Association between aortic peak wall stress and rupture index with abdominal aortic aneurysm-related events

Tejas P Singh; Joseph V Moxon; T Christian Gasser; Jason Jenkins; Michael Bourke; Benard Bourke; Jonathan Golledge

doi:10.1007/s00330-023-09488-1

Association between aortic peak wall stress and rupture index with abdominal aortic aneurysm-related events

Eur Radiol. 2023 Aug;33(8):5698-5706. doi: 10.1007/s00330-023-09488-1. Epub 2023 Mar 10.

Authors

Tejas P Singh^{1

2}, Joseph V Moxon^{1

3}, T Christian Gasser⁴, Jason Jenkins⁵, Michael Bourke^{6

7}, Benard Bourke⁶, Jonathan Golledge^{8

9

10}

Affiliations

¹ Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, 4811, Australia.
² The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia.
³ The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
⁴ Department of Engineering Mechanics, KTH Solid Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden.
⁵ Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital Brisbane, Herston, Queensland, Australia.
⁶ Gosford Vascular Services Gosford New South Wales Australia, Gosford, Australia.
⁷ The School of Biomedical Sciences & Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia.
⁸ Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, 4811, Australia. Jonathan.Golledge@jcu.edu.au.
⁹ The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia. Jonathan.Golledge@jcu.edu.au.
¹⁰ The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia. Jonathan.Golledge@jcu.edu.au.

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.

Keywords: Aortic aneurysm, abdominal; Peripheral vascular diseases; Vascular diseases.

Publication types

Observational Study

MeSH terms

Aorta, Abdominal / diagnostic imaging
Aortic Aneurysm, Abdominal* / complications
Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / epidemiology
Aortography / methods
Finite Element Analysis
Humans
Retrospective Studies
Risk Assessment
Risk Factors
Stress, Mechanical

Supplementary concepts

Achalasia Addisonianism Alacrimia syndrome