Sağlıklı çocuklarda çıkan aortanın elastisite parametrelerinin normal aralıklarının değerlendirilmesi

Öz

Çalışmamızda çıkan aorta çaplarından elde edilen verilerden üretilen aortik elastisite parametrelerinin yaş, cinsiyetlere göre normal dağılım aralıklarını belirmelemek ve aortik elastisite parametreleri üzerine etki eden faktörleri analiz etmek amaçlanmıştır. Tüm hastalar yaş gruplarına ve cinsiyetlere göre gruplandırılmıştır. Tüm hastaların demografik verilerinin yanında, transtorasik ekokardiyografi ile sol ventrikül sistolik ve diyastolik fonksiyonları, aortik çapları, sol ventrikül kütleleri değerlendirilmiştir. Aortik çaplardan; aortik strain, aortik stiffness, aortik distensibilite parametreleri elde edilmiştir. Çalışmamıza 215 hasta (erkek ve kız sırasıyla 103, 112) dahil edildi. Çalışmada yaş, vücut yüzey alanı (BSA) ortalama değerleri sırasıyla 8.49 (±5.37) yıl, 1.02 (±0.46) m2 idi. Aortik strain, stiffness, distensibilite değerleri sırasıyla %23.13 (±16.03), 3.33 (±1.95), 0.010 (±0.008) dyn-1*cm2*10-6 idi. Cinsiyete göre karşılaştırılma yapıldığında yaş, sol ventrikül fonksiyonları, aortik çaplar, aortik elastisite parametreleri benzer değerlerde bulundu. Yaş gruplarına ve cinsiyete göre aortik elastisite parametreleri normal değer aralıkları tablosu oluşturuldu. Aortik elastisite parametreleri ile yaş, BSA, sol ventrikül fonksiyonları, aortik çaplar ve kan basıncı ile değişen derecelerde korelasyon ilişkisi mevcuttu. Aortik elastisite parametreleri yaş gruplarına ve cinsiyetlere göre farklılık göstermektedir. Aortik elastisite parametreleri ile yaş, kalp fonksiyonları, aortik çaplar, kan basıncı ve pubertele birlikte değişen hormonal durum etki etmektedir.

Anahtar Kelimeler

• Çocuk
• aortik strain
• aortik stiffness
• aortik distensibilite
• normal aralık

Evaluation of normal ranges of elasticity parameters of ascending aorta in healty children

Öz

In this study, we aimed to determine the normal distribution ranges of aortic elasticity parameters produced from data obtained from ascending aortic diameters according to age and sex and to analyze the factors affecting aortic elasticity parameters. Patients were grouped according to age and sex. In addition to the demographic data of all patients, the left ventricular systolic and diastolic functions, aortic diameters, and left ventricular masses were evaluated using transthoracic echocardiography. The aortic diameters, aortic strain, aortic stiffness, and aortic distensibility were obtained. A total of 215 patients (103 boys and 112 girls) were included in our study. In the study, the mean values of age and body surface area (BSA) were 8.49 (±5.37) years and 1.02 (±0.46) m2, respectively. The aortic strain, stiffness, and distensibility values were 23.13% (±16.03), 3.33 (±1.95), and 0.010 (±0.008) dyn-1*cm2*10-6, respectively. When compared according to sex, age, left ventricular function, aortic diameter, and aortic elasticity parameters were similar. A table of normal value ranges of aortic elasticity parameters was created according to age group and sex. There were varying degrees of correlations between aortic elasticity parameters and age, BSA, left ventricular function, aortic diameter, and blood pressure. The aortic elasticity parameters vary according to age and sex. Aortic elasticity parameters are affected by age, heart function, aortic diameter, blood pressure, and hormonal status, which change during puberty.

Anahtar Kelimeler

• Child
• aortic strain
• aortic stiffness
• aortic distensibility
• normal range

Kaynakça

1. 1. Gkaliagkousi E, Douma SJH. The pathogenesis of arterial stiffness and its prognostic value in essential hypertension and cardiovascular diseases. 2009;13(2):70.
2. 2. Prakash A, Adlakha H, Rabideau N, Hass CJ, Morris SA, Geva T, et al. Segmental aortic stiffness in children and young adults with connective tissue disorders: relationships with age, aortic size, rate of dilation, and surgical root replacement. 2015;132(7):595-602.
3. 3. Roman MJ, Devereux RB, Schwartz JE, Lockshin MD, Paget SA, Davis A, et al. Arterial stiffness in chronic inflammatory diseases. 2005;46(1):194-9.
4. 4. Weismann CG, Lombardi KC, Grell BS, Northrup V, Sugeng L. Aortic stiffness and left ventricular diastolic function in children with well-functioning bicuspid aortic valves. 2016;17(2):225-30.
5. 5. S Stakos DA, Schuster DP, Sparks EA, Wooley CF, Osei K, Boudoulas H. Cardiovascular effects of type 1 diabetes mellitus in children. 2005;56(3):311-7.
6. 6. Vogt M, Kühn A, Baumgartner D, Baumgartner C, Busch R, Kostolny M, et al. Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair: proof of a systemic vascular disease of the prestenotic arteries? 2005;111(24):3269-73.
7. 7. Oyamada J, Toyono M, Shimada S, Aoki-Okazaki M, Takahashi T. Altered central aortic elastic properties in Kawasaki disease are related to changes in left ventricular geometry and coronary artery aneurysm formation. 2012;25(6):690-6.
8. 8. Wójtowicz J, Łempicka A, Łuczyński W, Szczepański W, Zomerfeld A, Semeran K, et al. Central aortic pressure, arterial stiffness and echocardiographic parameters of children with overweight/obesity and arterial hypertension. 2017;26(9).

9. 9. Schack-Nielsen L, Mølgaard C, Larsen D, Martyn C, Michaelsen KF. Arterial stiffness in 10-year-old children: current and early determinants. 2005;94(6):1004-11.
10. 10. Covic A, Mardare N, Gusbeth-Tatomir P, Brumaru O, Gavrilovici C, Munteanu M, et al. Increased arterial stiffness in children on haemodialysis. 2006;21(3):729-35.
11. 11. Ulger Z, Aydinok Y, Gurses D, Levent E, Ozyurek AR. Stiffness of the abdominal aorta in β-thalassemia major patients related with body iron load. 2006;28(10):647-52.
12. 12. Redheuil A, Yu W-C, Wu CO, Mousseaux E, De Cesare A, Yan R, et al. Reduced ascending aortic strain and distensibility: earliest manifestations of vascular aging in humans. 2010;55(2):319-26.
13. 13. Marti CN, Gheorghiade M, Kalogeropoulos AP, Georgiopoulou VV, Quyyumi AA, Butler J. Endothelial dysfunction, arterial stiffness, and heart failure. 2012;60(16):1455-69.
14. 14. Della Corte V, Tuttolomondo A, Pecoraro R, Di Raimondo D, Vassallo V, Pinto A. Inflammation, endothelial dysfunction and arterial stiffness as therapeutic targets in cardiovascular medicine. 2016;22(30):4658-68.
15. 15. Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. 2012;1(4):1-10.
16. 16. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. 2001;37(5):1236-41.
17. 17. Agabiti-Rosei E, Mancia G, O’Rourke MF, Roman MJ, Safar ME, Smulyan H, et al. Central blood pressure measurements and antihypertensive therapy: a consensus document. 2007;50(1):154-60.
18. 18. Boonyasirinant T, Rajiah P, Flamm SD. Abnormal aortic stiffness in patients with bicuspid aortic valve: phenotypic variation determined by magnetic resonance imaging. 2019;35(1):133-41.
19. 19. Covic A, Siriopol D. Pulse wave velocity ratio: the new “gold standard” for measuring arterial stiffness. Am Heart Assoc; 2015. p. 289-90.
20. 20. Ganten M, Boese JM, Leitermann D, Semmler WJ. Quantification of aortic elasticity: development and experimental validation of a method using computed tomography. 2005;15:2506-12.
21. 21. Oren A, Vos LE, Uiterwaal CS, Grobbee DE, Bots ML. Aortic stiffness and carotid intima‐media thickness: two independent markers of subclinical vascular damage in young adults? 2003;33(11):949-54.
22. 22. Hauser M, Kühn A, Petzuch K, Wolf P, Vogt M. Elastic Properties of the Ascending Aorta in Healthy Children and Adolescents–Age-Related Reference Values for Aortic Wall Stiffness and Distensibility Obtained on M-mode Echocardiography–. 2013;77(12):3007-14.
23. 23. Vanderschuren MM, Uiterwaal CS, van der Ent CK, Eising JB. Feasibility and characteristics of arterial stiffness measurement in preschool children. 2017;24(17):1895-902.
24. 24. Reusz GS, Cseprekal O, Temmar M, Kis E, Cherif AB, Thaleb A, et al. Reference values of pulse wave velocity in healthy children and teenagers. 2010;56(2):217-24.
25. 25. Thurn D, Doyon A, Sözeri B, Bayazit AK, Canpolat N, Duzova A, et al. Aortic pulse wave velocity in healthy children and adolescents: reference values for the vicorder device and modifying factors. 2015;28(12):1480-8.
26. 26. El Edelbi RA, Lindemalm S, Nydert P, Eksborg SJIJoP, Medicine A. Estimation of body surface area in neonates, infants, and children using body weight alone. 2021;8(4):221-8.
27. 27. Must A, Anderson SE. Body mass index in children and adolescents: considerations for population-based applications. 2006;30(4):590-4.
28. 28. Lopez L, Saurers DL, Barker PC, Cohen MS, Colan SD, Dwyer J, et al. Guidelines for performing a comprehensive pediatric transthoracic echocardiogram: recommendations from the American Society of Echocardiography. 2024;37(2):119-70.
29. 29. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. 1977;55(4):613-8.
30. 30. Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P. Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. 1990;11(11):990-6.
31. 31. van Meurs-van Woezik H, Klein HW, Markus-Silvis L, Krediet P. Comparison of the growth of the tunica media of the ascending aorta, aortic isthmus and descending aorta in infants and children. 1983;136(Pt 2):273.
32. 32. Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial stiffness and cardiovascular risk in hypertension. 2021;128(7):864-86.
33. 33. Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Cheng S, et al. Relations of central hemodynamics and aortic stiffness with left ventricular structure and function: the Framingham Heart Study. 2016;5(3):e002693.
34. 34. Eren M, Gorgulu S, Uslu N, Celik S, Dagdeviren B, Tezel T. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both. 2004;90(1):37-43.
35. 35. Styczynski G, Rdzanek A, Pietrasik A, Kochman J, Huczek Z, Sobieraj P, et al. Echocardiographic assessment of aortic pulse-wave velocity: validation against invasive pressure measurements. 2016;29(11):1109-16.
36. 36. Avolio AP, Chen SG, Wang RP, Zhang CL, Li MF, O'Rourke MF. Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. 1983;68(1):50-8.
37. 37. Allen J. Photoplethysmography and its application in clinical physiological measurement. 2007;28(3):R1.
38. 38. Tillin T, Chambers J, Malik I, Coady E, Byrd S, Mayet J, et al. Measurement of pulse wave velocity: site matters. 2007;25(2):383-9.
39. 39. I Isnard RN, Pannier BM, Laurent S, London GM, Diebold B, Safar ME. Pulsatile diameter and elastic modulus of the aortic arch in essential hypertension: a noninvasive study. 1989;13(2):399-405.
40. 40. O’rourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. 2007;50(1):1-13.