{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:18:28Z","timestamp":1787008708126,"version":"build-2736575974"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>To assess whether ascending aorta over-angulation, a morphological feature recently found to be associated with acute type A aortic dissection, precedes dissection and how it affects wall stress distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A baseline finite element model, previously created by a neural network tool from end-diastolic computed tomography angiography measurements in 124 healthy subjects, was modified to simulate the over-angulation accompanying aortic elongation, obtaining paradigmatic models with different ascending angulations (ascending-arch angle 145\u00b0\u2013110\u00b0). The models were discretized and embedded in a deformable continuum representing surrounding tissues, aortic wall anisotropy and nonlinearity were accounted for, pre-tensioning at diastolic pressures was applied and peak systolic stresses were computed. Then, from 15 patients\u2019 pre-dissection geometries, patient-specific finite element models of pre-dissection aorta were created through the same framework. The sites of maximum longitudinal stress were compared with the respective sites of dissection entry tear in post-dissection imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Paradigmatic models showed that progressive narrowing of the ascending-arch angle was associated with increasing longitudinal stress (becoming significant for angles &amp;lt;130\u00b0), whereas the impact on circumferential stress was less consistent. In pre-dissection patient-specific models, the ascending-arch angle was narrowed (113\u00b0\u00b111\u00b0), and the region of peak longitudinal stresses corresponded to the entry tear location in the respective post-dissection computed tomography angiography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study strongly supports the hypothesis that the ascending-arch angle, as quantifier of aorta over-angulation, can be a good predictor of aortic dissection, since its narrowing below 130\u00b0 increases longitudinal wall stress, and the dissection entry tears develop in the aortic wall in areas of highest longitudinal stress.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf053","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T23:22:47Z","timestamp":1739488967000},"source":"Crossref","is-referenced-by-count":4,"title":["Ascending aorta over-angulation is a risk factor for acute type A aortic dissection: evidence from advanced finite element simulations"],"prefix":"10.1093","volume":"67","author":[{"given":"Ione","family":"Ianniruberto","sequence":"first","affiliation":[{"name":"Department of Electronics, Information and Bioengineering, \u201cPolitecnico di Milano\u201d , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3303-3752","authenticated-orcid":false,"given":"Federica","family":"Lo Presti","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u201cL. 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Vanvitelli\u201d, Unit of Cardiac Surgery, V. Monaldi Hospital , Naples,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa","family":"De Feo","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u201cL. Vanvitelli\u201d, Unit of Cardiac Surgery, V. Monaldi Hospital , Naples,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9020-2188","authenticated-orcid":false,"given":"Alberto","family":"Redaelli","sequence":"additional","affiliation":[{"name":"Department of Electronics, Information and Bioengineering, \u201cPolitecnico di Milano\u201d , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Di Eusanio","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Lancisi Cardiovascular Center, \u201cOspedali Riuniti delle Marche\u201d, Polytechnic University of Marche , Ancona,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7115-0151","authenticated-orcid":false,"given":"Emiliano","family":"Votta","sequence":"additional","affiliation":[{"name":"Department of Electronics, Information and Bioengineering, \u201cPolitecnico di Milano\u201d , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4636-3339","authenticated-orcid":false,"given":"Alessandro","family":"Della Corte","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u201cL. 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