{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:16:07Z","timestamp":1781327767609,"version":"3.54.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,7,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Cervical arterial tortuosity is associated with adverse outcomes in Loeys\u2010Dietz syndrome and other heritable aortopathies.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A method to assess tortuosity based on curvature of the vessel centerline in 3\u2010dimensional space was developed. We measured cervical carotid tortuosity in 65 patients with Loeys\u2010Dietz syndrome from baseline computed tomography angiogram\/magnetic resonance angiogram and all serial images during follow\u2010up. Relations between baseline carotid tortuosity, age, aortic root diameter, and its change over time were compared. Patients with unoperated aortic roots were assessed for clinical end point (type A aortic dissection or aortic root surgery during 4\u2009years of follow\u2010up). Logistic regression was performed to assess the likelihood of clinical end point according to baseline carotid tortuosity. Total absolute curvature at baseline was 11.13\u00b15.76 and was relatively unchanged at 8 to 10\u2009years (fold change: 0.026\u00b10.298,\n              <jats:italic>P<\/jats:italic>\n              =1.00), whereas tortuosity index at baseline was 0.262\u00b10.131, with greater variability at 8 to 10\u2009years (fold change: 0.302\u00b10.656,\n              <jats:italic>P<\/jats:italic>\n              =0.818). Baseline total absolute curvature correlated with aortic root diameter (\n              <jats:italic>r<\/jats:italic>\n              =0.456,\n              <jats:italic>P<\/jats:italic>\n              =0.004) and was independently associated with aortic events during the 4\u2010year follow\u2010up (adjusted odds ratio [OR], 2.64 [95% CI, 1.02\u20136.85]). Baseline tortuosity index correlated with age (\n              <jats:italic>r<\/jats:italic>\n              =0.532,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and was not associated with events (adjusted OR, 1.88 [95% CI, 0.79\u20134.51]). Finally, baseline total absolute curvature had good discrimination of 4\u2010year outcomes (area under the curve=0.724,\n              <jats:italic>P<\/jats:italic>\n              =0.014), which may be prognostic or predictive.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Here we introduce cervical carotid tortuosity as a promising quantitative biomarker with validated, standardized characteristics. Specifically, we recommend the adoption of a curvature\u2010based measure, total absolute curvature, for early detection or monitoring of disease progression in Loeys\u2010Dietz syndrome.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.035171","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T10:46:29Z","timestamp":1718966789000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Validating a Curvature\u2010Based Marker of Cervical Carotid Tortuosity for Risk Assessment in Heritable Aortopathies"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8961-0125","authenticated-orcid":false,"given":"Jin Vivian","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery Washington University School of Medicine St. Louis MO USA"},{"name":"Department of Biomedical Engineering Washington University in St. Louis St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8625-4698","authenticated-orcid":false,"given":"Anna L.","family":"Huguenard","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Washington University School of Medicine St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9181-6413","authenticated-orcid":false,"given":"Ralph G.","family":"Dacey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Washington University School of Medicine St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1859-310X","authenticated-orcid":false,"given":"Alan C.","family":"Braverman","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine Washington University School of Medicine St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4308-9669","authenticated-orcid":false,"given":"Joshua W.","family":"Osbun","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery Washington University School of Medicine St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A6218"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001106"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa055695"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lpm.2015.02.024"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-012-0241-4"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezx147"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.990549"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/RCT.0000000000000764"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.029518"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2009.2021652"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2004.826946"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-008-0420-1"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.058948"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.05.072"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.11647"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A1651"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCGENETICS.116.001485"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.056"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.01.040"}],"container-title":["Journal 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