Automated Extraction of Pulsatile Stiffness and Wall Asymmetry from Aortic M-Mode Ultrasound Images

Q: What does this research mean for the field?

Automated segmentation of aortic M-mode ultrasound waveforms yields time-resolved pulsatile stiffness metrics that correlate strongly with conventional two-point stiffness measures, while wall asymmetry metrics independently correlate with coronary lesion burden. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Cheong-Ah Lee; Dong‐Guk Paeng; Joon Hyouk Choi

doi:10.3390/bioengineering13070727

June 24, 2026BioengineeringOpen Access

Automated Extraction of Pulsatile Stiffness and Wall Asymmetry from Aortic M-Mode Ultrasound Images

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Why the study?

Conventional ultrasound assessment of aortic stiffness uses two-point distension metrics that may not fully reflect time-resolved aortic wall dynamics.

Does automated extraction of pulsatile stiffness-β and wall asymmetry from aortic M-mode ultrasound images improve the assessment of vascular stiffness and coronary lesion burden compared to conventional stiffness-β in adult patients?

Key Points

To assess the feasibility and clinical relevance of extracting continuous diameter waveforms, pulsatile stiffness-β, and wall asymmetry from archived aortic M-mode ultrasound images using automated segmentation.
Analyzed archived aortic M-mode ultrasound images from N=79 cases using automated image processing to segment anterior and posterior aortic walls and reconstruct diameter waveforms.
Calculated conventional stiffness-β, time-series pulsatile stiffness-β, and wall asymmetry parameters, comparing them against hemodynamic metrics, tonometry, cardiovascular risk burden, and coronary Syntax scores.
Conventional and pulsatile stiffness-β correlated strongly, displaying directionally consistent associations with age, systolic blood pressure, pulse pressure, augmentation pressure, and cardiovascular risk.
Pulsatile stiffness-β performed as a waveform-informed extension of conventional stiffness rather than a superior standalone measure.
Parameters measuring aortic wall asymmetry demonstrated significant associations with coronary artery disease burden quantified by the Syntax score.

Structured PICO

Does automated extraction of pulsatile stiffness-β and wall asymmetry from aortic M-mode ultrasound images improve the assessment of vascular stiffness and coronary lesion burden compared to conventional stiffness-β in adult patients?

P

Population

79 adult patients (48 men, 31 women) with a mean age of 64.6 ± 11.3 years, with available and analyzable archived aortic M-mode ultrasound images at a single center in the Republic of Korea.

I

Intervention

Automated image processing and segmentation of archived aortic M-mode ultrasound images to derive time-resolved continuous diameter waveforms, enabling calculation of pulsatile stiffness-β and wall asymmetry-related parameters.

C

Comparator

Conventional stiffness-β derived from two-point distension metrics (maximum and minimum vessel diameters within a cardiac cycle).

O

Outcome

Feasibility and clinical relevance of time-series-based stiffness parameters, specifically their correlation with conventional stiffness-β and associations with hemodynamic, tonometric, coronary burden (Syntax score), and global cardiovascular risk variables.surrogate

Automated time-resolved analysis of archived aortic M-mode ultrasound images is feasible to extract pulsatile stiffness-β and wall asymmetry, providing physiologically consistent extensions to conventional two-point stiffness assessments.

Limitations

Single-center retrospective preliminary study with a modest sample size.
Pulsatility-ratio formulation requires external validation and reproducibility testing.
Segmentation validation was conducted at the derived measurement level rather than at the pixel-wise spatial contour level.
Specific waveform amplitude metric formulation was not selected through comparative optimization.
Wall asymmetry index and wall amplitude ratio are susceptible to M-mode probe angulation.

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Implication

Time-resolved aortic stiffness metrics are feasible retrospectively; hypothesis-generating and require prospective validation before any clinical consideration.

Abstract

Conventional ultrasound-based assessment of aortic stiffness relies on two-point distension metrics using maximum and minimum vessel diameters within a cardiac cycle, which may not fully reflect time-resolved aortic wall dynamics. This retrospective pilot study investigated the feasibility and clinical relevance of a time-series-based stiffness parameter, termed pulsatile stiffness-β, derived from automated segmentation of archived aortic M-mode ultrasound images. Seventy-nine cases with available aortic M-mode images were analyzed. Automated image processing was used to segment the anterior and posterior aortic walls and reconstruct diameter waveforms. Conventional stiffness-β, pulsatile stiffness-β, and wall asymmetry-related parameters were calculated and compared with demographic, tonometry-derived, hemodynamic, coronary burden, cardiovascular risk, and echocardiographic variables. Conventional and pulsatile stiffness-β were strongly correlated and showed directionally consistent associations with established vascular functional parameters, including systolic blood pressure, pulse pressure, augmentation pressure, age, and cardiovascular risk burden. Pulsatile stiffness-β demonstrated association patterns broadly comparable to conventional stiffness-β, suggesting its role as a waveform-informed extension rather than a superior alternative. Wall asymmetry-related parameters were associated with the Syntax score. Automated analysis of archived aortic M-mode images may provide feasible time-resolved vascular biomarkers for stiffness and wall motion assessment.

Discussion

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Cite This Study

Lee et al. (2026) studied this question.

synapsesocial.com/papers/6a72c31aaf0c21e939299181 https://doi.org/10.3390/bioengineering13070727

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Automated Extraction of Pulsatile Stiffness and Wall Asymmetry from Aortic M-Mode Ultrasound Images

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Automated Extraction of Pulsatile Stiffness and Wall Asymmetry from Aortic M-Mode Ultrasound Images

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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