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Farah M, Straus S, Wang G, Gaffey A, Malas M. The Effect of Smoking Cessation on Outcomes of Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2025; 120:18-26. [PMID: 40349832 DOI: 10.1016/j.avsg.2025.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 05/03/2025] [Accepted: 05/04/2025] [Indexed: 05/14/2025]
Abstract
BACKGROUND Smoking is known to be a strong predictive factor for deleterious outcomes after surgical procedures; however, there is limited research that has focused on the effect of smoking cessation on the outcomes of thoracic endovascular aortic repair (TEVAR). Using a multi-institutional database, we aimed to determine if smoking cessation was associated with improved outcomes following TEVAR. METHODS Patients undergoing thoracic endovascular aortic repair in Vascular Quality Initiative from 2013 to 2023 were categorized into three groups: never smokers (NS), those who quit smoking (QS) >30 days prior, or current smokers (CS) who quit ≤30 days prior or never quit. Primary outcomes include perioperative death, stroke, myocardial infarction, and spinal cord ischemia. Secondary outcomes include cardiac and pulmonary complications, prolonged length of stay (≥2 days), and leg and bowel ischemia. A multivariate logistic regression analysis was conducted to control for confounding variables. A subanalysis was performed to determine the impact of smoking cessation by TEVAR indication: thoracic aortic aneurysm and type B aortic dissection. Long-term outcomes were analyzed using Kaplan-Meier and Cox regression models. RESULTS There were 1,435 (30.4%) patients in the NS group, 1,867 patients (39.6%) in the QS group, and 1,412 (30.0%) patients in the CS group. Patients in the QS group were older and had the highest rate of comorbidities including diabetes, myocardial infarction, and congestive heart failure. Multivariate analysis revealed that the CS group had no significant difference in odds of perioperative death (adjusted odds ratio (aOR) = 1.40; [95% confidence interval (CI): 0.86-2.25]; P = 0.2), stroke (aOR = 1.19; [95% CI: 0.71-1.99]; P = 0.5), myocardial infarction (aOR = 1.54; [95% CI: 0.74-3.17]; P = 0.2), and spinal cord ischemia (aOR = 1.52; [95% CI: 0.95-2.45]; P = 0.083) compared to QS. However, CS had increased odds of leg ischemia (aOR = 3.75; [95% CI: 1.79-8.25]; P < 0.001) and 1-year mortality (adjusted hazard ratio (aHR) = 1.34; [95% CI: 1.01-1.79] P = 0.042) compared to QS. When stratified by indication, thoracic aortic aneurysm CS compared to QS had higher rates of leg ischemia (aOR = 3.46; [95% CI: 1.28-10.1]; P = 0.017) and 3-year mortality (aHR = 1.44; [95% CI: 1.02-2.03]; P = 0.036). Type B aortic dissection CS had no significant difference in postoperative outcomes but showed increased odds of 1-year mortality (aHR = 2.51; [95% CI: 1.17-5.54]; P = 0.02) compared to QS. CONCLUSION CS had similar risk of death, stroke, myocardial infarction, and spinal cord ischemia when compared to QS, regardless of indication. However, there was a significantly increased risk of 1-year and 3-year mortality for CS which was not seen with QS when compared to NS. These results suggest surgery should not be delayed for smoking cessation; however, smoking cessation counseling may be important for improving long-term outcomes.
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Affiliation(s)
- Marc Farah
- Center for Learning and Excellence in Vascular and Endovascular Research (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, CA; Georgetown University School of Medicine, Washington, DC
| | - Sabrina Straus
- Center for Learning and Excellence in Vascular and Endovascular Research (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, CA
| | - Grace Wang
- Division of Vascular and Endovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ann Gaffey
- Center for Learning and Excellence in Vascular and Endovascular Research (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, CA
| | - Mahmoud Malas
- Center for Learning and Excellence in Vascular and Endovascular Research (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, CA.
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Zhao Z, Sha T, Zhang P, Li J, Liu C. Surgical management of type A aortic dissection during the second trimester: a case report. J Cardiothorac Surg 2025; 20:201. [PMID: 40241219 PMCID: PMC12001569 DOI: 10.1186/s13019-025-03446-2] [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: 09/21/2024] [Accepted: 04/06/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Acute aortic dissection during pregnancy is a relatively rare but often life-threatening conditio. A previous study showed that the overall incidence of the disease was about 4 in 1 million women aged 15-45 years. Hormonal and Hemodynamics changes during pregnancy are a major cause of aortic dissection, and these changes may begin in the first and second trimesters, but are most pronounced in the third trimesters(about 50% and 33%, respectively).In addition, some genetic disorder such as Marfan syndrome may be associated with AD during pregnancy. CASE PRESENTATION A 29-year-old pregnant woman at 21 weeks of gestation presented with acute, non-radiating retrosternal tearing pain lasting 15 h, unrelieved and accompanied by three episodes of vomiting. Ultrasonography identified aortic root dilatation with aortic regurgitation, and contrast-enhanced aortic computed tomography (CT) confirmed type A aortic dissection (AD). Emergency surgery was performed, including ascending aortic replacement, total arch replacement with prosthetic graft placement, stented elephant trunk implantation (Sun's procedure), and aortic valvuloplasty under cardiopulmonary bypass (CPB). The patient was discharged on postoperative day (POD) 9, and the fetus remained viable. At 26 weeks of gestation, the family expressed concerns regarding maternal safety, prompting an early request for cesarean delivery due to cervical insufficiency and preeclampsia, resulting in the delivery of a healthy infant with no adverse events. CONCLUSION Although AD during pregnancy is uncommon, clinicians must maintain a high index of suspicion for pregnant women presenting with severe chest pain. CTA is essential for diagnosing the condition and determining surgical options. After 28 weeks of pregnancy, cesarean section should be prioritized [17-18]. In the early second trimester, ensuring fetal safety involves appropriately increasing mean arterial pressure, minimizing circulatory arrest time, and closely monitoring the fetus post-surgery.
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Affiliation(s)
- Zhenqing Zhao
- Department of Cardiac Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Tumin Sha
- Department of Cardiac Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Peng Zhang
- Department of Cardiac Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Jianqiang Li
- Department of Cardiac Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Chaoliang Liu
- Department of Cardiac Surgery, Yantai Yuhuangding Hospital, Yantai, China.
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Olson M, Anderson J, Knapke S, Kushner A, Martin L, Statile C, Shikany A, Miller EM. Cardiac genetic counseling services: Exploring downstream revenue in a pediatric medical center. J Genet Couns 2025; 34:e1984. [PMID: 39400486 PMCID: PMC11953579 DOI: 10.1002/jgc4.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/31/2024] [Accepted: 09/26/2024] [Indexed: 10/15/2024]
Abstract
Genetic counseling is an important component of pediatric cardiac care. The financial costs and benefits of this care have yet to be defined in the literature. Downstream revenue (DSR) analysis can be used to assess the economic impact of genetic counselors (GCs) at their institution beyond the initial patient contact. Previous literature has reported DSR generated by oncology GCs, but there is no published DSR data from a cardiac GC setting. This study measured the DSR generated at a private hospital following a cardiac GC appointment. A chart review identified patients seen by a cardiac GC between 2018 and 2022. The study population included patients and their pediatric relatives who had not previously seen a cardiologist. Patients were included if they were affected with or at-risk for long QT syndrome, hypertrophic cardiomyopathy, dilated cardiomyopathy, or familial thoracic aortic aneurysm at the time of the GC visit. We recorded the frequency of common cardiac services and calculated the reimbursement for all cardiology services for 1 year following the initial GC appointment. The cohort included 121 participants from 61 families. Most individuals were at-risk for (n = 114, 94.3%) rather than affected by an inherited cardiac condition and presented for screening. The total DSR was $247,592.27, with an annual median of $1819.50 per patient (IQR $0, $3761.33). Revenue was similar among individuals who had undergone genetic testing and those who had not. Among participants, 72 (59.5%) had subsequent cardiology services. Most frequently, a patient who presented for subsequent care had an EKG, an echocardiogram, and a cardiology appointment. While the economic contributions of GC services do not speak to the broader value of GC involvement in patient care, they are important metrics for sustainability. This study outlines an approach to evaluating DSR and establishes a baseline understanding of DSR related to cardiac GC services.
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Affiliation(s)
- Marianne Olson
- Division of Human GeneticsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- College of MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | - Jeffrey Anderson
- Heart InstituteCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Sara Knapke
- Division of Human GeneticsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Adam Kushner
- Heart InstituteCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Lisa Martin
- Division of Human GeneticsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Christopher Statile
- Heart InstituteCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Amy Shikany
- Heart InstituteCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Erin M. Miller
- Heart InstituteCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Jia S, Wang M, Wang M, Luo W, Liu Y, Jiang W, Zhang H. Impact of preoperative hyperuricemia on the prognosis of patients with acute type A aortic dissection. IJC HEART & VASCULATURE 2025; 57:101646. [PMID: 40162040 PMCID: PMC11953986 DOI: 10.1016/j.ijcha.2025.101646] [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: 02/03/2025] [Revised: 02/27/2025] [Accepted: 03/08/2025] [Indexed: 04/02/2025]
Abstract
Background The mortality of patients with acute type A aortic dissection remains high, and it is imperative to explore the risk factors that affect patient prognosis. Methods and results 485 patients with acute type A aortic dissection who underwent surgery were included in our study. Based on preoperative serum uric acid tests, the patients were divided into two groups. After adjusting baseline data (SMD < 0.1), the 30-day mortality (19.4 % vs 6.2 %, P < 0.001) in the hyperuricemia group were significantly higher. Univariate and multivariate COX regression revealed that hyperuricemia was an independent risk factor for 30-day mortality in patients (HR, 2.2; P = 0.016). In subgroup analysis, the trend of increased mortality in the hyperuricemia group was consistent. In a median follow-up time of 6.2 years, Landmark analysis showed that the mortality of the hyperuricemia group mainly increased significantly within 1 month after surgery (Log-rank P < 0.001), and there was no significant difference after 1 month (Log-rank P = 0.506). Through restricted cubic spline, it was found that the risk of death gradually increases with preoperative blood uric acid levels above 330 μmol/L. Conclusion Preoperative hyperuricemia was an independent risk factor for early mortality in patients with acute type A aortic dissection, but it did not affect the mid-term survival in patients who survived the early postoperative period.
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Affiliation(s)
- Songhao Jia
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing 100069, China
- Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100069, China
| | - Maozhou Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing 100069, China
- Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100069, China
| | - Meili Wang
- Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing 100069, China
- Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100069, China
- Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Wei Luo
- Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing 100069, China
- Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100069, China
- Center for Coronary Artery Disease, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yuyong Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing 100069, China
- Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100069, China
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Wenjian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing 100069, China
- Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100069, China
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing 100069, China
- Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing 100069, China
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Kageyama M, Koizumi S, Iwamatsu K, Saito F, Sakata T, Umezono R, Yokoyama H, Kanai M, Takayama S, Aoyagi M, Okuchi M, Minami K, Toyoda S, Inoue T. Challenges to Acute Aortic Dissection in a Regional Hospital. TOHOKU J EXP MED 2025; 265:143-150. [PMID: 39198144 DOI: 10.1620/tjem.2024.j081] [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: 09/01/2024]
Abstract
Acute aortic dissection is often a life-threatening disorder; in particular, type A aortic dissection necessitates urgent surgical intervention. Therefore, in regions where there are no cardiovascular surgeons, its treatment is quite challenging. Our facility, the Nasu Red Cross Hospital, located in the northern part of Tochigi Prefecture, is a core hospital for advanced emergency medical care, with eight cardiologists who can provide emergency coronary angioplasty for patients with acute coronary syndrome. However, we have no cardiovascular surgery section, so it is challenging to treat patients who require urgent surgical intervention. Therefore, we promptly transfer patients with type A aortic dissection to 8 facilities inside and outside the prefecture that have cardiovascular surgery sections. In regional hospitals like ours, without cardiovascular surgeons, it is necessary to provide a qualified diagnosis, initiate treatment for patients with acute aortic dissection including immediate blood pressure lowering and pain control using narcotics, and transfer patients eligible for urgent surgical intervention promptly to facilities with cardiovascular surgery sections. For smooth patient transfer, it is essential to build a close medical cooperation system that has daily interactions.
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Affiliation(s)
| | - Satoshi Koizumi
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Koichi Iwamatsu
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Fumiya Saito
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Tomohisa Sakata
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Ryu Umezono
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Haruka Yokoyama
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Masateru Kanai
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Sawa Takayama
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Masahide Aoyagi
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Masahisa Okuchi
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
| | - Kentaro Minami
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Nasu Red Cross Hospital
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
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Samman B, Deng MX, Chung JCY, Ouzounian M. Understanding Thoracic Aortic Disease in Women. Circ Res 2025; 136:606-617. [PMID: 40080538 DOI: 10.1161/circresaha.124.325681] [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: 12/30/2024] [Revised: 01/27/2025] [Accepted: 01/31/2025] [Indexed: 03/15/2025]
Abstract
Multifaceted disparities exist between men and women with thoracic aortic aneurysm and dissection. Despite a higher prevalence of thoracic aortic aneurysm and dissection among men, women experience disproportionately accelerated aneurysmal expansion, greater risks of rupture or dissection, and acute aortic syndromes that occur at relatively smaller diameters. In the context of acute type A aortic dissection, they also experience more complications, increased out-of-hospital mortality, delays in presentation and diagnosis, and worse postoperative survival. These gaps are largely driven by sex differences in vascular aging and remodeling, which include arterial stiffening associated with the hormonal changes that occur during menopause. Furthermore, the increased risk of acute type A aortic dissection during pregnancy in women with thoracic aortic disease necessitates a multidisciplinary approach to peripartum counseling and surveillance. Despite significant recent improvements in early postoperative outcomes, other disparities persist, emphasizing the need for sex-specific research, patient counseling, routine monitoring, and surgical thresholds to bridge the gap in outcomes of thoracic aortic care between sexes. Elucidating the underlying mechanisms of aortic aging and its difference between men and women, as well as moving toward personalized management protocols, will give rise to improved outcomes in the treatment of thoracic aortopathy.
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Affiliation(s)
- Bana Samman
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (B.S., M.X.D., J.C.Y.C., M.O.)
| | - Mimi X Deng
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (B.S., M.X.D., J.C.Y.C., M.O.)
- Division of Cardiac Surgery, University of Toronto, ON, Canada (M.X.D., J.C.Y.C., M.O.)
| | - Jennifer C Y Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (B.S., M.X.D., J.C.Y.C., M.O.)
- Division of Cardiac Surgery, University of Toronto, ON, Canada (M.X.D., J.C.Y.C., M.O.)
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, ON, Canada (M.X.D., J.C.Y.C., M.O.)
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Powell TR, Shah EB, Khalifa A, Orozco-Sevilla V, Tolpin DA. Anesthetic Management for Proximal Aortic Repair. Semin Cardiothorac Vasc Anesth 2025; 29:8-36. [PMID: 39891577 PMCID: PMC11872057 DOI: 10.1177/10892532251318061] [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: 02/03/2025]
Abstract
Surgical repair of the proximal aorta is a complex endeavor, requiring cardiopulmonary bypass (CPB) and often the use of hypothermic circulatory arrest (HCA). In addition to the normal considerations for patients undergoing cardiopulmonary bypass, additional challenges include cerebral and end-organ protection during periods of circulatory arrest. This review aims to provide an up-to-date, evidence-based review on anesthetic management for proximal aortic repair.
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Affiliation(s)
- Thomas R. Powell
- Division of Cardiovascular Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
- The Texas Heart Institute, Houston, TX, USA
| | - Emily B. Shah
- Division of Cardiac Anesthesia, Department of Anesthesiology, Houston Methodist Hospital, Houston, TX, USA
| | - Ali Khalifa
- Division of Cardiovascular Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
- The Texas Heart Institute, Houston, TX, USA
| | - Vicente Orozco-Sevilla
- The Texas Heart Institute, Houston, TX, USA
- Division of Cardiac Anesthesia, Department of Anesthesiology, Houston Methodist Hospital, Houston, TX, USA
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Daniel A. Tolpin
- Division of Cardiovascular Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
- The Texas Heart Institute, Houston, TX, USA
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Carrero MC, Matta MG, Constantin I, Masson G, Asch FM, on behalf of MATEAR study group. Sex-specific considerations in defining aortic dilation: findings from the MATEAR study. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2025; 95:171-177. [PMID: 40020182 PMCID: PMC12058107 DOI: 10.24875/acm.24000185] [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: 10/09/2024] [Accepted: 11/14/2024] [Indexed: 05/10/2025] Open
Abstract
Objectives Patient body size and sex are significant factors in determining aortic dimensions. While females generally have smaller aortic dimensions, the criteria for surgical intervention in thoracic aortic aneurysms primarily rely on absolute diameters, disregarding sex-specific differences. The aim of this study was to compare sex differences in the upper limit of normal (ULN) and Z score in the population of a prospective nationwide multicenter registry and to determine the usefulness and fairness of guideline recommendations regarding aortic diameters in females. Materials and methods Transthoracic echocardiograms were performed on all patients enrolled measuring aortic dimensions at six levels following the current standard recommendations. Absolute diameters and indexed diameters by body surface area (BSA) and height were compared between males and females. Results A total of 1,000 healthy adults were included, with an average age of 38.3 ± 12.7 years. Among them, 553 were females, and the majority were either Caucasian or Native American. Females exhibited lower values in all anthropometric parameters, echocardiographic measurements, and blood pressure. Analysis of aortic measurements revealed that females had lower absolute aortic diameters across all segments. However, when indexed parameters were examined in the aortic root and Sino tubular Junction, females demonstrated lower height-indexed diameters but higher BSA-indexed diameters. The ULN for females, correlating with a Z-score of 2.5, was determined to be 3.62 cm. Conclusion Our study demonstrates the need for sex-specific considerations in defining aortic dilation, as females exhibit lower absolute aortic diameters but variations in indexed parameters, highlighting the limitations of using a universal cutoff value.
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Affiliation(s)
- María C. Carrero
- Consejo de Ecocardiografía y Doppler vascular “Oscar Orías”, Sociedad Argentina de Cardiología, Buenos Aires, Argentina
| | - Maria G. Matta
- Department of Cardiology, Gold Coast University Hospital, Southport, Australia
| | - Iván Constantin
- Consejo de Ecocardiografía y Doppler vascular “Oscar Orías”, Sociedad Argentina de Cardiología, Buenos Aires, Argentina
| | - Gerardo Masson
- Consejo de Epidemiología, Sociedad Argentina de Cardiología, Buenos Aires, Argentina
| | - Federico M. Asch
- MedStar Health Research Institute y Georgetown University, Washington DC, United States of America
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Lei J, Zhang Z, Li Y, Wu Z, Pu H, Xu Z, Yang X, Wang R, Qiu P, Chen T, Lu X. Fluid balance and clinical outcomes in patients with aortic dissection: a retrospective case-control study based on ICU databases. BMJ Open 2025; 15:e083933. [PMID: 39922586 PMCID: PMC11808867 DOI: 10.1136/bmjopen-2024-083933] [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: 01/03/2024] [Accepted: 09/30/2024] [Indexed: 02/10/2025] Open
Abstract
OBJECTIVES Aortic dissection (AD) is a life-threatening condition that requires intensive care and management. This paper explores the role of fluid management in the clinical care of AD patients, which has been unclear despite the substantial existing research that has been conducted on the treatment of AD. DESIGN A retrospective case-control study using data for AD patients from public databases. SETTING Two public intensive care unit (ICU) databases with hospital courses from the USA, Medical Information Mart for Intensive Care (MIMIC)-IV critical care dataset and the eICU Collaborative Research Database, with data from 2008 to 2019. PARTICIPANTS A total of 751 adult AD patients with detailed fluid management records from two databases were included. INTERVENTIONS The mean 24-hour intake and output were calculated by dividing the total amount of intake and output by the number of days in the ICU, respectively. The mean 24-hour fluid balance was generated by subtracting the output from the intake. OUTCOME MEASURES The relationship between the mean 24-hour fluid management and all-cause in-hospital death was assessed through univariate and multivariable regression analyses. RESULTS A positive correlation was found between mean 24-hour fluid intake and in-hospital mortality among AD patients (OR 1.029, 95% CI (1.018, 1.041), p<0.001), whereas a negative correlation was revealed between mean 24-hour fluid output and in-hospital mortality (OR 0.941, 95% CI (0.914, 0.968), p<0.001). A similar result was found for mean 24-hour fluid balance (OR 1.030, 95% CI (1.019, 1.042), p<0.001), and the cut-off was selected to be 5.12 dL (AUC=0.778, OR 3.066, 95% CI (1.634, 5.753), p<0.001). CONCLUSIONS This study stresses the importance of fluid balance in the clinical care of AD patients and provides new insights for optimising fluid management and monitoring strategies beyond the conventional focus on blood pressure and heart rate management.
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Affiliation(s)
- Jiahao Lei
- Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Zhuojing Zhang
- Department of Economics, University of Waterloo, Waterloo, Ontario, Canada
- Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada
| | - Yixuan Li
- Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada
- Department of Anthropology, Economics and Political Science, MacEwan University, Edmonton, Alberta, Canada
| | - Zhaoyu Wu
- Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Zhijue Xu
- Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Xinrui Yang
- Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Ruihua Wang
- Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Tao Chen
- Department of Economics, University of Waterloo, Waterloo, Ontario, Canada
- Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada
- Senior Research Fellow, Labor and Worklife Program, Harvard University, Cambridge, Massachusetts, USA
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
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Fleischmann D, Mastrodicasa D, Willemink MJ, Turner VL, Hinostroza V, Burris NS, Yang B, Hanneman K, Ouzounian M, Trujillo DO, Afifi RO, Estrera AL, Lacomis JM, Sultan I, Gleason TG, Pacini D, Folesani G, Lovato L, Stillman AE, De Cecco CN, Chen EP, Hinzpeter R, Alkadhi H, Hedgire S, Sundt TM, van Kuijk SM, Schurink GWH, Chin AS, Codari M, Sailer AM, Mistelbauer G, Madani MH, Bäumler K, Shen J, Lai KM, Fischbein MP, Miller DC. Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study. Circ Cardiovasc Imaging 2025; 18:e016766. [PMID: 39965039 PMCID: PMC11839160 DOI: 10.1161/circimaging.124.016766] [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: 02/22/2024] [Accepted: 11/19/2024] [Indexed: 02/20/2025]
Abstract
BACKGROUND Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries. METHODS We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020. LAEs were defined as fatal or nonfatal aortic rupture, new refractory hypertension or pain, organ or limb ischemia, aortic aneurysm formation (≥6 cm), or rapid growth (≥1 cm per year). We applied the original model parameters to the validation cohort and examined the effect on risk categorization using LAE end points. RESULTS One hundred and seventy-six patients (44%) with incomplete imaging or clinical data were excluded. Of 225 patients in the final cohort, 90 (40%) developed LAEs, predominantly driven by aneurysm formation. Baseline maximum aortic diameter was significantly larger in patients with (42.6 [95% CI, 39.1-45.8] mm) compared with patients without LAEs (39.9 [95% CI, 36.3-44.2] mm; P=0.001). A multivariable Cox regression model indicated that only maximum diameter was associated with LAEs (hazard ratio, 1.07 [95% CI, 1.03-1.11] per mm; P<0.001), while the other parameters were not (P>0.05). Applying the original prediction model to the validation cohort resulted in a poor 5-year sensitivity (38%) and specificity (69%). CONCLUSIONS A clinical and imaging-based prediction model performed poorly in the ROADMAP cohort. Maximum aortic diameter remains the strongest predictor of LAEs in uncomplicated Stanford type B aortic dissection.
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Affiliation(s)
- Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Martin J. Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Valery L. Turner
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Virginia Hinostroza
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | | | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kate Hanneman
- Department of Radiology, University of Toronto, Toronto, Ontario, CANADA
| | - Maral Ouzounian
- Department of Surgery, University of Toronto, Toronto, Ontario, CANADA
| | | | - Rana O. Afifi
- Department of Cardiothoracic and Vascular Surgery, University of Texas Houston, Texas
| | - Anthony L. Estrera
- Department of Cardiothoracic and Vascular Surgery, University of Texas Houston, Texas
| | - Joan M. Lacomis
- Department of Radiology, University of Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pennsylvania
| | | | - Davide Pacini
- Department of Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, ITALY
| | - Gianluca Folesani
- Department of Cardiac Surgery, S. Orsola-Malpighi Hospital, University of Bologna, ITALY
| | - Luigi Lovato
- Department of Radiology, S. Orsola-Malpighi Hospital, University of Bologna, ITALY
| | | | | | - Edward P. Chen
- Department of Cardiothoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Ricarda Hinzpeter
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, SWITZERLAND
| | - Hatem Alkadhi
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, SWITZERLAND
| | - Sandeep Hedgire
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Thoralf M. Sundt
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sander M.J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, THE NETHERLANDS
| | | | - Anne S. Chin
- Department of Radiology, University of Montreal, Montreal, Quebec, CANADA
| | - Marina Codari
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Anna M. Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Gabriel Mistelbauer
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Mohammad H. Madani
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Kathrin Bäumler
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Jody Shen
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Kendrick M. Lai
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Michael P. Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - D. Craig Miller
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
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11
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Alkhas C, Kidess GG, Brennan MT, Basit J, Yasmin F, Jaroudi W, Alraies MC. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease: A Review of the Existing Literature. Cureus 2025; 17:e78192. [PMID: 40027070 PMCID: PMC11870031 DOI: 10.7759/cureus.78192] [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] [Accepted: 01/28/2025] [Indexed: 03/05/2025] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure used to replace a damaged aortic valve with a prosthetic valve. TAVR has exceeded surgical aortic valve replacement (SAVR) due to shorter procedures and recovery times. Though initially approved for patients with aortic stenosis at a high surgical risk, TAVR's indications have now broadened to include high, intermediate, and low-risk patients. This review focuses on the evolving role of TAVR in patients with bicuspid aortic valves (BAV). We examine the anatomical and hemodynamic differences between tricuspid aortic valve and BAV, highlighting the unique challenges TAVR faces in BAV patients.
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Affiliation(s)
- Chmsalddin Alkhas
- Department of Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - George G Kidess
- Department of Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Matthew T Brennan
- Department of Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Jawad Basit
- Department of Surgery, Holy Family Hospital, Rawalpindi, PAK
- Department of Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Farah Yasmin
- Department of Internal Medicine, Yale School of Medicine, New Haven, USA
| | - Wael Jaroudi
- Department of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, LBN
| | - M Chadi Alraies
- Department of Cardiology, Wayne State University Detroit Medical Center, Detroit, USA
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12
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Takahashi B, Kamohara K, Morokuma H, Amamoto S. Effect of Surgeons' Years of Experience on Outcomes of Acute Type A Aortic Dissection. Cureus 2024; 16:e75499. [PMID: 39803072 PMCID: PMC11717673 DOI: 10.7759/cureus.75499] [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] [Accepted: 11/29/2024] [Indexed: 01/16/2025] Open
Abstract
Background The effect of surgeons' years of experience on the outcomes of acute type A aortic dissection (ATAAD) repair has not yet been studied. This study aimed to evaluate the association between the surgeon's years in practice and the outcomes of ATAAD repair. Methods Surgical records of ATAAD repairs performed at Saga University Hospital between 2004 and 2020 were reviewed. Surgeons were divided into two groups based on their surgical experience: late-career surgeons (LCSs) and early-career surgeons (ECSs) with ≥16 years and <16 of practice, respectively. The surgeons were designated as the primary surgeons or first assistants and grouped as follows: LCS-LCS, LCS-ECS, ECS-LCS, and ECS-ECS. Results During the study period, 25 primary surgeons performed 203 ATAAD repairs with 31 different first assistants: LCS-LCS, 50 repairs; LCS-ECS, 82 repairs; ECS-LCS, 55 repairs; and ECS-ECS, 16 repairs. The mean years in practice as a primary surgeon was 19.8 ± 3.3 for LCSs and 13.0 ± 1.8 for ECSs (p < 0.01). The unadjusted in-hospital mortality rates were 10.0%, 12.2%, 5.5%, and 6.3% for the LCS-LCS, LCS-ECS, ECS-LCS, and ECS-ECS groups, respectively (p = 0.63). Multivariable regression analysis showed that the surgeon's years of experience in practice were not a risk factor for in-hospital mortality. Furthermore, the long-term survival rate did not differ between the groups (p = 0.62). Conclusions The surgeons' years in practice had no effect on the outcomes of ATAAD repair. These investigations could aid in on-call coverage for ATAAD in medium-sized centers.
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Affiliation(s)
- Baku Takahashi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, JPN
| | - Keiji Kamohara
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, JPN
| | - Hiroyuki Morokuma
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, JPN
| | - Sojiro Amamoto
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, JPN
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13
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Kim YS, Kim JG, Choi HY, Lee D, Kong JW, Kang GH, Jang YS, Kim W, Lee Y, Kim J, Shin DG, Park JK, Lee G, Kim B. Detection of Aortic Dissection and Intramural Hematoma in Non-Contrast Chest Computed Tomography Using a You Only Look Once-Based Deep Learning Model. J Clin Med 2024; 13:6868. [PMID: 39598012 PMCID: PMC11594775 DOI: 10.3390/jcm13226868] [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: 09/29/2024] [Revised: 11/06/2024] [Accepted: 11/12/2024] [Indexed: 11/29/2024] Open
Abstract
Background/Objectives: Aortic dissection (AD) and aortic intramural hematoma (IMH) are fatal diseases with similar clinical characteristics. Immediate computed tomography (CT) with a contrast medium is required to confirm the presence of AD or IMH. This retrospective study aimed to use CT images to differentiate AD and IMH from normal aorta (NA) using a deep learning algorithm. Methods: A 6-year retrospective study of non-contrast chest CT images was conducted at a university hospital in Seoul, Republic of Korea, from January 2016 to July 2021. The position of the aorta was analyzed in each CT image and categorized as NA, AD, or IMH. The images were divided into training, validation, and test sets in an 8:1:1 ratio. A deep learning model that can differentiate between AD and IMH from NA using non-contrast CT images alone, called YOLO (You Only Look Once) v4, was developed. The YOLOv4 model was used to analyze 8881 non-contrast CT images from 121 patients. Results: The YOLOv4 model can distinguish AD, IMH, and NA from each other simultaneously with a probability of over 92% using non-contrast CT images. Conclusions: This model can help distinguish AD and IMH from NA when applying a contrast agent is challenging.
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Affiliation(s)
- Yu-Seop Kim
- Department of Convergence Software, Hallym University, Chuncheon 24252, Republic of Korea; (Y.-S.K.); (D.L.); (J.-W.K.)
| | - Jae Guk Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.G.K.); (G.H.K.); (Y.S.J.); (W.K.); (Y.L.)
- Hallym Biomedical Informatics Convergence Research Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (G.L.); (B.K.)
| | - Hyun Young Choi
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.G.K.); (G.H.K.); (Y.S.J.); (W.K.); (Y.L.)
- Hallym Biomedical Informatics Convergence Research Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (G.L.); (B.K.)
| | - Dain Lee
- Department of Convergence Software, Hallym University, Chuncheon 24252, Republic of Korea; (Y.-S.K.); (D.L.); (J.-W.K.)
| | - Jin-Woo Kong
- Department of Convergence Software, Hallym University, Chuncheon 24252, Republic of Korea; (Y.-S.K.); (D.L.); (J.-W.K.)
| | - Gu Hyun Kang
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.G.K.); (G.H.K.); (Y.S.J.); (W.K.); (Y.L.)
- Hallym Biomedical Informatics Convergence Research Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (G.L.); (B.K.)
| | - Yong Soo Jang
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.G.K.); (G.H.K.); (Y.S.J.); (W.K.); (Y.L.)
- Hallym Biomedical Informatics Convergence Research Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (G.L.); (B.K.)
| | - Wonhee Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.G.K.); (G.H.K.); (Y.S.J.); (W.K.); (Y.L.)
- Hallym Biomedical Informatics Convergence Research Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (G.L.); (B.K.)
| | - Yoonje Lee
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.G.K.); (G.H.K.); (Y.S.J.); (W.K.); (Y.L.)
- Hallym Biomedical Informatics Convergence Research Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (G.L.); (B.K.)
| | - Jihoon Kim
- Department of Thoracic and Cardiovascular Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea;
| | - Dong Geum Shin
- Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea;
| | - Jae Keun Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea;
| | - Gayoung Lee
- Hallym Biomedical Informatics Convergence Research Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (G.L.); (B.K.)
- Department of Health Policy and Management, Ewha Womans University Graduate School of Clinical Biohealth, Seoul 03760, Republic of Korea
| | - Bitnarae Kim
- Hallym Biomedical Informatics Convergence Research Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (G.L.); (B.K.)
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14
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Jha V, Bhadada S, Das L, Kumar S. Acute aortic dissection related to bilateral pelvic paragangliomas. BMJ Case Rep 2024; 17:e261425. [PMID: 39515829 DOI: 10.1136/bcr-2024-261425] [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: 11/16/2024] Open
Abstract
A female in late adolescence with severe chest pain, dyspnoea, diaphoresis and dizziness presented to the emergency department where she was found to have exceptionally high blood pressure (250/150 mm Hg) and a diastolic murmur. Initial examinations showed left ventricular hypertrophy, and urgent CT angiography confirmed a Stanford type A aortic dissection. Following successful surgical repair, further evaluations were prompted by her persistent, drug-resistant hypertension, revealing elevated normetanephrine and 3-methoxytyramine. Subsequent imaging identified bilateral pelvic paragangliomas, which were surgically removed, significantly reducing her hypertension. Her postoperative period showed biochemical remission, and genetic testing was positive for germline SDHB mutation. Monitoring and follow-up imaging are ongoing. This case highlights the rare association of pelvic paragangliomas with acute aortic dissection in young adults, emphasising the importance of possible endocrine hypertension in young people with hypertensive emergencies.
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Affiliation(s)
- Vivek Jha
- Endocrinology, PGIMER, Chandigarh, Chandigarh, India
| | | | - Liza Das
- Endocrinology, PGIMER, Chandigarh, Chandigarh, India
| | - Santosh Kumar
- Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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15
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Dang HNN, Luong TV, Nguyen Khoi Q, Nguyen UNP, Pham NNK, Tran HTN, Tran HK, Cao MTT, Ho BA, Doan TC, Nguyen HM, Anh Hoang T, Van Huynh M. Alterations in aortic elasticity indices among type 2 diabetes patients in a low and middle income country using M-mode echocardiography: A cross-sectional comparative study. PLoS One 2024; 19:e0305799. [PMID: 39446822 PMCID: PMC11500911 DOI: 10.1371/journal.pone.0305799] [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: 06/05/2024] [Accepted: 09/30/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Diabetes is one of the leading causes of noncommunicable diseases worldwide. It is known to induce cardiovascular remodeling, which can result in a variety of complications, including a considerable increase in aortic stiffness. While studies in Western populations have explored these effects, data on Asians, mainly Vietnamese, are limited. This study aimed to assess aortic elasticity in type 2 diabetes mellitus (T2DM) patients compared to healthy individuals. METHODS This quantitative, cross-sectional study compared aortic elasticity indices between individuals with T2DM and healthy controls in Vietnam. Aortic elasticity indices were assessed for all participants using M-mode echocardiography. RESULTS A comparison between the healthy and T2DM groups revealed substantial differences in aortic elasticity indices. The aortic stiffness index (ASI) was significantly greater in the T2DM group than in the control group, with median values of 6.10 (3.64-12.47) and 3.79 (2.40-8.50), respectively (p = 0.003). Aortic strain (AS) was substantially lower in the T2DM group than in the control group, with median values of 8.21% (4.24-13.07) and 10.66% (6.01-18.23), respectively (p = 0.039). Furthermore, the median aortic compliance (AC, 10-2mm/mmHg) and aortic distensibility (AD, 10-3mmHg-1) in individuals with T2DM were 4.07 (2.28-7.44) and 3.08 (1.57-5.26), respectively, lower than those in the control group, with median values of 6.40 (3.08-10.75) and 5.33 (2.80-9.79). A longer diabetes duration was linked to a greater ASI (r = 0.43, p < 0.05), while the AS decreased (r = -0.37, p < 0.05). CONCLUSIONS Substantial variations in aorta elasticity indices were found in patients with T2DM using M-mode echocardiography. These differences highlight the impact of T2DM on vascular health. More research is needed to investigate the consequences of these discrepancies and their significance for clinical purposes.
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Affiliation(s)
| | - Thang Viet Luong
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Quan Nguyen Khoi
- College of Health Sciences, Vin University, Hanoi, Vietnam
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | | | - Hung Khanh Tran
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Mai Thi Thu Cao
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Binh Anh Ho
- Cardiovascular Center, Hue Central Hospital, Hue, Vietnam
| | - Thang Chi Doan
- Cardiovascular Center, Hue Central Hospital, Hue, Vietnam
| | - Hung Minh Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Ha Noi, Vietnam
| | - Tien Anh Hoang
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Minh Van Huynh
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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16
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Duarte VE, Singh MN. Genetic syndromes associated with congenital heart disease. Heart 2024; 110:1231-1237. [PMID: 38040449 DOI: 10.1136/heartjnl-2023-323126] [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: 12/03/2023] Open
Abstract
Congenital heart defects are the most common type of birth defect, affecting 1% of live births. The underlying cause of congenital heart disease is frequently unknown. However, advances in human genetics and genome technologies have helped expand congenital heart disease pathogenesis knowledge during the last few decades. When the cardiac defects are part of a genetic syndrome, they are associated with extracardiac conditions and require multidisciplinary care and surveillance. Some genetic syndromes can have subtle clinical findings and remain undiagnosed well into adulthood. Each syndrome is associated with specific congenital and acquired comorbidities and a particular clinical risk profile. A timely diagnosis is essential for risk stratification, surveillance of associated conditions and counselling, particularly during family planning. However, genetic testing and counselling indications can be challenging to identify in clinical practice. This document intends to provide an overview of the most clinically relevant syndromes to consider, focusing on the phenotype and genotype diagnosis, outcome data, clinical guidelines and implications for care.
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Affiliation(s)
- Valeria E Duarte
- Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael N Singh
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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17
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Morris SA, Flyer JN, Yetman AT, Quezada E, Cappella ES, Dietz HC, Milewicz DM, Ouzounian M, Rigelsky CM, Tierney S, Lacro RV. Cardiovascular Management of Aortopathy in Children: A Scientific Statement From the American Heart Association. Circulation 2024; 150:e228-e254. [PMID: 39129620 DOI: 10.1161/cir.0000000000001265] [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: 08/13/2024]
Abstract
Aortopathy encompasses a spectrum of conditions predisposing to dilation, aneurysm, dissection, or rupture of the aorta and other blood vessels. Aortopathy is diagnosed commonly in children, from infancy through adolescence, primarily affecting the thoracic aorta, with variable involvement of the peripheral vasculature. Pathogeneses include connective tissue disorders, smooth muscle contraction disorders, and congenital heart disease, including bicuspid aortic valve, among others. The American Heart Association has published guidelines for diagnosis and management of thoracic aortic disease. However, these guidelines are predominantly focused on adults and cannot be applied adeptly to growing children with emerging features, growth and developmental changes, including puberty, and different risk profiles compared with adults. Management to reduce risk of progressive aortic dilation and dissection or rupture in children is complex and involves genetic testing, cardiovascular imaging, medical therapy, lifestyle modifications, and surgical guidance that differ in many ways from adult management. Pediatric practice varies widely, likely because aortopathy is pathogenically heterogeneous, including genetic and nongenetic conditions, and there is limited published evidence to guide care in children. To optimize care and reduce variation in management, experts in pediatric aortopathy convened to generate this scientific statement regarding the cardiovascular care of children with aortopathy. Available evidence and expert consensus were combined to create this scientific statement. The most common causes of pediatric aortopathy are reviewed. This document provides a general framework for cardiovascular management of aortopathy in children, while allowing for modification based on the personal and familial characteristics of each child and family.
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18
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Changlani N, Panjiyar BK, Jha SK, Khan SW, Kaushal A, Cherukuru S, Mahendru D, Kaleem S. Endovascular Aortic Repair in Traumatic Descending Thoracic Aortic Transection: A Case Report. Cureus 2024; 16:e68787. [PMID: 39371759 PMCID: PMC11456282 DOI: 10.7759/cureus.68787] [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] [Accepted: 09/06/2024] [Indexed: 10/08/2024] Open
Abstract
Aortic transection, a near-complete tear through the layers of the aorta, is a critical condition often resulting from trauma such as motor vehicle collisions. The urgency of managing aortic transection underscores the critical need for effective interventions. We report the case of a male in his early 50s with no significant medical history who presented to the emergency department following a motor vehicle collision, sustaining multiple injuries including a descending thoracic aortic transection. Rapid diagnostic assessment confirmed the severity of the injury, necessitating immediate intervention. Endovascular aortic repair was successfully employed, highlighting its efficacy in managing acute aortic injuries. The patient responded well to treatment, underscoring the importance of timely intervention in improving patient outcomes. This case emphasizes the critical role of rapid diagnostic assessment and endovascular intervention in managing life-threatening thoracic aortic injuries, particularly in the acute setting.
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Affiliation(s)
- Nikita Changlani
- Internal Medicine, Paul L. Foster School of Medicine, El Paso, USA
| | - Binay K Panjiyar
- Cardiology, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Research, Harvard Medical School, Boston, USA
- Research Fellowship, Ventolini's Lab, Texas Tech University Health Sciences Center, Odessa, USA
| | - Saroj K Jha
- Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Sanam W Khan
- Internal Medicine, Combined Military Hospital Lahore Medical College, Lahore, PAK
| | - Akshita Kaushal
- Internal Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, IND
| | | | - Diksha Mahendru
- Internal Medicine, Crozer-Chester Medical Center, Upland, USA
| | - Safa Kaleem
- Medicine, Shadan Institute of Medical Sciences, Hyderabad, IND
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19
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Abstract
OBJECTIVE Reporting clinical outcomes of acute type A aortic dissection. METHODS Data derived from the survey of the Japanese Association for Thoracic Surgery, the Japan Cardiovascular Database, and the Japanese Registry of All Cardiac and Vascular Diseases were analyzed. RESULTS Between 2012 and 2015, the Japanese Registry of All Cardiac and Vascular Diseases study collected 13,131 patients and the hospital mortality was 24.3%. The surgical mortality was significantly lower than medical one (11.8% vs 49.7%; p < 0.001). The Japanese Association for Thoracic Surgery survey disclosed the number of surgeries has been increased to 6157 in 2018 and the hospital death has decreased to 10.5%. The Japan Cardiovascular Database, collected 29,486 patients from 2013 to 2018. Age at surgery was 59.8 ± 14.2 years and patients younger than 65 years in 61% and 21% were older than 75 years. Ninety-four percent had surgery within 24 h after diagnosis. Antegrade cerebral perfusion was used in 74% and deep hypothermic circulatory arrest with/without retrograde cerebral perfusion in 26%. Replacement of the ascending aorta was performed in 62% and total arch replacement in 28%. The aortic valve was replaced in 7.9% and repaired in 4.4%. The hospital mortality was 11%. New stroke occurred in 12%, hemodialysis in 7.3%, paraplegia in 3.9%, and prolonged ventilation in 15%. CONCLUSION The number of operations for type A aortic dissection has increased, and hospital mortality has improved. Although the early results after surgery for type A aortic dissection are acceptable, new strategies to improve early outcomes in patients with preoperative comorbidities are required.
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Linardi D, Gardellini J, Boschetti V, Di Nicola V, Denora M, Puntel G, Puppini G, Luciani GB. Patient-Tailored Therapy for Complex Aortic Arch Anatomy: An Evolving Research Field with Custom-Made Solutions. J Clin Med 2024; 13:4975. [PMID: 39274191 PMCID: PMC11396027 DOI: 10.3390/jcm13174975] [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: 07/20/2024] [Revised: 08/12/2024] [Accepted: 08/19/2024] [Indexed: 09/16/2024] Open
Abstract
The treatment of complex aortic pathologies requires specialized techniques and tailored approaches due to each patient's unique anatomical and clinical challenges. The European Association for Cardiothoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) new guidelines identify the aorta as the body's 24th organ and reiterate that multidisciplinary aortic teams are recommended for shared decision-making to determine optimal treatment strategies. Patients treated for conditions such as aneurysms, dissections, intramural hematomas, or penetrating aortic ulcers may develop complex forms over time, necessitating careful follow-up and timely corrective actions. Endovascular solutions can be favorable for older patients with complex anatomies and multiple comorbidities. However, when endovascular treatment is not feasible, hybrid treatments or open surgery must be considered if the patient's condition allows it. The risk-benefit ratio of each procedure must be carefully evaluated; choosing the best intervention or deciding not to intervene becomes a critical and challenging decision. At our Cardiac Surgery Center in Verona, a multidisciplinary team with over 20 years of experience in treating complex aortic arch pathologies extensively discussed different cases of complex aortic pathologies treated with endovascular, hybrid, or surgical approaches, emphasizing the importance of considering both anatomical and patient-specific characteristics. The decisions and treatments were often challenging, and unanimity was not always achieved, reflecting the complexity of finding the best solutions.
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Affiliation(s)
- Daniele Linardi
- Cardiac Surgery Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Jacopo Gardellini
- Cardiac Surgery Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Vincenzo Boschetti
- Cardiac Surgery Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Venanzio Di Nicola
- Cardiac Surgery Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Mariateresa Denora
- Cardiac Surgery Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Gino Puntel
- Radiology Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Giovanni Puppini
- Radiology Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Giovanni B Luciani
- Cardiac Surgery Department, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
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21
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Kim H, Lee JH, Chung SR, Park PW, Park TK, Kang IS, Huh J, Kim DK, Cho YH, Sung K. Impact of early diagnosis on surgical outcomes in patients with Loeys-Dietz syndrome. Front Cardiovasc Med 2024; 11:1429222. [PMID: 39221421 PMCID: PMC11363540 DOI: 10.3389/fcvm.2024.1429222] [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: 05/07/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Background This study aimed to investigate the influence of early diagnosis (ED) on surgical outcomes in patients definitively diagnosed with Loeys-Dietz syndrome (LDS). Methods A retrospective review was conducted on 38 patients with LDS who underwent aortic surgery at our institution between January 1995 and June 2022. The primary endpoint was freedom from aortic reoperation. Results Among the patients, the median age at the initial surgery was 33 (range: 39-44) years, and 23 (60.5%) patients were male. Twenty-one (55.3%; aortic dissection or rupture (n = 2) and aneurysm (n = 19)) patients were diagnosed with LDS before the initial surgery (ED group). Meanwhile, the remaining 17 (44.7%; aortic dissection or rupture (n = 13) and aneurysm (n = 4)) patients were after surgery [delayed diagnosis (DD) group]. The ED group had significantly lower rates of emergency surgery and concomitant arch procedure (P < .001, respectively) but a higher rate of valve-sparing root surgery (P = .018) compared to the DD group. No in-hospital mortality was observed in either group. Nevertheless, the ED group had a shorter postoperative hospital stay (median difference: 3 days, P = .032) and a lower rate of aortic reoperation (P = .013). Conclusion Early detection of LDS may help in preventing acute aortic syndrome, reducing the risk of aortic reoperation, and potentially shortening hospital stay. Careful medical management before surgery could contribute to better clinical outcomes and an improved quality of life for patients with LDS.
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Affiliation(s)
- Hongsun Kim
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Su Ryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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22
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Sakai Y, Kanno A, Sato Y, Ito T, Matsumoto K, Ueno M, Sumitomo K, Furukawa K. A case of polymyalgia rheumatica complicated with giant thoracic aortic aneurysm with massive intraluminal thrombosis. Geriatr Gerontol Int 2024; 24:814-815. [PMID: 39004935 DOI: 10.1111/ggi.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/07/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Yuta Sakai
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsuhiro Kanno
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Yoshiaki Sato
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Takehito Ito
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Keiji Matsumoto
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Masamichi Ueno
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Kazuhiro Sumitomo
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Katsutoshi Furukawa
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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23
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Chen MH, Deng ES, Yamada JM, Choudhury S, Scotellaro J, Kelley L, Isselbacher E, Lindsay ME, Walsh CA, Doan RN. Contributions of Germline and Somatic Mosaic Genetics to Thoracic Aortic Aneurysms in Nonsyndromic Individuals. J Am Heart Assoc 2024; 13:e033232. [PMID: 38958128 PMCID: PMC11292778 DOI: 10.1161/jaha.123.033232] [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: 11/14/2023] [Accepted: 02/20/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Thoracic aortic aneurysm (TAA) is associated with significant morbidity and mortality. Although individuals with family histories of TAA often undergo clinical molecular genetic testing, adults with nonsyndromic TAA are not typically evaluated for genetic causes. We sought to understand the genetic contribution of both germline and somatic mosaic variants in a cohort of adult individuals with nonsyndromic TAA at a single center. METHODS AND RESULTS One hundred eighty-one consecutive patients <60 years who presented with nonsyndromic TAA at the Massachusetts General Hospital underwent deep (>500×) targeted sequencing across 114 candidate genes associated with TAA and its related functional pathways. Samples from 354 age- and sex-matched individuals without TAA were also sequenced, with a 2:1 matching. We found significant enrichments for germline (odds ratio [OR], 2.44, P=4.6×10-6 [95% CI, 1.67-3.58]) and also somatic mosaic variants (OR, 4.71, P=0.026 [95% CI, 1.20-18.43]) between individuals with and without TAA. Likely genetic causes were present in 24% with nonsyndromic TAA, of which 21% arose from germline variants and 3% from somatic mosaic alleles. The 3 most frequently mutated genes in our cohort were FLNA (encoding Filamin A), NOTCH3 (encoding Notch receptor 3), and FBN1 (encoding Fibrillin-1). There was increased frequency of both missense and loss of function variants in TAA individuals. CONCLUSIONS Likely contributory dominant acting genetic variants were found in almost one quarter of nonsyndromic adults with TAA. Our findings suggest a more extensive genetic architecture to TAA than expected and that genetic testing may improve the care and clinical management of adults with nonsyndromic TAA.
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Affiliation(s)
- Ming Hui Chen
- Department of CardiologyBoston Children’s HospitalBostonMAUSA
- Division of Genetics and Genomics, Department of PediatricsBoston Children’s HospitalBostonMAUSA
- Department of PediatricsHarvard Medical SchoolBostonMAUSA
| | - Ellen S. Deng
- Division of Genetics and Genomics, Department of PediatricsBoston Children’s HospitalBostonMAUSA
| | - Jessica M. Yamada
- Division of Genetics and Genomics, Department of PediatricsBoston Children’s HospitalBostonMAUSA
| | - Sangita Choudhury
- Division of Genetics and Genomics, Department of PediatricsBoston Children’s HospitalBostonMAUSA
- Department of PediatricsHarvard Medical SchoolBostonMAUSA
| | - Julia Scotellaro
- Division of Genetics and Genomics, Department of PediatricsBoston Children’s HospitalBostonMAUSA
| | - Lily Kelley
- Division of Genetics and Genomics, Department of PediatricsBoston Children’s HospitalBostonMAUSA
| | - Eric Isselbacher
- Division of Cardiology, Massachusetts General Hospital Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Mark E. Lindsay
- Division of Cardiology, Massachusetts General Hospital Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Christopher A. Walsh
- Division of Genetics and Genomics, Department of PediatricsBoston Children’s HospitalBostonMAUSA
- Department of PediatricsHarvard Medical SchoolBostonMAUSA
- Department of NeurologyHarvard Medical SchoolBostonMAUSA
- Department of PediatricsHoward Hughes Medical Institute, Boston Children’s HospitalBostonMAUSA
| | - Ryan N. Doan
- Division of Genetics and Genomics, Department of PediatricsBoston Children’s HospitalBostonMAUSA
- Department of PediatricsHarvard Medical SchoolBostonMAUSA
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24
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Udugampolage NS, Frolova S, Taurino J, Pini A, Martelli F, Voellenkle C. Coding and Non-Coding Transcriptomic Landscape of Aortic Complications in Marfan Syndrome. Int J Mol Sci 2024; 25:7367. [PMID: 39000474 PMCID: PMC11242319 DOI: 10.3390/ijms25137367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Marfan syndrome (MFS) is a rare congenital disorder of the connective tissue, leading to thoracic aortic aneurysms (TAA) and dissection, among other complications. Currently, the most efficient strategy to prevent life-threatening dissection is preventive surgery. Periodic imaging applying complex techniques is required to monitor TAA progression and to guide the timing of surgical intervention. Thus, there is an acute demand for non-invasive biomarkers for diagnosis and prognosis, as well as for innovative therapeutic targets of MFS. Unraveling the intricate pathomolecular mechanisms underlying the syndrome is vital to address these needs. High-throughput platforms are particularly well-suited for this purpose, as they enable the integration of different datasets, such as transcriptomic and epigenetic profiles. In this narrative review, we summarize relevant studies investigating changes in both the coding and non-coding transcriptome and epigenome in MFS-induced TAA. The collective findings highlight the implicated pathways, such as TGF-β signaling, extracellular matrix structure, inflammation, and mitochondrial dysfunction. Potential candidates as biomarkers, such as miR-200c, as well as therapeutic targets emerged, like Tfam, associated with mitochondrial respiration, or miR-632, stimulating endothelial-to-mesenchymal transition. While these discoveries are promising, rigorous and extensive validation in large patient cohorts is indispensable to confirm their clinical relevance and therapeutic potential.
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Affiliation(s)
| | - Svetlana Frolova
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy; (S.F.); (C.V.)
- Department of Biosciences, University of Milan, 20122 Milan, Italy
| | - Jacopo Taurino
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy; (N.S.U.); (J.T.); (A.P.)
| | - Alessandro Pini
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy; (N.S.U.); (J.T.); (A.P.)
| | - Fabio Martelli
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy; (S.F.); (C.V.)
| | - Christine Voellenkle
- Molecular Cardiology Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy; (S.F.); (C.V.)
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25
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Shen X, Li J, Yan H, Zhou S, Yang S, Li W. Combined blood pressure and heart rate trajectories are associated with prognosis in critically ill patients with acute aortic dissection: A group-based multi-trajectory analysis. Heliyon 2024; 10:e29934. [PMID: 38707356 PMCID: PMC11066306 DOI: 10.1016/j.heliyon.2024.e29934] [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: 07/10/2023] [Revised: 03/16/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Background Managing systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) is pivotal in acute aortic dissection (AAD) care. However, no prior studies have jointly analyzed the trajectories of these parameters. This research aimed to characterize their joint longitudinal trajectories and investigate the influence on AAD prognosis. Methods We included AAD patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Using group-based multi-trajectory modeling (GBMTM), we identified combined trajectories of SBP, DBP, and HR within the initial 24 h of intensive care unit (ICU) admission. Cox proportional hazard regression, log-binomial regression, and logistic regression were employed to assess the association between trajectory groups and mortality outcomes. Results Data from 337 patients were analyzed. GBMTM identified five combined trajectory groups. Group 1 featured rapidly declining SBP and DBP with high pulse pressure and low HR; Group 2 showed high to moderate SBP with slight rebound and persistently low HR; Group 3 displayed persistently moderate BP and HR; Group 4 was characterized by moderate blood pressure with persistently high HR; and Group 5 had high to moderate SBP with slight rebound, high but gradually declining DBP, and slightly high HR. Group 3 demonstrated a lower risk of mortality, with an adjusted hazard ratio of 0.32 (95 % CI, 0.14-0.74), and the adjusted relative risks for in-hospital, 30-day, and 1-year mortalities were 0.37 (95 % CI, 0.15-0.87), 0.25 (95 % CI, 0.10-0.62), and 0.41 (95 % CI, 0.22-0.79), respectively. The time-independent C-index curve demonstrated that the multi-trajectory groups had higher C-index values than any univariate trajectory groups or admission values of SBP, DBP, and HR. Conclusions Utilization of GBMTM can yield data-driven insights to identify distinct subphenotypes in AAD patients. The combined trajectories of SBP, DBP, and HR within 24 h of ICU admission significantly influenced the mortality rate.
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Affiliation(s)
- Xuejun Shen
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- Shantou University Medical College, Shantou, 515041, China
| | - Jufang Li
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- Shantou University Medical College, Shantou, 515041, China
| | - Hongle Yan
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- Shantou University Medical College, Shantou, 515041, China
| | - Shuyi Zhou
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- Shantou University Medical College, Shantou, 515041, China
| | - Shengli Yang
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Weiping Li
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
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26
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Bramlet M, Mohamadi S, Srinivas J, Dassanayaka T, Okammor T, Shadden M, Sutton BP. Automating aortic cross-sectional measurement of 3D aorta models. J Med Imaging (Bellingham) 2024; 11:034503. [PMID: 38817710 PMCID: PMC11135202 DOI: 10.1117/1.jmi.11.3.034503] [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: 09/01/2023] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose Aortic dissection carries a mortality as high as 50%, but surgical palliation is also fraught with morbidity risks of stroke or paralysis. As such, a significant focus of medical decision making is on longitudinal aortic diameters. We hypothesize that three-dimensional (3D) modeling affords a more efficient methodology toward automated longitudinal aortic measurement. The first step is to automate the measurement of manually segmented 3D models of the aorta. We developed and validated an algorithm to analyze a 3D segmented aorta and output the maximum dimension of minimum cross-sectional areas in a stepwise progression from the diaphragm to the aortic root. Accordingly, the goal is to assess the diagnostic validity of the 3D modeling measurement as a substitute for existing 2D measurements. Approach From January 2021 to June 2022, 66 3D non-contrast steady-state free precession magnetic resonance images of aortic pathology with clinical aortic measurements were identified; 3D aorta models were manually segmented. A novel mathematical algorithm was applied to each model to generate maximal aortic diameters from the diaphragm to the root, which were then correlated to clinical measurements. Results With a 76% success rate, we analyzed the resulting 50 3D aortic models utilizing the automated measurement tool. There was an excellent correlation between the automated measurement and the clinical measurement. The intra-class correlation coefficient and p -value for each of the nine measured locations of the aorta were as follows: sinus of valsalva, 0.99, < 0.001 ; sino-tubular junction, 0.89, < 0.001 ; ascending aorta, 0.97, < 0.001 ; brachiocephalic artery, 0.96, < 0.001 ; transverse segment 1, 0.89, < 0.001 ; transverse segment 2, 0.93, < 0.001 ; isthmus region, 0.92, < 0.001 ; descending aorta, 0.96, < 0.001 ; and aorta at diaphragm, 0.3, < 0.001 . Conclusions Automating diagnostic measurements that appease clinical confidence is a critical first step in a fully automated process. This tool demonstrates excellent correlation between measurements derived from manually segmented 3D models and the clinical measurements, laying the foundation for transitioning analytic methodologies from 2D to 3D.
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Affiliation(s)
- Matthew Bramlet
- University of Illinois College of Medicine at Peoria, Pediatric Cardiology, Peoria, Illinois, United States
| | - Salman Mohamadi
- University of Illinois Urbana Champaign, Bioengineering, Champaign, Illinois, United States
| | - Jayishnu Srinivas
- University of Illinois College of Medicine Peoria, Peoria, Illinois, United States
| | - Tehan Dassanayaka
- University of Illinois Urbana Champaign, Bioengineering, Champaign, Illinois, United States
| | - Tafara Okammor
- University of Illinois Urbana Champaign, Bioengineering, Champaign, Illinois, United States
| | | | - Bradley P. Sutton
- University of Illinois Urbana Champaign, Bioengineering, Champaign, Illinois, United States
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Grigorescu AE, Anghel A, Feier H. Successful Interventional Endovascular Management of Ruptured Penetrating Aortic Ulcer with Associated Enormous Right Pleural False Aneurysm. Clin Pract 2024; 14:619-628. [PMID: 38666807 PMCID: PMC11049587 DOI: 10.3390/clinpract14020049] [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: 12/24/2023] [Revised: 01/24/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Penetrating aortic injuries represent critical medical emergencies that necessitate immediate intervention to prevent life-threatening consequences. When accompanied by the presence of an enormous right pleural false aneurysm, the clinical scenario becomes exceptionally rare and complex. This case report details the successful management of a patient who presented with a penetrating aortic ulcer and an extensive false aneurysm within the right pleura, employing an interdisciplinary approach involving cardiac surgeons, cardiologists, interventional cardiologists, and radiologists. The pivotal intervention involved the deployment of a covered and bare stent graft into the descending thoracic aorta to seal the aortic rupture. The patient's clinical condition stabilized postoperatively, with no signs of recurrent hemorrhage. This case underscores the importance of rapid diagnosis, timely intervention, and the collaborative efforts of a specialized medical team in successfully managing such complex vascular injuries. Early recognition and referral to specialized centers are essential for improving patient outcomes in cases of penetrating aortic injuries with associated giant pseudoaneurysms.
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Affiliation(s)
- Andrei Emanuel Grigorescu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (A.E.G.); (H.F.)
- Research Center of the Institute of Cardiovascular and Heart Disease of Timisoara, 300310 Timisoara, Romania
- Division of Cardiovascular Surgery, Institute for Cardiovascular Diseases, 300391 Timisoara, Romania
- Doctoral School Medicine—Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Andrei Anghel
- Department of Biochemistry, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Horea Feier
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (A.E.G.); (H.F.)
- Research Center of the Institute of Cardiovascular and Heart Disease of Timisoara, 300310 Timisoara, Romania
- Division of Cardiovascular Surgery, Institute for Cardiovascular Diseases, 300391 Timisoara, Romania
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Hassab AH, Hur DJ, Vallabhajosyula P, Tellides G, Assi R. Intimomedial tears of the aorta heal by smooth muscle cell-mediated fibrosis without atherosclerosis. JCI Insight 2024; 9:e172437. [PMID: 38592807 PMCID: PMC11141924 DOI: 10.1172/jci.insight.172437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUNDDisease of the aorta varies from atherosclerosis to aneurysms, with complications including rupture, dissection, and poorly characterized limited tears. We studied limited tears without any mural hematoma, termed intimomedial tears, to gain insight into aortic vulnerability to excessive wall stresses. Our premise is that minimal injuries in aortas with sufficient medial resilience to prevent tear progression correspond to initial mechanisms leading to complete structural failure in aortas with significantly compromised medial resilience.METHODSIntimomedial tears were macroscopically identified in 9 of 108 ascending aortas after surgery and analyzed by histology and immunofluorescence confocal microscopy.RESULTSNonhemorrhagic, nonatheromatous tears correlated with advanced aneurysmal disease and most lacked distinctive symptoms or radiological signs. Tears traversed the intima and part of the subjacent media, while the resultant defects were partially or completely filled with neointima characterized by differentiated smooth muscle cells, scattered leukocytes, dense fibrosis, and absent elastic laminae despite tropoelastin synthesis. Healed lesions contained organized fibrin at tear edges without evidence of plasma and erythrocyte extravasation or lipid accumulation.CONCLUSIONThese findings suggest a multiphasic model of aortic wall failure in which primary lesions of intimomedial tears either heal if the media is sufficiently resilient or progress as dissection or rupture by medial delamination and tear completion, respectively. Moreover, mural incorporation of thrombus and cellular responses to injury, two historically important concepts in atheroma pathogenesis, contribute to vessel wall repair with adequate conduit function, but even together are not sufficient to induce atherosclerosis.FUNDINGNIH (R01-HL146723, R01-HL168473) and Yale Department of Surgery.
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Affiliation(s)
| | - David J. Hur
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | | | - George Tellides
- Department of Surgery (Cardiac), and
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Program in Vascular Biology and Therapeutics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Roland Assi
- Department of Surgery (Cardiac), and
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Program in Vascular Biology and Therapeutics, Yale School of Medicine, New Haven, Connecticut, USA
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29
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Nguyen K, Shin JG, Andrusaitis J. Hypertensive Emergency Team-Based Learning. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2024; 9:T1-T39. [PMID: 38707946 PMCID: PMC11068318 DOI: 10.21980/j8bp90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/08/2024] [Indexed: 05/07/2024]
Abstract
Audience The target audiences for this team-based learning (TBL) activity are resident physicians and medical students. Introduction According to the Centers for Disease Control and Prevention (CDC), nearly half of the adults in the United States have hypertension,1 which is a leading cause of cardiovascular disease and premature death.2 In extreme cases, patients may present in hypertensive emergencies, defined as an acute, marked elevation of systolic blood pressure >180mmHg or diastolic blood pressure >120mmHg with evidence of organ dysfunction.3,4 Patients presenting to the emergency department (ED) with symptoms of hypertensive emergencies must be promptly diagnosed and treated to prevent further morbidity and mortality. This TBL utilizes four clinical cases to educate resident physicians and medical students not only on the recognition of hypertensive emergencies, but also on the workup, management, and disposition of patients who present to the ED with hypertension. Educational Objectives By the end of this TBL session, learners should be able to: 1) define features of asymptomatic hypertension versus hypertensive emergency, 2) discuss which patients with elevated blood pressure may require further diagnostic workup and intervention, 3) identify a differential diagnosis for patients presenting with elevated blood pressures, 4) recognize the features of different types of end-organ damage, 5) review an algorithm for the pharmacologic management of hypertensive emergencies, 6) indicate dosing and routes of various anti-hypertensive medications, 7) choose the appropriate treatment for a patient who is hypertensive and presenting with flash pulmonary edema, 8) identify an aortic dissection on computed tomography (CT), 9) choose the appropriate treatment for a patient who is hypertensive and presenting with an aortic dissection, 10) identify intracranial hemorrhage on CT, 11) choose the appropriate treatment for a patient who is hypertensive and presenting with an intracranial hemorrhage, and 12) describe the intervention for warfarin reversal. Educational Methods This is a classic TBL that includes an individual readiness assessment test (iRAT), a multiple-choice group readiness assessment test (gRAT), and a group application exercise (GAE). Research Methods Learners and instructors were given the opportunity to provide verbal feedback after completion of the TBL. Learners included senior medical students and first-, second-, and third-year emergency-medicine residents. Learners were specifically asked if they felt the cases were educational, relevant, and useful to their training. Results Six resident physicians and three medical students volunteered their verbal feedback, and agreed when they were specifically asked if the cases were educational, relevant, and useful to their training. The same learners also agreed when asked if they felt the TBL was a more enjoyable activity than a direct lecture to refresh their knowledge and skills. One instructor observed that interns and medical students were generally able to reach a correct diagnosis; however, they seemed to struggle more with describing appropriate pharmacologic interventions when compared to more senior learners. Discussion Hypertension is a common complaint and incidental finding in patients presenting to the ED. Given its non-specific value, it can be a difficult topic for the novice healthcare provider to master. The differential diagnosis for a patient presenting with hypertension is vast, ranging from benign to emergent, and can sometimes necessitate minimal to substantial workups. Thus, this TBL is a useful, relevant, and effective exercise for residents-in-training to review and understand the management of hypertension. Topics Hypertension, hypertensive emergency, asymptomatic hypertension, flash pulmonary edema, aortic dissection, intracranial hemorrhage, warfarin reversal, team-based learning.
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Affiliation(s)
- Khoa Nguyen
- University of California, Irvine, Department of Emergency Medicine, Orange, CA
| | | | - Jessica Andrusaitis
- University of California, Irvine, Department of Emergency Medicine, Orange, CA
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Yoon JA, Ahmad MM, Syed MN, Ahmad MN, Hussaini SF, Muhammad MN, Pir SHA, Khandheria BK, Tajik AJ, Ammar KA. Refining the upper limit of normal for the ascending aorta: In search of optimal criteria -- a large database study of normal individuals. Vascular 2024; 32:254-261. [PMID: 36412136 DOI: 10.1177/17085381221140171] [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: 02/17/2024]
Abstract
OBJECTIVES The cutoff for dilated mid-ascending aorta (mAA) is controversial and has several definitions. The present study was carried out to determine the prevalence of mAA dilation based on published definitions and to identify the optimal cutoff. METHODS Echocardiographic studies of patients >15 years of age performed at a large tertiary care center over 4 years, n = 49,330, were retrospectively evaluated. Leading-edge-to-leading-edge technique was used to measure the mAA in diastole. Several cutoff criteria were included. In addition, we defined normals in our database as those who, after 28 causes of dilated aorta were excluded, were normal both clinically and echocardiographically (n = 2334). RESULTS The mean age was 64.2 ± 17.1 years, and 31.5% were men. The prevalence of dilated mAA based on absolute criteria with sex stratification varied between 17% and 23% and based on relative criteria (to age, body surface area, and sex) varied between 6% and 11%. It further decreased to 7.6% on the addition of narrow age stratification (10 year intervals) performed on normals in our database. The multivariate adjusted R2 (for variation in mAA diameter) was 0.25 for age, decreasing to 0.12 for weight and 0.07 for sex and height. CONCLUSIONS The lowest prevalence of 7.6% probably represents the optimal cutoff for dilated mAA because it includes age, which explains most of the variation in mAA, in narrow (10 year) intervals only performed in our normals, which represents the largest sample size to date.
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Affiliation(s)
- Ji Ae Yoon
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - Mirza Mujadil Ahmad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - Muhammad Nabeel Syed
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - Mirza Nubair Ahmad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - Sharmeen Fatima Hussaini
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - Mustafa Noor Muhammad
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - Syed Haris A Pir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
| | - Khawaja Afzal Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI, USA
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Godugu S, Sinha T, Pradeepan M, Eze-Odurukwe A, Bokhari SFH, Islam R, Bakht D, Islam H, Farhan M. Unraveling the Enigma of Aortic Dissection: From Genetics to Innovative Therapies. Cureus 2024; 16:e57803. [PMID: 38721226 PMCID: PMC11077317 DOI: 10.7759/cureus.57803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 01/06/2025] Open
Abstract
Aortic dissection (AD) presents a critical medical emergency characterized by a tear in the aortic wall, necessitating prompt recognition and management to mitigate catastrophic complications. Despite advancements in medical technology and therapeutic interventions, AD remains a formidable challenge, often resulting in severe morbidity and mortality. This narrative review provides a comprehensive overview of AD, encompassing its clinical presentation, diagnostic modalities, and management strategies, while also exploring emerging trends and innovations in its management. Genetic predispositions significantly influence AD pathogenesis, with over 30 contributory genes identified, emphasizing the importance of genetic screening and counseling. Classification systems such as Stanford and DeBakey, alongside their revised counterparts, aid in categorizing AD and guiding treatment decisions. Advancements in diagnostic imaging, including transesophageal echocardiography and computed tomography angiography, have enhanced diagnostic precision, augmented by artificial intelligence and machine learning algorithms. Pharmacological innovations focus on optimizing medical therapy, while surgical and endovascular approaches offer minimally invasive treatment options. Hybrid procedures and aortic valve-sparing techniques broaden treatment avenues, while bioresorbable stent grafts hold promise for tissue regeneration. Collaborative efforts and ongoing research are essential to address remaining challenges and improve outcomes in managing AD. This review contributes to the understanding of AD's complexity and facilitates informed decision-making in clinical practice, underscoring the imperative for continued innovation and research in AD management.
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Affiliation(s)
- Swathi Godugu
- General Medicine, Zaporizhzhia State Medical University, Zaporizhzhia, UKR
| | - Tanya Sinha
- Medical Education, Tribhuvan University, Kathmandu, NPL
| | | | | | | | - Rabia Islam
- Medicine and Surgery, Faisalabad Medical University, Faisalabad, PAK
| | - Danyal Bakht
- Medicine and Surgery, Mayo Hospital, Lahore, PAK
| | - Hamza Islam
- Internal Medicine, Punjab Medical College, Faisalabad, PAK
| | - Muhammad Farhan
- Department of Medicine, Ajman University, College of Medicine, Ajman, ARE
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Zamirpour S, Xuan Y, Wang Z, Gomez A, Leach JR, Mitsouras D, Saloner DA, Guccione JM, Ge L, Tseng EE. Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm. IJC HEART & VASCULATURE 2024; 51:101375. [PMID: 38435381 PMCID: PMC10909604 DOI: 10.1016/j.ijcha.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/13/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Objectives Current diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surface area (BSA) is unknown. Our objective was to compare aTAA wall stresses with indexed diameters in relation to all-cause mortality at 3.75 years follow-up. Methods Finite element analyses were performed in a veteran population with aortas ≥ 4.0 cm. Three-dimensional geometries were reconstructed from computed tomography with models accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain wall stress distributions under systolic pressure. Peak wall stresses were compared across guideline thresholds for diameter/BSA and diameter/height. Hazard ratios for all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models. Results Of 253 veterans, 54 (21 %) had aneurysm repair at 3.75 years. Indexed diameter alone would have prompted repair at baseline in 17/253 (6.7 %) patients, including only 4/230 (1.7 %) with diameter < 5.5 cm. Peak wall stresses did not significantly differ across guideline thresholds for diameter/BSA (circumferential: p = 0.15; longitudinal: p = 0.18), but did differ for diameter/height (circumferential: p = 0.003; longitudinal: p = 0.048). All-cause mortality was independently associated with peak longitudinal stresses (p = 0.04). Peak longitudinal stresses were best predicted by diameter (c-statistic = 0.66), followed by diameter/height (c-statistic = 0.59), and diameter/BSA (c-statistic = 0.55). Conclusions Diameter/height improved stratification of peak wall stresses compared to diameter/BSA. Peak longitudinal stresses predicted all-cause mortality independent of age and indexed diameter and may aid risk stratification for aTAA adverse events.
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Affiliation(s)
- Siavash Zamirpour
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
- School of Medicine, University of California, San Francisco, USA
| | - Yue Xuan
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Zhongjie Wang
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Axel Gomez
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Joseph R. Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Dimitrios Mitsouras
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - David A. Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Julius M. Guccione
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Liang Ge
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
| | - Elaine E. Tseng
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, USA
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Yang J, Yu J, Wang Y, Liao M, Ji Y, Li X, Wang X, Chen J, Qi B, Yang F. Development of hypertension models for lung cancer screening cohorts using clinical and thoracic aorta imaging factors. Sci Rep 2024; 14:6862. [PMID: 38514739 PMCID: PMC10957886 DOI: 10.1038/s41598-024-57396-1] [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: 12/02/2023] [Accepted: 03/18/2024] [Indexed: 03/23/2024] Open
Abstract
This study aims to develop and validate nomogram models utilizing clinical and thoracic aorta imaging factors to assess the risk of hypertension for lung cancer screening cohorts. We included 804 patients and collected baseline clinical data, biochemical indicators, coexisting conditions, and thoracic aorta factors. Patients were randomly divided into a training set (70%) and a validation set (30%). In the training set, variance, t-test/Mann-Whitney U-test and standard least absolute shrinkage and selection operator were used to select thoracic aorta imaging features for constructing the AIScore. Multivariate logistic backward stepwise regression was utilized to analyze the influencing factors of hypertension. Five prediction models (named AIMeasure model, BasicClinical model, TotalClinical model, AIBasicClinical model, AITotalClinical model) were constructed for practical clinical use, tailored to different data scenarios. Additionally, the performance of the models was evaluated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analyses (DCA). The areas under the ROC curve for the five models were 0.73, 0.77, 0.83, 0.78, 0.84 in the training set, and 0.77, 0.78, 0.81, 0.78, 0.82 in the validation set, respectively. Furthermore, the calibration curves and DCAs of both sets performed well on accuracy and clinical practicality. The nomogram models for hypertension risk prediction demonstrate good predictive capability and clinical utility. These models can serve as effective tools for assessing hypertension risk, enabling timely non-pharmacological interventions to preempt or delay the future onset of hypertension.
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Affiliation(s)
- Jinrong Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Yu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaoling Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Liao
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingying Ji
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Li
- Shanghai United Imaging Intelligence Inc., Shanghai, China
| | - Xuechun Wang
- Shanghai United Imaging Intelligence Inc., Shanghai, China
| | - Jun Chen
- Precision Healthcare Institute, GE Healthcare, Shanghai, China
| | - Benling Qi
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Lin CY, Kao MC, Lee HF, Wu MY, Tseng CN. Acute type a aortic intramural hematoma complicated with preoperative hemopericardium: early and late surgical outcome analyses. J Cardiothorac Surg 2024; 19:123. [PMID: 38481322 PMCID: PMC10936043 DOI: 10.1186/s13019-024-02616-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Acute type A aortic intramural hematoma (ATAIMH) is a variant of acute type A aortic dissection (ATAAD), exhibiting an increased risk of hemopericardium and cardiac tamponade. It can be life-threatening without emergency treatment. However, comprehensive studies of the clinical features and surgical outcomes of preoperative hemopericardium in patients with ATAIMH remain scarce. This retrospective study aims to investigate the clinical features and early and late outcomes of patients who underwent aortic repair surgery for ATAIMH complicated with preoperative hemopericardium. METHODS We investigated 132 consecutive patients who underwent emergency ATAIMH repair at this institution between February 2007 and August 2020. These patients were dichotomized into the hemopericardium (n = 58; 43.9%) and non-hemopericardium groups (n = 74; 56.1%). We compared the clinical demographics, surgical information, postoperative complications, 5-year cumulative survival rates, and freedom from reoperation rates. Furthermore, multivariable logistic regression analysis was utilized to identify independent risk factors for patients who underwent re-exploration for bleeding. RESULTS In the hemopericardium group, 36.2% of patients presented with cardiac tamponade before surgery. Moreover, the hemopericardium group showed higher rates of preoperative shock and endotracheal intubation and was associated with an elevated incidence of intractable perioperative bleeding, necessitating delayed sternal closure for hemostasis. The hemopericardium group exhibited higher blood transfusion volumes and rates of re-exploration for bleeding following surgery. However, the 5-year survival (59.5% vs. 75.0%; P = 0.077) and freedom from reoperation rates (93.3% vs. 85.5%; P = 0.416) were comparable between both groups. Multivariable analysis revealed that hemopericardium, cardiopulmonary bypass time, and delayed sternal closure were the risk factors for bleeding re-exploration. CONCLUSIONS The presence of hemopericardium in patients with ATAIMH is associated with an elevated incidence of cardiac tamponade and unstable preoperative hemodynamics, which could lead to perioperative bleeding tendencies and high complication rates. However, patients of ATAIMH complicated with hemopericardium undergoing aggressive surgical intervention exhibited long-term surgical outcomes comparable to those without hemopericardium.
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Affiliation(s)
- Chun-Yu Lin
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
- Department of Cardiothoracic and Vascular Surgery, New Taipei Municipal TuCheng Hospital, No.6, Sec.2, JinCheng Rd, TuCheng, New Taipei City, 236, Taiwan.
| | - Ming-Chang Kao
- Department of Anesthesiology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Hsin-Fu Lee
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Cardiology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Meng-Yu Wu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Cardiothoracic and Vascular Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chi-Nan Tseng
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Cardiothoracic and Vascular Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Tarraf SA, de Souza RB, Herrick A, Pereira LV, Bellini C. The Fbn1 gene variant governs passive ascending aortic mechanics in the mgΔ lpn mouse model of Marfan syndrome when superimposed to perlecan haploinsufficiency. Front Cardiovasc Med 2024; 11:1319164. [PMID: 38545339 PMCID: PMC10965555 DOI: 10.3389/fcvm.2024.1319164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/12/2024] [Indexed: 11/11/2024] Open
Abstract
Introduction Ascending thoracic aortic aneurysms arise from pathological tissue remodeling that leads to abnormal wall dilation and increases the risk of fatal dissection/rupture. Large variability in disease manifestations across family members who carry a causative genetic variant for thoracic aortic aneurysms suggests that genetic modifiers may exacerbate clinical outcomes. Decreased perlecan expression in the aorta of mgΔlpn mice with severe Marfan syndrome phenotype advocates for exploring perlecan-encoding Hspg2 as a candidate modifier gene. Methods To determine the effect of concurrent Hspg2 and Fbn1 mutations on the progression of thoracic aortopathy, we characterized the microstructure and passive mechanical response of the ascending thoracic aorta in female mice of four genetic backgrounds: wild-type, heterozygous with a mutation in the Fbn1 gene (mgΔlpn), heterozygous with a mutation in the Hspg2 gene (Hspg2+/-), and double mutants carrying both the Fbn1 and Hspg2 variants (dMut). Results Elastic fiber fragmentation and medial disarray progress from the internal elastic lamina outward as the ascending thoracic aorta dilates in mgΔlpn and dMut mice. Concurrent increase in total collagen content relative to elastin reduces energy storage capacity and cyclic distensibility of aortic tissues from mice that carry the Fbn1 variant. Inherent circumferential tissue stiffening strongly correlates with the severity of aortic dilatation in mgΔlpn and dMut mice. Perlecan haploinsufficiency superimposed to the mgΔlpn mutation curbs the viability of dMut mice, increases the occurrence of aortic enlargement, and reduces the axial stretch in aortic tissues. Discussion Overall, our findings show that dMut mice are more vulnerable than mgΔlpn mice without an Hspg2 mutation, yet later endpoints and additional structural and functional readouts are needed to identify causative mechanisms.
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Affiliation(s)
- Samar A. Tarraf
- Department of Bioengineering, Northeastern University, Boston, MA, United States
| | | | - Ashley Herrick
- Department of Bioengineering, Northeastern University, Boston, MA, United States
| | - Lygia V. Pereira
- Department of Genetics and Evolutionary Biology, University of São Paulo, São Paulo, Brazil
| | - Chiara Bellini
- Department of Bioengineering, Northeastern University, Boston, MA, United States
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Patel NN, Kurnick A, Bukharovich I. Atypical Presentation of a Type A Aortic Dissection in a Patient With an Undiagnosed Genetic Predisposition. Cureus 2024; 16:e56394. [PMID: 38633927 PMCID: PMC11023514 DOI: 10.7759/cureus.56394] [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] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
A 60-year-old female with a past medical history of hypertension presents to the ED with one day of throbbing left knee pain with associated numbness that worsened with ambulation. EKG shows lateral T-wave inversions with no prior for comparison. The patient had bloodwork drawn and a chest x-ray ordered. Her pain was improving with acetaminophen, and during further workup, she went into cardiac arrest. The advanced cardiac life support protocol was initiated, the patient was intubated, and point-of-care ultrasound revealed pericardial effusion. Despite all her efforts, she couldn't regain consciousness and was pronounced dead. An autopsy confirmed that the patient suffered a type A aortic dissection (AD), with findings indicating a predisposing genetic component. This case confirms that type A AD can present with different clinical symptoms and that a high index of suspicion is crucial in providing lifesaving measures.
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Affiliation(s)
- Nishal N Patel
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Adam Kurnick
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Inna Bukharovich
- Department of Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA
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Hibino M, Verma S, Jarret CM, Shimamura J, Verma R, Hibino H, Baeza CR, Aune D, Yanagawa B, Usui A, Nienaber CA, Pelletier MP. Temporal trends in mortality of aortic dissection and rupture in the UK, Japan, the USA and Canada. Heart 2024; 110:331-336. [PMID: 37648437 DOI: 10.1136/heartjnl-2023-323042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Aortic dissection and aortic aneurysm rupture are aortic emergencies and their clinical outcomes have improved over the past two decades; however, whether this has translated into lower mortality across countries remains an open question. The purpose of this study was to compare mortality trends from aortic dissection and rupture between the UK, Japan, the USA and Canada. METHODS We analysed the WHO mortality database to determine trends in mortality from aortic dissection and rupture in four countries from 2000 to 2019. Age-standardised mortality rates per 100 000 persons were calculated, and annual percentage change was estimated using joinpoint regression. RESULTS Age-standardised mortality rates per 100 000 persons from aortic dissection and rupture in 2019 were 1.04 and 1.80 in the UK, 2.66 and 1.16 in Japan, 0.76 and 0.52 in the USA, and 0.67 and 0.81 in Canada, respectively. There was significantly decreasing trends in age-standardised mortality from aortic rupture in all four countries and decreasing trends in age-standardised mortality from aortic dissection in the UK over the study period. There was significantly increasing trends in mortality from aortic dissection in Japan over the study period. Joinpoint regression identified significant changes in the aortic dissection trends from decreasing to increasing in the USA from 2010 and Canada from 2012. In sensitivity analyses stratified by sex, similar trends were observed. CONCLUSIONS Trends in mortality from aortic rupture are decreasing; however, mortality from aortic dissection is increasing in Japan, the USA and Canada. Further study to explain these trends is warranted.
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Affiliation(s)
- Makoto Hibino
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Craig M Jarret
- Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Junichi Shimamura
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Raj Verma
- Royal College of Surgeon in Ireland, Dublin, Ireland
| | - Hiromi Hibino
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Cristian R Baeza
- Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton and 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
| | - Marc P Pelletier
- Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Ibraheem A, Abdullah A, Priyam K, Fakhruddin R. Type B Aortic Dissection Masquerading As Acute Pyelonephritis: Think Beyond Measures. Cureus 2024; 16:e54343. [PMID: 38500931 PMCID: PMC10948085 DOI: 10.7759/cureus.54343] [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] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Aortic dissection (AD) is a life-threatening medical emergency with a high mortality rate if misdiagnosed; therefore, an urgent and precise diagnosis is crucial for prompt treatment. This article presents a rare case report of AD with an atypical clinical presentation that led to delayed diagnosis and a complicated clinical course. Herein, we aim to contribute to the existing literature by providing insights into the varied presentations of AD and offering valuable lessons for clinicians faced with similar diagnostic scenarios. A 64-year-old female with an extended history of hypertension and other comorbidities presented to the emergency department with a one-day duration of right-sided loin pain and fever. Her blood investigations demonstrated evidence of leukocytosis and high c-reactive protein (CRP) levels. She was preliminarily treated as a case of acute pyelonephritis since, initially, clinical and radiographic evidence did not yield an alternative diagnosis. Despite antibiotics, her condition deteriorated, and her urine output became less than 0.5 mL/kg/hour for six consecutive hours. Additionally, the obtained urine culture was negative on the third day of admission, which made the medical team repeat her history taking and clinical examination, revealing a previously overlooked weight loss. This red flag prompted the medical team to conduct thorough chest and abdominal imaging studies in search of any hidden malignancy, especially when her thyroid function test returned normal. Surprisingly, a contrast-enhanced abdominal CT scan demonstrated an infarcted right kidney by thromboembolism that originated from the partially obstructive thrombus in the proximal abdominal aorta, which was later confirmed to be a type B AD by a CT angiogram. A multidisciplinary team guided her treatment, which included carefully controlling her blood pressure, using anticoagulants, and closely monitoring the patient. The take-home messages of this case report underscore the critical importance of recognizing atypical clinical presentations of AD, overcoming diagnostic challenges through comprehensive approaches, tailoring treatments to individual patient needs, and advocating for a multidisciplinary and patient-centered approach to enhance overall clinical outcomes.
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Affiliation(s)
- Anas Ibraheem
- Internal Medicine, Imamein Kadhimein Medical City, Baghdad, IRQ
- Internal Medicine/Clinical Hematology, Al Karama Teaching Hospital, Baghdad, IRQ
| | - Abdullah Abdullah
- General Medicine, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, GBR
| | - Kumari Priyam
- General Medicine, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, GBR
| | - Rebin Fakhruddin
- Acute Medicine, Pilgrim Hospital, United Lincolnshire Hospitals Trust, Boston, GBR
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Gottlieb M. SPEED of sound: The role of ultrasound in aortic dissection. Acad Emerg Med 2024; 31:201-203. [PMID: 38375964 DOI: 10.1111/acem.14885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Dowling S, Li W, Zuniga ZR, Anderson KL. Adult male with constant pleuritic chest pain. J Am Coll Emerg Physicians Open 2024; 5:e13074. [PMID: 38322378 PMCID: PMC10844752 DOI: 10.1002/emp2.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 02/08/2024] Open
Affiliation(s)
- Sean Dowling
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Wendi Li
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Zachary R. Zuniga
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Kenton L. Anderson
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
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Tan Z, Mao M, Jiang Z, Hu H, He C, Zhai C, Qian G. Causal Relationship between Gut Microbiota and Aneurysm: A Mendelian Randomization Study. Cerebrovasc Dis 2024; 54:59-69. [PMID: 38228101 DOI: 10.1159/000536177] [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: 09/15/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION Observational studies have suggested a possible relationship between gut microbiota (GM) and aneurysm development. However, the nature of this association remains unclear due to the inherent limitations of observational research, such as reverse causation and confounding factors. To address this knowledge deficit, this study aimed to investigate and establish a causal link between GM and aneurysm development. METHODS Summary statistics regarding GM and aneurysms were collected from relevant genome-wide association studies. Two samples were used in mendelian randomization (MR). The principal MR technique utilized was inverse-variance weighting, a technique renowned for producing reliable causal effect estimations. Additional MR methods, including weighted median (WM), MR-Egger, MR-PRESSO, and simple mode methods, were employed to ensure the robustness of the aforementioned association and investigate potential biases. Sensitivity analyses were performed to determine the consistency of the MR findings. RESULTS Varying associations were observed between specific microbial taxa and the different aneurysms analyzed. A negative correlation was observed between aortic aneurysm (AA) and Lentisphaerae, Lentisphaeria, and Victivallales. Conversely, the genus FamilyXIIIUCG001 exhibited an increased risk association. Regarding abdominal AA, Victivallaceae showed a reduced risk, and Bilophila and Catenibacterium were associated with an increased risk. For thoracic AA, negative and positive correlations were observed with Lentisphaerae and Turicibacter, respectively. Lastly, in the case of cerebral aneurysm (CA), Firmicutes and Haemophilus were associated with a decreased risk, and Lachnoclostridium demonstrated an increased risk of association. CONCLUSION Our research has established causal relationships between specific GM components and various aneurysms. The obtained knowledge may aid in the development of microbiome-based interventions and the identification of novel biomarkers for targeted prevention strategies.
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Affiliation(s)
- Zhentao Tan
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, China,
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China,
| | - Menghui Mao
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhe Jiang
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Huilin Hu
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chaojie He
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Changlin Zhai
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Gang Qian
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
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Kazaleh M, Gioscia-Ryan R, Ailawadi G, Salmon M. Oxidative Stress and the Pathogenesis of Aortic Aneurysms. Biomedicines 2023; 12:3. [PMID: 38275364 PMCID: PMC10813769 DOI: 10.3390/biomedicines12010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Aortic aneurysms are responsible for significant morbidity and mortality. Despite their clinical significance, there remain critical knowledge gaps in the pathogenesis of aneurysm disease and the mechanisms involved in aortic rupture. Recent studies have drawn attention to the role of reactive oxygen species (ROS) and their down-stream effectors in chronic cardiovascular diseases and specifically in the pathogenesis of aortic aneurysm formation. This review will discuss current mechanisms of ROS in mediating aortic aneurysms, the failure of endogenous antioxidant systems in chronic vascular diseases, and their relation to the development of aortic aneurysms.
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Affiliation(s)
- Matthew Kazaleh
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (M.K.); (G.A.)
| | - Rachel Gioscia-Ryan
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Gorav Ailawadi
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (M.K.); (G.A.)
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Morgan Salmon
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (M.K.); (G.A.)
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
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Liao KM, Shen CW, Huang YH, Lu CH, Lai HL, Chen CY. Prescription pattern and effectiveness of antihypertensive drugs in patients with aortic dissection who underwent surgery. Front Pharmacol 2023; 14:1291900. [PMID: 38026966 PMCID: PMC10667675 DOI: 10.3389/fphar.2023.1291900] [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] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Surgical patients with aortic dissection often require multiple antihypertensive drugs to control blood pressure. However, the prescription pattern and effectiveness of antihypertensive drugs for these patients are unclear. We aimed to investigate the prescription pattern and effectiveness of different classes of antihypertensive drugs in surgical patients with aortic dissection. Methods: Newly diagnosed aortic dissection patients who underwent surgery, aged >20 years, from 1 January 2012 to 31 December 2017 were identified. Patients with missing data, in-hospital mortality, aortic aneurysms, or congenital connective tissue disorders, such as Marfan syndrome, were excluded. Prescription patterns of antihypertensive drugs were identified from medical records of outpatient visits within 90 days after discharge. Antihypertensive drugs were classified into four classes: 1) β-blockers, 2) calcium channel blockers (CCBs), 3) renin-angiotensin system, and 4) other antihypertensive drugs. Patients were classified according to the number of classes of antihypertensive drugs as follows: 1) class 0, no exposure to antihypertensive drugs; 2) class 1, antihypertensive drugs of the same class; 3) class 2, antihypertensive drugs of two classes; 4) class 3, antihypertensive drugs of three classes; or 5) class 4, antihypertensive drugs of four classes. The primary composite outcomes included rehospitalization associated with aortic dissection, death due to aortic dissection, and all-cause mortality. Results: Most patients were prescribed two (28.87%) or three classes (28.01%) of antihypertensive drugs. In class 1, β-blockers were most commonly used (8.79%), followed by CCBs (5.95%). In class 2, β-blockers+CCB (10.66%) and CCB+RAS (5.18%) were the most common drug combinations. In class 3, β-blockers + CCB+RAS (14.84%) was the most prescribed combination. Class 0 had a significantly higher hazard of the composite outcome (HR, 2.1; CI, 1.46-3.02; p < 0.001) and all-cause mortality (HR, 2.34; CI, 1.56-3.51; p < 0.001) than class 1. There were no significant differences in hazards for rehospitalization associated with aortic dissection among classes. Conclusion: Among operated patients with type A aortic dissection, no specific type of antihypertensive drug was associated with a better outcome, whereas among those with type B aortic dissection, the use of β-blockers and CCBs was related to a significantly lower risk of the composite outcome.
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Affiliation(s)
| | - Chuan-Wei Shen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Hui Huang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chun-Hui Lu
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hsuan-Lin Lai
- Division of Pharmacy, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Mitsui T, Bando YK, Hirakawa A, Furusawa K, Morimoto R, Taguchi E, Kimura A, Kamiya H, Nishikimi N, Komori K, Nishigami K, Murohara T. Role of Common Antihypertensives in the Growth of Abdominal Aortic Aneurysm at the Presurgical Stage. Circ Rep 2023; 5:405-414. [PMID: 37969233 PMCID: PMC10632072 DOI: 10.1253/circrep.cr-23-0071] [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: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 11/17/2023] Open
Abstract
Background: Whether drug therapy slows the growth of abdominal aortic aneurysms (AAAs) in the Japanese population remains unknown. Methods and Results: In a multicenter prospective open-label study, patients with AAA at the presurgical stage (mean [±SD] AAA diameter 3.27±0.58 cm) were randomly assigned to treatment with candesartan (CAN; n=67) or amlodipine (AML; n=64) considering confounding factors (statin use, smoking, age, sex, renal function), with effects of blood pressure control minimized setting a target control level. The primary endpoint was percentage change in AAA diameter over 24 months. Secondary endpoints were changes in circulating biomarkers (high-sensitivity C-reactive protein [hs-CRP], malondialdehyde-low-density lipoprotein, tissue-specific inhibitor of metalloproteinase-1, matrix metalloproteinase [MMP] 2, MMP9, transforming growth factor-β1, plasma renin activity [PRA], angiotensin II, aldosterone). At 24 months, percentage changes in AAA diameter were comparable between the CAN and AML groups (8.4% [95% CI 6.23-10.59%] and 6.5% [95% CI 3.65-9.43%], respectively; P=0.23]. In subanalyses, AML attenuated AAA growth in patients with comorbid chronic kidney disease (CKD; P=0.04) or systolic blood pressure (SBP) <130 mmHg (P=0.003). AML exhibited a definite trend for slowing AAA growth exclusively in never-smokers (P=0.06). Among circulating surrogate candidates for AAA growth, PRA (P=0.02) and hs-CRP (P=0.001) were lower in the AML group. Conclusions: AML may prevent AAA growth in patients with CKD or lower SBP, associated with a decline in PRA and circulating hs-CRP.
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Affiliation(s)
- Toko Mitsui
- Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan
- Meijo Hospital Nagoya Japan
| | - Yasuko K Bando
- Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan
- Department of Molecular Physiology and Cardiovascular Biology, Mie University Graduate School of Medicine Tsu Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Tokyo Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan
| | | | | | - Haruo Kamiya
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Nagoya Japan
| | - Naomichi Nishikimi
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Nagoya Japan
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine Nagoya Japan
- Saiseikai Yahata General Hospital Kitakyushu Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan
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Graby J, Harris M, Jones C, Waring H, Lyen S, Hudson BJ, Rodrigues JCL. Assessing the role of an artificial intelligence assessment tool for thoracic aorta diameter on routine chest CT. Br J Radiol 2023; 96:20220853. [PMID: 37335231 PMCID: PMC10607407 DOI: 10.1259/bjr.20220853] [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: 09/07/2022] [Revised: 02/19/2023] [Accepted: 04/02/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy and clinical impact of automated artificial intelligence (AI) measurement of thoracic aorta diameter on routine chest CT. METHODS A single-centre retrospective study involving three cohorts. 210 consecutive ECG-gated CT aorta scans (mean age 75 ± 13) underwent automated analysis (AI-Rad Companion Chest CT, Siemens) and were compared to a reference standard of specialist cardiothoracic radiologists for accuracy measuring aortic diameter. A repeated measures analysis tested reporting consistency in a second cohort (29 patients, mean age 61 ± 17) of immediate sequential pre-contrast and contrast CT aorta acquisitions. Potential clinical impact was assessed in a third cohort of 197 routine CT chests (mean age 66 ± 15) to document potential clinical impact. RESULTS AI analysis produced a full report in 387/436 (89%) and a partial report in 421/436 (97%). Manual vs AI agreement was good to excellent (ICC 0.76-0.92). Repeated measures analysis of expert and AI reports for the ascending aorta were moderate to good (ICC 0.57-0.88). AI diagnostic performance crossed the threshold for maximally accepted limits of agreement (>5 mm) at the aortic root on ECG-gated CTs. AI newly identified aortic dilatation in 27% of patients on routine thoracic imaging with a specificity of 99% and sensitivity of 77%. CONCLUSION AI has good agreement with expert readers at the mid-ascending aorta and has high specificity, but low sensitivity, at detecting dilated aortas on non-dedicated chest CTs. ADVANCES IN KNOWLEDGE An AI tool may improve the detection of previously unknown thoracic aorta dilatation on chest CTs vs current routine reporting.
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Affiliation(s)
| | - Maredudd Harris
- Department of Radiology, Royal United Hospital, Bath, United Kingdom
| | - Calum Jones
- Department of Radiology, Royal United Hospital, Bath, United Kingdom
| | - Harry Waring
- Department of Radiology, Royal United Hospital, Bath, United Kingdom
| | - Stephen Lyen
- Department of Radiology, Royal United Hospital, Bath, United Kingdom
| | - Benjamin J Hudson
- Department of Radiology, Royal United Hospital, Bath, United Kingdom
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Kanagala SG, Sawhney A, Parikh K, Gupta V, Mahmood T, Anamika FNU, Jain R, Garg N. Navigating the challenges of bicuspid aortic valve-aortopathy. Glob Cardiol Sci Pract 2023; 2023:e202327. [PMID: 38404628 PMCID: PMC10886853 DOI: 10.21542/gcsp.2023.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/12/2023] [Indexed: 02/27/2024] Open
Abstract
Bicuspid aortic valve (BAV) is a congenital heart defect that affects 0.5-2% of the general population with familial predominance. The modifications in hemodynamics and structure change at cellular level contribute to the dilation of aorta, resulting in bicuspid aortopathy, which can result in catastrophic aortic events. The American Heart Association recommends screening first-degree relatives of patients with bicuspid aortic valve and aortic root disease. BAV may or may not be associated with a syndrome, with the non-syndromic variety having a higher chance of predisposition to congenital and vascular abnormalities. Many genes have been implicated in the etiology of non-syndromic aortic aneurysm such as ACTA2, MYH11, FLNA, and SMAD3. Common diagnostic modalities include transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), multi system computer tomography (MSCT), and cardiac MRI. Medical management reduces the rate of disease progression and surgical management is indicated based on the diameter of the ascending aorta, which differs in American and European guidelines. Our article aims to explore the current understanding of the pathophysiology, clinical aspects, and surgical management of bicuspid aortic valve disease. Additionally, we have included a discussion on the management of this condition in special populations, such as athletes and pregnant women, who require distinct treatment recommendations.
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Affiliation(s)
| | - Aanchal Sawhney
- Department of Internal Medicine, Crozer Chester Medical Center, Pennsylvania, USA
| | | | - Vasu Gupta
- Dayanand Medical College and Hospital, Ludhiana, India
| | | | - FNU Anamika
- University College of Medical Sciences, New Delhi, India
| | - Rohit Jain
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Nikita Garg
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, 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: 2] [Impact Index Per Article: 1.0] [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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Glotzbach JP, Hanson HA, Tonna JE, Horns JJ, Allen CM, Presson AP, Griffin CL, Zak M, Sharma V, Tristani-Firouzi M, Selzman CH. Familial Associations of Prevalence and Cause-Specific Mortality for Thoracic Aortic Disease and Bicuspid Aortic Valve in a Large-Population Database. Circulation 2023; 148:637-647. [PMID: 37317837 PMCID: PMC10527074 DOI: 10.1161/circulationaha.122.060439] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Thoracic aortic disease and bicuspid aortic valve (BAV) likely have a heritable component, but large population-based studies are lacking. This study characterizes familial associations of thoracic aortic disease and BAV, as well as cardiovascular and aortic-specific mortality, among relatives of these individuals in a large-population database. METHODS In this observational case-control study of the Utah Population Database, we identified probands with a diagnosis of BAV, thoracic aortic aneurysm, or thoracic aortic dissection. Age- and sex-matched controls (10:1 ratio) were identified for each proband. First-degree relatives, second-degree relatives, and first cousins of probands and controls were identified through linked genealogical information. Cox proportional hazard models were used to quantify the familial associations for each diagnosis. We used a competing-risk model to determine the risk of cardiovascular-specific and aortic-specific mortality for relatives of probands. RESULTS The study population included 3 812 588 unique individuals. Familial hazard risk of a concordant diagnosis was elevated in the following populations compared with controls: first-degree relatives of patients with BAV (hazard ratio [HR], 6.88 [95% CI, 5.62-8.43]); first-degree relatives of patients with thoracic aortic aneurysm (HR, 5.09 [95% CI, 3.80-6.82]); and first-degree relatives of patients with thoracic aortic dissection (HR, 4.15 [95% CI, 3.25-5.31]). In addition, the risk of aortic dissection was higher in first-degree relatives of patients with BAV (HR, 3.63 [95% CI, 2.68-4.91]) and in first-degree relatives of patients with thoracic aneurysm (HR, 3.89 [95% CI, 2.93-5.18]) compared with controls. Dissection risk was highest in first-degree relatives of patients who carried a diagnosis of both BAV and aneurysm (HR, 6.13 [95% CI, 2.82-13.33]). First-degree relatives of patients with BAV, thoracic aneurysm, or aortic dissection had a higher risk of aortic-specific mortality (HR, 2.83 [95% CI, 2.44-3.29]) compared with controls. CONCLUSIONS Our results indicate that BAV and thoracic aortic disease carry a significant familial association for concordant disease and aortic dissection. The pattern of familiality is consistent with a genetic cause of disease. Furthermore, we observed higher risk of aortic-specific mortality in relatives of individuals with these diagnoses. This study provides supportive evidence for screening in relatives of patients with BAV, thoracic aneurysm, or dissection.
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Affiliation(s)
- Jason P. Glotzbach
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Heidi A. Hanson
- Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN
| | - Joseph E. Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Joshua J. Horns
- Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Chelsea McCarty Allen
- Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Angela P. Presson
- Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Claire L. Griffin
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Megan Zak
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Vikas Sharma
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Martin Tristani-Firouzi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Kesävuori R, Kaseva T, Salli E, Raivio P, Savolainen S, Kangasniemi M. Deep learning-aided extraction of outer aortic surface from CT angiography scans of patients with Stanford type B aortic dissection. Eur Radiol Exp 2023; 7:35. [PMID: 37380806 DOI: 10.1186/s41747-023-00342-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/01/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Guidelines recommend that aortic dimension measurements in aortic dissection should include the aortic wall. This study aimed to evaluate two-dimensional (2D)- and three-dimensional (3D)-based deep learning approaches for extraction of outer aortic surface in computed tomography angiography (CTA) scans of Stanford type B aortic dissection (TBAD) patients and assess the speed of different whole aorta (WA) segmentation approaches. METHODS A total of 240 patients diagnosed with TBAD between January 2007 and December 2019 were retrospectively reviewed for this study; 206 CTA scans from 206 patients with acute, subacute, or chronic TBAD acquired with various scanners in multiple different hospital units were included. Ground truth (GT) WAs for 80 scans were segmented by a radiologist using an open-source software. The remaining 126 GT WAs were generated via semi-automatic segmentation process in which an ensemble of 3D convolutional neural networks (CNNs) aided the radiologist. Using 136 scans for training, 30 for validation, and 40 for testing, 2D and 3D CNNs were trained to automatically segment WA. Main evaluation metrics for outer surface extraction and segmentation accuracy were normalized surface Dice (NSD) and Dice coefficient score (DCS), respectively. RESULTS 2D CNN outperformed 3D CNN in NSD score (0.92 versus 0.90, p = 0.009), and both CNNs had equal DCS (0.96 versus 0.96, p = 0.110). Manual and semi-automatic segmentation times of one CTA scan were approximately 1 and 0.5 h, respectively. CONCLUSIONS Both CNNs segmented WA with high DCS, but based on NSD, better accuracy may be required before clinical application. CNN-based semi-automatic segmentation methods can expedite the generation of GTs. RELEVANCE STATEMENT Deep learning can speeds up the creation of ground truth segmentations. CNNs can extract the outer aortic surface in patients with type B aortic dissection. KEY POINTS • 2D and 3D convolutional neural networks (CNNs) can extract the outer aortic surface accurately. • Equal Dice coefficient score (0.96) was reached with 2D and 3D CNNs. • Deep learning can expedite the creation of ground truth segmentations.
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Affiliation(s)
- Risto Kesävuori
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland.
| | - Tuomas Kaseva
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland
| | - Eero Salli
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland
| | - Peter Raivio
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sauli Savolainen
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Marko Kangasniemi
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, FI-00290, Helsinki, Finland
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50
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Beyer SE, Secemsky EA, Khabbaz K, Carroll BJ. Elective ascending aortic aneurysm repair outcomes in a nationwide US cohort. Heart 2023; 109:1080-1087. [PMID: 36928243 DOI: 10.1136/heartjnl-2022-322033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To quantify contemporary outcomes following elective ascending aortic aneurysm repair, to determine risk factors for adverse events and to evaluate difference by institutional surgical volume. METHODS We included all elective hospitalisations of adult patients with an ascending aortic aneurysm who underwent aneurysm repair in the Nationwide Readmissions Database between 2016 and 2019. The primary outcome was a composite of in-hospital mortality, stroke (ischaemic and non-ischaemic) and myocardial infarction (MI). We identified independent predictor of adverse events and investigated outcomes by institutional volume. RESULTS Among 12 043 patients (mean 62.8 years of age, 28.0% female), MI, stroke or in-hospital death occurred in 598 (4.9%) patients during the index admission (acute stroke: 2.7%, MI: 0.7%, in-hospital death: 2.0%). The strongest predictors of in-hospital death, stroke or MI were chronic weight loss, pulmonary circulation disorder and concomitant descending aortic surgery. Higher procedural volume was associated with a lower incidence of in-hospital death, stroke or MI (OR comparing the highest with the lowest tertile 0.71, 95% CI 0.57 to 0.87; p=0.001) and in-hospital death (OR 0.51, 95% CI 0.37 to 0.72; p<0.001), but no difference in 30-day readmissions. CONCLUSIONS The overall rate of in-hospital death, stroke and MI is nearly 5% in patients undergoing elective ascending aortic aneurysm repair. Among several predictors, chronic weight loss is associated with the largest increase in the risk of poor outcomes. Higher hospital volume is associated with a lower in-hospital mortality, highlighting the importance to refer patients to high-volume centres while discussing the risks and benefits of proceeding with repair.
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Affiliation(s)
- Sebastian E Beyer
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Eric A Secemsky
- Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamal Khabbaz
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Brett J Carroll
- Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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