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An C, Li Z, Chen Y, Huang S, Yang F, Hu Y, Xu T, Zhang C, Ge S. The cGAS-STING pathway in cardiovascular diseases: from basic research to clinical perspectives. Cell Biosci 2024; 14:58. [PMID: 38720328 PMCID: PMC11080250 DOI: 10.1186/s13578-024-01242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
The cyclic guanosine monophosphate (GMP)-adenosine monophosphate (AMP) synthase-stimulator of interferon genes (cGAS-STING) signaling pathway, an important component of the innate immune system, is involved in the development of several diseases. Ectopic DNA-induced inflammatory responses are involved in several pathological processes. Repeated damage to tissues and metabolic organelles releases a large number of damage-associated molecular patterns (mitochondrial DNA, nuclear DNA, and exogenous DNA). The DNA fragments released into the cytoplasm are sensed by the sensor cGAS to initiate immune responses through the bridging protein STING. Many recent studies have revealed a regulatory role of the cGAS-STING signaling pathway in cardiovascular diseases (CVDs) such as myocardial infarction, heart failure, atherosclerosis, and aortic dissection/aneurysm. Furthermore, increasing evidence suggests that inhibiting the cGAS-STING signaling pathway can significantly inhibit myocardial hypertrophy and inflammatory cell infiltration. Therefore, this review is intended to identify risk factors for activating the cGAS-STING pathway to reduce risks and to simultaneously further elucidate the biological function of this pathway in the cardiovascular field, as well as its potential as a therapeutic target.
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Affiliation(s)
- Cheng An
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230032, Anhui, China
| | - Zhen Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yao Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230032, Anhui, China
| | - Shaojun Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230032, Anhui, China
| | - Fan Yang
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ying Hu
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China
| | - Tao Xu
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
| | - Chengxin Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230032, Anhui, China.
| | - Shenglin Ge
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230032, Anhui, China.
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Pedersen MW, Duch K, Lindgren FL, Lundgren NLO, Tayal B, Hagendorff A, Jensen GB, Biering-Sørensen T, Schnohr P, Møgelvang R, Høst N, Kragholm K, Andersen NH, Søgaard P. Aortic Root Dimension Using Transthoracic Echocardiography: Results from the Copenhagen City Heart Study. Am J Cardiol 2024; 218:86-93. [PMID: 38452843 DOI: 10.1016/j.amjcard.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
Findings regarding the relation between aortic size and risk factors are heterogeneous. This study aimed to generate new insights from a population-based adult cohort on aortic root dimensions and their association with age, anthropometric measures, and cardiac risk factors and evaluate the incidence of acute aortic events. Participants from the fifth examination round of the Copenhagen City Heart study (aged 20 to 98 years) with applicable echocardiograms and no history of aortic disease or valve surgery were included. Aorta diameter was assessed at the annulus, sinus of Valsalva, sinotubular junction, and the tubular part of the ascending aorta. The study population comprised 1,796 men and 2,316 women; mean age: 56.4 ± 17.0 and 56.9 ± 18.1 years, respectively. Men had larger aortic root diameters than women regardless of height indexing (p <0.01). Age, height, weight, systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, hypertension, diabetes, ischemic heart disease, and smoking were positively correlated with aortic sinus diameter in the crude and gender-adjusted analyses. However, after full adjustment, only height, weight, and diastolic blood pressure remained significantly positively correlated with aortic sinus diameter (p <0.001). For systolic blood pressure and pulse pressure, the correlation was inverse (p <0.001). During follow-up (median 5.4 [quartile 1 to quartile 3 4.5 to 6.3] years), the incidence rate of first-time acute aortic events was 13.6 (confidence interval 4.4 to 42.2) per 100,000 person-years. In conclusion, beyond anthropometric measures, age, and gender, diastolic blood pressure was the only cardiac risk factor that was independently correlated with aortic root dimensions. The number of aortic events during follow-up was low.
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Affiliation(s)
- Maria W Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Kirsten Duch
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Filip L Lindgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nils L O Lundgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Gorm B Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Nordsjællands Hospital, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Zhang YJ, Sun Y, Zhao YB, Ma D. α-HBDH is a superior to LDH in predicting major adverse cardiovascular events in patients with acute aortic dissection. Heliyon 2024; 10:e29155. [PMID: 38681572 PMCID: PMC11053288 DOI: 10.1016/j.heliyon.2024.e29155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Acute aortic dissection (AAD) with a high mortality and postoperative complications remains presently no effective indicators to conjunctly predict the short-term mortality and the prognosis. This study aimed to investigate the predictive role of α-HBDH on in-hospital mortality and postoperative Major adverse cardiovascular events (MACE) in patients with AAD. Methods In this retrospective study, a total of 369 enrolled patients from 2015 to 2021 were divided into three groups (T1: low, T2: medium and T3: high) based on the tertiles of α-HBDH levels on admission. In terms of the preoperative, intraoperative and postoperative indicators among 3 groups, the relationship between α-HBDH and studying endpoints was determined by logistic regression models, along with the consolidation using Kaplan-Meier and restricted cubic spline (RCS) analysis for predicting the in-hospital death and MACE complications. Last, subgroup analysis further verified the predictive value of α-HBDH. Results Logistic regression analysis showed that α-HBDH was independently associated with in-hospital mortality of patients with AAD [OR(95CI): 4.771(1.043-21.832), P = 0.044] and MACE [OR(95CI): 9.869(2.148-45.349), P = 0.003]. Moreover, Kaplan-Meier analysis also showed an increased α-HBDH levels associated with poor survival within 30 days (log rank test, P < 0.01), especially in acute Stanford A dissection. RCS presented that 204 U/L was the optimal cut-off value of α-HBDH for in-hospital mortality and postoperative MACE, which facilitated clinical stratification of patients with AAD. Subgroup analysis confirmed a stable correlation between α-HBDH level and hospital mortality and MACE (P > 0.05). Conclusions α-HBDH is a predictor of the in-hospital mortality and postoperative MACE, guiding admission stratification of patients with AAD.
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Affiliation(s)
- Yun-jing Zhang
- Department of Biochemistry and Molecular Biology, Key Laboratory of Neural and Vascular Biology, Ministry of Education, and Hebei Key Laboratory of Cardiovascular Homeostasis and Aging, Hebei Medical University, Shijiazhuang, Hebei, 050017, PR China
| | - Yue Sun
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 051000, PR China
| | - Yong-bo Zhao
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 051000, PR China
| | - Dong Ma
- Department of Biochemistry and Molecular Biology, Key Laboratory of Neural and Vascular Biology, Ministry of Education, and Hebei Key Laboratory of Cardiovascular Homeostasis and Aging, Hebei Medical University, Shijiazhuang, Hebei, 050017, PR China
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Meccanici F, Thijssen CGE, Gökalp AL, Bom AW, Geuzebroek GSC, ter Woorst JF, van Kimmenade RRJ, Post MC, Takkenberg JJM, Roos-Hesselink JW. Long-Term Health-Related Quality of Life following Acute Type A Aortic Dissection with a Focus on Male-Female Differences: A Cross Sectional Study. J Clin Med 2024; 13:2265. [PMID: 38673538 PMCID: PMC11050969 DOI: 10.3390/jcm13082265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Objectives: Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency, of which the long-term impact on health-related quality of life (HRQoL) and male-female-specific insights remain inadequately clarified. Methods: Consecutive adult ATAAD patients who underwent surgery were retrospectively included between 2007 and 2017 in four referral centers in the Netherlands, and baseline data were collected. The 36-Item Short-Form (SF-36) Health Survey was sent to all survivors between 2019 and 2021 and compared to validated SF-36 scores of the Dutch general population stratified by age group and sex. Results: In total, 324/555 surviving patients returned the SF-36 questionnaire (response rate 58%), of which 40.0% were female; the median follow-up was 6.5 years (range: 1.7-13.9, IQR: 4.0-9.4) after surgery for ATAAD. In comparison to the general population, ATAAD patients scored significantly lower on 6/8 SF-36 subdomains and higher on bodily pain. Differences in HRQoL domains compared to the sex-matched data were largely comparable between sexes, apart from bodily pain. In the age-matched subgroups impaired HRQoL was most pronounced in younger patients aged 41-60 (5/8 impaired domains). Female ATAAD patients scored significantly worse on 5/8 SF-36 subdomains and the physical component summary (PCS) scores than male patients. Age at ATAAD, female sex, hypertension, COPD, and prior thoracic aortic aneurysm were associated with worse PCS scores. Conclusions: Long-term HRQoL was impaired in both male and female ATAAD patients when compared to the general population. Further studies on the nature of this impairment and on interventions to improve HRQoL after ATAAD are clearly warranted, with special attention to females and younger patients.
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Affiliation(s)
| | - Carlijn G. E. Thijssen
- Department of Cardiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Arjen L. Gökalp
- Department of Cardiothoracic Surgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Annemijn W. Bom
- Department of Cardiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Guillaume S. C. Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Joost F. ter Woorst
- Department of Cardiothoracic Surgery, Catharina Ziekenhuis Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - Roland R. J. van Kimmenade
- Department of Cardiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Marco C. Post
- Department of Cardiology, St. Antonius Ziekenhuis, 3435 CM Nieuwegein, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Maroto LC, Ferrera C, Cobiella J, Carnero M, Beltrao R, Martínez I, Campelos P, Martín-Sánchez FJ, Carrero AM, Domínguez MJ, Álvarez E, Fernández F, Cabeza B, Colorado E, Villacastín JP, Vilacosta I. Improvement of Early Outcomes in Type A Acute Aortic Syndrome After an Aorta Code Implementation. Ann Thorac Surg 2024; 117:770-778. [PMID: 37488005 DOI: 10.1016/j.athoracsur.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Reduction of variability through process reengineering can improve surgical results for patients with type A acute aortic syndrome. We compare short-term results before and after implementation of an Aorta Code for patients with type A acute aortic syndrome who underwent surgery. METHODS The Aorta Code was implemented in a 5-hospital healthcare network in 2019. This critical pathway was based on a simple diagnostic algorithm, ongoing training, immediate patient transfer, and treatment by an expert multidisciplinary team. We retrospectively compared all patients operated on in our center before (2005-2018) and after (January 2019 to February 2023) its implementation. RESULTS One hundred two and 70 patients underwent surgery in the precode and code periods, respectively. In the code period the number of patients operated on per year increased (from 7.3 to 16.8), and the median elapsed time until diagnosis (6.5 hours vs 4.2 hours), transfer (4 hours vs 2.2 hours), and operating room (2.7 hours vs 1.8 hours) were significantly shorter (P < .05). Aortic root repair and total arch replacement were more frequent (66.7% vs 82.9% [P = .003] and 20.6% vs 40% [P = .001]). Cardiopulmonary bypass and ischemia times were also shorter (179.7 minutes vs 148.2 minutes [P = .001] and 105 minutes vs 91.2 minutes [P = .022]). Incidence of prolonged mechanical ventilation (53.9% vs 34.3%, P = .011), major stroke (17.7% vs 7.1%, P = .047), and 30-day mortality (27.5% vs 7.1%, P = .001) decreased significantly. CONCLUSIONS An Aorta Code can be successfully implemented by using a standardized protocol within a hospital network. The number of cases increased; time to diagnosis, transfer, and operating room were reduced; and 30- day mortality significantly decreased.
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Affiliation(s)
- Luis C Maroto
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
| | - Carlos Ferrera
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Cobiella
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Rosa Beltrao
- Department of Anesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Isaac Martínez
- Department of Vascular Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Paula Campelos
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ana M Carrero
- Emergency Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - María J Domínguez
- Emergency Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Esther Álvarez
- Emergency Department, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Fátima Fernández
- Emergency Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - Beatriz Cabeza
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
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Ge X, Cai Q, Cai Y, Mou C, Fu J, Lin F. Roles of pyroptosis and immune infiltration in aortic dissection. Front Mol Biosci 2024; 11:1277818. [PMID: 38567101 PMCID: PMC10985243 DOI: 10.3389/fmolb.2024.1277818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction: Aortic dissection (AD) is often fatal, and its pathogenesis involves immune infiltration and pyroptosis, though the molecular pathways connecting these processes remain unclear. This study aimed to investigate the role of immune infiltration and pyroptosis in AD pathogenesis using bioinformatics analysis. Methods: Two Gene Expression Omnibus datasets and a Gene Cards dataset of pyroptosis-related genes (PRGs) were utilized. Immunological infiltration was assessed using CIBERSORT, and AD diagnostic markers were identified through univariate logistic regression and least absolute shrinkage and selection operator regression. Interaction networks were constructed using STRING, and weighted gene correlation network analysis (WGCNA) was employed to identify important modules and essential genes. Single-sample gene set enrichment analysis determined immune infiltration, and Pearson correlation analysis assessed the association of key genes with infiltrating immune cells. Results: Thirty-one PRGs associated with inflammatory response, vascular epidermal growth factor receptor, and Rap1 signaling pathways were identified. WGCNA revealed seven important genes within a critical module. CIBERSORT detected immune cell infiltration, indicating significant changes in immune cell infiltration and pyroptosis genes in AD and their connections. Discussion: Our findings suggest that key PRGs may serve as indicators for AD or high-risk individuals. Understanding the role of pyroptosis and immune cell infiltration in AD pathogenesis may lead to the development of novel molecular-targeted therapies for AD. Conclusion: This study provides insights into the molecular mechanisms underlying AD pathogenesis, highlighting the importance of immune infiltration and pyroptosis. Identification of diagnostic markers and potential therapeutic targets may improve the management of AD and reduce associated morbidity and mortality.
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Affiliation(s)
- Xiaogang Ge
- Vascular and Endovascular Surgery, Huangyan Hospital Affiliated to Wenzhou Medical University, Taizhou First People’s Hospital, Taizhou, Zhejiang, China
| | - Qiqi Cai
- Department of Emergency Intensive Care Unit, Huangyan Hospital Affiliated to Wenzhou Medical University, Taizhou First People’s Hospital, Taizhou, Zhejiang, China
| | - Yangyang Cai
- Vascular and Endovascular Surgery, Huangyan Hospital Affiliated to Wenzhou Medical University, Taizhou First People’s Hospital, Taizhou, Zhejiang, China
| | - Caiguo Mou
- Vascular and Endovascular Surgery, Huangyan Hospital Affiliated to Wenzhou Medical University, Taizhou First People’s Hospital, Taizhou, Zhejiang, China
| | - Junhui Fu
- Vascular and Endovascular Surgery, Huangyan Hospital Affiliated to Wenzhou Medical University, Taizhou First People’s Hospital, Taizhou, Zhejiang, China
| | - Feng Lin
- Vascular and Endovascular Surgery, Huangyan Hospital Affiliated to Wenzhou Medical University, Taizhou First People’s Hospital, Taizhou, Zhejiang, China
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Smedberg C, Hultgren R, Olsson C, Steuer J. Incidence, presentation and outcome of acute aortic dissection: results from a population-based study. Open Heart 2024; 11:e002595. [PMID: 38485121 PMCID: PMC10941176 DOI: 10.1136/openhrt-2023-002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES To describe the incidence of acute aortic dissection in a clearly defined population, to assess onset symptoms and admission biochemical marker levels and to analyse variables potentially associated to mortality. METHODS Medical records and CT angiograms of all patients hospitalised for acute aortic dissection in the Stockholm County during the 5-year period 2012-2016 were reviewed. The patients were followed until date of death or until 31 December 2020. The annual incidence was determined. Associations between clinical and biochemical variables and 30-day mortality, respectively, were analysed using multivariable logistic regression models. RESULTS A total of 344 patients were included. The mean annual incidence of acute aortic dissection was 4.1 per 100 000. Median age was 67 years (range 24-91) and 34% (n=118) were women. Type A dissection was predominant; 220 patients (64%) had type A and 124 (36%) had type B. Painless dissection was more common in type A than in type B (18% vs 15%, p=0.003). Type A dissection patients also more commonly had elevated plasma troponin T (44% vs 21%, p<0.001) and thrombocytopenia (26% vs 15%, p=0.010) than type B dissection patients on admission. Overall, 30-day mortality was 28% in type A and 11% in type B (p<0.001). Both painless dissection (OR 4.30, 95% CI 1.80 to 10.28, p=0.001) and elevated troponin T (OR 3.78, 95% CI 2.01 to 7.12, p<0.001), respectively, were associated with increased 30-day mortality in all acute aortic dissection patients. Thrombocytopenia was associated with elevated 30-day mortality only in patients with type A (OR 3.09, 95% CI 1.53 to 6.21, p=0.002). CONCLUSIONS Nearly two-thirds of acute aortic dissection patients had type A. Levels of troponin T and platelets, respectively, paired with presence or absence of typical symptoms may become useful adjuncts in risk stratification of patients with acute aortic dissection.
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Affiliation(s)
- Christian Smedberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södersjukhuset AB, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Johnny Steuer
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södersjukhuset AB, Stockholm, Sweden
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8
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Peng H, Wang X, Zhang L, Su Y, Yan J, Wu X. Correlation of the serum cell division cycle 42 with CD4 + T cell subsets and in-hospital mortality in Stanford type B aortic dissection patients. Front Cardiovasc Med 2024; 11:1324345. [PMID: 38476381 PMCID: PMC10927740 DOI: 10.3389/fcvm.2024.1324345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
Objective Cell division cycle 42 (CDC42) regulates CD4+ T-cell differentiation and participates in vascular stiffness and atherosclerosis and is involved in the progression of Stanford type B aortic dissection (TBAD). This study aimed to explore the correlation between serum CDC42 level and CD4+ T cell subsets and in-hospital mortality in TBAD patients. Methods Serum CDC42 and peripheral blood T-helper (Th) 1, Th2, and Th17 cells were detected in 127 TBAD patients by enzyme-linked immunosorbent assay and flow cytometry, respectively. Serum CDC42 was also quantified in 30 healthy controls. Results Serum CDC42 was decreased in TBAD patients vs. healthy controls (median [interquartile range (IQR)]: 418.0 (228.0-761.0) pg/ml vs. 992.0 (716.3-1,445.8) pg/ml, P < 0.001). In TBAD patients, serum CDC42 was negatively correlated with Th17 cells (P = 0.001), but not Th1 (P = 0.130) or Th2 cells (P = 0.098). Seven (5.5%) patients experienced in-hospital mortality. Serum CDC42 was reduced in patients who experienced in-hospital mortality vs. those who did not (median (IQR): 191.0 (145.0-345.0) pg/ml vs. 451.5 (298.3-766.8) pg/ml, P = 0.006). By receiver operating characteristic analysis, serum CDC42 showed a good ability for estimating in-hospital mortality [area under curve = 0.809, 95% confidence interval (CI) = 0.662-0.956]. By the multivariate logistic regression analysis, elevated serum CDC42 [odd ratio (OR) = 0.994, 95% CI = 0.998-1.000, P = 0.043] was independently correlated with lower risk of in-hospital mortality, while higher age (OR = 1.157, 95% CI = 1.017-1.316, P = 0.027) was an independent factor for increased risk of in-hospital mortality. Conclusion Serum CDC42 negatively associates with Th17 cells and is independently correlated with decreased in-hospital mortality risk in TBAD patients.
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Affiliation(s)
- Hui Peng
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Xugang Wang
- Department of Cardiovascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Longfei Zhang
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Yang Su
- Department of Cerebrovascular Neurosurgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Jieli Yan
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Xin Wu
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
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9
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024:S0003-4975(24)00077-8. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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10
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McLatchie R, Reed MJ, Freeman N, Parker RA, Wilson S, Goodacre S, Cowan A, Boyle J, Clarke B, Clarke E. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J 2024; 41:136-144. [PMID: 37945311 DOI: 10.1136/emermed-2023-213266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The diagnosis of acute aortic syndrome (AAS) is commonly delayed or missed in the ED. We describe characteristics of ED attendances with symptoms potentially associated with AAS, diagnostic performance of clinical decision tools (CDTs) and physicians and yield of CT aorta angiogram (CTA). METHODS This was a multicentre observational cohort study of adults attending 27 UK EDs between 26 September 2022 and 30 November 2022, with potential AAS symptoms: chest, back or abdominal pain, syncope or symptoms related to malperfusion. Patients were preferably identified prospectively, but retrospective recruitment was also permitted. Anonymised, routinely collected patient data including components of CDTs, was abstracted. Clinicians treating prospectively identified patients were asked to record their perceived likelihood of AAS, prior to any confirmatory testing. Reference standard was radiological or operative confirmation of AAS. 30-day electronic patient record follow-up evaluated whether a subsequent diagnosis of AAS had been made and mortality. RESULTS 5548 patients presented, with a median age of 55 years (IQR 37-72; n=5539). 14 (0.3%; n=5353) had confirmed AAS. 10/1046 (1.0%) patients in whom the ED clinician thought AAS was possible had AAS. 5/147 (3.4%) patients in whom AAS was considered the most likely diagnosis had AAS. 2/3319 (0.06%) patients in whom AAS was considered not possible did have AAS. 540 (10%; n=5446) patients underwent CT, of which 407 were CTA (7%). 30-day follow-up did not reveal any missed AAS diagnoses. AUROC (area under the receiver operating characteristic) curve for ED clinician AAS likelihood rating was 0.958 (95% CI 0.933 to 0.983, n=4006) and for individual CDTs were: Aortic Dissection Detection Risk Score (ADD-RS) 0.674 (95% CI 0.508 to 0.839, n=4989), AORTAs 0.689 (95% CI 0.527 to 0.852, n=5132), Canadian 0.818 (95% CI 0.686 to 0.951, n=5180) and Sheffield 0.628 (95% CI 0.467 to 0.788, n=5092). CONCLUSION Only 0.3% of patients presenting with potential AAS symptoms had AAS but 7% underwent CTA. CDTs incorporating clinician gestalt appear to be most promising, but further prospective work is needed, including evaluation of the role of D-dimer. TRIAL REGISTRATION NUMBER NCT05582967; NCT05582967.
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Affiliation(s)
- Rachel McLatchie
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- Acute Care Edinburgh, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nicola Freeman
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Wilson
- Emergency Department, Wexham Park Hospital, Slough, Frimley Health NHS Foundation Trust, UK
| | - Steve Goodacre
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Alicia Cowan
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jessica Boyle
- The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Benjamin Clarke
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ellise Clarke
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
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11
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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12
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Yammine H, Briggs CS, Frederick JR, Stanley G, Crespo Soto H, Nussbaum T, Madjarov JM, Arko FR. Disparities in Outcomes Between Sexes in Type B Aortic Dissection Patients Treated with TEVAR. Ann Vasc Surg 2024; 99:223-232. [PMID: 37797834 DOI: 10.1016/j.avsg.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND To evaluate differences in presentation and outcomes between sexes in patients who underwent thoracic endovascular aortic repair for type B aortic dissection (TBAD). METHODS Between January 1, 2012 and January 1, 2017 186 patients underwent thoracic endovascular aortic repair for TBAD at a single institution. Men (n = 112) and women (n = 74) were compared based on presenting demographics, comorbidities, and postoperative complications. Primary outcomes were survival and need for reintervention. RESULTS Women were older (P = 0.04) and had a lower body mass index (P = 0.03). More women (F) presented with continued pain or refractory hypertension (51.0% F, 30.0% M), while more men (M) presented with acute complicated dissections (19.0% F, 39.0% M) (P = 0.008). At presentation, women had statistically higher relative rates of chronic obstructive pulmonary disease (P = 0.05), hyperlipidemia (P = 0.03), and smoking (P = 0.03). Significantly more women were on Medicare without Medicaid (55.0% F, 34.0% M), while men had private insurance (35.0% F, 13.0% M) (P = 0.005). There was no significant difference in blood pressure control at presentation, discharge, or at 30 days. When normalized by body surface area, women had larger ascending aortic diameters (19.2(3.10)F, 17.5(2.40)M, P = 0.0002), as well as proportionally larger true lumens at the left subclavian artery (14.9(2.90)F, 13.4(2.50)M, P = 0.0002), carina (12.6(5.80)F, 9.90(4.80)M, P = 0.0009), and celiac (10.5(4.50)F, 8.50(4.10)M, P = 0.006) levels, and at the largest point of dissection (11.6(6.50)F, 9.60(4.80)M, P = 0.04), as well as proportionately smaller false lumens at the carina (5.90(5.60)F, 9.30(6.10)M, P = 0.003). Despite not being statistically significant, women had lower rates of stroke (6.80% F, 8.00% M, P = 0.7) and acute kidney injury (5.40% F, 11.6% M, P = 0.2), as well fewer days in the intensive care unit (ICU) (3.20(4.30)F, 4.60(6.60)M, P = 0.2) and an overall shorter length of stay (6.80(6.70)F, 8.00(8.20)M, P = 0.5). Kaplan-Meier estimates for survival for women versus men were 96.0% vs. 92.0%, 90.0% vs. 79.0%, and 70.0% vs. 69.0% at 30 days, 1 year, and 3 years, respectively (P = 0.042). Kaplan-Meier estimates for freedom from reintervention for women versus men were 89.0% vs. 90.0%, 58.0% vs. 72.0%, and 48.0% vs. 58.0% at 30 days, 1 year, and 3 years, respectively (P = 0.13). CONCLUSIONS Women present with TBAD at an older age, have more comorbidities, lower socioeconomic status, and have larger ascending aortic diameters for their size. Despite having less severe dissections as evidenced by smaller false lumens and wider true lumens, it does not appear that this correlates with improved outcomes for women when compared to men. It appears that this is one of the few, if not only, aortic pathologies that result in comparable outcomes between sexes.
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Affiliation(s)
- Halim Yammine
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC.
| | - Charles S Briggs
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | - John R Frederick
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | - Gregory Stanley
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | | | - Tzvi Nussbaum
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | - Jeko M Madjarov
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | - Frank R Arko
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
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13
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Tuffley RH, Qayyum AA. Multiple spontaneous isolated arterial dissections: a rare case report. Am J Transl Res 2024; 16:356-362. [PMID: 38322547 PMCID: PMC10839373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/12/2023] [Indexed: 02/08/2024]
Abstract
Spontaneous dissections in multiple arteries are a rare condition with clinical presentation varying from asymptomatic conditions to sudden death. We present a rare case where a routine thoracic computed tomography (CT) scan showed a type B aortic dissection. Medical records showed that the patient previously had been diagnosed with bilateral spontaneous isolated internal carotid artery dissections, which caused an attack of amaurosis fugax a few months earlier. The patient was asymptomatic during the admission with type B aortic dissection. However, the patient had a high blood pressure which was medically treated. A new CT scan confirmed earlier findings and revealed a spontaneous isolated dissection in the superior mesenteric artery. No progression was seen when the scan was compared to a new CT scan performed 10 days later. The type B aortic dissection was considered to be chronic and stable with no need for vascular intervention. This case report illustrates a rare condition of four isolated arterial dissections. The present case demonstrates the necessity of further examinations, which should be considered carefully when a patient presents with several independent arterial dissections.
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Affiliation(s)
- Rebecca Hvidt Tuffley
- Department of Cardiology, Hvidovre Hospital, University of CopenhagenCopenhagen, Denmark
| | - Abbas Ali Qayyum
- Department of Cardiology, Hvidovre Hospital, University of CopenhagenCopenhagen, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of CopenhagenCopenhagen, Denmark
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14
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Vilacosta I, Ferrera C, San Román A. [Acute aortic syndrome]. Med Clin (Barc) 2024; 162:22-28. [PMID: 37640592 DOI: 10.1016/j.medcli.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
Acute aortic syndrome embraces a group of heterogenous pathological entities involving the aortic wall with a common clinical profile. The current epidemiology, clinical presentation, diagnosis and treatment strategy are discussed in this review. Besides, the importance of multidisciplinary aortic teams, aortic centers and the implementation of an aortic code are emphasized.
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Affiliation(s)
- Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España.
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España
| | - Alberto San Román
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario de Valladolid, Valladolid, España
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15
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Nienaber CA, Yuan X. Commentary: The X and Y of zero gender gap in outcomes of aortic dissection. J Thorac Cardiovasc Surg 2024; 167:86-88. [PMID: 35337675 DOI: 10.1016/j.jtcvs.2022.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust; and Department of Cardiology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.
| | - Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust; and Department of Cardiology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
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16
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Chen Y, Wang L, Xu X, Li K, Sun Y, Wang Y, Wang DW. Genetic architecture of thoracic aortic dissection in the female population. Gene 2023; 887:147727. [PMID: 37625564 DOI: 10.1016/j.gene.2023.147727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Sex-related differences in cardiovascular disease are now gaining much more attention and their importance is increasingly being recognized, but little is known about the genetic distribution, genotype-phenotype correlation, and outcomes in the female population with thoracic aortic dissection (TAD). METHODS One hundred seventy-nine Chinese female probands with TAD were enrolled from Tongji Hospital between October 2009 and October 2020. Genetic analysis was performed among 12 genes, and participants were subsequently followed up for a median of 38.2 months for TAD-related death. RESULTS We identified 18 pathogenic or likely pathogenic variants among 18 (10.1%) probands and 21 variants of uncertain significance in 21 (11.7%) patients. Individuals with positive variants presented with a significant risk of TAD (OR: 12.0, 95% CI: 5.87-26.8), and an association between FBN1 (p = 2.60E-11, OR = 19.8), MYLK (p = 0.006, OR = 14.0) variants and an increased risk for female TAD was identified as well. Furthermore, nearly half of the variants were found in the FBN1 gene, which was significantly linked to early aortic dissection and tended to cause death at a young age. CONCLUSION This study revealed the monogenic contribution of known TAD genes to the female TAD population with East Asian ancestry. Patients who tested positive for FBN1 were significantly younger at the time of aortic dissection and had a higher probability of dying at an early age.
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Affiliation(s)
- Yanghui Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, PR China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan 430000, PR China
| | - Linlin Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, PR China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan 430000, PR China
| | - Xin Xu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, PR China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan 430000, PR China
| | - Ke Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, PR China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan 430000, PR China
| | - Yang Sun
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, PR China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan 430000, PR China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, PR China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan 430000, PR China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, PR China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Wuhan 430000, PR China.
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17
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Tao Y, Li G, Yang Y, Wang Z, Wang S, Li X, Yu T, Fu X. Epigenomics in aortic dissection: From mechanism to therapeutics. Life Sci 2023; 335:122249. [PMID: 37940070 DOI: 10.1016/j.lfs.2023.122249] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Aortic dissection (AD) has an unfavorable prognosis. It requires early diagnosis, appropriate treatment strategies, and suspicion to recognize symptoms; thus, it is commonly described as an acute aortic emergency. The clinical manifestations of painless AD are complex and variable. However, there is no effective treatment to prevent the progression of AD. Therefore, study of the molecular targets and mechanisms of AD to enable prevention or early intervention is particularly important. Although multiple gene mutations have been proposed as linked to AD development, evidence that multiple epigenetic elements are strongly associated is steadily increasing. These epigenetic processes include DNA methylation, N6-methyladenosine, histone modification, non-histone posttranslational modification, and non-coding RNAs (ncRNAs). Among these processes, resveratrol targeting Sirtuin 1 (SIRT1), 5-azacytidine (5azaC) targeting DNA methyltransferase (DNMT), and vitamin C targeting ten-eleven translocation 2 (Tet2) showed unique advantages in improving AD and vascular dysfunction. Finally, we explored potential epigenetic drugs and diagnostic methods for AD, which might provide options for the future.
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Affiliation(s)
- Yan Tao
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, People's Republic of China
| | - Gang Li
- Department of Vascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, Shandong 250021, China; Department of Vascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwu Road, Jinan, Shandong 250021, People's Republic of China
| | - Yanyan Yang
- Department of Immunology, Basic Medicine School, Qingdao University, No. 308 Ningxia Road, Qingdao 266071, People's Republic of China
| | - Zhibin Wang
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, People's Republic of China
| | - Shizhong Wang
- The department of Cardiology surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, People's Republic of China
| | - Xiaolu Li
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, People's Republic of China
| | - Tao Yu
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, People's Republic of China; Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, Qingdao 266021, People's Republic of China.
| | - Xiuxiu Fu
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, People's Republic of China.
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Filiberto AC, Ramadan OI, Wang GJ, Cooper MA. Sex disparities in patients with acute aortic dissection: A scoping review. Semin Vasc Surg 2023; 36:492-500. [PMID: 38030323 DOI: 10.1053/j.semvascsurg.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 12/01/2023]
Abstract
Disparities in outcomes for patients with cardiovascular disease and those undergoing cardiac or vascular operations are well-established. These disparities often span several dimensions and persist despite advancements in medical and surgical care; sex is among the most pervasive. Specifically, females sex has been implicated as a predictor of poor outcomes in both patients with acute type A aortic dissections (ATAADs) and type B aortic dissections (TBADs). For instance, one study, using the International Registry of Acute Aortic Dissection database, found that females with acute aortic dissection-including ATAAD and TBAD that were either medically or surgically managed-had 40% higher odds of in-hospital mortality than men. Notably, both types of acute aortic dissections affect men more commonly than females and can be life-threatening without prompt, appropriate treatment. The underlying mechanisms for these disparities are unclear but are thought to be multifactorial. The association of sex with patterns of disease and outcomes in patients with ATAAD or TBAD remains unclear, with conflicting reports from different studies. Thus, we sought to review the literature regarding sex disparities in patients with ATAAD and TBAD.
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Affiliation(s)
- Amanda C Filiberto
- Department of Surgery, Division of Vascular Surgery, 1329 SW 16th St., University of Florida, Gainesville, FL, 32610
| | - Omar I Ramadan
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Grace J Wang
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Michol A Cooper
- Department of Surgery, Division of Vascular Surgery, 1329 SW 16th St., University of Florida, Gainesville, FL, 32610.
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Meccanici F, Bom A, Knol W, Gökalp A, Thijssen C, Bekkers J, Geuzebroek G, Mokhles M, van Kimmenade R, Budde R, Takkenberg J, Roos-Hesselink J. Male-female differences in thoracic aortic diameters at presentation of acute type A aortic dissection. IJC HEART & VASCULATURE 2023; 49:101290. [PMID: 37942298 PMCID: PMC10628350 DOI: 10.1016/j.ijcha.2023.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023]
Abstract
Background Acute type A aortic dissection (ATAAD) is a highly lethal event, associated with aortic dilatation. It is not well known if patient height, weight or sex impact the thoracic aortic diameter (TAA) at ATAAD. The study aim was to identify male-female differences in TAA at ATAAD presentation. Methods This retrospective cross-sectional study analysed all adult patients who presented with ATAAD between 2007 and 2017 in two tertiary care centres and underwent contrast enhanced computed tomography (CTA) before surgery. Absolute aortic diameters were measured at the sinus of Valsalva (SoV), ascending (AA) and descending thoracic aorta (DA) using double oblique reconstruction, and indexed for body surface area (ASI) and height (AHI). Z-scores were calculated using the Campens formula. Results In total, 59 % (181/308) of ATAAD patients had CT-scans eligible for measurements, with 82 female and 99 male patients. Females were significantly older than males (65.5 ± 12.4 years versus 60.3 ± 2.3, p = 0.024). Female patients had larger absolute AA diameters than male patients (51.0 mm [47.0-57.0] versus 49.0 mm [45.0-53.0], p = 0.023), and larger ASI and AHI at all three levels. Z-scores for the SoV and AA were significantly higher for female patients (2.99 ± 1.66 versus 1.34 ± 1.77, p < 0.001 and 5.27 [4.38-6.26] versus 4.06 [3.14-5.02], p < 0.001). After adjustment for important clinical factors, female sex remained associated with greater maximal TAA (p = 0.019). Conclusion Female ATAAD patients had larger absolute ascending aortic diameters than males, implying a distinct timing in disease presentation or selection bias. Translational studies on the aortic wall and studies on growth patterns should further elucidate these sex differences.
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Affiliation(s)
- F. Meccanici
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - A.W. Bom
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - W.G. Knol
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - A.L. Gökalp
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - C.G.E. Thijssen
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - J.A. Bekkers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - G.S.C. Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - M.M. Mokhles
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Utrecht University Medical Centre, Utrecht, Netherlands
| | - R.R.J. van Kimmenade
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - R.P.J. Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - J.J.M. Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - J.W. Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
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20
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Zhang Y, Wang Y, Chen J, Li J, Sun Y, Lai H, Wang C, Ji Q. No Sex-Based Differences Exist in Clinical Outcomes of Extended Aortic Arch Repair for Acute Type A Aortic Dissection. Can J Cardiol 2023; 39:1675-1685. [PMID: 37480989 DOI: 10.1016/j.cjca.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Reports regarding the association between sex and clinical outcomes after surgical repair of acute type A aortic dissection (ATAAD) are not exhaustive and in part even conflicting. METHODS A total of 786 eligible adult patients with ATAAD undergoing extended arch repair from January 2015 to December 2021 were included. They were divided into a female group (n = 161) and a male group (n = 625). In-hospital outcomes (surgical mortality and major postoperative morbidity) and midterm outcomes (survival and aortic reintervention) between the 2 groups were compared before and after propensity score matching (1:1). RESULTS Compared with male patients, female patients were more likely to be older (median [interquartile range]: 57 [46-67] vs 50 [42-59] years; P < 0.001) and to have a lower body mass index, but were less likely to be current smokers. Operative death occurred in 66 patients (6.8% female vs 8.8% male), without significant differences between groups before and after matching (P = 0.422 and P > 0.999, respectively). Major postoperative morbidity was observed in 313 patients (39.8%), including 57 (35.4%) female and 256 (41.0%) male patients (P = 0.199). Sex-based grouping was not significantly associated with operative mortality or major postoperative morbidity. The 5-year cumulative survival and incidence of aortic reintervention among female patients were 90.6% and 6.0%, respectively, which were not statistically different from those observed in male patients before and after matching. CONCLUSIONS No sex-based differences were found in terms of in-hospital and midterm outcomes of extended arch repair for ATAAD.
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Affiliation(s)
- Yixiao Zhang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Yulin Wang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Jinmiao Chen
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Yongxin Sun
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Municipal Institute for Cardiovascular Diseases, Shanghai, China.
| | - Qiang Ji
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China.
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21
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Murana G, Gliozzi G, Rucci P, Votano D, Orioli V, Rosa S, Folesani G, Buia F, Lovato L, Pacini D. Survival and reoperation in acute aortic syndromes-a single-centre experience of 912 patients. Eur J Cardiothorac Surg 2023; 64:ezad350. [PMID: 37878821 PMCID: PMC10722879 DOI: 10.1093/ejcts/ezad350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/21/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES Acute aortic syndromes are associated with poor outcomes, despite diagnostic and therapeutic advances. We analysed trends in volumes and outcomes from 2000 to 2021. METHODS The study population includes 494 type A acute aortic syndromes (TAAAS) (54.2%) and 418 type B acute aortic syndromes (TBAAS) (45.8%). Primary outcomes were in-hospital mortality, long-term survival and freedom from aortic reoperation. RESULTS Regardless the type of acute aortic syndrome, patient volumes increased over time. Patients with TBAAS were older, more likely to have comorbid conditions and previous cardiac surgery (P < 0.001), while cerebrovascular accidents were more frequent in TAAAS (P < 0.05). Among TAAAS, 143 (28.9%) required total arch and 351 (71.1%) hemiarch replacement. TBAAS management was medical therapy in 182 (43.5%), endovascular in 198 (47.4%) and surgical in 38 (9.1%) cases. Overall in-hospital mortality was 14.6% [18.2% in TAAAS (95% confidence interval (CI) 14.4-21.2%) vs 10.7% in TBAAS (95% CI 7.8%-13.7%); P = 0.0027]. After propensity score adjustment, in-hospital mortality exhibited a significantly decreasing trend from 2000 to 2021 (P < 0.001) in TAAAS and TBAAS. 1-, 5- and 10-year survival was 74.2%, 62.2% and 45.5% in TAAAS and 75.4%, 60.7% and 41.0% in TBAAS (P = 0.975), with no differences among treatment strategies. The adjusted cumulative reoperation risk at 10 years was more than two-fold in TBAAS versus TAAAS (9.5% vs 20.5%, hazard ratio (HR) = 2.30, 95% I 1.31-4.04). CONCLUSIONS In the last decades, better patient triage and surgical/endovascular techniques led to substantial improvements in the management of acute aortic syndrome, with reduction in early mortality and reoperation rate. However, long-term mortality is still >50%.
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Affiliation(s)
- Giacomo Murana
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Daniela Votano
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Orioli
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gianluca Folesani
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Buia
- Cardiovascular Radiology Unit, Cardio-Thoraco-Vascular Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Lovato
- Cardiovascular Radiology Unit, Cardio-Thoraco-Vascular Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Wang Z, Xue Y, Qian S, Liu Y, Zhu J, Sun L, Zhang H, Li H. Differences between sexes in patients who underwent total arch replacement and frozen elephant trunk procedures for acute dissection. Perfusion 2023; 38:1478-1491. [PMID: 35941723 DOI: 10.1177/02676591221118322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the effect of sex on the short-time prognosis in two different age subgroups (≤55 years old and >55 years old). METHODS From January 2009 to 2019, 1522 patients with DeBakey I acute aortic dissection (AAD) underwent frozen elephant trunk and total arch replacement at a Tertiary Center in China were divided into female group (n = 324) and male group (n = 1198). The demographic characteristics, clinical presentation, management, short-term outcomes were described in the different sex groups. The risk factors of 30-days mortality for females and males were identified by univariate and multivariable logistic regression analysis. Then, random Forest regression was used to analyze the association between age and 30-days mortality in the different sexes groups. The cut-off age for 30-days mortality in females was then identified as 55 years. The patients were divided into two subgroups: young patients (≤55 years old) and elderly patients (>55 years old). Clinical prognosis between different sex groups was further compared in the age subgroups. RESULTS Approximately four-fifths of the patients were males. Males with DeBakey I AAD were younger than females (47 vs 52 years; p < 0.01). The proportion of males gradually declined with age. The cut-off age for 30-days mortality in females and males was identified as 55 years old and 63 years old, respectively. In young patients (≤55 years old), the 30-days mortality rate for females was lower than males (hazard ratio [HR, 2.02, p < 0.05). Following adjustment using the multivariable Cox regression analysis, females were identified as an independent protective factor for 30-days mortality (HR, 2.24, p = 0.03). CONCLUSIONS Our study showed that females present with DeBakey I AAD less frequently than males and they tend to present with DeBakey AAD later in life. In young patients, females had better early outcomes despite similar time for symptom onset to diagnosis and surgical technique than males.
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Affiliation(s)
- Zeling Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuan Xue
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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23
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Zhang J, Gao S. Clinical analysis of 908 patients with aortic dissection under different Stanford types: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35219. [PMID: 37713852 PMCID: PMC10508451 DOI: 10.1097/md.0000000000035219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
This study aims to investigate the difference of clinical characteristics and risk factors in aortic dissection (AD) of patients with 2 Stanford subtypes. A retrospective analysis was conducted on 908 patients admitted to Tongji Hospital from July 2019 to January 2021, and the aortic computed tomography angiography was used to clearly diagnose the artery dissection. Patient basic information as well as blood test indicators containing leukocytes, neutrophils, lymphocytes, hemoglobin, myoglobin, hypersensitive cardiac troponin, γ-glutamyl transferase, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, ultrasensitive C-reactive protein, glucose were recorded and analyzed. There was no significant difference in gender, heart rate, smoking history, hypertension history and diabetes history between the 2 groups (P > .05), however, compared with type A patients, type B patients were older, and had a significantly higher frequency of alcohol consumption (P < .05); On laboratory tests, type A patients had significantly higher mean leukocytes and neutrophils (P < .05), and significantly lower frequency of reduced hemoglobin than type B patients (P < .05), although there was no statistical difference in lymphocyte, γ-glutamyl transferase, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein and glucose counts between the 2 groups. Additionally, type A patients had a significantly higher number of abnormal myoglobin, hypersensitive cardiac troponin and ultrasensitive C-reactive protein test results than type B patients (P < .05). The receiver operating characteristic curve analysis showed that the area under the curve for each parameter was 0.605 (0.538-0.673) for hemoglobin, 0.610 (0.543-0.677) for leukocytes and 0.627 (0.561-0.693) for neutrophils. Understanding the relevant clinical indicators and risk factors of patients with different types of AD can provide a new perspective to assist the classification and diagnosis of AD and a basis for effective and rational treatment.
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Affiliation(s)
- Jinhua Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sikang Gao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Crousillat D, Briller J, Aggarwal N, Cho L, Coutinho T, Harrington C, Isselbacher E, Lindley K, Ouzounian M, Preventza O, Sharma J, Sweis R, Russo M, Scott N, Narula N. Sex Differences in Thoracic Aortic Disease and Dissection: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:817-827. [PMID: 37612014 DOI: 10.1016/j.jacc.2023.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/05/2023] [Accepted: 05/17/2023] [Indexed: 08/25/2023]
Abstract
Despite its higher prevalence among men, women with thoracic aortic aneurysm and dissection (TAAD) have lower rates of treatment and surgical intervention and often have worse outcomes. A growing number of women with TAAD also desire pregnancy, which can be associated with an increased risk of aortic complications. Understanding sex-specific differences in TAAD has the potential to improve care delivery, reduce disparities in treatment, and optimize outcomes for women with TAAD.
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Affiliation(s)
- Daniela Crousillat
- Division of Cardiovascular Sciences, Department of Medicine and Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
| | - Joan Briller
- Division of Cardiology, Department of Medicine, University Illinois at Chicago, Chicago, Illinois, USA
| | - Niti Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Leslie Cho
- Department of Cardiovascular Medicine, Heart, Vascular Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thais Coutinho
- Division of Cardiology, Division of Cardiac Prevention and Rehabilitation, Canadian Women's Heart Health Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Colleen Harrington
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Isselbacher
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn Lindley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maral Ouzounian
- Peter Munk Cardiac Centre, Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ourania Preventza
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA; Cardiothoracic Surgery, University of Virginia Health, Charlottesville, Virginia, USA
| | - Jyoti Sharma
- Piedmont Heart Institute, Department of Cardiology, Atlanta, Georgia, USA
| | - Ranya Sweis
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Russo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nandita Scott
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nupoor Narula
- Division of Cardiology and Weill Cornell Women's Heart Program, Weill Cornell Medicine, New York, New York, USA
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Higo Y, Sawayama Y, Takashima N, Harada A, Yano Y, Yamamoto T, Shioyama W, Fujii T, Tanaka-Mizuno S, Kita Y, Miura K, Nozaki K, Suzuki T, Nakagawa Y. Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan - Shiga Stroke and Heart Attack Registry. Circ J 2023; 87:1155-1161. [PMID: 37211402 DOI: 10.1253/circj.cj-22-0758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Acute aortic dissection (AAD) is a life-threatening cardiovascular disease, with a reported incidence rate ranging from 2.5 to 7.2 per 100,000 person-years in several population-based registries in Western countries, but epidemiological data are lacking in Japan.Methods and Results: The Shiga Stroke and Heart Attack Registry is an ongoing multicenter population-based registry of cerebro-cardiovascular diseases. We enrolled patients who developed AAD, defined by any imaging examination method from 2014 to 2015 in Shiga Prefecture. Death certificates were used to identify cases that were not registered at acute care hospitals. The incidence rates of AAD were calculated by age categories and adjusted using standard populations for comparison. We evaluated differences in patient characteristics between Stanford type A-AAD and type B-AAD subtypes. A total of 402 incident cases with AAD were analyzed. The age-adjusted incidence rates using the 2015 Japanese population and the 2013 European Standard Population were 15.8 and 12.2 per 100,000 person-years, respectively. Compared with cases of type B-AAD, those with type A-AAD were older (75.0 vs. 69.9 years, P=0.001) and more likely to be women (62.3% vs. 28.6%, P<0.001). CONCLUSIONS Population-based incidence rates of AAD in Japan appear to be higher than in previous reports from Western countries. Incident cases with type A-AAD were older and female predominance.
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Affiliation(s)
- Yosuke Higo
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Yuichi Sawayama
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Naoyuki Takashima
- NCD Epidemiology Research Center, Shiga University of Medical Science
- Department of Public Health, Kindai University Faculty of Medicine
| | - Akiko Harada
- NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Yuichiro Yano
- NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Takashi Yamamoto
- Department of Cardiovascular Medicine, Shiga University of Medical Science
- Department of Cardiovascular Medicine, Kohka Public Hospital
| | - Wataru Shioyama
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Takako Fujii
- NCD Epidemiology Research Center, Shiga University of Medical Science
- Department of Nursing, Meio University
| | - Sachiko Tanaka-Mizuno
- NCD Epidemiology Research Center, Shiga University of Medical Science
- Department of Digital Health and Epidemiology, Kyoto University
| | - Yoshikuni Kita
- NCD Epidemiology Research Center, Shiga University of Medical Science
- Faculty of Nursing Science, Tsuruga Nursing University
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science
- Department of Public Health, Shiga University of Medical Science
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
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Carbone A, Ranieri B, Castaldo R, Franzese M, Rega S, Cittadini A, Czerny M, Bossone E. Sex differences in type A acute aortic dissection: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:1074-1089. [PMID: 36629802 DOI: 10.1093/eurjpc/zwad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND In acute aortic dissection (AAD) sex heterogeneity reports are not exhaustive and in part even conflicting. AIMS To explore sex differences in clinical features, management, and outcomes among patients with type A AAD. METHODS AND RESULTS A systematic review and meta-analysis of the literature were conducted for studies (2004-2022) reporting type A AAD sex differences. Among the 1938 studies retrieved, 16 (16 069 patients, 7142 women, and 8927 men) fulfilled all eligibility criteria. Data were aggregated used the random-effects model as pooled risk ratio and mean difference. Due to information reported by considered manuscripts, analysis were performed only among surgically treated type A AAD patients. At the time of hospital presentation type A AAD women were older than men but had lower body mass index (BMI), body surface area (BSA), and creatinine plasma levels. Active smoking, bicuspid aortic valve, and previous cardiac surgery were less common in women while diabetes mellitus was more frequent. Furthermore, women experienced more frequently pericardial effusion/cardiac tamponade than men. Interestingly, in-hospital surgical mortality did not differ between sexes [risk ratio (RR), 1.02; 95% confidence interval (CI), 0.53-1.99; P = 0.95], whereas 5 (RR 0.94; 95% CI: 0.92-0.97; P < 0.001) and 10-year survival (RR 0.82; 95% CI: 0.74-0.92; P = 0.004) was higher among men. A descriptive analysis of in-hospital outcomes among medically treated type A AAD patients confirmed prohibitive high mortality for both sexes (men 58.6% vs. women 53.8%, P = 0.59). CONCLUSIONS A female sex phenotype appears to be evident in type A AAD implying the need for a personalized management patient approach along with tailored preventive strategies. PROSPERO REGISTRY ID CRD42022359072.
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Affiliation(s)
- Andreina Carbone
- Unit of Cardiology, University of Campania 'Luigi Vanvitelli', Naples 80138, Italy
| | - Brigida Ranieri
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113, Naples 80143, Italy
| | - Rossana Castaldo
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113, Naples 80143, Italy
| | - Monica Franzese
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113, Naples 80143, Italy
| | - Salvatore Rega
- Department of Public Health, University of Naples 'Federico II', Via Pansini, 5, Naples 80131, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University of Naples 'Federico II', Via S Pansini, 5, Naples 80131, Italy
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples 80131, Italy
| | - Martin Czerny
- University Heart Center Freiburg Bad Krozingen, University Hospital Freiburg, Südring, 15, Bad Krozingen 79189, Germany
- Faculty of Medicine, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Eduardo Bossone
- Department of Public Health, University of Naples 'Federico II', Via Pansini, 5, Naples 80131, Italy
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Xu W, Haran C, Dean A, Lim E, Bernau O, Mani K, Khanafer A, Pitama S, Khashram M. Acute aortic syndrome: nationwide study of epidemiology, management, and outcomes. Br J Surg 2023; 110:1197-1205. [PMID: 37303206 PMCID: PMC10416687 DOI: 10.1093/bjs/znad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/03/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Epidemiological studies on acute aortic syndrome (AAS) have relied largely on unverified administrative coding, leading to wide-ranging estimates of incidence. This study aimed to evaluate the incidence, management, and outcomes of AAS in Aotearoa New Zealand. METHODS This was a national population-based retrospective study of patients presenting with an index admission of AAS from 2010 to 2020. Cases from the Ministry of Health National Minimum Dataset, National Mortality Collection, and the Australasian Vascular Audit were cross-verified with hospital notes. Poisson regression adjusted for sex and age was used to investigate trends over time. RESULTS During the study interval, 1295 patients presented to hospital with confirmed AAS, including 790 with type A (61.0 per cent) and 505 with type B (39.0 per cent) AAS. A total of 290 patients died out of hospital between 2010 and 2018. The overall incidence of aortic dissection including out-of-hospital cases was 3.13 (95 per cent c.i. 2.96 to 3.30) per 100 000 person-years, and this increased by an average of 3 (95 per cent c.i. 1 to 6) per cent per year after adjustment for age and sex adjustment on Poisson regression, driven by increasing type A cases. Age-standardized rates of disease were higher in men, and in Māori and Pacific populations. The management strategies used, and 30-day mortality rates among patients with type A (31.9 per cent) and B (9.7 per cent) disease have remained constant over time. CONCLUSION Mortality after AAS remains high despite advances over the past decade. The disease incidence and burden are likely to continue to increase with an ageing population. There is impetus now for further work on disease prevention and the reduction of ethnic disparities.
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Affiliation(s)
- William Xu
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cheyaanthan Haran
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Anastasia Dean
- Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Eric Lim
- Department of Vascular Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Oliver Bernau
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Adib Khanafer
- Department of Vascular Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Habib M, Lindström D, Lilly JB, D'Oria M, Wanhainen A, Khashram M, Dean A, Mani K. Descending thoracic aortic emergencies: Past, present, and future. Semin Vasc Surg 2023; 36:139-149. [PMID: 37330228 DOI: 10.1053/j.semvascsurg.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
The most important descending thoracic aortic (DTA) pathologies are aneurysms, dissections, and traumatic injuries. In acute settings, these conditions can constitute a significant risk of bleeding or ischemia of vital organs, resulting in a fatal outcome. Morbidity and mortality associated with aortic pathologies remain significant, despite improvements in medical therapy and endovascular techniques. In this narrative review, we present an overview of the transitions in the management of these pathologies and discuss current challenges and future perspectives. Diagnostic challenges include differentiating between thoracic aortic pathologies and cardiac diseases. Efforts have been made to identify a blood test that can rapidly differentiate these pathologies. Computed tomography is the cornerstone of diagnosing thoracic aortic emergencies. Our understanding of DTA pathologies has improved substantially due to the significant advancement in imaging modalities in the last 2 decades. On the basis of this understanding, the treatment of these pathologies has been revolutionized. Unfortunately, robust evidence from prospective and randomized studies is still lacking for the management of most DTA diseases. Medical management plays a crucial role in achieving early stability during these life-threatening emergencies. This includes intensive care monitoring, heart rate and blood pressure control, and considering permissive hypotension for patients presenting with ruptured aneurysms. Over the years, surgical management of DTA pathologies changed from open repair to endovascular repair with dedicated stent-grafts. Techniques in both spectrums have improved substantially.
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Affiliation(s)
- Mohammed Habib
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, 75185, Sweden
| | - David Lindström
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, 75185, Sweden
| | - Jacob Budtz Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, 75185, Sweden
| | - Manar Khashram
- Department of Vascular and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Anastasia Dean
- Department of Surgery, University of Auckland, Auckland, New Zealand; Department of Vascular Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, 75185, Sweden.
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29
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Chang CYY, Wu CF, Muo CH, Chang SS, Chen PC. Sex Differences in Temporal Trends and Risk Factors of Aortic Dissection in Taiwan. J Am Heart Assoc 2023; 12:e027833. [PMID: 36846990 PMCID: PMC10111447 DOI: 10.1161/jaha.122.027833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Although sex differences in the epidemiological features of aortic dissection (AD) are known, whether there were sex differences in the associations of comorbidities and risk factors with AD is unclear. We evaluated the temporal trends and risk factors of AD by sex. Methods and Results Using claims data from a universal health insurance program linked to the National Death Registry in Taiwan, we identified 16 368 men and 7052 women with newly diagnosed AD from 2005 to 2018. In the case-control analysis, a matched control group without AD was selected for men and women separately. Conditional logistic regression was used to evaluate risk factors of AD and sex differences. Over the 14 years, the annual incidence of diagnosed AD was 12.69 and 5.34 per 100 000 in men and women, respectively. The 30-day mortality was greater in women than in men (18.1% versus 14.1%; adjusted odds ratio [95% CI], 1.19 [1.10-1.29]), and the sex difference was observed mainly in patients not treated with surgery. The 30-day mortality declined over time in male patients undergoing surgical treatments, but no significantly temporal change was found in other patient groups stratified by sex and surgery. After multivariable adjustments, atrial fibrillation, chronic kidney disease, and coronary artery bypass graft surgery were associated with a greater increase in the odds of AD occurrence in women than in men. Conclusions Greater 30-day mortality and stronger associations of atrial fibrillation, chronic kidney disease, and coronary artery bypass graft surgery with AD in women than in men require further attention.
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Affiliation(s)
- Cherry Yin-Yi Chang
- Department of Obstetrics and Gynaecology China Medical University Hospital Taichung Taiwan.,Department of Medicine, School of Medicine China Medical University Taichung Taiwan
| | - Ching-Feng Wu
- Department of Surgery China Medical University Hospital Taichung Taiwan
| | - Chih-Hsin Muo
- Department of Public Health China Medical University Taichung Taiwan
| | - Shih-Sheng Chang
- Division of Cardiovascular Medicine China Medical University Hospital Taichung Taiwan.,School of Medicine, College of Medicine China Medical University Taichung Taiwan
| | - Pei-Chun Chen
- Department of Public Health China Medical University Taichung Taiwan
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30
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Booth K. Acute aortic dissection (AAD) - a lethal disease: the epidemiology, pathophysiology and natural history. THE BRITISH JOURNAL OF CARDIOLOGY 2023; 30:9. [PMID: 37705834 PMCID: PMC10495757 DOI: 10.5837/bjc.2023.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Aortic dissection is a life-threatening condition that is often under-recognised. In the first in a series of articles about the condition, the epidemiology, pathology, classification and clinical presentation of aortic dissection are discussed.
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Affiliation(s)
- Karen Booth
- Aortic and Cardiothoracic Transplant Surgeon Freeman Hospital, Freeman Road, Newcastle, NE7 7DN
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31
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Bhatt N, Chung JCY. Gender differences in acute aortic syndromes. Curr Opin Cardiol 2023; 38:75-81. [PMID: 36718617 DOI: 10.1097/hco.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Acute aortic syndromes include acute aortic dissection, intramural hematoma, and penetrating aortic ulcer, and are associated with high mortality and morbidity. This review focuses on recent findings and current understanding of gender-related and sex-related differences in acute aortic syndromes. RECENT FINDINGS Large international and national registries, population studies, and multicentre national prospective cohort studies show evidence of sex differences in acute aortic syndromes. Recent studies of risk factors, aorta remodelling, and genetics provide possible biological basis for sex differences. The 2022 American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Management of Aortic Disease revise recommendations for surgical management for aortic root and ascending aorta dilatation, which could impact outcome differences between the sexes. SUMMARY Acute aortic syndromes affect men more frequently than women. The prevalence of acute aortic syndromes and prevalence of many risk factors rise sharply with age in women leading to higher age at presentation for women. Times from symptom onset to presentation and presentation to diagnosis are delayed in female patients. Females with type A dissection are also more commonly treated conservatively than male counterparts. These factors likely contribute to higher early mortality and complications in women.
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32
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Meccanici F, de Bruijn JWC, Dommisse JS, Takkenberg JJM, van den Bosch AE, Roos-Hesselink JW. Prevalence and development of aortic dilation and dissection in women with Turner syndrome: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2023; 21:133-144. [PMID: 36688313 DOI: 10.1080/14779072.2023.2172403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Women with Turner syndrome (TS) have an increased risk of aortic disease, reducing life-expectancy. This study aimed to systematically review the prevalence of thoracic aortic dilatation, aortic dimensions and growth, and the incidence of aortic dissection. METHODS A systematic literature search was conducted up to July 2022. Observational studies with an adult TS population were included, and studies including children aged <15 years old or specific TS populations were excluded. RESULTS In total 21 studies were included. The pooled prevalence of ascending aortic dilatation was 23% (95% CI 19-26) at a mean pooled age of 29 years (95% CI 26-32), while the incidence of aortic dissection was 164 per 100.000 patient-years (95% CI 95-284). Three reporting studies showed aortic growth over time to be limited. Risk factors for aortic dilation or dissection were older age, bicuspid aortic valve, aortic coarctation, and hypertension. CONCLUSION In adult TS women, ascending aortic dilatation is common and the hazard of aortic dissection increased compared to the general population, whereas aortic growth is limited. Conventional risk markers do not explain all aortic dissection cases; therefore, new imaging parameters and blood biomarkers are needed to improve prediction, allowing for patient-tailored follow-up and surgical decision-making.
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Affiliation(s)
- F Meccanici
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J W C de Bruijn
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J S Dommisse
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A E van den Bosch
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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33
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Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Maßmann A, Zeyer K, Schelzig H. Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. GEFASSCHIRURGIE 2023; 28:1-28. [PMCID: PMC10123596 DOI: 10.1007/s00772-023-00995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A. Oberhuber
- German Society of Vascular Surgery and Vascular Medicine (DGG); Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - A. Raddatz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Hospital, Homburg, Germany
| | - S. Betge
- German Society of Angiology and Vascular Medicine (DGG); Department of Internal Medicine and Angiology, Helios Hospital Salzgitter, Salzgitter, Germany
| | - C. Ploenes
- German Society of Geriatrics (DGG); Department of Angiology, Schön Klinik Düsseldorf, Düsseldorf, Germany
| | - W. Ito
- German Society of Internal Medicine (GSIM) (DGIM); cardiovascular center Oberallgäu Kempten, Hospital Kempten, Kempten, Germany
| | - R. A. Janosi
- German Cardiac Society (DGK); Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - C. Ott
- German Society of Nephrology (DGfN); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - E. Langheim
- German Society of prevention and rehabilitation of cardiovascular diseaese (DGPR), Reha Center Seehof, Teltow, Germany
| | - M. Czerny
- German Society of Thoracic and Cardiovascular Surgery (DGTHG), Department University Heart Center Freiburg – Bad Krozingen, Freiburg, Germany
- Albert Ludwigs University Freiburg, Freiburg, Germany
| | - R. Puls
- German Radiologic Society (DRG); Institute of Diagnostic an Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - A. Maßmann
- German Society of Interventional Radiology (DeGIR); Department of Diagnostic an Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - K. Zeyer
- Marfanhilfe e. V., Weiden, Germany
| | - H. Schelzig
- German Society of Surgery (DGCH); Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
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34
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Eidt JF, Vasquez J. Changing Management of Type B Aortic Dissections. Methodist Debakey Cardiovasc J 2023; 19:59-69. [PMID: 36910545 PMCID: PMC10000326 DOI: 10.14797/mdcvj.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/12/2023] [Indexed: 03/09/2023] Open
Abstract
The purpose of this manuscript is to review recent trends in the management of acute type B aortic dissection. Due to its efficacy and low morbidity, thoracic endografting has rapidly been adopted as the treatment of choice for most patients with malperfusion or rupture as a consequence of acute aortic dissection. This technology is increasingly applied to patients without rupture or malperfusion, so-called "uncomplicated" dissections, to reduce the incidence of late aneurysmal degeneration in the ungrafted segments of the thoracoabdominal aorta. A variety of techniques have been proposed, including intentional rupture of the dissection membrane to obliterate the false lumen as well as the candy-plug technique to eliminate retrograde flow in the false lumen.
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Affiliation(s)
- John F Eidt
- Texas A&M College of Medicine, Bryan, Texas, US.,Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, US
| | - Javier Vasquez
- Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, US
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35
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Obel LM, Lindholt JS, Lasota AN, Jensen HK, Benhassen LL, Mørkved AL, Srinanthalogen R, Christiansen M, Bundgaard H, Liisberg M. Clinical Characteristics, Incidences, and Mortality Rates for Type A and B Aortic Dissections: A Nationwide Danish Population-Based Cohort Study From 1996 to 2016. Circulation 2022; 146:1903-1917. [PMID: 36321467 DOI: 10.1161/circulationaha.122.061065] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Population-based epidemiologic studies of aortic dissections (ADs) are needed. This study aimed to report clinical characteristics, incidences, and mortality rates for adult patients admitted to Danish hospitals with type A AD (TAAD) or type B AD (TBAD) from 1996 through 2016. METHODS We conducted a nationwide, population-based register study. All cases of AD registered with International Classification of Diseases, Tenth Revision codes in the Danish National Patient Registry at time of admission to a hospital with available medical records underwent validation. Data were merged between nationwide health registries including the cause of death registry. Patients with validated AD were matched 1:10 on sex and age with patients with hypertension from the general Danish population. RESULTS Of 5018 registered cases of AD, 4183 cases underwent review and 3023 (60.2%) were validated as AD. After exclusions, the distribution of validated TAAD and TBAD was 1620 (60.5%) and 1059 (39.5%; P<0.001), 67.5% and 67.0% of patients were men, and mean ages at dissection were 63.5±12.9 and 67.5±12.2 years (P<0.001), respectively. The most prevalent comorbidities for TAAD were hypertension (55.2%), thoracic aortic aneurysms (14.6%), and chronic obstructive pulmonary disease (13.1%); for TBAD, the most prevalent comorbidities were hypertension (64.1%), aortic aneurysms at any location (7.5% to 12.0%), and chronic obstructive pulmonary disease (15.7%). The overall mean annual incidence rate was 4.2/100 000 patient-years. Incidence was significantly higher for TAAD (2.2/100 000) compared with TBAD (1.5/100 000; P<0.001). The 30-day mortality rates for validated TAAD and TBAD were 22.0% and 13.9% (P<0.001), respectively, with no significant changes over time or between sexes. Adjusted 5-year overall mortality rates for TAAD and TBAD were hazard ratio 3.2 (2.9 to 3.5; P<0.001; aortic-related cause of death, 57.0%) and hazard ratio 2.1 (1.9 to 2.4; P<0.001; aortic-related cause of death, 42.8%), respectively, compared with the general hypertensive population. Among patients who survived 30 days from dissection, the adjusted 5-year overall mortality rates were hazard ratio 1.1 (1.0 to 1.3; P=0.12; aortic-related cause of death, 23.2%) and hazard ratio 1.4 (1.2 to 1.6; P<0.001; aortic-related cause of death, 25.6%) for TAAD and TBAD, respectively. CONCLUSIONS Hypertension, aortic aneurysms, and chronic obstructive pulmonary disease were the most prevalent comorbidities. The 30-day mortality frequencies were consistent over time with no significant differences between sexes. The 5-year mortality rate was higher for TAAD than TBAD. If the patient survived 30 days from dissection, the mortality rate for patients with TAAD was comparable with that of the general hypertensive population, but the mortality rate was significantly higher in patients with TBAD.
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Affiliation(s)
- Lasse M Obel
- Department of Cardiothoracic and Vascular Surgery (L.M.O., J.S.L., M.L.), Odense University Hospital, Denmark.,Elitary Research Centre of Individualized Medicine in Arterial Disease (L.M.O., J.S.L., M.L.), Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense (L.M.O., M.L.)
| | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery (L.M.O., J.S.L., M.L.), Odense University Hospital, Denmark.,Elitary Research Centre of Individualized Medicine in Arterial Disease (L.M.O., J.S.L., M.L.), Odense University Hospital, Denmark
| | - Anne N Lasota
- Department of Vascular Surgery, Aalborg University Hospital, Denmark (A.N.L.)
| | - Henrik K Jensen
- Departments of Cardiology (H.K.J.), Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University Health, Denmark (H.K.J., L.L.B., A.L.M.)
| | - Leila L Benhassen
- Cardiothoracic and Vascular Surgery (L.L.B., A.L.M., R.S.), Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University Health, Denmark (H.K.J., L.L.B., A.L.M.)
| | - Amalie L Mørkved
- Cardiothoracic and Vascular Surgery (L.L.B., A.L.M., R.S.), Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University Health, Denmark (H.K.J., L.L.B., A.L.M.)
| | - Reshaabi Srinanthalogen
- Cardiothoracic and Vascular Surgery (L.L.B., A.L.M., R.S.), Aarhus University Hospital, Denmark
| | - Malina Christiansen
- Department of Cardiology, The Heart Center, University of Copenhagen, Denmark (M.C., H.B.)
| | - Henning Bundgaard
- Department of Cardiology, The Heart Center, University of Copenhagen, Denmark (M.C., H.B.)
| | - Mads Liisberg
- Department of Cardiothoracic and Vascular Surgery (L.M.O., J.S.L., M.L.), Odense University Hospital, Denmark.,Elitary Research Centre of Individualized Medicine in Arterial Disease (L.M.O., J.S.L., M.L.), Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense (L.M.O., M.L.)
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Andic M, Mustafi M, Bonorden C, Grözinger G, Artzner C, Schlensak C, Lescan M. Longitudinal morphological changes of the aorta and the endograft position before and after distal stent graft-induced new entry in aortic dissections. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6881081. [PMID: 36477549 DOI: 10.1093/ejcts/ezac547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to assess the endograft position and aortic geometry changes after thoracic endovascular aortic repair (TEVAR) and frozen elephant trunk (FET) in distal stent-induced new entry (dSINE) patients. METHODS In this retrospective cohort study, the baseline demographic and the follow-up data were extracted from the hospital records, and computed tomography scans of dSINE patients after TEVAR or FET between 2011 and 2021 were analysed regarding endograft oversizing, length and migration, taper ratio, aortic diameter at the endograft end, aortic elongation (thoracic inner and outer curvature), wedge apposition angle and tortuosity angle in the distal landing zone. RESULTS dSINE was found in 22/213 (10%) of TEVAR and 10/31 (32%) of FET patients. The total follow-up time was 45 (27; 59) months. TEVAR was mainly performed with Relay NBS endograft (77%) and FET with Evita open prosthesis (80%). Paraplegia and stroke rates were 3%. dSINE occurred 17 (7; 35) months post-TEVAR and was instantly treated in 18 patients (56%) or followed up for 21 (11; 34) months (n = 14). Migration [+5 mm (1; 11; P < 0.001)], birdbeak angle [+9° (0; 27; P = 0.039)] and aortic diameter +5 mm (1; 11; P < 0.001) increased after dSINE, whereas aortic elongation increased already before [+12 mm (0; 27; P = 0.015)] and peaked after dSINE [+30 mm (9; 38; P < 0.001)]. The aortic elongation was more pronounced in the outer aortic curvature before and after dSINE (before: P = 0.039, after: P = 0.024). Postoperative wedge apposition [17° (12; 20)] increased before dSINE [21° (16; 35; P < 0.001)] and peaked thereafter [31° (21; 40; P < 0.001)]. CONCLUSIONS Aortic elongation may influence the endograft position and provoke TEVAR failure in the distal and proximal landing zones.
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Affiliation(s)
- Mateja Andic
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Constantin Bonorden
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Gerd Grözinger
- Department of Radiology, University Medical Center Tübingen, Tübingen, Germany
| | - Christoph Artzner
- Department of Radiology, University Medical Center Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
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Meccanici F, Roos-Hesselink J. Angiotensin II-receptor blockers in bicuspid aortic valve patients with aortic dilation: Groping in the dark. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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38
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Shetty V, Narayan P. Sex-based differences in acute type A aortic dissection-Biology or bias? J Card Surg 2022; 37:4348-4350. [PMID: 36183404 DOI: 10.1111/jocs.16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Varun Shetty
- Department of Cardiac Surgery, Narayana Institute of Cardiac Sciences, Narayan Health, Bengaluru, Karnataka, India
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
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Aortic dissection: global epidemiology. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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40
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Zeng Y, Hu Y, Jiang B, Tan L, Tang H. Unusual combination of acute aortic dissection, Mayer-Rokitansky-Küster-Hauser syndrome, and 46,XX gonadal dysgenesis: A case report. Front Cardiovasc Med 2022; 9:1030160. [PMID: 36440024 PMCID: PMC9685306 DOI: 10.3389/fcvm.2022.1030160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/17/2022] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Acute Stanford type A aortic dissection (ATAAD) is a life-threatening disease. Elderly patients are the high-risk population for aortic dissection (AD). Young patients with AD usually have heritable connective tissue diseases such as Marfan syndrome and Loeys-Dietz syndrome. However, young AD patients without heritable connective tissue disease are relatively rare. CASE PRESENTATION Herein, we report a case of a 25-year-old female diagnosed with ATAAD accompanied by undeveloped secondary sexual characteristics. Computed tomography angiography (CTA) showed that her AD involved the ascending and abdominal aorta. She had undergone thoracic endovascular aortic stent graft implantation in a local hospital due to acute Stanford type B aortic dissection at age 19. No uterus or ovaries were found on CTA and transabdominal ultrasonography. Sex hormone detection revealed a low estrogen level. G-banded karyotyping analyses revealed a normal 46,XX karyotype. Finally, her abnormalities in the reproductive system were diagnosed as MRKH syndrome and 46,XX gonadal dysgenesis. Whole-exome sequencing (WES) in the patient found an SNP variant of ACTA2 c.773G>A and MYH11 c.5081A>G. MYH11 c.5081A>G was also found in her mother and younger brother. Copy number variations sequencing (CNV-seq) found an approximately 109.30 Kb duplication at chromosome 6p22.3 (Chr 6: g.24920238-25029535) with a copy number of 3. We performed emergent total aortic arch replacement with frozen elephant trunk surgery, and the patient recovered well after surgery. However, her abdominal AD was stilling progression during 6 months of follow-up. CONCLUSION To our knowledge, we report the world's first case of early-onset recurrent AD combined with MRKH syndrome and 46,XX gonadal dysgenesis.
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Affiliation(s)
| | | | | | - Ling Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hao Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Smedberg C, Hultgren R, Leander K, Steuer J. Pharmacological treatment in patients with aortic dissection. Open Heart 2022; 9:openhrt-2022-002082. [PMID: 36396295 PMCID: PMC9677041 DOI: 10.1136/openhrt-2022-002082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To describe medical management in aortic dissection (AD) and to analyse the possible associations between antihypertensive, antithrombotic, anticoagulant and statin agents, respectively, and long-term survival. Methods From Swedish medical registers, all patients diagnosed with AD in 2006–2015 were identified. Filled prescriptions prior to admission and within 1 year from discharge in patients discharged and alive at 30 days were registered. Associations between pharmacological treatment and long-term survival were analysed using Cox proportional hazards models. Results Of 3951 patients hospitalised with acute AD, 3046 (77%) were discharged and alive at 30 days. In hospitalised patients, mean age was 66 years (SD 13), and 36% (n=1098) were women. Within 1 year from discharge, 96% (n=2939) had at least one antihypertensive drug. Beta blocker was the most commonly used drug type (90%, n=2741). Statin treatment (47%, n=1418) was associated with higher long-term survival; HR 0.74 (95% CI 0.63 to 0.87, p<0.001). The positive association between statins and long-term survival remained, in subgroup analysis, in medically managed patients (HR 0.72 (95% CI 0.60 to 0.86, p<0.001)), but not in patients undergoing surgical repair (HR 0.82 (95% CI 0.58 to 1.14, p=0.230)). Beta blockers were associated with favourable long-term survival in surgically managed patients (HR 0.58 (95% CI 0.35 to 0.97, p=0.038)) but not in medically managed patients (HR 0.93 (95% CI 0.72 to 1.12, p=0.057)). Neither antiplatelet therapy nor anticoagulants were associated with long-term survival. Conclusions Statin treatment was associated with favourable long-term outcome in medically managed AD patients, whereas treatment with beta blocker was associated with higher survival only in surgically managed AD patients. Statin use as well as optimal antihypertensive therapy in the chronic stage of the disease need to be further analysed, preferably in randomised controlled trials.
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Affiliation(s)
- Christian Smedberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johnny Steuer
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
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Yuan X, Mitsis A, Nienaber CA. Current Understanding of Aortic Dissection. Life (Basel) 2022; 12:1606. [PMID: 36295040 PMCID: PMC9605578 DOI: 10.3390/life12101606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023] Open
Abstract
The aorta is the largest artery in the body, delivering oxygenated blood from the left ventricle to all organs. Dissection of the aorta is a lethal condition caused by a tear in the intimal layer of the aorta, followed by blood loss within the aortic wall and separation of the layers to full dissection. The aorta can be affected by a wide range of causes including acute conditions such as trauma and mechanical damage; and genetic conditions such as arterial hypertension, dyslipidaemia, and connective tissue disorders; all increasing the risk of dissection. Both rapid diagnostic recognition and advanced multidisciplinary treatment are critical in managing aortic dissection patients. The treatment depends on the severity and location of the dissection. Open surgical repair is the gold standard of treatment for dissections located to the proximal part of the aorta and the arch, while endovascular interventions are recommended for most distal or type B aortic dissections. In this review article, we examine the epidemiology, pathophysiology, contemporary diagnoses, and management of aortic dissection.
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Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Strovolos 2029, Cyprus
| | - Christoph A. Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
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43
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Zhao Q, Yin K, Zhou N, Wu Q, Xiao Y, Zheng J, Zheng D, Bi Q, Quan L, Hu B, Cheng J. The characteristics of thoracic aortic dissection in autopsy-diagnosed individuals: An autopsy study. Front Cardiovasc Med 2022; 9:973530. [PMID: 36304553 PMCID: PMC9592848 DOI: 10.3389/fcvm.2022.973530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic aortic dissection (TAD) is the most common cause of sudden cardiac death associated with aortic diseases. The age of TAD victims in forensic studies is significantly younger than hospitalized patients with TAD, while only a few studies have been conducted on autopsy-diagnosed TAD deceased. A retrospective study was conducted at the Medicolegal Center of Sun Yat-sen University from 1999 to 2019 to address the characteristics of TAD victims. A total of 200 deceased from spontaneous rupture of TAD were assessed, with 165 (82.5%) males and 175 (87.5%) Stanford type A deceased. Our main results showed that compared with patients with TAD diagnosed during their lifetime, individuals diagnosed with TAD until an autopsy showed an earlier onset (43.80 years old) and less accompanied hypertension (<50%). Sudden death was the initial symptom of 32 decedents. Instead of chest/back pain (40 decedents), abdominal pain (59 decedents) was the most common initial symptom, and 42 decedents presented with no accompanying pain. A higher proportion of abdominal pain and the painless symptom was associated with a higher risk of misdiagnosis. Women showed a more atypical clinical presentation and rapid progression than men. Younger decedents showed more pronounced left heart changes. The present study implicated the TAD individuals diagnosed until an autopsy as a particular entity, indicating the urgent need for further investigation on early diagnosis and pathogenesis of patients with TAD with atypical pain and painless or with younger age to reduce the burden of TAD-related sudden death.
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Affiliation(s)
- Qianhao Zhao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Kun Yin
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Nan Zhou
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Qiuping Wu
- Division of Forensic Medicine, Department of Pathology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Yuxi Xiao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Jinxiang Zheng
- Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China,Henan Key Laboratory of Molecular Pathology, Zhengzhou, China
| | - Da Zheng
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Qiming Bi
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Li Quan
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Bingjie Hu
- Division of Forensic Medicine, Department of Pathology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China,*Correspondence: Bingjie Hu
| | - Jianding Cheng
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China,Jianding Cheng
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Evangelista Masip A, López-Sainz Á, Barros Membrilla AJ, Calvo Iglesias F, López Ayerbe J, Azqueta Molluna M, Mosquera Rodríguez VX, Arregui Montoya F, Tarrío Fernández R, Revilla Orodea A, Sánchez Sánchez V, Cantero Pérez EM, Ferrera C, Toral Sepúlveda D, Nistal F, Fernández Golfín C, Sao A, Rodríguez-Palomares J. Spanish Registry of Acute Aortic Syndrome (RESA). Changes in therapeutic management and lower mortality in acute aortic syndrome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:816-824. [PMID: 35527170 DOI: 10.1016/j.rec.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations. METHODS We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019). RESULTS AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments. CONCLUSIONS The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications.
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Affiliation(s)
| | - Ángela López-Sainz
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Jordi López Ayerbe
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Francisco Arregui Montoya
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Ana Revilla Orodea
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Carlos Ferrera
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - David Toral Sepúlveda
- Servei de Cirurgia Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Nistal
- Servicio de Cirugía Cardiaca, Hospital Universitario Valdecilla, Santander, Spain
| | | | - Augusto Sao
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Fialka NM, Bozso SJ, El-Andari R, Kang JJ, O'Connell A, Moon MC, Macarthur R, Nagendran J. Sex differences in acute type A aortic dissection: a systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:632-644. [PMID: 35687063 DOI: 10.23736/s0021-9509.22.12273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The objective of this study is to provide a comprehensive comparison of outcomes following acute type A aortic dissection (ATAAD) repair in males and females. EVIDENCE ACQUISITION PubMed, Medline, and Web of Science were systematically searched by two authors for studies published from January 1st, 2000, to May 10th, 2021. Overall, 2405 articles were screened, and 16 were included in this review. Meta-analysis of the compiled data was performed. EVIDENCE SYNTHESIS Pooled estimates indicated no difference in operative (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.59-1.67, P=0.99, I2=52%), in-hospital (OR 0.78, 95% CI 0.56-1.08; P=0.13, I2=57%), and 30-day mortality (OR 1.09, 95% CI 0.83-1.43, P=0.52, I2=45%) between the sexes. However, males had significantly reduced 5-year mortality rates (OR 0.71, 95% CI 0.51-1.00, P=0.05, I2=45%). There was no difference between sexes in rates of postoperative stroke (OR 1.07, 95% CI 0.86-1.33, P=0.54, I2=0%), atrial fibrillation (OR 0.99, 95% CI 0.82-1.19, P=0.92, I2=0%), as well as mesenteric or limb ischemia (OR 0.73, 95% CI 0.22-2.43, P=0.61, I2=77%; OR 0.83, 95% CI 0.30-2.30, P=0.72, I2=76%, respectively). Males did experience significantly increased rates of acute renal failure and reoperation (OR 1.35, 95% CI 1.16-1.56, P=0.0001, I2=29%; OR 1.40, 95% CI 1.09-1.81, P=0.010, I2=42%). CONCLUSIONS Composite analysis indicates that early mortality does not differ between the sexes; however, late outcomes favor males. Differences in preoperative presentation and subsequent procedure selection between the sexes likely contribute to the disparity in late outcomes. Decision-making for surgical treatment of ATAAD should account for sex-specific risk factors.
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Affiliation(s)
- Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan El-Andari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jimmy J Kang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Andrew O'Connell
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Roderick Macarthur
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada -
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Cote CL, De Waard D, Kivell M, Fagan A, Horne G, Hassan A, Hajizadeh M, Herman CR. Sex Differences in Trends in Incidence of Thoracic Aortic Aneurysm Repair and Aortic Dissection: 2005-2015. CJC Open 2022; 4:1081-1089. [PMID: 36562011 PMCID: PMC9764113 DOI: 10.1016/j.cjco.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/26/2022] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of this study was to examine trends in the incidence of thoracic aortic aneurysm (TAA) repair and aortic dissection. Methods A retrospective study was conducted of patients from the period 2005-2015 with thoracic aortic disease. Unadjusted mortality was compared in women vs men. Rates of scheduled TAA repair, dissection events, acute type A aortic dissection (TAAD) repair, and aorta-related mortality were obtained from our institution's clinical registry and administrative data sources and used to calculate the age-adjusted incidence for each sex, adjusted to the Canadian standard population. Weighted linear regression was performed to analyze trends over time. Results A total of 382 scheduled TAA repair operations, 345 dissection events, 85 TAAD repairs, and 182 aorta-related mortalities were identified. Women accounted for 23% of TAA repairs, 39% of dissection events, 22% of TAAD repairs, and 45% of aorta-related mortalities. The incidence of TAA repair was 3.5 per 100,000 person-years (95% confidence interval [CI]: 3.2-3.9), and increased in men (P = 0.02) but not women (P = 0.10) over time. The incidence of aortic dissection was 3.4 per 100,000 (95% CI: 3.1-3.8) and was stable over time (P = 0.43). The average annual age-adjusted incidence of TAAD repair was 0.8 per 100,000 (95% CI: 0.6-1.0) and increased over time (P = 0.001). The overall incidence of aorta-related mortality was 1.8 per 100,000 (95% CI: 1.5-2.0) and decreased over time (P = 0.02). Conclusion The incidence of TAA repair is increasing in men but not women. Although aorta-related mortality is decreasing overall, disparities exist between the male and female population.
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Affiliation(s)
- Claudia L. Cote
- Division of Cardiac Surgery, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada,School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada,Corresponding author: Claudia Cote, Nova Scotia Health, Division of Cardiac Surgery, 2269-1796 Summer St., Halifax, Nova Scotia B3H 3A7, Canada. Tel.: +1-902-473-5590; fax: +1-902-473-4448
| | - Dominique De Waard
- Division of Cardiac Surgery, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Kivell
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Fagan
- Division of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabrielle Horne
- Division of Cardiology, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ansar Hassan
- Department of Cardiovascular Surgery, Maine Medical Centre, Portland, Maine, USA
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine R. Herman
- Division of Cardiac Surgery, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada,Division of Vascular Surgery, Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
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Wu MY, Bang TJ, Restauri N, Chawla A, Khawaja RDA, Vargas D. Imaging Acute Aortic Syndromes. Semin Roentgenol 2022; 57:335-344. [DOI: 10.1053/j.ro.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022]
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Tracking an Elusive Killer: State of the Art of Molecular-Genetic Knowledge and Laboratory Role in Diagnosis and Risk Stratification of Thoracic Aortic Aneurysm and Dissection. Diagnostics (Basel) 2022; 12:diagnostics12081785. [PMID: 35892496 PMCID: PMC9329974 DOI: 10.3390/diagnostics12081785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 02/08/2023] Open
Abstract
The main challenge in diagnosing and managing thoracic aortic aneurysm and dissection (TAA/D) is represented by the early detection of a disease that is both deadly and “elusive”, as it generally grows asymptomatically prior to rupture, leading to death in the majority of cases. Gender differences exist in aortic dissection in terms of incidence and treatment options. Efforts have been made to identify biomarkers that may help in early diagnosis and in detecting those patients at a higher risk of developing life-threatening complications. As soon as the hereditability of the TAA/D was demonstrated, several genetic factors were found to be associated with both the syndromic and non-syndromic forms of the disease, and they currently play a role in patient diagnosis/prognosis and management-guidance purposes. Likewise, circulating biomarker could represent a valuable resource in assisting the diagnosis, and several studies have attempted to identify specific molecules that may help with risk stratification outside the emergency department. Even if promising, those data lack specificity/sensitivity, and, in most cases, they need more testing before entering the “clinical arena”. This review summarizes the state of the art of the laboratory in TAA/D diagnostics, with particular reference to the current and future role of molecular-genetic testing.
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49
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Li N, Yi X, He Y, Huo B, Chen Y, Zhang Z, Wang Q, Li Y, Zhong X, Li R, Zhu XH, Fang Z, Wei X, Jiang DS. Targeting Ferroptosis as a Novel Approach to Alleviate Aortic Dissection. Int J Biol Sci 2022; 18:4118-4134. [PMID: 35844806 PMCID: PMC9274489 DOI: 10.7150/ijbs.72528] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/04/2022] [Indexed: 12/12/2022] Open
Abstract
A variety of programmed cell death types have been shown to participate in the loss of smooth muscle cells (SMCs) during the development of aortic dissection (AD), but it is still largely unclear whether ferroptosis is involved in the development of AD. In the present study, we found that the expression of key ferroptosis regulatory proteins, solute carrier family 7 member 11 (SLC7A11), ferroptosis suppressor protein 1 (FSP1) and glutathione peroxidase 4 (GPX4) were downregulated in aortas of Stanford type A AD (TAAD) patients, and liproxstatin-1, a specific inhibitor of ferroptosis, obviously abolished the β-aminopropionitrile (BAPN)-induced development and rupture of AD in mice. Furthermore, the expression of methyltransferase-like 3 (METTL3), a major methyltransferase of RNA m6A, was remarkably upregulated in the aortas of TAAD patients, and the protein levels of METTL3 were negatively correlated with SLC7A11 and FSP1 levels in human aortas. Overexpression of METTL3 in human aortic SMCs (HASMCs) inhibited, while METTL3 knockdown promoted SLC7A11 and FSP1 expression. More importantly, overexpression of METTL3 facilitated imidazole ketone erastin- and cystine deprivation-induced ferroptosis, while knockdown of METTL3 repressed ferroptosis of HASMCs. Overexpression of either SLC7A11 or FSP1 largely abrogated the effect of METTL3 on HASMC ferroptosis. Therefore, we have revealed that ferroptosis is a critical cause of AD in both humans and mice and that METTL3 promotes ferroptosis of HASMCs by inhibiting the expression of SLC7A11 and FSP1. Thus, targeting ferroptosis or m6A RNA methylation is a potential novel strategy for the treatment of AD.
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Affiliation(s)
- Na Li
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Yi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yi He
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Huo
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yue Chen
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zihao Zhang
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qunhui Wang
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Li
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoxuan Zhong
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rui Li
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xue-Hai Zhu
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
| | - Zemin Fang
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
| | - Ding-Sheng Jiang
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei, China
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Gender Differences in Acute Aortic Dissection. J Pers Med 2022; 12:jpm12071148. [PMID: 35887644 PMCID: PMC9324420 DOI: 10.3390/jpm12071148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 01/16/2023] Open
Abstract
Cardiovascular disease (CVD) represents the most important cause of mortality and morbidity worldwide. There is heterogeneity in the epidemiology and management of CVD between male and female patients. In the specific case of acute aortic dissection (AAD), women, at the time of diagnosis, are older than men and complain less frequently of an abrupt onset of pain with delayed presentation to the emergency department. Furthermore, a history of hypertension and chronic obstructive pulmonary disease is more common among women. In type A AAD, women more often experience pleural effusion and coronary artery compromise, but experience less neurological and malperfusion symptoms. They undergo less frequent surgical treatment and have higher overall in-hospital mortality. Conversely, in type B AAD no significant differences were shown for in-hospital mortality between the two genders. However, it should be highlighted that further studies are needed in order to develop AAD gender specific preventive, diagnostic and therapeutic strategies.
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