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. 2022 May 19:9:793722.
doi: 10.3389/fcvm.2022.793722. eCollection 2022.

Dynamic Changes in the Aorta During the Cardiac Cycle Analyzed by ECG-Gated Computed Tomography

Wenying Zhu  1   2 , Yingliang Wang  1   2 , Yang Chen  1   2 , Jiacheng Liu  1   2 , Chen Zhou  1   2 , Qin Shi  1   2 , Songjiang Huang  1   2 , Chongtu Yang  1   2 , Tongqiang Li  1   2 , Bin Xiong  1   2
Affiliations

Dynamic Changes in the Aorta During the Cardiac Cycle Analyzed by ECG-Gated Computed Tomography

Wenying Zhu et al. Front Cardiovasc Med. .

Abstract

Background: To characterize the difference in aortic dimensions during the cardiac cycle with electrocardiogram (ECG)-gated computed tomography angiography (CTA) and to determine whether other parameters in comparison to diameter could potentially provide a more accurate size reference for stent selection at the aortic arch and the proximal thoracic descending aorta.

Methods: The CTA imaging of 90 patients during the cardiac cycle was reviewed. Three anatomic locations were selected for analysis (level A: 1 cm proximal to the innominate artery; level B: 1 cm distal to the left common carotid artery; and level C: 1 cm distal to the left subclavian artery). We measured the maximum diameter, the minimum diameter, the lumen area, the lumen perimeter, and the diameter derived from the lumen area, and the changes of each parameter at each level during the cardiac cycle were compared.

Results: The mean age was 60.9 ± 12.4 years (range, 16-78 years). There was a significant difference in the aortic dimensions during the cardiac cycle (p < 0.001). The diameter derived from the lumen area at all three levels was changed least over time when compared to the area, perimeter, and the maximum aortic diameter (all p < 0.01).

Conclusion: The aortic dimensional differences during the cardiac cycle are significant. The aortic diameter derived from the lumen area over other parameters may provide a better evaluation for selecting the size of the stent at the aortic arch and the proximal thoracic descending aorta. A prospective study comparing these different measurement parameters regarding the outcomes is still needed to evaluate the clinical implications.

Keywords: aorta; cardiac cycle; diameter; dynamic changes; oversizing.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of inclusion of patients.
Figure 2
Figure 2
Locations of the measurements in the aorta; level A: 1 cm proximal to the innominate artery; level B: 1 cm distal to the left common carotid artery; and level C: 1 cm distal to the left subclavian artery.
Figure 3
Figure 3
Multiplanar views of aortic measurements in sagittal view (A), frontal (B), axial (C), 3-dimensional (D), and the centerline of the aorta (formula image) with the location of level C (1 cm distal to the left subclavian artery). The system calculated the maximum and minimum aortic diameter (D: 22.9/24.4 mm), area (area: 437.5 mm2), perimeter (perim: 74.3 mm), and diameter derived from the lumen area [Deff (area): 23.6 mm] automatically.
Figure 4
Figure 4
Mean changes in the aortic area, aortic perimeter, maximum diameter (Dmax), and diameter deriving from the lumen area (Darea) at 3 different locations per cardiac cycle.
Figure 5
Figure 5
Bland-Altman plots show high consistency of inter-observer (A) and intra-observer (B) for the aortic area, perimeter, diameter, and diameter derived from the lumen area at level A. The upper and lower limits of each measurement difference during the cardiac cycle were included in the 95% CIs.
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