Epidemiology of aortic dissection

Predictive Value of the White Blood Cells Count for the Prognosis of Hospitalized Patients with Acute Aortic Dissection

Objective

Our study evaluated the prognostic significance of white blood cells (WBC) count and WBC subsets in relation to the risk of mortality in acute aortic dissection (AAD) patients during their hospital stay.

Methods

We included 833 patients with AAD in this retrospective study. The primary outcome was in-hospital mortality. Cox regression analysis was employed to determine the independent risk factors for mortality in patients with AAD. Amidst the low- and high-WBC groups, we use Kaplan‒Meier survival analysis to compare the cumulative survival rates of patients with AAD.

Results

Within 342 patients with type A AAD, patients belonging to the high-WBC group exhibited a notably higher mortality rate compared to patients in the low-WBC group. Kaplan-Meier analysis exhibited that the patients in high-WBC patients had a significantly higher mortality rate. Multivariable Cox regression analysis demonstrated that an elevated WBC was an independent impact factor of in-hospital mortality of patients with type A AAD (hazard ratio, 2.01; 95% confidence interval (CI): 1.24 to 3.27; p = 0.005). Corresponding outcomes were witnessed in 491 patients with type B AAD.

Conclusions

An elevated WBC count was strongly correlated with an elevated risk of mortality in hospitalized patients afflicted with either type A or type B AAD.

Systematic Morphological Assesment of the Ascending Aorta Dissection: Application of Cardiovascular Pathology Consensus Statement in Tertiaty Care Hospital in Finland

This study investigated the distinguishing characteristics between acute type A aortic dissection (ATAAD) and aortic wall dilatation. Utilizing systematic histopathology criteria from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology consensus statement, the analysis focused on degeneration, atherosclerosis, and inflammation in patients undergoing surgery in a Finnish tertiary care hospital. The study included 156 patients, those undergoing surgery for ATAAD (n = 116) and those with dilatation (n = 40). Despite similar clinical characteristics, histological analysis of the aortic wall indicated a higher overall degeneration in ATAAD compared to dilatation (2.4 ± 0.6 vs. 1.9 ± 0.8, Point score unit (PSU), p < 0.001). Findings included increased intralamellar mucoid extracellular matrix accumulation (69 vs. 32, p = 0.020; extent 2.0 ± 0.3 vs. 1.7 ± 0.5, PSU, p < 0.001; severity 1.8 ± 0.6 vs. 1.5 ± 0.5, PSU, p = 0.005) elastic fiber thinning (68 vs. 9, p = 0.001; extent 1.0 ± 0.9 vs. 0.4 ± 0.8, PSU, p < 0.001; severity 0.8 ± 0.8 vs. 0.4 ± 0.8, PSU, p = 0.001), elastic fiber disorganization (89 vs. 21, p = 0.005; extent 1.2 ± 0.8 vs. 0.9 ± 0.9, PSU, p = 0.029) and laminar medial collapse (64 vs. 6, p < 0.001; type 0.7 ± 0.7 vs. 0.2 ± 0.4, PSU, p < 0.001; extent 0.9 ± 0.9 vs. 0.9 ± 0.9, PSU, p < 0.001) in ATAAD compared to dilatation. Elastic fiber pathology and laminar medial collapse are distinct features of ATAAD compared to aortic dilatation in patients undergoing ascending aorta surgery.

Type A Aortic Dissection Following Abdominal Solid Organ Transplantation: Population-Level Outcomes in the United States

BACKGROUND

This study aims to analyze the patient characteristics, clinical outcomes, and contemporary trends concerning type A aortic dissection (TAAD) in previous recipients of abdominal solid organ transplantation (ASOT) in the United States.

METHODS

The National Inpatient Sample was queried to identify all patients aged ≥18 with TAAD and a history of ASOT (TAAD-ASOT) between 2002 and 2015Q3 using ICD-9 diagnosis and procedure codes. Baseline characteristics and in-hospital outcomes were compared between TAAD-ASOT patients and TAAD patients without a history of ASOT (TAAD-non-ASOT).

RESULTS

We identified a weighted total of 71 061 TAAD patients. Among them, 346 (0.49%) were ASOT recipients; of these, 318 (91.9%) were kidney transplant recipients, and 28 (8.1%) were liver transplant recipients. There is an increasing trend in the incidence of TAAD among ASOT recipients over the study period (p-trend < 0.001). Compared to TAAD-non-ASOT patients, TAAD-ASOT patients were younger (54.7 vs. 60.7 years, p < 0.001), less likely to be White (53.8% vs. 69.1%, p = 0.008), and associated with a higher Charlson Comorbidity Index (3.79 vs. 2.26, p < 0.001). TAAD-ASOT patients also exhibited significantly higher in-hospital mortality (27.4% vs. 17.8%, p = 0.03) and a greater risk of renal complications (53.5% vs. 29.7%, p < 0.001). Multivariable analysis indicated that a history of ASOT was independently associated with an increased in-hospital mortality rate in TAAD patients (adjusted odds ratio = 1.83, 95% CI = 1.01-3.31, p = 0.04).

CONCLUSIONS

TAAD-ASOT patients were younger but presented a higher comorbidity burden, an elevated in-hospital mortality rate, and an increased risk of postoperative complications compared to TAAD-non-ASOT patients. The rising incidence and unfavorable outcomes emphasize the need for future preventative measures and enhancements in surgical outcomes.

Anesthetic Considerations for Endovascular Repair of the Thoracic Aorta

Thoracic aorta pathologies, especially those of the ascending aorta and aortic arch, were traditionally approached via open surgical repair. This carries risk of ischemic end-organ damage and other complications. Endovascular repair of ascending aorta and aortic arch pathologies is becoming more successful and widespread, thereby posing numerous challenges to the anesthesiologist. This article reviews the anesthesia-pertinent pathophysiology, repair techniques, preoperative evaluation, intraoperative management, and postoperative care of patients presenting for endovascular repair of thoracic aorta pathologies.

Renal Artery Vasculopathy: Case Study and Literature Review

Non-atherosclerotic renal artery vasculopathies are rare and can be caused by heterogenous group of diseases, some of which has bad prognosis. The literature addressing this rare group of disease is scarce. A single center analysis of all adult patients evaluated for renal artery disease including dissection, aneurysm, stenosis, vasculitis, thrombosis, irregularity, and renal infarct treated at our center, from January 2000 to April 2022. Baseline data collected included demographics, comorbidities, vital signs, laboratory values, pathology, genetic testing, and imaging results/diagnoses. Additionally, treatment modality, follow-up, and symptom relief/recurrence from follow-up visits were collected if available. Out of the included 227 patients, 91 (40%) had renal infarction, 70 (31%) had renal artery dissection, 69 (30%) had aneurysm, 33 (15%) had stenosis, and 32 (14%) had thrombosis. The most common diagnoses were fibromuscular dysplasia (n = 86, 38%) and thromboembolism (n = 38, 17%). Most patients improved with conservative management, reserving endovascular or surgical interventions for symptomatic patients with more complicated presentations. To our knowledge, this is the only case study and general review in the literature that addresses the diagnosis and management of non-atherosclerotic renal arteriopathies showing good outcome for most of the underlying etiologies.

Total Arch Replacement is Safe as Hemiarch Repair in Acute Type A Aortic Dissection in a Middle-Income Country Setting

OBJECTIVER

The aim of this study was to determine the clinical outcomes of patients with acute type A aortic dissection comparing proximal aortic repair vs. total arch replacement.

METHODS

This was a retrospective cohort study. We included all acute type A aortic dissection procedures from January 2002 to November 2022. Groups were defined according to the extent of aortic replacement (hemiarch repair vs. total arch replacement). We collected data from pre, intra, and postoperative variables. Our main endpoints were stroke rate, spinal cord injury, and in-hospital mortality. We performed a statistical analysis for between-group comparisons according to the nature and distribution of variables. Bivariate analyses were done using the Mann-Whitney U test and for categorical variables, the Chi-square test or Fisher's exact test. Significance was established at alpha level of 0.05.

RESULTS

We identified 107 acute type A aortic dissection procedures (69 hemiarch repairs vs. 38 total arch replacements). There were no differences in postoperative outcomes such as surgical site infection or acute kidney injury. Bleeding reoperation was more frequent in the hemiarch group (30% vs. 11 %). We did not find statistically significant differences in stroke rate, spinal cord injury, or in-hospital mortality.

CONCLUSION

Acute type A aortic dissection treatment is still a challenge. Total arch replacement does not increase the risk of major early postoperative complications in comparison to hemiarch repair. The extended repair seems to provide benefits such as a lower risk of reoperation. Total arch replacement should be performed in selected patients, as it may improve long-term outcomes.

Machine Learning Model-Based Prediction of In-Hospital Acute Kidney Injury Risk in Acute Aortic Dissection Patients

Background

This study aimed to identify the risk factors for in-hospital acute kidney injury (AKI) in patients with acute aortic dissection (AAD) and to establish a machine learning model for predicting in-hospital AKI.

Methods

We extracted data on patients with AAD from the Medical Information Mart for Intensive Care (MIMIC)-IV database and developed seven machine learning models: support vector machine (SVM), gradient boosting machine (GBM), neural network (NNET), eXtreme gradient boosting (XGBoost), K-nearest neighbors (KNN), light gradient boosting machine (LightGBM), and categorical boosting (CatBoost). Model performance was assessed using the area under the receiver operating characteristic curve (AUC), and the optimal model was interpreted using Shapley Additive explanations (SHAP) visualization analysis.

Results

A total of 325 patients with AAD were identified from the MIMIC-IV database, of which 84 patients (25.85%) developed in-hospital AKI. This study collected 42 features, with nine selected for model building. A total of 70% of the patients were randomly allocated to the training set, while the remaining 30% were allocated to the test set. Machine learning models were built on the training set and validated using the test set. In addition, we collected AAD patient data from the MIMIC-III database for external validation. Among the seven machine learning models, the CatBoost model performed the best, with an AUC of 0.876 in the training set and 0.723 in the test set. CatBoost also performed strongly during the validation, achieving an AUC of 0.712. SHAP visualization analysis identified the most important risk factors for in-hospital AKI in AAD patients as maximum blood urea nitrogen (BUN), body mass index (BMI), urine output, maximum glucose (GLU), minimum BUN, minimum creatinine, maximum creatinine, weight and acute physiology score III (APSIII).

Conclusions

The CatBoost model, constructed using risk factors including maximum and minimum BUN levels, BMI, urine output, and maximum GLU, effectively predicts the risk of in-hospital AKI in AAD patients and shows compelling results in further validations.

Analysis of angiotensin-converting enzyme (ACE), ACE2, and their genetic polymorphisms in patients with acute aortic dissection and coronary heart disease

BACKGROUND

This study aimed to elucidate the distinctions between the expression levels of angiotensin-converting enzyme (ACE) and ACE2, as well as their genetic polymorphisms, in patients with acute aortic dissection (AD) and coronary heart disease (CHD).

METHODS

A cohort of 86 patients was enrolled, comprising 34 individuals with acute AD (encompassing Stanford types A and B), 18 with ascending aortic aneurysm, 21 with CHD, and 13 healthy controls. Aortic tissue samples were procured from 44 patients during surgical interventions.

RESULTS

Statistically significant differences were observed in ACE and ACE2 expression levels among the ascending aortic aneurysm, CHD, and control groups (p < 0.05). However, the expression of ACE messenger ribonucleic acid (mRNA) in the aortic wall was significantly higher in the AD group than in the ascending aortic aneurysm and CHD groups (p < 0.05). Additionally, the expression of ACE2 mRNA and the ACE/ACE2 ratio in the aortic wall were significantly different in the AD group compared with the ascending aortic aneurysm and CHD groups (p < 0.05).

CONCLUSION

Plasma ACE levels, and the gene expressions of ACE and ACE2, are markedly reduced in patients with acute AD. The observed imbalance in ACE and ACE2 expressions may play a pivotal role in the pathogenesis of AD.

Ferroptosis in Cardiovascular Diseases and Ferroptosis-Related Intervention Approaches

OBJECTIVE

Cardiovascular diseases (CVDs) are major public health problems that threaten the lives and health of individuals. The article has reviewed recent progresses about ferroptosis and ferroptosis-related intervention approaches for the treatment of CVDs and provided more references and strategies for targeting ferroptosis to prevent and treat CVDs.

METHODS

A comprehensive review was conducted using the literature researches.

RESULTS AND DISCUSSION

Many ferroptosis-targeted compounds and ferroptosis-related genes may be prospective targets for treating CVDs and our review provides a solid foundation for further studies about the detailed pathological mechanisms of CVDs.

CONCLUSION

There are challenges and limitations about the translation of ferroptosis-targeted potential therapies from experimental research to clinical practice. It warrants further exploration to pursure safer and more effective ferroptosis-targeted thereapeutic approaches for CVDs.

METTL3-mediated m6A modification of NORAD inhibits the ferroptosis of vascular smooth muscle cells to attenuate the aortic dissection progression in an YTHDF2-dependent manner

Ferroptosis of vascular smooth muscle cells (VSMCs) is related to the incidence of aortic dissection (AD). Long non-coding RNA (lncRNA) NORAD plays a crucial role in the progression of various diseases. The present study aimed to investigate the effects of NORAD on the ferroptosis of VSMCs and the molecular mechanisms. The expression of NORAD, HUR, and GPX4 was detected using quantitative real-time PCR (qPCR) or western blot. Ferroptosis was evaluated by detecting lactate dehydrogenase (LDH) activity, lipid reactive oxygen species (ROS), malonaldehyde (MDA) content, L-Glutathione (GSH) level, Fe2+ content, and ferroptosis-related protein levels. The molecular mechanism was assessed using RNA pull-down, RNA-binding protein immunoprecipitation (RIP), and luciferase reporter assay. The histology of aortic tissues was assessed using H&E, elastic Verhoeff-Van Gieson (EVG), and Masson staining assays. The data indicated that NORAD was downregulated in patients with AD and AngII-treated VSMCs. Overexpression of NORAD promoted VSMC growth and inhibited the ferroptosis induced by AngII. Mechanistically, NORAD interacted with HUR, which promoted GPX4 mRNA stability and elevated GPX4 levels. Knockdown of GPX4 abrogated the effects of NORAD on cell growth and ferroptosis of AngII-treated VSMCs. Moreover, METTL3 promoted m6A methylation of NORAD in an YTHDF2-dependent manner. In addition, NORAD attenuated AAD symptoms, incidence, histopathology, inflammation, and ferroptosis in AAD mice. In conclusion, METTL3-mediated NORAD inhibited ferroptosis of VSMCs via the HUR/GPX4 axis and decelerated AAD progression, suggesting that NORAD may be an AD therapeutic target.

CircNRIP1 promotes proliferation, migration and phenotypic switch of Ang II-induced HA-VSMCs by increasing CXCL5 mRNA stability via recruiting IGF2BP1

Circular RNA (circRNA) has been found to be differentially expressed and involved in regulating the processes of human diseases, including thoracic aortic dissection (TAD). However, the role and mechanism of circNRIP1 in the TAD process are still unclear. GEO database was used to screen the differentially expressed circRNA and mRNA in type A TAD patients and age-matched normal donors. Angiotensin II (Ang II)-induced human aortic vascular smooth muscle cells (HA-VSMCs) were used to construct TAD cell models. The expression levels of circNRIP1, NRIP1, CXC-motif chemokine 5 (CXCL5) and IGF2BP1 were detected by quantitative real-time PCR. Cell proliferation and migration were determined by EdU assay, transwell assay and wound healing assay. The protein levels of synthetic phenotype markers, contractile phenotype markers, CXCL5 and IGF2BP1 were tested by western blot analysis. The interaction between IGF2BP1 and circNRIP1/CXCL5 was confirmed by RIP assay, and CXCL5 mRNA stability was assessed by actinomycin D assay. CircNRIP1 was upregulated in TAD patients and Ang II-induced HA-VSMCs. Knockdown of circNRIP1 suppressed Ang II-induced proliferation, migration and phenotypic switch of HA-VSMCs. Also, high expression of CXCL5 was observed in TAD patients, and its knockdown could inhibit Ang II-induced HA-VSMCs proliferation, migration and phenotypic switch. Moreover, CXCL5 overexpression reversed the regulation of circNRIP1 knockdown on Ang II-induced HA-VSMCs functions. Mechanistically, circNRIP1 could competitively bind to IGF2BP1 and subsequently enhance CXCL5 mRNA stability. CircNRIP1 might contribute to TAD progression by promoting CXCL5 mRNA stability via recruiting IGF2BP1.

Impact of concomitant coronary artery bypass grafting on the outcomes of total arch repair with frozen elephant trunk for type A aortic dissection

OBJECTIVES

Coronary artery bypass grafting (CABG) is often performed alongside type A aortic dissection (TAAD) repair. However, the association between concomitant CABG and the clinical outcomes of TAAD repair remains uncertain.

METHODS

This study included 1002 consecutive TAAD patients who underwent total aortic arch replacement (TAR) with frozen elephant trunk from June 2019 to January 2024. Concomitant CABG during TAR and frozen elephant trunk was performed under 3 conditions: planned CABG for coronary ostial involvement, planned CABG for coronary artery disease and rescue CABG. Patients who underwent rescue CABG (N = 42) were compared with those who had planned CABG (N = 218) and those who did not undergo CABG (non-CABG: N = 742). Logistic regression, Kaplan-Meier and Cox regression analyses were employed.

RESULTS

Operative mortality rate was 2.40%; 42 (4.19%) patients underwent rescue CABG. The rescue CABG group had the highest operative mortality (23.81%) among the 3 groups (P < 0.001). Rescue CABG was associated with increased operative mortality compared with non-CABG [odds ratio: 18.96, 95% confidence interval (CI) 7.32-49.08, P < 0.001], whereas planned CABG was not significant. The median follow-up period was 24.80 (interquartile range 11.73-39.10) months. Kaplan-Meier analysis demonstrated poorer overall survival in the rescue CABG group (log-rank P-value < 0.001). Rescue CABG significantly increased all-cause late mortality compared with non-CABG (hazard ratio 13.69, 95% CI 6.53-28.70, P < 0.001), while planned CABG did not. The 2-year cumulative incidence of graft occlusion among CABG patients was 24.54%.

CONCLUSIONS

Rescue CABG is significantly associated with increased operative and all-cause mortality in patients undergoing TAR and frozen elephant trunk for TAAD. Further research is required to identify the causes of rescue CABG.

Effects of age, elastin density, and glycosaminoglycan accumulation on the delamination strength of human thoracic and abdominal aortas

Aortic dissection is a life-threatening condition caused by layer separation. Despite extensive research, the relationship between the aortic wall's structural integrity and dissection risk remains unclear. Glycosaminoglycan (GAG) accumulation and elastin loss are suspected to play significant roles. We investigated how age-related changes in aortic structure affect dissection susceptibility. Peeling tests were performed on longitudinal and circumferential thoracic (TA) and abdominal aortic (AA) strips from 35 donors aged 13-76 years (mean 38 ± 15 years, 34 % female). GAG, elastin, collagen, and smooth muscle cell (SMC) contents were assessed using bidirectional histology. Young TAs resisted longitudinal peeling better than circumferential, with delamination strengths of 65.4 mN/mm and 44.2 mN/mm, respectively. Delamination strength decreased with age in both directions, more rapidly longitudinally, equalizing at ∼20-25 mN/mm in older TAs. Delamination strength in AAs was 22 % higher than in TAs. No sex differences were observed. GAG density increased, while elastin density decreased by 2.5 % and 4 % per decade, respectively. Collagen density did not change with age, while SMC density decreased circumferentially. GAGs partially mediated the reduction in longitudinal delamination strength due to aging, while circumferential strength reduction was not mediated by changes in either GAG or elastin densities. This study explains why aortic dissections are more common in TAs, especially in older individuals, and why they typically propagate spirally. TAs exhibit lower delamination strength compared to AAs and experience strength reduction with age, a phenomenon linked to increased GAG accumulation and elastin loss. These findings enhance our understanding of the pathophysiological mechanisms behind aortic dissection. STATEMENT OF SIGNIFICANCE: This work explores the age-dependent relationships between delamination strength in human aortas and wall structural content. We investigated 35 human aortas from donors aged 13 to 76 years, providing new insights into the biomechanical and histological factors that influence aortic dissection risk. Our findings elucidate how variations in elastin, glycosaminoglycan, collagen, and smooth muscle cell densities impact the structural integrity of the aorta, contributing significantly to the understanding of aortic dissection mechanisms.

Early growth response 1 exacerbates thoracic aortic aneurysm and dissection of mice by inducing the phenotypic switching of vascular smooth muscle cell through the activation of Krüppel-like factor 5

AIM

Vascular smooth muscle cell (VSMC) phenotypic switching has been reported to regulate vascular function and thoracic aortic aneurysm and dissection (TAAD) progression. Early growth response 1 (Egr1) is associated with the differentiation of VSMCs. However, the mechanisms through which Egr1 participates in the regulation of VSMCs and progression of TAAD remain unknown. This study aimed to investigate the role of Egr1 in the phenotypic switching of VSMCs and the development of TAAD.

METHODS

Wild-type C57BL/6 and SMC-specific Egr1-knockout mice were used as experimental subjects and fed β-aminopropionitrile for 4 weeks to construct the TAAD model. Ultrasound and aortic staining were performed to examine the pathological features in thoracic aortic tissues. Transwell, wound healing, CCK8, and immunofluorescence assays detected the migration and proliferation of synthetic VSMCs. Egr1 was directly bound to the promoter of Krüppel-like factor 5 (KLF5) and promoted the expression of KLF5, which was validated by JASPAR database and dual-luciferase reporter assay.

RESULTS

Egr1 expression increased and was partially co-located with VSMCs in aortic tissues of mice with TAAD. SMC-specific Egr1 deficiency alleviated TAAD and inhibited the phenotypic switching of VSMC. Egr1 knockdown prevented the phenotypic switching of VSMCs and subsequently suppressed the migration and proliferation of synthetic VSMCs. The inhibitory effects of Egr1 deficiency on VSMCs were blunted once KLF5 was overexpressed.

CONCLUSION

Egr1 aggravated the development of TAAD by promoting the phenotypic switching of VSMCs via enhancing the transcriptional activation of KLF5. These results suggest that inhibition of SMC-specific Egr1 expression is a promising therapy for TAAD.

Central nervous injury risk factors after endovascular repair of a thoracic aortic aneurysm with type B aortic dissection

BACKGROUND

Aortic dissection is the deadliest disease of the cardiovascular system. Type B aortic dissection accounts for 30%-60% of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair (TEVAR). However, patients are prone to various complications after surgery, with central nervous system injury being the most common, which seriously affects their prognosis and increases the risk of disability and death. Therefore, exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control.

AIM

To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection.

METHODS

We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022. The patients were categorized into injury (n = 159) and non-injury (n = 147) groups based on central nervous system injury following surgery. The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups. Multivariate logistic regression analysis was performed.

RESULTS

The Association between age, history of hypertension, blood pH value, surgery, mechanical ventilation, intensive care unit stay, postoperative recovery times on the first day after surgery, and arterial partial pressure of oxygen on the first day after surgery differed substantially (P < 0.05). Multivariate logistic regression analysis indicated that age, surgery time, history of hypertension, duration of mechanical ventilation, and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection (P < 0.05).

CONCLUSION

For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection, early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.

Aortic Dissection Masquerading as Pneumonia: A Case Report of an Atypical Presentation

Aortic dissection is a critical and life-threatening condition that can present with atypical symptoms, often leading to misdiagnosis and delayed treatment. The report presents a case of a 65-year-old male who initially exhibited fever, right-sided chest pain, and a productive cough, resulting in an initial diagnosis of pneumonia. Despite empirical antibiotic therapy, his symptoms persisted, prompting further investigation. A computed tomography (CT) scan ultimately revealed a Type B aortic dissection. The patient was then transferred to a specialized tertiary care facility for successful endovascular intervention. This case underscores the importance of considering aortic dissection in patients presenting with persistent, atypical symptoms that do not respond to standard treatments, such as unexplained fever and chest pain. It highlights the crucial role of advanced imaging techniques, such as CT scans, in achieving an accurate and timely diagnosis. Clinicians must maintain a high index of suspicion and ensure prompt referral to specialized centers to improve patient outcomes in this potentially fatal condition.

The role of oxidative stress in aortic dissection: a potential therapeutic target

The incidence of aortic dissection (AD) is steadily increasing, driven by the rising prevalence of chronic conditions such as hypertension and the global aging of the population. Oxidative stress emerges as a pivotal pathophysiological mechanism contributing to the progression of AD. Oxidative stress triggers apoptosis in vascular smooth muscle cells, reshapes the extracellular matrix (ECM), and governs ECM degradation and remodeling, subsequently impacting aortic compliance. Furthermore, oxidative stress not only facilitates the infiltration of macrophages and mononuclear lymphocytes but also disrupts the integral structure and functionality of endothelial cells, thereby inducing endothelial cell dysfunction and furthering the degeneration of the middle layer of the aortic wall. Investigating antioxidants holds promise as a therapeutic avenue for addressing AD.

Navigating clinical appropriateness: A review of management strategies for type B aortic dissection

Aortic dissection is a catastrophic, life-threatening event. Its management depends on the anatomic location of the intimal tear (type A v B) and the clinical presentation in type B aortic dissection. In this article, the current evidence supporting clinical practice, gaps in knowledge, and the need for more rigorous research and higher-quality studies are reviewed.

Unmasking a Silent Threat: Office-Based Diagnosis of an Ascending Aortic Dissection With Transthoracic Echocardiography

Type A aortic dissection (TAAD) is a potentially life-threatening diagnosis that can present with elusive symptomatology. A high degree of clinical suspicion is necessary for prompt diagnosis and management. We describe a case of a transthoracic echo (TTE) in a non-suspicious clinic patient diagnosed with TAAD. A 66-year-old Caucasian male presented for a routine clinic visit with one episode of acute severe chest pain. An echocardiogram was ordered for further workup of hypertension and chest discomfort. The echocardiogram demonstrated an ejection fraction of 60% without significant valvular abnormalities. There was suspicion of aortic pathology, which required multiple attending to review the images. The final interpretation was TAAD with a thrombus present in the false lumen. The patient then presented to the Emergency Department. A computed tomographic angiography was performed, which subsequently confirmed the TAAD. The patient was admitted to the cardiovascular ICU and ultimately underwent a successful repair of the dissection. The patient had an unremarkable post-operative course and was ultimately discharged home. Our case demonstrated a diagnosis of TAAD by office-based TTE as the original imaging modality. While this was unconventional, a TAAD should remain on the differential diagnosis when being ordered for the patient's with uncontrolled hypertension with chest pain as a presenting symptom.

Late Post-Dissection Dynamic Intermittent Malperfusion of the Aortic Arch in Association with a Rare Heterogenous LOX Gene Variation

Late ischaemic consequences of type A aortic dissection are rare. We present a 6-year late complication of type A aortic dissection treated by Bentall surgery in a 41-year-old patient. The patient presented with several episodes of lipothymia associated with hypertensive attacks with anisotension, cervicalgia, hemicranial headache, abdominal pain and lower limb slipping initially on exertion and later at rest. On dynamic examination, we diagnosed an intermittent dynamic occlusion of the aortic arch and rare LOX gene variation, which is considered to be associated with aneurysm or dissection of the ascending aorta in young patients. Surgical treatment by replacement of the ascending aorta and the aortic arch with reimplantation of the brachiocephalic trunk (BcTr) allowed the symptoms to resolve.

Efficacy of predictive pain intervention in patients with aortic dissection

BACKGROUND

Aortic dissection is usually managed with interventional therapy, conservative therapy, and surgery to inhibit disease progression and improve prognoses. Nevertheless, the absence of meticulous and effective nursing during the treatment greatly increases the complication rates, which is detrimental to the recovery of patients.

OBJECTIVE

This study aimed to explore the efficacy of predictive pain intervention in the nursing process of patients with aortic dissection.

METHODS

Sixty patients with aortic dissection who were admitted to our hospital from December 2018 to December 2020 were observed in this study. Specifically, these patients were randomly and equally classified into Group A (patients who were given conventional nursing intervention) and Group B (patients who were given predictive pain intervention). Subsequently, the pain score, complication rates, and nursing satisfaction in the two groups were compared and analyzed.

RESULTS

Compared with patients in Group A, patients in Group B had significantly lower pain scores (P< 0.05); complication rates were significantly lower in Group B than in Group A (6.67% vs. 23.33%, P< 0.05); patient satisfaction with care was significantly better in Group B compared to Group A (96.67% vs. 73.33%, P< 0.05).

CONCLUSION

Predictive pain intervention is widely recognized as useful in the treatment of patients with aortic dissection. It has significant clinical application value as it can largely alleviate pain and is relatively safe for patients.

MALT1 Positively Relates to T Helper 1 and T Helper 17 cells, and Serves as a Potential Biomarker for Predicting 30-Day Mortality in Stanford Type A Aortic Dissection Patients

Mucosa-associated lymphoid tissue 1 (MALT1) regulates inflammation and T helper (Th) cell differentiation, which may participate in the progression of Stanford type A aortic dissection (TAAD). This study intended to assess the association of MALT1 expression with prognosis in TAAD patients. In this prospective study, MALT1 expression was measured by reverse transcription-quantitative polymerase chain reaction assay from peripheral blood samples in 100 TAAD patients and 100 non-AD controls (non-AD patients with chest pain) before treatment. Besides, Th1, Th2, and Th17 cells of TAAD patients before treatment were measured by flow cytometry assay, and their 30-day mortality was recorded. MALT1 expression was ascended in TAAD patients vs. non-AD controls (P < 0.001). In TAAD patients, elevated MALT1 expression was linked with hypertension complication (P = 0.009), increased systolic blood pressure (r = 0.291, P = 0.003), C-reactive protein (CRP) (r = 0.286, P = 0.004), and D-dimer (r = 0.359, P < 0.001). Additionally, MALT1 expression was positively correlated with Th1 cells (r = 0.312, P = 0.002) and Th17 cells (r = 0.397, P < 0.001), but not linked with Th2 cells (r = -0.166, P = 0.098). Notably, the 30-day mortality of TAAD patients was 28.0%. MALT1 expression [odds ratio (OR) = 1.936, P = 0.004], CRP (OR = 1.108, P = 0.002), D-dimer (OR = 1.094, P = 0.003), and surgery timing (emergency vs. selective) (OR = 8.721, P = 0.024) independently predicted increased risk of death within 30 days in TAAD patients. Furthermore, the combination of the above-mentioned independent factors had an excellent ability in predicting 30-day mortality with the area under curve of 0.949 (95% confidence interval: 0.909-0.989). MALT1 expression relates to increased Th1 cells, Th17 cells, and 30-day mortality risk in TAAD patients.

Endovascular stenting of the ascending aorta for visceral malperfusion in a patient with type A aortic dissection

A type A aortic dissection is a challenging condition for both cardiothoracic and vascular surgeons. Although open surgery remains the gold standard, there is considerable interest in the use of endovascular techniques for patients who present with malperfusion. We present the case of an unstable 55-year-old man with visceral malperfusion from a type A dissection who was stabilized using an endovascular technique as a bridge to open surgery. A bare metal thoracic endograft was used in the ascending aorta to rapidly restore perfusion. This hybrid approach to the problem of malperfusion in type A dissection could be useful for these patients with complicated cases.

Pregnancy-related maternal deaths due to cardiovascular diseases in Japan from 2010 to 2019: an analysis of maternal death exploratory committee data

OBJECTIVE

Cardiovascular disease (CVD) is the leading cause of maternal deaths in high-income countries. This study aimed to assess the characteristics of maternal deaths due to CVDs and the quality of care provided to patients, and to identify elements to improve maternal care in Japan.

METHODS

This descriptive study used the maternal death registration data of the Maternal Deaths Exploratory Committee of Japan between 2010 and 2019.

RESULTS

Of 445 eligible pregnancy-related maternal deaths, 44 (9.9%) were attributed to CVD. The most frequent cause was aortic dissection (18 patients, 40.9%), followed by peripartum cardiomyopathy (8 patients, 18.2%), and pulmonary hypertension (5 patients, 11.4%). In 31.8% of cases, cardiopulmonary arrest occurred within 30 min after initial symptoms. Frequent symptoms included pain (27.3%) and respiratory symptoms (27.3%), with 61.4% having initial symptoms during the prenatal period. 63.6% of the patients had known risk factors, with age ≥35 years (38.6％), hypertensive disorder (15.9%), and obesity (15.9%) being the most common. Quality of care was assessed as suboptimal in 16 (36.4%) patients. Cardiac risk assessment was insufficient in three patients with preexisting cardiac disease, while 13 patients had symptoms and risk factors warranting intensive monitoring and evaluation.

CONCLUSION

Aortic dissection was the leading cause of maternal death due to CVDs. Obstetrics care providers need to be familiar with cardiac risk factors and clinical warning signs that may lead to impending fatal cardiac events. Timely risk assessment, patient awareness, and a multidisciplinary team approach are key to improving maternal care in Japan.

MiR-590-3p Promotes the Phenotypic Switching of Vascular Smooth Muscle Cells by Targeting Lysyl Oxidase

ABSTRACT

We investigated the clinical characteristics of patients with acute aortic dissection (AAD) and miR-590-3p levels in serum, tissue, and vascular smooth muscle cells. The effect of miR-590-3p on the vascular smooth muscle cell phenotype was assessed, and the regulation of lysyl oxidase by miR-5903p was determined. C57BL/6 mice were used to investigate the incidence of AAD and effects of miR-5903p on AAD. The miR-590-3p levels were measured in the aortae of mice, and hematoxylin and eosin staining and Masson staining were performed to identify the morphological features of the aorta. Comparative analysis revealed significant differences in clinical characteristics between patients with AAD and healthy control subjects, with most patients with AAD exhibiting concomitant hypertension and nearly 50% having atherosclerosis. Lysyl oxidase was a direct target of miR-590-3p. Lysyl oxidase overexpression inhibited switching of the vascular smooth muscle cell phenotype from contractile to synthetic, but miR-590-3p overexpression significantly reversed this change. In the mouse model, miR-590-3p upregulation increased the incidence of AAD to 93.3%, and its incidence decreased to 13.3% after miR-590-3p inhibition. Hematoxylin and eosin and Masson staining revealed that the miR-590-3p agomiR group had a greater loss of the contractile phenotype in the dissected aortic wall and an increased number of muscle fibers in the aortic wall, which contributed to thickening of the aortic wall and the formation of a false lumen in aortic dissection. miR-590-3p might be pivotal in the pathogenesis of AAD. Thus, targeting miR-590-3p or its downstream pathways could represent a therapeutic approach for AAD.

Association of troponin I and macrophages in cardiac tamponade with Stanford type A aortic dissection

Background

Acute aortic dissection has a high mortality rate, especially for Stanford type A with a dissected ascending aorta. Cardiac tamponade is one of the most common complications of acute type A aortic dissection (ATAAD) and can cause death. However, the pathogenesis is often unclear. We aimed to examine laboratory findings at the onset of disease and macrophage involvement.

Methods

Hematological and biochemical parameters, and D-dimer, brain natriuretic peptide (BNP), and high-sensitivity troponin I (hs-cTnI) levels in 70 patients with ATAAD at our hospital were investigated. Additionally, the myocardium and aorta after autopsy of an ATAAD case with cardiac tamponade were pathologically examined.

Results

Forty-four ATAAD cases were complicated by cardiac tamponade. The mean age of patients with cardiac tamponade and proportion of patients over 70 years of age were both significantly higher than for those without cardiac tamponade. Evaluable D-dimer values were higher than 0.5 μg/mL in all patients. Significantly elevated laboratory parameters in patients with cardiac tamponade included: lactate dehydrogenase, aspartate aminotransferase, C-reactive protein, lactate, BNP, and hs-cTnI. However, multivariate analysis showed only hs-cTnI was significantly associated with cardiac tamponade. Histological examination revealed numerous M2-like macrophages infiltrating the myocardium and dissecting aorta, expressing CC chemokine ligand (CCL)2 together with vascular endothelial growth factor-C and matrix metalloproteinase-9. The peripheral monocyte-to-neutrophil ratio (MNR) was also significantly higher in cardiac tamponade.

Conclusions

In ATAAD patients with cardiac tamponade, hs-cTnI was significantly elevated and CCL2 expression was observed, which may be involved in the expression of M2-like macrophages via an increased MNR.

How to help aortic dissection survivors with recovery?: A health promotion program based on the comprehensive theory of health behavior change and literature review

For aortic dissection survivors, health promotion can help them recover from the disease, which requires systematic program support. The aim of this study was to construct a health promotion program for aortic dissection survivors. Literature search, group discussion, and expert consultation were used. The Integrated Theory of Health Behavior Change was the theoretical basis of the program. Multiple medical-related databases were searched. Based on a literature search and group discussion, 3 primary items, 8 secondary items, and 34 tertiary items were formed. After 2 rounds of expert consultation (number of experts = 25), 3 primary items, 16 secondary items, and 54 tertiary items were retained. The authority coefficients of the 2 rounds of experts were 0.890 and 0.905, respectively. The Kendall W coefficient of the 2 rounds were 0.210 to 0.370 (P < .05) and 0.221 to 0.378 (P < .05), respectively. The mean importance value and coefficient of variation of each item were >3.5 and <0.25, respectively. The health promotion program constructed in this study was reasonable and scientific, which could provide a reference for clinical work.

Single-cell transcriptomic analysis reveals differential cell subpopulations and distinct phenotype transition in normal and dissected ascending aorta

BACKGROUND

Acute thoracic aortic dissection (ATAD) is a fatal condition characterized by tear of intima, formation of false lumen and rupture of aorta. However, the subpopulations of normal and dissected aorta remain less studied.

METHODS

Single-cell RNA sequencing was performed including 5 patients with ATAD and 4 healthy controls. Immunohistochemistry and immunofluorescence were used to verify the findings.

RESULTS

We got 8 cell types from human ascending aorta and identified 50 subpopulations including vascular smooth muscle cells (VSMCs), endothelial cells, fibroblasts, neutrophils, monocytes and macrophages. Six transmembrane epithelial antigen of prostate 4 metalloreductase (STEAP4) was identified as a new marker of synthetic VSMCs. CytoTRACE identified subpopulations with higher differentiation potential in specified cell types including synthetic VSMCs, enolase 1⁺ fibroblasts and myeloid-derived neutrophils. Synthetic VSMCs-derived C-X-C motif chemokine ligand 12 (CXCL12) might interact with neutrophils and fibroblasts via C-X-C motif chemokine receptor 4 (CXCR4) and atypical chemokine receptor 3 (ACKR3), respectively, which might recruit neutrophils and induce transdifferentitation of fibroblasts into synthetic VSMCs.

CONCLUSION

We characterized signatures of different cell types in normal and dissected human ascending aorta and identified a new marker for isolation of synthetic VSMCs. Moreover, we proposed a potential mechanism that synthetic VSMCs might interact with neutrophils and fibroblasts via CXCL12-CXCR4/ACKR3 axis whereby deteriorating the progression of ATAD, which might provide new insights to better understand the development and progression of ATAD.

Applying multi-omics techniques to the discovery of biomarkers for acute aortic dissection

Acute aortic dissection (AAD) is a cardiovascular disease that manifests suddenly and fatally. Due to the lack of specific early symptoms, many patients with AAD are often overlooked or misdiagnosed, which is undoubtedly catastrophic for patients. The particular pathogenic mechanism of AAD is yet unknown, which makes clinical pharmacological therapy extremely difficult. Therefore, it is necessary and crucial to find and employ unique biomarkers for Acute aortic dissection (AAD) as soon as possible in clinical practice and research. This will aid in the early detection of AAD and give clear guidelines for the creation of focused treatment agents. This goal has been made attainable over the past 20 years by the quick advancement of omics technologies and the development of high-throughput tissue specimen biomarker screening. The primary histology data support and add to one another to create a more thorough and three-dimensional picture of the disease. Based on the introduction of the main histology technologies, in this review, we summarize the current situation and most recent developments in the application of multi-omics technologies to AAD biomarker discovery and emphasize the significance of concentrating on integration concepts for integrating multi-omics data. In this context, we seek to offer fresh concepts and recommendations for fundamental investigation, perspective innovation, and therapeutic development in AAD.

Aortic Dissection

Acute aortic dissection is a highly morbid condition with high mortality that requires emergent surgical evaluation and repair. The intraoperative management of acute aortic dissection requires the anesthesiologist to do far more than administer anesthesia and begins before the patient arrives at the operative theater. High-fidelity communication with the surgeon, knowledge of the surgical plan, knowledge of the anatomy of the dissection, and a nuanced understanding of aortic dissection pathophysiology are all critical aspects of anesthetic management.

Individualized exercise prescription and cardiac rehabilitation following a spontaneous coronary artery dissection or aortic dissection

Aims

Prescribed aerobic-based exercise training is a low-risk fundamental component of cardiac rehabilitation (CR). Secondary prevention therapeutic strategies following a spontaneous coronary artery dissection (SCAD) or aortic dissection (AD) should include CR. Current exercise guidance for post-dissection patients recommends fundamental training components including target heart rate zones are not warranted. Omitting fundamental elements from exercise prescriptions risks safety and makes it challenging for both clinicians and patients to understand and implement recommendations in real-world practice. We review the principles of exercise prescription for CR, focusing on translating guidelines and evidence from well-studied high-risk CR populations to support the recommendation that exercise testing and individualized exercise prescription are important for patients following a dissection.

Methods and results

When patients self-perceive exercise intensity there is a tendency to underestimate intensities within metabolic domains that should be strictly avoided during routine exercise training following a dissection. However, exercise testing associated with CR enrolment has gained support and has not been linked to adverse events in optimally medicated post-dissection patients. Graded heart rate and blood pressure responses recorded throughout exercise testing provide key information for developing an exercise prescription. An exercise prescription that is reflective of medical history, medications, and cardiorespiratory fitness optimizes patient safety and yields improvements in blood pressure control and cardiorespiratory fitness, among other benefits.

Conclusion

This clinical practice and education article demonstrates how to develop and manage a CR exercise prescription for post-acute dissection patients that can be safe and effective for maintaining blood pressure control and improving cardiorespiratory fitness pre-post CR.

ALDH2 knockout protects against aortic dissection

Background

The incidence and mortality of aortic dissection (AD) are increasing. In pathological studies, macrophages, T lymphocytes and dendritic cells were found in the tunica media of the aorta. Acetaldehyde dehydrogenase 2 (ALDH₂) gene polymorphisms are associated with a high incidence of hypertension in Asian populations. However, there is no clear evidence of the relationship between ALDH₂ and aortic dissection in Asians. The aim of this study was to investigate the incidence of aortic dissection in different ALDH₂ genotypes and explore changes in the vasculature.

Materials and methods

Three-week-old male mice were administered freshly prepared β-aminopropionitrile solution dissolved in drinking water (1 g/kg/d) for 28 days to induce TAD. An animal ultrasound imaging system was used to observe the formation of arterial dissection and changes in cardiac function. Subsequently, mice were euthanized by cervical dislocation. The aortas were fixed for HE staining and EVG staining to observe aortic elastic fiber tears and pseudoluma formation under a microscope.

Results

Knockout of ALDH₂ mitigated β-aminopropionitrile-induced TAD formation in animal studies. Ultrasound results showed that ALDH₂ knockout reduced the degree of ascending aortic widening and the incidence of aortic dissection rupture. Pathological sections of multiple aortic segments showed that the protective effect of ALDH₂ knockout was observed in not only the ascending aorta but also the aortic arch and descending aorta. The expression levels of genes related to NK CD56bright cells, Th17 cells, T cells and T helper cells were decreased in ALDH₂ knockout mice treated with β-aminopropionitrile for 28 days.

Conclusion

ALDH₂ knockout protects against aortic dissection by altering the inflammatory response and immune response and protecting elastic fibers.

Endovascular Repair of the Thoracic Aorta Combined with Drug Therapy in Acute Uncomplicated Type B Aortic Dissection

Objective

This study was to evaluate the clinical efficacy of thoracic endovascular aortic repair (TEVAR) combined with Best Medical Therapy (BMT) in acute uncomplicated type B aortic dissection (TBAD).

Methods

Using the random method, 90 patients admitted to our hospital between January 2018 and January 2020 with acute uncomplicated TBAD were randomly divided into a control group and a study group, with 45 cases in each of the groups. The effectiveness of BMT combined with TEVAR treatment was compared.

Results

The incidence of recent adverse reactions did not differ significantly between the two groups. Compared to the control group, the 1-year survival rate and 2-year survival rate of patients in the study group were considerably higher. In order to examine the relationship between survival and time, the Kaplan-Meier curve was used. Both groups reached the median survival time after 24 months of follow-up. The expected survival time of the study group was longer than that of the control group. False lumen thrombosis or absence of thrombus was significantly more prevalent in the study group than in the control group.

Conclusion

For patients with acute uncomplicated TBAD, BMT combined with TEVAR can significantly improve the long-term survival rate and increase the expected survival time.

The Correlation and Copathogenesis of Coronary Aortic Sandwich and Renal Cysts

Objective

To determine the correlation for aortic occlusion and hydronephrosis and the pathogenesis of copathogenesis.

Methods

A retrospective census was established to probe the correlation with renal cysts by gathering aortic coarctation details concerning generic symptoms, diabetes, and liver and kidney profiles from 244 hospitalized aortic clinographers from April 2014 to December 2021 (study category, SG category), 150 hypertensive clients with primary hypertension attending our institution in the same period (matched category, MG category), and 150 able-bodied volunteers (control category, CG category).

Results

(1) Intercategory discrepancies in regard to aortic occlusion, diabetic malfunction, and kidney and liver abnormality were neither mutually nor predominantly measured (P > 0.05); (2) 244 enrolled SG for aortic occlusion and 150 CG for aortic occlusion were categorized by whether or not aortic occlusion was manifested, and the correlation between maternal age, gender, diabetic malfunction, and kidney and liver abnormality and renal cysts was estimated. The correlation of clogged aorta was demonstrated by a multifactorial logistic regression with gender and the presence of renal cysts (P < 0.05); (3) the correlation of clogged aorta was demonstrated by a multifactorial logistic regression with renal cysts as an independent risk factor for clogged aorta (95% CI: 1.028–10.291;P = 0.031).

Conclusion

As renal cysts are an autonomous risk of aortic coarctation, it is recommendable to strengthen clinical investigations such as monitoring of clinical blood pressures in kidney cyst recipients to assess their aortic function in order to evaluate their prognosis and minimize the prevalence of aortic coarctation.

High Neutrophil-to-Platelet Ratio Is Associated with Poor Survival in Patients with Acute Aortic Dissection

BACKGROUND

Acute aortic dissection (AAD), a serious and fatal cardiovascular disease, is characterized by inflammation that may further aggravate the condition. We evaluated the value of the neutrophil-to-platelet ratio (NPR) in the prognosis of AAD.

METHODS

We collected records of patients with AAD and clinical data from 2010 to 2020 and followed up on the relevant information for 136 months. The Kaplan-Meier (K-M) survival along with the univariate and multivariate Cox analyses was used to examine the prognostic value of NPR in AAD. In addition, nomograms were constructed by combining NPR, age, Stanford typing, and treatment methods. The accuracy of nomograms was evaluated using calibration plots, and the prediction efficiency of nomograms was evaluated by receiver operating characteristic curve analysis and decision curve analysis (DCA).

RESULTS

The K-M analysis showed that AAD patients with higher NPR exhibited worse prognosis. In addition, different Stanford typing and treatment methods produced varied prognosis results. Univariate and multivariate Cox analyses showed that NPR value, age, classification, and treatment were independent prognostic factors for the overall survival time of patients with AAD. Nomograms constructed by combining NPR, age, Stanford typing, and treatment methods showed good predictive efficacy, and the AUC values for 1-, 3-, and 5-year predicting were 0.82, 0.79, and 0.74, respectively.

CONCLUSIONS

Our results suggest that pretreatment NPR can be used as a potential prognostic marker of overall survival time in patients with AAD.

Discomfort of postoperative patients with aortic dissection after discharge: telephone follow-up analysis of a cross-sectional study

Background

Postoperative discomfort is one of the important manifestations of disease changes, but few studies have reported detailed description of postoperative discomfort in patients with aortic dissection after discharge. The aim of this study is to investigate the discomfort symptoms and to explore the possible influencing factors of discomfort symptoms.

Method

This cross-sectional study based on convenience sampling collected medical records from 999 patients hospitalized in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology, Wuhan, Hubei, China from January 1, 2019 to December 31, 2019. Postoperative patients with first onset and confirmed aortic dissection were eligible for follow-up. Telephone follow-up was conducted from July 20, 2020 to August 20, 2020. Symptoms of discomfort were reported by patients or their immediate family members. Univariate and multivariable logistic regression analysis were performed to identify factors associated with symptoms of discomfort.

Results

A total of 675 patients were followed up, 185 patients (27.4%) were lost to follow-up, and the remaining 490 patients were divided into survival group (N = 428) and death group (N = 62) and were included in the study. There was no difference in gender and age among the three groups. 152 of 428 patients reported discomfort. The uncomfortable symptoms of postoperative patients were diverse, and mainly manifested as back and chest pain (32.24%, 49/152), chest tightness (15.79%, 24/152), dizzy (10.53%, 16/152) and weakness (10.53%, 16/152). Multivariable logistic regression analysis of postoperative discomfort showed length of discharge (OR 0.995; P 0.018; 95% CI 0.990–0.999) and positive history of drinking (OR 3.519; P 0.018; 95% CI 1.236–10.022) were significant among patients with Stanford A AD, and diagnosis was made in the first visiting hospital (OR 0.395; P 0.001; 95% CI 0.230–0.677) was a protective factor for patients.

Conclusions

The incidence of postoperative discomfort in patients with aortic dissection was high and the symptoms were diverse and not single. In order to reduce the possibility of postoperative discomfort, it is important to formulate effective public policies to limit the public to drink alcohol and timely diagnose aortic dissection. Long term follow-up is necessary for patients with aortic dissection to observe the recovery process of aortic dissection.

Beyond Vessel Diameters: Non-invasive Monitoring of Flow Patterns and Immune Cell Recruitment in Murine Abdominal Aortic Disorders by Multiparametric MRI

The pathophysiology of the initiation and progression of abdominal aortic aneurysms (AAAs) and aortic dissections (AADs) is still unclear. However, there is strong evidence that monocytes and macrophages are of crucial importance in these processes. Here, we utilized a molecular imaging approach based on background-free ¹⁹F MRI and employed perfluorocarbon nanoemulsions (PFCs) for in situ ¹⁹F labeling of monocytes/macrophages to monitor vascular inflammation and AAA/AAD formation in angiotensin II (angII)-treated apolipoproteinE-deficient (apoE^-/-) mice. In parallel, we used conventional ¹H MRI for the characterization of aortic flow patterns and morphology. AngII (1 μg/kg/min) was infused into apoE^-/- mice via osmotic minipumps for 10 days and mice were monitored by multiparametric ¹H/¹⁹F MRI. PFCs were intravenously injected directly after pump implantation followed by additional applications on day 2 and 4 to allow an efficient ¹⁹F loading of circulating monocytes. The combination of angiographic, hemodynamic, and anatomical measurements allowed an unequivocal classification of mice in groups with developing AAAs, AADs or without any obvious aortic vessel alterations despite the exposure to angII. Maximal luminal and external diameters of the aorta were enlarged in AAAs, whereas AADs showed either a slight decrease of the luminal diameter or no alteration. ¹H/¹⁹F MRI after intravenous PFC application demonstrated significantly higher ¹⁹F signals in aortae of mice that developed AAAs or AADs as compared to mice in which no aortic disorders were detected. High resolution ¹H/¹⁹F MRI of excised aortae revealed a patchy pattern of the ¹⁹F signals predominantly in the adventitia of the aorta. Histological analysis confirmed the presence of macrophages in this area and flow cytometry revealed higher numbers of immune cells in aortae of mice that have developed AAA/AAD. Importantly, there was a linear correlation of the ¹⁹F signal with the total number of infiltrated macrophages. In conclusion, our approach enables a precise differentiation between AAA and AAD as well as visualization and quantitative assessment of inflammatory active vascular lesions, and therefore may help to unravel the complex interplay between macrophage accumulation, vascular inflammation, and the development and progression of AAAs and AADs.