diameter alone.

Conclusion: PWS and PWRI predicted the risk of AAA events but only PWRI significantly improved the risk stratification compared to aortic diameter alone.

Key Points: • Aortic diameter is an imperfect measure of abdominal aortic aneurysm (AAA) rupture risk. • This observational study of 210 participants found that peak wall stress (PWS) and peak wall rupture index (PWRI) predicted the risk of aortic rupture or AAA repair. • PWRI, but not PWS, significantly improved the risk stratification for AAA events compared to aortic diameter alone.

Citing Articles

Regional Stiffness and Hardening Indices: New Indicators Derived from Multidimensional Dynamic CTA for Aneurysm Risk Assessment.

Huang T, Qi X, Cao L, Yang M, Luo H, Li Q Adv Sci (Weinh). 2024; 11(47):e2400653.

PMID: 39449669 PMC: 11653626. DOI: 10.1002/advs.202400653.

Deep learning-based segmentation of abdominal aortic aneurysms and intraluminal thrombus in 3D ultrasound images.

Nievergeld A, Cetinkaya B, Maas E, van Sambeek M, Lopata R, Awasthi N Med Biol Eng Comput. 2024; .

PMID: 39448511 DOI: 10.1007/s11517-024-03216-7.

Peak wall rupture index is associated with risk of rupture of abdominal aortic aneurysms, independent of size and sex.

Siika A, Talvitie M, Lindquist Liljeqvist M, Bogdanovic M, Gasser T, Hultgren R Br J Surg. 2024; 111(5).

PMID: 38782730 PMC: 11116082. DOI: 10.1093/bjs/znae125.

References

Golledge J . Abdominal aortic aneurysm: update on pathogenesis and medical treatments. Nat Rev Cardiol. 2018; 16(4):225-242. DOI: 10.1038/s41569-018-0114-9. View

Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T . Corrigendum to 'European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms' [European Journal of Vascular & Endovascular Surgery 57/1 (2019) 8-93]. Eur J Vasc Endovasc Surg. 2019; 59(3):494. DOI: 10.1016/j.ejvs.2019.11.026. View

Cao P, de Rango P, Verzini F, Parlani G, Romano L, Cieri E . Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial. Eur J Vasc Endovasc Surg. 2010; 41(1):13-25. DOI: 10.1016/j.ejvs.2010.08.026. View

Golledge J, Norman P, Murphy M, Dalman R . Challenges and opportunities in limiting abdominal aortic aneurysm growth. J Vasc Surg. 2016; 65(1):225-233. DOI: 10.1016/j.jvs.2016.08.003. View

Golledge J, Wolanski P, Parr A, Buttner P . Measurement and determinants of infrarenal aortic thrombus volume. Eur Radiol. 2008; 18(9):1987-94. DOI: 10.1007/s00330-008-0956-3. View

Singh T, Moxon J, Gasser T, Golledge J . Systematic Review and Meta-Analysis of Peak Wall Stress and Peak Wall Rupture Index in Ruptured and Asymptomatic Intact Abdominal Aortic Aneurysms. J Am Heart Assoc. 2021; 10(8):e019772. PMC: 8174183. DOI: 10.1161/JAHA.120.019772. View

Doyle B, Bappoo N, Syed M, Forsythe R, Powell J, Conlisk N . Biomechanical Assessment Predicts Aneurysm Related Events in Patients with Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg. 2020; 60(3):365-373. DOI: 10.1016/j.ejvs.2020.02.023. View

Singh T, Moxon J, Iyer V, Gasser T, Jenkins J, Golledge J . Comparison of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms. Br J Surg. 2021; 108(6):652-658. DOI: 10.1002/bjs.11995. View

Siika A, Lindquist Liljeqvist M, Hultgren R, Gasser T, Roy J . Aortic Lumen Area Is Increased in Ruptured Abdominal Aortic Aneurysms and Correlates to Biomechanical Rupture Risk. J Endovasc Ther. 2018; 25(6):750-756. DOI: 10.1177/1526602818808292. View

10.

Gasser T, Nchimi A, Swedenborg J, Roy J, Sakalihasan N, Bockler D . A novel strategy to translate the biomechanical rupture risk of abdominal aortic aneurysms to their equivalent diameter risk: method and retrospective validation. Eur J Vasc Endovasc Surg. 2014; 47(3):288-95. DOI: 10.1016/j.ejvs.2013.12.018. View

11.

Gasser T . Biomechanical Rupture Risk Assessment: A Consistent and Objective Decision-Making Tool for Abdominal Aortic Aneurysm Patients. Aorta (Stamford). 2016; 4(2):42-60. PMC: 5054755. DOI: 10.12945/j.aorta.2015.15.030. View

12.

Teutelink A, Cancrinus E, van de Heuvel D, Moll F, de Vries J . Preliminary intraobserver and interobserver variability in wall stress and rupture risk assessment of abdominal aortic aneurysms using a semiautomatic finite element model. J Vasc Surg. 2011; 55(2):326-30. DOI: 10.1016/j.jvs.2011.08.012. View

13.

Hyhlik-Durr A, Krieger T, Geisbusch P, Kotelis D, Able T, Bockler D . Reproducibility of deriving parameters of AAA rupture risk from patient-specific 3D finite element models. J Endovasc Ther. 2011; 18(3):289-98. DOI: 10.1583/10-3384MR.1. View

14.

Khosla S, Morris D, Moxon J, Walker P, Gasser T, Golledge J . Meta-analysis of peak wall stress in ruptured, symptomatic and intact abdominal aortic aneurysms. Br J Surg. 2014; 101(11):1350-7. DOI: 10.1002/bjs.9578. View

15.

Groeneveld M, Meekel J, Rubinstein S, Merkestein L, Tangelder G, Wisselink W . Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture. J Am Heart Assoc. 2018; 7(13). PMC: 6064909. DOI: 10.1161/JAHA.117.007791. View

16.

Golledge J, Cronin O, Iyer V, Bradshaw B, Moxon J, Cunningham M . Body mass index is inversely associated with mortality in patients with peripheral vascular disease. Atherosclerosis. 2013; 229(2):549-55. DOI: 10.1016/j.atherosclerosis.2013.04.030. View

17.

Golledge J, Ewels C, Muller R, Walker P . Association of chronic kidney disease categories defined with different formulae with major adverse events in patients with peripheral vascular disease. Atherosclerosis. 2014; 232(2):289-97. DOI: 10.1016/j.atherosclerosis.2013.11.034. View

18.

Golledge J, Pinchbeck J, Tomee S, Rowbotham S, Singh T, Moxon J . Efficacy of Telmisartan to Slow Growth of Small Abdominal Aortic Aneurysms: A Randomized Clinical Trial. JAMA Cardiol. 2020; 5(12):1374-1381. PMC: 7450408. DOI: 10.1001/jamacardio.2020.3524. View

19.

Singh T, Morris D, Smith S, Moxon J, Golledge J . Systematic Review and Meta-Analysis of the Association Between C-Reactive Protein and Major Cardiovascular Events in Patients with Peripheral Artery Disease. Eur J Vasc Endovasc Surg. 2017; 54(2):220-233. DOI: 10.1016/j.ejvs.2017.05.009. View

20.

Thomas Manapurathe D, Moxon J, Krishna S, Rowbotham S, Quigley F, Jenkins J . Cohort Study Examining the Association Between Blood Pressure and Cardiovascular Events in Patients With Peripheral Artery Disease. J Am Heart Assoc. 2019; 8(6):e010748. PMC: 6475052. DOI: 10.1161/JAHA.118.010748. View