University of Oulu

Kauhanen, S.P., Liimatainen, T., Kariniemi, E. et al. A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress. Eur Radiol 30, 5149–5157 (2020).

A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress

Saved in:
Author: Kauhanen, S. Petteri1,2; Liimatainen, Timo3,4; Kariniemi, Elina2,5;
Organizations: 1Doctoral Programme of Clinical Research, University of Eastern Finland, Kuopio, Finland
2Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
3Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
4Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
5Department of Clinical Physiology and Nuclear Medicine, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
6School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
7Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 3.5 MB)
Persistent link:
Language: English
Published: Springer Nature, 2020
Publish Date: 2020-11-11


Objectives: The aim of this study was to evaluate whether the orientation of the heart, measured as an angle between the long axis of the heart and ascending aorta midline (heart-aorta-angle, HAA), associates with ascending aortic (AA) dilatation. Furthermore, the association between HAA and wall shear stress (WSS) was studied.

Methods: HAA was retrospectively measured in 1000 consecutive coronary artery computed tomographic angiography (CCTA) images in patients with low-to-moderate pretest probability for coronary artery disease (CAD). To evaluate the effects of HAA on AA flow, 4D flow MRI was performed for 28 patients with AA dilatation (> 40 mm) and WSS was analyzed.

Results: The mean age of patients undergoing CCTA was 52.9 ± 9.8 years; 66.5% were women. Their median HAA was 128.7° and interquartile range 123.3–134.1°. HAA was significantly smaller in patients with dilated AA (median 126.7° [121.3–130.8°]) compared with the patients with normal AA (median 129.5° [124.3–135.3°], p < 0.001). HAA was smaller in males (p < 0.001) and in patients with diabetes (p = 0.016), hypertension (p = 0.001), CAD (p = 0.003), hypercholesterolemia (p < 0.001), and bicuspid aortic valve (p = 0.025) than without these factors. In a subpopulation without any of these underlying diseases (n = 233), HAA was still significantly smaller in the patients with dilated AA (median 127.9° [124.3–134.3°]) compared with patients with normal AA (median 131.9° [127.6–136.9°], p = 0.013). In 4D flow MRI, a smaller HAA correlated with increased total WSS in the outer curvature of the proximal AA (r = − 0.510, p = 0.006).

Conclusions: A smaller HAA associates with AA dilatation and affects the blood flow in the proximal AA.

see all

Series: European radiology
ISSN: 0938-7994
ISSN-E: 1432-1084
ISSN-L: 0938-7994
Volume: 30
Issue: 9
Pages: 5149 - 5157
DOI: 10.1007/s00330-020-06852-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Open access funding provided by University of Eastern Finland (UEF) including Kuopio University Hospital. This study has received funding by Oiva Vaittinen Will Grant, Aarne Koskelo Foundation, Finnish Society of Angiology, Radiological Society of Finland, Northern Savonia Foundation of the Finnish Cultural Foundation, Finnish Foundation of Cardiovascular Research, Ida Montin Foundation, Mauri and Sirkka Wiljasalo Foundation, and Instrumentarium Science Foundation.
Copyright information: © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit