Bence Ágg1,2, Bálint Szilveszter1,3, Noémi Daradics1,2, Roland Stengl1,2, Kálmán Benke1,2, Miklós Pólos1,2, Béla Merkely1, Zoltán Szabolcs1,2
1 Heart and Vascular Center, Semmelweis University, Budapest
2 Hungarian Marfan Foundation, Budapest
3 MTA-SE Cardiovascular Imaging Research Group, Budapest
Introduction: Clinical evidence suggests that the currently recommended approach to estimate the risk of aortic dissection in Marfan syndrome (MFS) by mainly focusing on aortic diameters and aortic growth rate is not reliable enough. According to previous findings assessing arterial tortuosity could improve risk stratification.
Aims: In this study we investigated the tortuosity of renal and splenic arteries that are not influenced by the skeletal features of MFS.
Method: In our retrospective analysis the centerline of splenic and renal arteries was exported for 46 MFS patients and 92 age and gender matched control subjects using helical thoracic and abdominal CT angiography imaging. To measure tortuosity distance metric (DM) and the 3D version of sum of angles metric (SOAM) and inflection count metric (ICM) were calculated. Mann-Whitney U-test was used for statistical analysis.
Results: DM of the right and left renal, and splenic artery was significantly higher in MFS patients than in controls (1.24±0.21 vs. 1.13±0.11 p=0.002; 1.54±0.39 vs. 1.19±0.15 p<0.001; 2.39±0.83 vs. 2.00±0.80 p<0.001). A similar tendency was observed for ICM values. SOAM of the right and left renal artery was significantly lower in the MFS group compared to controls (0.55±0.14 vs. 0.63±0.15 p=0.005; 0.53±0.44 vs. 0.61±0.32 p<0.001).
Conclusion: To our knowledge this is the first demonstration of increased arterial tortuosity in MFS on visceral arteries. Visceral arterial tortuosity, dominated by curves of lower frequency but higher amplitude according to the observed opposite tendency between the DM and SOAM metrics, could be a possible new predictor of serious manifestations of MFS.
Doctoral School: Pharmaceutical Sciences
Program: Experimental and Clinical Pharmacology
Supervisor: Zoltán Szabolcs
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