Biomechanical indices are more sensitive than diameter in
predicting rupture of asymptomatic abdominal aortic aneurysms

J 2020

Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms

POLZER, Stanislav, T. Christian GASSER, Robert VLACHOVSKÝ, Luboš KUBÍČEK, Lukas LAMBERT et. al.

Basic information

Original name

Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms

Authors

POLZER, Stanislav (203 Czech Republic, guarantor), T. Christian GASSER (752 Sweden), Robert VLACHOVSKÝ (203 Czech Republic, belonging to the institution), Luboš KUBÍČEK (203 Czech Republic, belonging to the institution), Lukas LAMBERT (203 Czech Republic), Vojtech MAN (203 Czech Republic), Kamil NOVAK (203 Czech Republic), Martin SLAZANSKY (203 Czech Republic), Jiri BURSA (203 Czech Republic) and Robert STAFFA (203 Czech Republic, belonging to the institution)

Edition

Journal of Vascular Surgery, New York, Mosby Inc. 2020, 0741-5214

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30212 Surgery

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.268

RIV identification code

RIV/00216224:14110/20:00115438

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.jvs.2019.03.051

UT WoS

000508630800037

Keywords in English

Aneurysm; Biomechanics; Rupture risk; Predictability; FEM

Abstract

V originále

Objective: Several studies of biomechanical rupture risk assessment (BRRA) showed its advantage over the diameter criterion in rupture risk assessment of abdominal aortic aneurysm (AAA). However, BRRA studies have not investigated the predictability of biomechanical risk indices at different time points ahead of rupture, nor have they been performed blinded for biomechanical analysts. The objective of this study was to test the predictability of the BRRA method against diameter-based risk indices in a quasi-prospective patient cohort study. Methods: In total, 12 women and 31 men with intact AAAs at baseline have been selected retrospectively at two medical centers. Within 56 months, 19 cases ruptured, whereas 24 cases remained intact within 2 to 56 months. This outcome was kept confidential until all biomechanical activities in this study were finished. The biomechanical AAA rupture risk was calculated at baseline using high-fidelity and low-fidelity finite element method models. The capability of biomechanics-based and diameter-based risk indices to predict the known outcomes at 1 month, 3 months, 6 months, 9 months, and 12 months after baseline was validated. Besides common cohort statistics, the area under the curve (AUC) of receiver operating characteristic curves has been used to grade the different rupture risk indices. Results: Up to 9 months ahead of rupture, the receiver operating characteristic analysis of biomechanics-based risk indices showed a higher AUC than diameter-based indices. Six months ahead of rupture, the largest difference was observed with an AUC of 0.878 for the high-fidelity biomechanical risk index, 0.859 for the low-fidelity biomechanical risk index, 0.789 for the diameter, and 0.821 for the sex-adjusted diameter. In predictions beyond 9 months, none of the risk indices proved to be superior. Conclusions: High-fidelity biomechanical modeling improves the predictability of AAA rupture. Asymptomatic AAA patients with high biomechanical AAA rupture risk indices have an increased risk of rupture. Integrating biomechanics-based diagnostic indices may significantly decrease the false-positive rate in AAA treatment.

Citovat

POLZER, Stanislav, T. Christian GASSER, Robert VLACHOVSKÝ, Luboš KUBÍČEK, Lukas LAMBERT, Vojtech MAN, Kamil NOVAK, Martin SLAZANSKY, Jiri BURSA and Robert STAFFA. Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms. Journal of Vascular Surgery. New York: Mosby Inc., 2020, vol. 71, No 2, p. "617-626"-"e1-e6", 16 pp. ISSN 0741-5214. Available from: https://dx.doi.org/10.1016/j.jvs.2019.03.051.

@article{1637756,
   author = {Polzer, Stanislav and Gasser, T. Christian and Vlachovský, Robert and Kubíček, Luboš and Lambert, Lukas and Man, Vojtech and Novak, Kamil and Slazansky, Martin and Bursa, Jiri and Staffa, Robert},
   article_location = {New York},
   article_number = {2},
   doi = {http://dx.doi.org/10.1016/j.jvs.2019.03.051},
   keywords = {Aneurysm; Biomechanics; Rupture risk; Predictability; FEM},
   language = {eng},
   issn = {0741-5214},
   journal = {Journal of Vascular Surgery},
   title = {Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms},
   url = {http://dx.doi.org/10.1016/j.jvs.2019.03.051},
   volume = {71},
   year = {2020}
}

TY  - JOUR
ID  - 1637756
AU  - Polzer, Stanislav - Gasser, T. Christian - Vlachovský, Robert - Kubíček, Luboš - Lambert, Lukas - Man, Vojtech - Novak, Kamil - Slazansky, Martin - Bursa, Jiri - Staffa, Robert
PY  - 2020
TI  - Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms
JF  - Journal of Vascular Surgery
VL  - 71
IS  - 2
SP  - "617-626"-"e1-e6"
EP  - "617-626"-"e1-e6"
PB  - Mosby Inc.
SN  - 07415214
KW  - Aneurysm
KW  - Biomechanics
KW  - Rupture risk
KW  - Predictability
KW  - FEM
UR  - http://dx.doi.org/10.1016/j.jvs.2019.03.051
L2  - http://dx.doi.org/10.1016/j.jvs.2019.03.051
N2  - Objective: Several studies of biomechanical rupture risk assessment (BRRA) showed its advantage over the diameter criterion in rupture risk assessment of abdominal aortic aneurysm (AAA). However, BRRA studies have not investigated the predictability of biomechanical risk indices at different time points ahead of rupture, nor have they been performed blinded for biomechanical analysts. The objective of this study was to test the predictability of the BRRA method against diameter-based risk indices in a quasi-prospective patient cohort study. Methods: In total, 12 women and 31 men with intact AAAs at baseline have been selected retrospectively at two medical centers. Within 56 months, 19 cases ruptured, whereas 24 cases remained intact within 2 to 56 months. This outcome was kept confidential until all biomechanical activities in this study were finished. The biomechanical AAA rupture risk was calculated at baseline using high-fidelity and low-fidelity finite element method models. The capability of biomechanics-based and diameter-based risk indices to predict the known outcomes at 1 month, 3 months, 6 months, 9 months, and 12 months after baseline was validated. Besides common cohort statistics, the area under the curve (AUC) of receiver operating characteristic curves has been used to grade the different rupture risk indices. Results: Up to 9 months ahead of rupture, the receiver operating characteristic analysis of biomechanics-based risk indices showed a higher AUC than diameter-based indices. Six months ahead of rupture, the largest difference was observed with an AUC of 0.878 for the high-fidelity biomechanical risk index, 0.859 for the low-fidelity biomechanical risk index, 0.789 for the diameter, and 0.821 for the sex-adjusted diameter. In predictions beyond 9 months, none of the risk indices proved to be superior. Conclusions: High-fidelity biomechanical modeling improves the predictability of AAA rupture. Asymptomatic AAA patients with high biomechanical AAA rupture risk indices have an increased risk of rupture. Integrating biomechanics-based diagnostic indices may significantly decrease the false-positive rate in AAA treatment.
ER  -

POLZER, Stanislav, T. Christian GASSER, Robert VLACHOVSKÝ, Luboš KUBÍČEK, Lukas LAMBERT, Vojtech MAN, Kamil NOVAK, Martin SLAZANSKY, Jiri BURSA and Robert STAFFA. Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms. \textit{Journal of Vascular Surgery}. New York: Mosby Inc., 2020, vol.~71, No~2, p.~''617-626''-''e1-e6'', 16 pp. ISSN~0741-5214. Available from: https://dx.doi.org/10.1016/j.jvs.2019.03.051.

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