Analyse der aortalen Gefäßsteifigkeit bei pädiatrischen Patienten

Walser, Matthias (2025): Analyse der aortalen Gefäßsteifigkeit bei pädiatrischen Patienten: Evaluation einer nicht-invasiven Messmethodik und klinische Implementierung bei Patienten mit Fontan-Palliation. Dissertation, LMU München: Medizinische Fakultät

Abstract

Introduction Both studies investigate pulse wave velocity (PWV) as an indicator of arterial stiffness. The first study focuses on validating a non-invasive PWV measurement using the Mobil-O-Graph® in pediatric patients with a physiological cardiovascular system. The second study examined PWV in patients with Fontan palliation compared to hearttransplanted control subjects with biventricular circulation, aiming to analyze specific vascular stiffness and its relationship with hemodynamic parameters. Methods The first study enrolled 60 patients aged 3-35 years, of which 51 were heart transplant recipients and nine underwent interventional ASD closure. PWV was measured invasively by cardiac catheterization in the ascending aorta (aPWV) and the entire central aorta (cPWV) and compared with non-invasive, oscillometric PWV measurement using the Mobil-O-Graph® (oPWV). In the second study, 20 Fontan patients and 49 heart-transplanted controls were examined invasively in the same manner. In addition to invasive PWV (aPWV, cPWV), hemodynamic parameters such as central blood pressures, cardiac output, and systemic vascular resistance index were determined wherever appropriate. Results The first study showed a positive correlation between both invasive PWV measurements and oPWV across all age groups (aPWV/oPWV: r=0.628 | cPWV/oPWV: r=0.417; p<0.001). The agreement between invasive and non-invasive measurements was highest with aPWV, particularly in the group under 18 years of age, with a mean difference of 0.41 ± 0.41 m/s. Additionally, cPWV was faster and correlated more with age (r=0.39) than aPWV. In the second study, Fontan patients showed significantly higher aPWV (Fontan: 7.2 ± 2.4 | Controls: 4.9 ± 0.7 m/s; p<0.001). While aPWV and cPWV were almost identical in the control group, multivariate analysis confirmed an increased aPWV in Fontan patients that was independent of age and BMI. Except for a significant correlation of cPWV with age (r=0.43), systemic vascular resistance index (r=0.44), and central arterial blood pressure (r > 0.4), no association was found between aPWV and other hemodynamic parameters. Conclusion The first study confirms that the Mobil-O-Graph® is a reliable method for measuring PWV in children and adults, supporting its use for cardiovascular risk stratification in pediatrics. The Mobil-O-Graph® seems to most accurately reflect PWV in the ascending aorta. The second study suggests that Fontan patients have a specific increase of arterial stiffness in the ascending aorta, possibly due to the high degree of surgical manipulation in patients with Fontan circulation.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: PWV, Pulswellengeschwindigkeit, pulse-wave-velocity, Gefäßsteifigkeit, Mobil-O-Graph
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 3. April 2025
• 1. Bericht­erstatter:in: Haas, Nikolaus