Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Three-dimensional evaluation of thoracic aorta enlargement and unfolding in hypertensive men using non-contrast computed tomography

Journal of Human Hypertension volume 27, pages 504–509 (2013)Cite this article

Subjects

Abstract

Aging produces a simultaneous thoracic aorta (TA) enlargement and unfolding. We sought to analyze the impact of hypertension on these geometric changes. Non-contrast computed tomography images were obtained from coronary artery calcium scans, including the entire aortic arch, in 200 normotensive and 200 hypertensive asymptomatic men. An automated algorithm reconstructed the vessel in three-dimensions, estimating orthogonal aortic sections along the whole TA pathway, and calculated several geometric descriptors to assess TA morphology. Hypertensive patients were older with respect to normotensive (P<0.001). Diameter and volume of TA ascending, arch and descending segments were higher in hypertensive patients with respect to normotensive (P<0.001) and differences persisted after adjustment for age. Hypertension produced an accelerated unfolding effect on TA shape. We found increments in aortic arch width (P<0.001), radius of curvature (P<0.001) and area under the arch curve (P<0.01) with a concomitant tortuosity decrease (P<0.05) and no significant change in aortic arch height. Overall, hypertension produced an equivalent effect of 2−7-years of aging. In multivariate analysis adjusted for age and hypertension treatment, diastolic pressure was more associated to TA size and shape changes than systolic pressure. These data suggest that hypertension accelerates TA enlargement and unfolding deformation with respect to the aging effect.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Lam CS, Xanthakis V, Sullivan LM, Lieb W, Aragam J, Redfield MM et al. Aortic root remodeling over the adult life course: longitudinal data from the Framingham Heart Study. Circulation 2010; 122: 884–890.

    Article  Google Scholar 

  2. O’Rourke M, Farnsworth A, O’Rourke J . Aortic dimensions and stiffness in normal adults. JACC Cardiovasc Imaging 2008; 1: 749–751.

    Article  Google Scholar 

  3. Wolak A, Gransar H, Thomson LEJ, Friedman JD, Hachamovitch R, Gutstein A et al. Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area. JACC: Cardiovascular Imaging 2008; 1: 200–209.

    PubMed  Google Scholar 

  4. Elefteriades JA, Farkas EA . Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. J Am Coll Cardiol 2010; 55: 841–857.

    Article  CAS  Google Scholar 

  5. Hinchliffe RJ, Krasznai A, Schultzekool L, Blankensteijn JD, Falkenberg M, Lonn L et al. Observations on the failure of stent-grafts in the aortic arch. Eur J Vasc Endovasc Surg 2007; 34: 451–456.

    Article  CAS  Google Scholar 

  6. Melissano G, Civilini E, Bertoglio L, Calliari F, Setacci F, Calori G et al. Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg 2007; 33: 561–566.

    Article  CAS  Google Scholar 

  7. Mao SS, Ahmadi N, Shah B, Beckmann D, Chen A, Ngo L et al. Normal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adults: impact of age and gender. Acad Radiol 2008; 15: 827–834.

    Article  Google Scholar 

  8. Chironi G, Orobinskaia L, Megnien JL, Sirieix ME, Clement-Guinaudeau S, Bensalah M et al. Early thoracic aorta enlargement in asymptomatic individuals at risk for cardiovascular disease: determinant factors and clinical implication. J Hypertens 2010; 28: 2134–2138.

    Article  CAS  Google Scholar 

  9. Redheuil A, Yu WC, Mousseaux E, Harouni AA, Kachenoura N, Wu CO et al. Age-related changes in aortic arch geometry: relationship with proximal aortic function and left ventricular mass and remodeling. J Am Coll Cardiol 2011; 58: 1262–1270.

    Article  Google Scholar 

  10. Sugawara J, Hayashi K, Yokoi T, Tanaka H . Age-associated elongation of the ascending aorta in adults. J Am Coll Cardiol Img 2008; 1: 739–748.

    Article  Google Scholar 

  11. Craiem D, Chironi G, Redheuil A, Casciaro M, Mousseaux E, Simon A et al. Aging impact on thoracic aorta 3D morphometry in intermediate-risk subjects: looking beyond coronary arteries with non-contrast cardiac CT. Ann Biomed Eng 2012; 40: 1028–1038.

    Article  Google Scholar 

  12. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA et al2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2010 56: e50–103.

    Article  Google Scholar 

  13. Chironi G, Simon A, Megnien JL, Sirieix ME, Mousseaux E, Pessana F et al. Impact of coronary artery calcium on cardiovascular risk categorization and lipid-lowering drug eligibility in asymptomatic hypercholesterolemic men. Int J Cardiol 2011; 151: 200–204.

    Article  Google Scholar 

  14. Agmon Y, Khandheria BK, Meissner I, Schwartz GL, Sicks JD, Fought AJ et al. Is aortic dilatation an atherosclerosis-related process? Clinical, laboratory, and transesophageal echocardiographic correlates of thoracic aortic dimensions in the population with implications for thoracic aortic aneurysm formation. J Am Coll Cardiol 2003; 42: 1076–1083.

    Article  Google Scholar 

  15. Vasan RS, Larson MG, Levy D . Determinants of echocardiographic aortic root size. The Framingham Heart Study. Circulation 1995; 91: 734–740.

    Article  CAS  Google Scholar 

  16. Zhao F, Zhang H, Wahle A, Thomas MT, Stolpen AH, Scholz TD et al. Congenital aortic disease: 4D magnetic resonance segmentation and quantitative analysis. Med Image Anal 2009; 13: 483–493.

    Article  Google Scholar 

  17. Wood NB, Zhao SZ, Zambanini A, Jackson M, Gedroyc W, Thom SA et al. Curvature and tortuosity of the superficial femoral artery: a possible risk factor for peripheral arterial disease. J Appl Physiol 2006; 101: 1412–1418.

    Article  CAS  Google Scholar 

  18. Mitchell GF, Conlin PR, Dunlap ME, Lacourciere Y, Arnold JM, Ogilvie RI et al. Aortic diameter, wall stiffness, and wave reflection in systolic hypertension. Hypertension 2008; 51: 105–111.

    Article  CAS  Google Scholar 

  19. Ingelsson E, Pencina MJ, Levy D, Aragam J, Mitchell GF, Benjamin EJ et al. Aortic root diameter and longitudinal blood pressure tracking. Hypertension 2008; 52: 473–477.

    Article  CAS  Google Scholar 

  20. Jondeau G, Boutouyrie P, Lacolley P, Laloux B, Dubourg O, Bourdarias JP et al. Central pulse pressure is a major determinant of ascending aorta dilation in Marfan syndrome. Circulation 1999; 99: 2677–2681.

    Article  CAS  Google Scholar 

  21. O’Rourke MF, Nichols WW . Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension 2005; 45: 652–658.

    Article  Google Scholar 

  22. Bella JN, Wachtell K, Boman K, Palmieri V, Papademetriou V, Gerdts E et al. Relation of left ventricular geometry and function to aortic root dilatation in patients with systemic hypertension and left ventricular hypertrophy (the LIFE study). Am J Cardiol 2002; 89: 337–341.

    Article  Google Scholar 

  23. Cuspidi C, Meani S, Fusi V, Valerio C, Sala C, Zanchetti A . Prevalence and correlates of aortic root dilatation in patients with essential hypertension: relationship with cardiac and extracardiac target organ damage. J Hypertens 2006; 24: 573–580.

    Article  CAS  Google Scholar 

  24. Mitchell GF, Lacourciere Y, Ouellet JP, Izzo JL, Neutel J, Kerwin LJ et al. Determinants of elevated pulse pressure in middle-aged and older subjects with uncomplicated systolic hypertension: the role of proximal aortic diameter and the aortic pressure-flow relationship. Circulation 2003; 108: 1592–1598.

    Article  Google Scholar 

  25. Chen CH, Nevo E, Fetics B, Pak PH, Yin FC, Maughan WL et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. Circulation 1997; 95: 1827–1836.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was partially supported by post-doctoral scholarship cooperation program between France and Argentina ‘Bernardo Houssay’. We thank Mrs Latifa Boudali for her invaluable assistance in database management.

Author information

Authors and Affiliations

  1. Centre de Médecine Préventive Cardiovasculaire, Hôpital Européen Georges Pompidou, APHP, Paris, France

    D Craiem, G Chironi & A Simon

  2. Universidad Favaloro, CONICET, Buenos Aires, Argentina

    D Craiem & M E Casciaro

  3. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France

    G Chironi, A Redheuil, E Mousseaux & A Simon

  4. Centre de Recherche Cardiovasculaire de l'HEGP (INSERM U970), Paris, France

    G Chironi & A Simon

  5. Département de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou, APHP, Paris, France

    A Redheuil & E Mousseaux

  6. Unité INSERM 678, Paris, France

    A Redheuil & E Mousseaux

Authors
  1. D Craiem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Chironi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M E Casciaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Redheuil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E Mousseaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D Craiem.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Craiem, D., Chironi, G., Casciaro, M. et al. Three-dimensional evaluation of thoracic aorta enlargement and unfolding in hypertensive men using non-contrast computed tomography. J Hum Hypertens 27, 504–509 (2013). https://doi.org/10.1038/jhh.2012.69

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2012.69

Keywords

This article is cited by

Search

Advanced search

Quick links