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In Vivo Strain Analysis of Dilated Ascending Thoracic Aorta by ECG-Gated CT Angiographic Imaging

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Abstract

Accurate assessment of aortic extensibility is a requisite first step for elucidating the pathophysiology of an ascending thoracic aortic aneurysm (ATAA). This study aimed to develop a framework for the in vivo evaluation of the full-field distribution of the aortic wall strain by imaging analysis of electrocardiographic- (ECG) gated thoracic data of 34 patients with ATAA. Seven healthy controls (i.e., non-aneurysmal aorta) from patients who underwent ECG-gated CT angiography for coronary artery diseases were included for comparison. To evaluate the systolic function, ECG-gated computed tomography (CT) angiography was used to generate patient-specific geometric meshes of the ascending aorta, and then to estimate both the displacement and strain fields using a mathematical algorithm. Results evidenced stiff behavior for the aneurysmal aorta compared with that of the healthy ascending aorta of the controls, with patients over 55 years of age displaying significantly lower extensibility. Moreover, the patient risk as quantified by the ratio of in vivo strain to the ruptured one increased significantly with increased systolic blood pressure, older age, and higher pressure-strain modulus. Statistical analysis also indicated that an increased pressure-strain modulus is a risk factor for ATAAs with bicuspid aortic valve, suggesting a different mechanism of failure in these patients. The approach here proposed for the in vivo evaluation of the aortic wall strain is simple and fast, with promising applicability in routine clinical imaging, and could be used to develop a rupture potential criterion on the basis of the aortic aneurysm extensibility.

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Acknowledgments

This work was supported by a “Ricerca Finalizzata” grant from the Italian Ministry of Health (GR-2011-02348129) to Salvatore Pasta, and by the Fondazione Ri.MED for research on aneurysm biomechanics.

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Authors and Affiliations

  1. Fondazione Ri.MED, Palermo, Italy

    Salvatore Pasta & Marzio Di Giuseppe

  2. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy

    Salvatore Pasta, Valentina Agnese, Giuseppe M. Raffa, Diego Bellavia & Michele Pilato

  3. Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy

    Giovanni Gentile

Authors
  1. Salvatore Pasta
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  2. Valentina Agnese
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  3. Marzio Di Giuseppe
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  4. Giovanni Gentile
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  5. Giuseppe M. Raffa
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  6. Diego Bellavia
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  7. Michele Pilato
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Correspondence to Salvatore Pasta.

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Associate Editor Lakshmi Prasad Dasi oversaw the review of this article.

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Pasta, S., Agnese, V., Di Giuseppe, M. et al. In Vivo Strain Analysis of Dilated Ascending Thoracic Aorta by ECG-Gated CT Angiographic Imaging. Ann Biomed Eng 45, 2911–2920 (2017). https://doi.org/10.1007/s10439-017-1915-4

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  • DOI: https://doi.org/10.1007/s10439-017-1915-4

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