Incidence and Survival of Aortic Dissection in Urban China: Results from the National Insurance Claims for Epidemiological Research (NICER) Study

Symptom characteristics in patients undergoing acute type A aortic dissection surgery post-discharge phase: a prospective observational study

OBJECTIVES

In recent years, most studies on symptom characteristics in patients undergoing cardiac surgery have focused on the preoperative and postoperative phases. Relatively little knowledge is available related to the post-discharge phase. In this context, this paper aimed to analyze the symptoms and needs of patients with acute type A aortic dissection (AAAD) during the post-discharge phase.

METHODS

We recruited and studied patients who underwent acute type A aortic dissection surgery at Fujian Heart Medical Center from June 2022 to August 2023. At 3 months following the surgery, these subjects were investigated using the general information questionnaire and relevant symptom assessment scales, including the Mini-Mental State Examination Scale (MMSE), Athens Insomnia Scale (AIS), Hospital Anxiety and Depression Scale (HADS), and Fatigue Severity Scale (FSS). Meanwhile, grip strength and average step per day were measured for the exercise endurance assessment. A latent class analysis (LCA) based on the symptoms was performed, and differences in demographic and disease characteristics among different subgroups of patients were identified and compared using multivariate logistic regression.

RESULTS

A total of 228 patients were enrolled and categorized into three latent classes: fatigue-sleep disturbance (44.3%), anxiety-locomotion decline (16.9%), and high symptom groups (38.8%). Results showed that patients with cardiopulmonary bypass time > 200 min, higher BMI, or decreased grip strength were more likely to be classified as the high symptom group and those were unemployment status have a higher possibility of being defined as the anxiety-locomotion decline group.

CONCLUSIONS

The symptom characteristics in patients with AAAD during the postoperative rehabilitation phrase exhibit heterogeneity. It is suggested that Clinical healthcare personnel improve the identification of symptoms in high-risk patients, particularly patients cardiopulmonary bypass time > 200 min, overweight or obese, unemployed status or decreased grip strength, relevant nursing interventions should be carried out to prevent the occurrence of surgical stress and complications in patients with AAAD early to improve the quality of life of patients.

Exploring disease perception and experiences of postoperative patients with Stanford type A aortic dissection: a qualitative study

BACKGROUND

Stanford type A aortic dissection (TAAD) is a critical cardiovascular emergency characterized by acute onset, rapid progression, severe clinical manifestations, high mortality rates, and frequent complications. Patient's postoperative experiences are closely linked to their physical and mental health. Therefore, understanding their illness experience is essential to facilitate recovery.

OBJECTIVE

This study aimed to explore disease perception and postoperative experience of TAAD patients through semi-structured interviews, providing a formulation for developing standardized postoperative management protocols.

METHODS

A phenomenological qualitative study was conducted in the cardiac and vascular surgery department of a tertiary hospital in Ningxia Hui Autonomous Region between January and May 2023. Purposive sampling was used to recruit postoperative TAAD patients. Semi-structured interviews were conducted to explore disease perception and experiences. Interview data were analyzed using Colaizzi's seven-step analysis.

RESULTS

A total of 16 patients were interviewed. Based on the interview data, 296 codes were extracted and pooled into 17 subthemes, which were finally integrated into 4 themes related to disease perception and experiences: significant symptom burden, complex and varied psychological experiences, different coping styles, and diverse needs for health services.

CONCLUSION

Postoperative TAAD patients face numerous health challenges. Healthcare providers should closely monitor physical symptoms, systematically address psychological fluctuations, develop targeted interventions based on identified coping patterns, and design patient-centered care models to address unmet needs. These strategies may alleviate adverse experiences and enhance rehabilitation outcomes.

Incidence of the Stevens-Johnson syndrome spectrum and its patterns in urban China

Stevens-Johnson syndrome (SJS) spectrum is a series of rare, but life-threatening mucocutaneous hypersensitivity reactions. However, the epidemiological evidence of it is limited, especially in developing countries. The shape associations with age and its seasonal pattern are still uncertain. Therefore, this study aimed to describe the nationwide incidence of SJS spectrum, its associations with age and season, and its subsequent diagnosed diseases across urban China. By using national health insurance datasets from 2013 to 2017, this retrospective cohort study estimated the incidence of SJS spectrum and its associations in 23 Chinese provinces. SJS spectrum was defined to include SJS and/or toxic epidermal necrolysis (ICD-10 code: L51.1-2). First, age-specific incidence rates were estimated in each province and then pooled using a random-effects model. Relative risks (RR) of SJS spectrum in different seasons were estimated by Poisson regression. Diseases diagnosed within 6 months following SJS occurrence were described. In total, 9308 patients were identified (50.17% women, median age 45). The average standardized incidence rate of SJS spectrum was 3.43 (95% confidence interval [CI] 3.04-3.84) per million person-years, which increased by 0.57 (95% CI 0.29-0.84) per million person-years. Incidence rates were significantly higher among children age <10 years (5.48, 95% CI 4.02-7.09, p = 0.0036) and adults age ≥ 40 (5.50, 95% CI 4.35-6.78, p = 0.00085) than the group aged 10-40 years (3.12, 95% CI 2.29-4.07). The risk of SJS spectrum was highest in summer (vs autumn: RR = 1.83, 95% CI 1.72-1.93). The most frequently diagnosed disease within 6 months after the onset of SJS was respiratory disease (43.8%). In conclusion, this study provides evidence on the epidemiology of SJS spectrum in developing countries and supports the two-peak distribution of its incidence across age. Its high occurrence in summer needs further confirmation.

Calpain inhibition as a novel therapeutic strategy for aortic dissection with acute lower extremity ischemia

BACKGROUND

Aortic dissection (AD) patients with malperfusion present significant challenges and are associated with high postoperative mortality rates. Limited data exist regarding the management of patients with AD and acute lower extremity ischemia. Early diagnosis of the extent of malperfusion and timely intervention are critical for improving patient prognosis.

METHODS

A total of 104 patients diagnosed with AD were enrolled in this observational retrospective study, of which 11 (10.6%) presented with lower limb ischemia (LLI). A comparative analysis was conducted on the clinical data of the AD group and the AD + LLI group. Plasma concentrations of SBDP145, a specific indicator of Calpain activity, were quantified in Control, AD, and AD + LLI groups using ELISA. To explore the role of Calpain in LLI and AD, pharmacological inhibition with Calpeptin and transgenic mice overexpressing calpastatin (Tg-CAST) were utilized in mouse models. RNA sequencing and functional assays were employed to identify the downstream effectors of Calpain.

RESULTS

Patients in the AD + LLI group exhibited significantly elevated leukocyte counts, percentages of neutrophils and lymphocytes, as well as increased serum levels of AST, creatinine, total cholesterol, low-density lipoprotein, uric acid, and creatine kinase compared to those in the AD group. Furthermore, the mean calcium ion concentration and Ca2+-dependent Calpain activation were significantly higher in the AD + LLI patients. Both endogenous and exogenous Calpain inhibitors effectively promoted the restoration of blood flow to ischemic hind limbs by inhibiting the inflammatory response and promoting vascular regeneration. Additionally, Calpain inhibition prevented the onset and progression of AD. RNA sequencing and Western Blot assays demonstrated that Calpain inhibition significantly increased levels of Fabp3, which is involved in the ischemia-induced fatty acid metabolism pathway.

CONCLUSIONS

Inhibition of Calpain has been demonstrated to decrease the incidence of AD and enhance the restoration of blood flow perfusion in ischemic lower extremities. This effect may be mediated by the upregulation of Fabp3. These findings highlight the potential for targeted interventions against Calpain as a novel therapeutic strategy in the treatment of cardiovascular disease.

Decreased serum calcium levels predict severe complications after initial diagnosis in patients with acute type B aortic dissection: A retrospective cohort study

This study sought to investigate the temporal variations in serum calcium concentrations among patients with acute type B aortic dissection (ATBAD) following initial diagnosis, document the incidence of severe complications, and evaluate their potential associations. In this retrospective analysis, we examined 42 consecutive patients diagnosed with ATBAD at Zhejiang Hospital between April 2019 and April 2024. Serum-ionized calcium levels were measured at admission and 24 hours post-admission. Based on changes in calcium levels, patients were categorized into either the elevated or decreased groups. Univariate and multivariate logistic regression analyses were performed to compare clinical characteristics and assess the incidence of severe complications following the initial diagnosis. The study further explored the association between 24-hour serum calcium levels, their dynamic changes, and the occurrence of severe complications in patients with ATBAD. The results showed that the decreased group had a significantly higher frequency of severe complications, including mortality, cardiac complications, acute renal failure, and organ hypoperfusion (P < 0.05), while no significant differences were observed for neurological or pulmonary complications (P > 0.05). Logistic regression revealed that a decline in serum calcium levels within 24 hours was an independent risk factor for severe complications (OR = 16.722, P = 0.03). The receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.864. Decreased serum calcium concentration is an independent predictor of severe complications in ATBAD patients, significantly associated with mortality, cardiac complications, acute kidney injury, and inadequate organ perfusion. No significant correlation with neurological and pulmonary complications was observed.

Influencing factors of health promotion behaviour in patients with aortic dissection: a qualitative study using the COM-B model

OBJECTIVES

This study aimed to understand influencing factors of health promotion behaviour in patients with aortic dissection (AD) using the capability, opportunity, motivation, behaviour (COM-B) model of behaviour.

DESIGN

A descriptive qualitative design was adopted. Data were collected using face-to-face semi-structured interviews and analysed using directed content analysis.

SETTING

Fujian Medical University Union Hospital.

PARTICIPANTS

A purposive sample of 16 patients with AD.

RESULTS

The following themes and subthemes were identified. Psychological capability: (1) lack of disease knowledge; physical capability: (1) physical function limitation; (2) fatigue; physical opportunity: (1) limited access to disease knowledge; (2) communication between providers and patients; (3) objective condition restriction; social opportunity: (1) stigma; (2) social support; reflective motivation: (1) self-efficacy; (2) perceived benefits; (3) personal and family responsibilities; automatic motivation: (1) post-traumatic growth; (2) fear of disease progression.

CONCLUSION

This study adopted a novel approach to understanding factors affecting health promotion behaviour among patients with AD. Interventions can be implemented using the Behaviour Change Wheel framework and study findings to improve health promotion behaviour in this patient population.

[Research progress on the role of ferroptosis in aortic dissection]

Recent studies have shown that iron metabolism dysregulation and lipid peroxidation-induced ferroptosis, triggered by oxidative stress, play a key role in the development of aortic dissection. Dysregulated iron metabolism leads to excessive production of hydroxyl radicals due to abnormal iron levels and heme metabolism, while lipid peroxidation is linked to system Xc－ dysfunction and accumulation of phospholipid hydroperoxides. These factors synergistically disrupt aortic homeostasis and drive ferroptosis in vascular cells, including endothelial and smooth muscle cells. Furthermore, disruptions in ferroptosis-related genes, along with risk factors such as smoking, epigenetic modifications such as protein methylation, and abnormalities in immune cells, particularly T cells, are closely linked to aortic dissection. Several small molecules and nanomaterials have shown potential in inhibiting ferroptosis in this context. This review elucidates the roles of ferroptosis in aortic dissection and proposes strategies for its targeted prevention and treatment.

Progress and perspectives of metabolic biomarkers in human aortic dissection

BACKGROUND

Aortic dissection (AD) significantly threated human cardiovascular health, extensive clinical-scientific research programs have been executed to uncover the pathogenesis and prevention. Unfortunately, no specific biomarker was identified for the causality or development of human AD.

AIM OF REVIEW

Metabolomics, a high-throughput technique capable of quantitatively detecting metabolites, holds considerable promise in discovering specific biomarkers and unraveling the underlying pathways involved. Aiming to provide a metabolite prediction in human AD, we collected the metabolomics data from 2003 to 2023, and diligently scrutinized with the online system MetaboAnalyst 6.0.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Based on the data obtained, we have concluded the metabolic dynamics were highly correlated with human AD. Such metabolites (choline, serine and uridine) were frequently involved in the AD. Besides, the pathways, including amino acids metabolism and lipids metabolism, were also dysregulated in the disease. Due to the current limitation of metabolism analysis, the integrative omics data including genomics, transcriptomics, and proteomics were required for developing the specific biomarker for AD.

Case Report: The application of amplatzer vascular plug to repair aortic dissection intimal tears and false lumen

In recent years, significant advancements have been made in endovascular therapy for aortic dissection, resulting in the development of various treatment methods. Nevertheless, there is a contentious discussion regarding the suitability of different treatment methods for addressing the unique features of individual lesions. Specifically, the matter of whether the presence of small intimal tears or multiple distal tears requires extensive aortic coverage with graft stents, which may block the blood supply to important organs, intercostal arteries, or lumbar arteries, remains unresolved. Further research is necessary to determine the need for complex fenestrated or branched endovascular aortic repair (F/B-EVAR) in the management of chronic post-dissection aneurysms involving visceral arteries. Our report highlights the successful endovascular repair of three patients with aortic dissection, encompassing one Stanford A type and two Stanford B types. Utilizing the Amplatzer Vascular Plug (AVP) alone or in combination with the coil embolization technique, we achieved favorable clinical outcomes. This article aims to provide valuable insights and new perspectives on the tailored management of aortic dissection by conducting a comprehensive examination of the subtle differences in the treatment processes and techniques applied to these three patients.

Analysis of serum calcium change trajectories and prognostic factors in patients with acute type A aortic dissection

OBJECTIVES

This study aimed to analyze the correlation between serum calcium changes and short-term prognosis of patients with acute type A aortic dissection.

METHODS

Patients who underwent acute type A aortic dissection surgery at Fujian Heart Medical Center between June 2019 and June 2021 were retrospectively analyzed.

RESULTS

A total of 383 patients were enrolled. According to the changing track of serum calcium in patients after acute type A aortic dissection, three potential category tracks were determined: high-level (n = 85), medium-level (n = 259), and continuous low-level groups (n = 39). Using the medium-level group as the control, regression analysis showed that poor prognosis risk was increased in the group with continuous low serum calcium (odds ratio = 2.454, P < 0.05) and in the group with continuous low serum calcium > 48 h (odds ratio = 3.595, P < 0.05). Age (odds ratio = 1.063, P < 0.001), body mass index (odds ratio = 1.138, P < 0.05), hypertension (odds ratio = 3.697, P < 0.05), and the highest lactic acid within 72 h after surgery(odds ratio = 1.093, P < 0.05) were independent risk factors for poor prognosis after aortic dissection.

CONCLUSION

Continuous low serum calcium was an independent predictor of poor prognosis in patients with acute type A aortic dissection.

Incidence, prevalence and characteristics of multimorbidity in different age groups among urban hospitalized patients in China

The aim of the study was to investigate the incidence, prevalence and characteristics of multimorbidity in urban inpatients of different age groups. This study used data from the National Insurance Claim for Epidemiology Research (NICER) to calculate the overall incidence, prevalence, geographic and age distribution patterns, health care burden, and multimorbidity patterns for multimorbidity in 2017. According to our study, the overall prevalence of multimorbidity was 6.68%, and the overall prevalence was 14.87% in 2017. The prevalence of multimorbidity increases with age. The pattern of the geographic distribution of multimorbidity shows that the prevalence of multimorbidity is relatively high in South East China. The average annual health care expenditure of patients with multimorbidity increased with age and rose rapidly, especially among older patients. Patients with cancer and chronic kidney disease have higher treatment costs. Patients with hypertension or ischemic heart disease had a significantly higher relative risk of multimorbidity than other included noncommunicable diseases (NCDs). Hyperlipidemia has generated the highest number of association rules, which may suggest that hyperlipidemia may be both a risk factor for other NCDs and an outcome of them.

Short-term effects of air pollution and weather changes on the occurrence of acute aortic dissection in a cold region

Background

Air pollution and severe weather conditions can adversely affect cardiovascular disease emergencies. Nevertheless, it remains unclear whether air pollutants and low ambient temperature can trigger the occurrence of acute aortic dissection (AAD) in cold regions.

Methods

We applied a retrospective analysis to assess the short-term effects of air pollution and ambient temperature on the occurrence of AAD in Harbin, China. A total of 564 AAD patients were enrolled from a major hospital in Harbin between January 1, 2017, and February 5, 2021. Weather condition data and air pollutant concentrations, including fine particulate matter smaller than 10 μm (PM10) and 2.5 μm in diameter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3), were collected every day. Conditional logistic regressions and correlation analysis were applied to analyze the relationship of environmental and atmospheric parameters with AAD occurrence at lags of 0 to 7 days. Specifically, we appraised the air quality index, CO, NO2, SO2, O3, PM10, PM2.5, temperature, dew point temperature, atmospheric pressure, and cloud amount.

Results

A total of 1,496 days at risk were assessed, of which 564 patients developed AAD. Specifically, AAD did not occur on 1,043 (69.72%) days, while 1 or more cases occurred on 453 (30.28%) days. Several pollution and weather predictors for AAD were confirmed by multilevel modeling. The air quality index (p = 0.0012), cloud amount (p = 0.0001), and concentrations of PM2.5 (p = 0.0004), PM10 (p = 0.0013), NO2 (p = 0.0007) and O3 (p = 0.0001) predicted AAD as early as 7 days before the incident (lag of 7 days) in the study period. However, only concentrations of the air pollutants NO2 (p = 0.0468) and O3 (p = 0.011) predicted the occurrence of AAD after the COVID-19 outbreak. Similar predictive effects were observed for temperature, dew point temperature, and atmospheric pressure (all p < 0.05) on all days.

Conclusion

The risk of AAD is closely related to air pollution and weather characteristics in Harbin. While causation was not determined, the impact of air pollutants on the risk of AAD was reduced after the COVID-19 outbreak.

Angiogenesis in Aortic Aneurysm and Dissection: A Literature Review

Aortic aneurysm and aortic dissection (AA/AD) are critical aortic diseases with a hidden onset and sudden rupture, usually resulting in an inevitable death. Several pro- and anti-angiogenic factors that induce new capillary formation in the existing blood vessels regulate angiogenesis. In addition, aortic disease mainly manifests as the proliferation and migration of endothelial cells of the adventitia vasa vasorum. An increasing number of studies have shown that angiogenesis is a characteristic change that may promote AA/AD occurrence, progression, and rupture. Furthermore, neocapillaries are leaky and highly susceptible to injury by cytotoxic agents, which promote extracellular matrix remodeling, facilitate inflammatory cell infiltration, and release coagulation factors and proteases within the wall. Mechanistically, inflammation, hypoxia, and angiogenic factor signaling play important roles in angiogenesis in AA/AD under the complex interaction of multiple cell types, such as smooth muscle cells, fibroblasts, macrophages, mast cells, and neutrophils. Therefore, based on current evidence, this review aims to discuss the manifestation, pathological role, and underlying mechanisms of angiogenesis involved in AA/AD, providing insights into the prevention and treatment of AA/AD.

Develop ment and validation of a prognostic dynamic nomogram for in-hospital mortality in patients with Stanford type B aortic dissection

Background

This study aimed to identify the risk factors for in-hospital mortality in patients with Stanford type B aortic dissection (TBAD) and develop and validate a prognostic dynamic nomogram for in-hospital mortality in these patients.

Methods

This retrospective study involved patients with TBAD treated from April 2002 to December 2020 at the General Hospital of Northern Theater Command. The patients with TBAD were divided into survival and non-survival groups. The data were analyzed by univariate and multivariate logistic regression analyses. To identify independent risk factors for in-hospital mortality, multivariate logistic regression analysis, least absolute shrinkage, and selection operator regression were used. A prediction model was constructed using a nomogram based on these factors and validated using the original data set. To assess its discriminative ability, the area under the receiver operating characteristic curve (AUC) was calculated, and the calibration ability was tested using a calibration curve and the Hosmer-Lemeshow test. Clinical utility was evaluated using decision curve analysis (DCA) and clinical impact curves (CIC).

Results

Of the 978 included patients, 52 (5.3%) died in hospital. The following variables helped predict in-hospital mortality: pleural effusion, systolic blood pressure ≥160 mmHg, heart rate >100 bpm, anemia, ischemic cerebrovascular disease, abnormal cTnT level, and estimated glomerular filtration rate <60 ml/min. The prediction model demonstrated good discrimination [AUC = 0.894; 95% confidence interval (CI), 0.850-0.938]. The predicted probabilities of in-hospital death corresponded well to the actual prevalence rate [calibration curve: via 1,000 bootstrap resamples, a bootstrap-corrected Harrell's concordance index of 0.905 (95% CI, 0.865-0.945), and the Hosmer-Lemeshow test (χ² = 8.3334, P = 0.4016)]. DCA indicated that when the risk threshold was set between 0.04 and 0.88, the predictive model could achieve larger clinical net benefits than "no intervention" or "intervention for all" options. Moreover, CIC showed good predictive ability and clinical utility for the model.

Conclusion

We developed and validated prediction nomograms, including a simple bed nomogram and online dynamic nomogram, that could be used to identify patients with TBAD at higher risk of in-hospital mortality, thereby better enabling clinicians to provide individualized patient management and timely and effective interventions.

TG/HDL-C ratio predicts in-hospital mortality in patients with acute type A aortic dissection

Background

In recent years, abnormalities in serum lipids and lipoproteins have been shown to be associated with cardiovascular disease risk. However, their prognostic value for acute type A aortic dissection is unclear. This study analyzed the correlation between triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and in-hospital mortality in patients with AAAD, and aimed to investigate the clinical significance of preoperative blood lipids and lipoproteins on the prognosis of acute type A aortic dissection.

Methods

A total of 361 patients who underwent type A aortic dissection surgery in Fujian Cardiac Medical Center from June 2018 to March 2020 were retrospectively collected. According to the baseline TG/HDL-C ratio, the patients were divided into 3 groups according to the tertile method, the low TG/HDL-C ratio T1 group (< 1.18) and the middle TG/HDL-C ratio T2 group (1.18–1.70). T3 group with high TG/HDL-C ratio (> 1.70). Kaplan–Meier was used for survival analysis, and Cox proportional hazards regression model was used to analyze the factors affecting the prognosis of patients. The receiver operating characteristic (ROC) curve was used for the diagnostic efficacy.

Results

Among the 361 patients in this study, the mean age was 52.4 ± 11.3 years, 73 (20.2%) were female, and 82 (22.7%) died in hospital. Kaplan–Meier curve showed that with the increase of TG/HDL-C ratio, the risk of in-hospital death gradually increased (P < 0.001). Multivariate Cox regression analysis showed that age (HR = 1.031), body mass index (HR = 1.052), hypertension (HR = 3.491), white blood cells (HR = 1.073), TG/HDL-C ratio (HR = 1.604), MODS (HR = 1.652) was positively correlated with in-hospital mortality (P < 0.05). After adjusting for age, sex, and other risk factors, a significant association was found between the TG/HDL-C ratio and in-hospital mortality for acute type A aortic dissection (HR = 1.472, 95% CI, 1.354–3.451, P = 0.019).

Conclusion

Patients with type A aortic dissection have obvious abnormal blood lipid metabolism, and serum TG/HDL-C levels are positively correlated with in-hospital mortality in patients with AAAD.

Projection of global burden and risk factors for aortic aneurysm - timely warning for greater emphasis on managing blood pressure

RATIONALE

Aortic aneurysm (AA) is a serious condition that largely increases the risk of aortic dissection and sudden death. Exploring the global burden of disease and changes in risk factors for AA is essential for public health policy development.

OBJECTIVE

To project the death burden from AA and its attributable risk factors in the following decade based on the epidemiological data over the past 30 years.

METHODS AND RESULTS

We analysed the death burden of AA and trends of four risk factors from 1990-2019 using the updated 2019 Global Burden of Disease study database by Joinpoint regression analysis. Furthermore, we project the AA-related death burden for the next decade using the Bayesian age-period-cohort model. This study discovered that the global burden of death attributable to AA began to increase after decreasing for two decades. This upward trend will continue in the subsequent decade (average annual percent change: 0.318%, 95% CI: 0.288 to 0.348). Meanwhile, the disease burdens in all economic regions except high-middle socio-demographic index (SDI) regions will continuously increase in the next decade, with the fastest acceleration in the low-middle SDI region (average annual percent change: 1.183%, 95% CI: 1.166 to 1.200). Notably, high systolic blood pressure will surpass the contribution of smoking to become the most important risk factor for mortality due to AA.

CONCLUSION

This study discovered a rebounding trend in the aortic aneurysm-related death burden globally. High systolic blood pressure will be the top risk factor attributed to death from AA. Therefore, it should be considered as the first-degree risk factor in the guidance of AA management and criteria for population-based screening programs.Key messagesThe death burden of aortic aneurysms is beginning to rebound globally, and the trend will continue for the next decade.High systolic blood pressure will replace smoking as the most important risk factor associated with aortic aneurysm death.

Metabolomic Profile Reveals That Ceramide Metabolic Disturbance Plays an Important Role in Thoracic Aortic Dissection

Aims

Thoracic aortic dissection (TAD) is a life-threatening disease with no effective drug therapy thus far. New therapeutic targets and indications for timely surgical intervention are urgently needed. Our aim is to investigate new pathological mechanisms and potential biomarkers of TAD through global metabolomic profiling of aortic aneurysm and dissection patients.

Methods and Results

We performed untargeted metabolomics to determine plasma metabolite concentrations in an aortic disease cohort, including 70 thoracic aortic aneurysm (TAA) and 70 TAD patients, as well as 70 healthy controls. Comparative analysis revealed that sphingolipid, especially its core metabolite C18-ceramide, was significantly distinguished in TAD patients but not in TAA patients, which was confirmed by subsequent quantitative analysis of C18-ceramide in a validation cohort. By analyzing our existing multiomics data in aortic tissue in a murine TAD model and TAD patients, we found that an enhanced ceramide de novo synthesis pathway in macrophages might contribute to the elevated ceramide. Inhibition of the ceramide de novo synthesis pathway by myriocin markedly alleviated BAPN-induced aortic inflammation and dissection in mice. In vitro studies demonstrated that exogenous C18-ceramide promoted macrophage inflammation and matrix metalloprotein (MMP) expression through the NLRP3-caspase 1 pathway. In contrast, inhibition of endogenous ceramide synthesis by myriocin attenuated lipopolysaccharide (LPS)-induced macrophage inflammation.

Conclusions

Our findings demonstrated that ceramide metabolism disturbance might play a vital role in TAD development by aggravating aortic inflammation through the NLRP3 pathway, possibly providing a new target for pharmacological therapy and a potential biomarker of TAD.