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Banceu CM, Banceu DM, Kauvar DS, Popentiu A, Voth V, Liebrich M, Halic Neamtu M, Oprean M, Cristutiu D, Harpa M, Brinzaniuc K, Suciu H. Acute Aortic Syndromes from Diagnosis to Treatment-A Comprehensive Review. J Clin Med 2024; 13:1231. [PMID: 38592069 PMCID: PMC10932437 DOI: 10.3390/jcm13051231] [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: 01/24/2024] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
This work aims to provide a comprehensive description of the characteristics of a group of acute aortic diseases that are all potentially life-threatening and are collectively referred to as acute aortic syndromes (AASs). There have been recent developments in the care and diagnostic plan for AAS. A substantial clinical index of suspicion is required to identify AASs before irreversible fatal consequences arise because of their indefinite symptoms and physical indicators. A methodical approach to the diagnosis of AAS is addressed. Timely and suitable therapy should be started immediately after diagnosis. Improving clinical outcomes requires centralising patients with AAS in high-volume centres with high-volume surgeons. Consequently, the management of these patients benefits from the increased use of aortic centres, multidisciplinary teams and an "aorta code". Each acute aortic entity requires a different patient treatment strategy; these are outlined below. Finally, numerous preventive strategies for AAS are discussed. The keys to good results are early diagnosis, understanding the natural history of these disorders and, where necessary, prompt surgical intervention. It is important to keep in mind that chest pain does not necessarily correspond with coronary heart disease and to be alert to the possible existence of aortic diseases because once antiplatelet drugs are administered, a blocked coagulation system can complicate aortic surgery and affect prognosis. The management of AAS in "aortic centres" improves long-term outcomes and decreases mortality rates.
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Affiliation(s)
- Cosmin M. Banceu
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (C.M.B.)
- Department of Surgery M3, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - Diana M. Banceu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - David S. Kauvar
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Adrian Popentiu
- Faculty of Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania
| | | | | | - Marius Halic Neamtu
- Swiss Federal Institute of Forest, Snow and Landscape Research WSL, 8903 Birmensdorf, Switzerland
- Institute of Environmental Engineering, ETH Zurich, 8039 Zurich, Switzerland
| | - Marvin Oprean
- Mathematics and Statistics Department, Amherst College, Amherst, MA 01002, USA
| | - Daiana Cristutiu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - Marius Harpa
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (C.M.B.)
- Department of Surgery M3, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
| | - Klara Brinzaniuc
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (C.M.B.)
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Horatiu Suciu
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (C.M.B.)
- Department of Surgery M3, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
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Zhao Y, Fu W, Wang L. Biomarkers in aortic dissection: Diagnostic and prognostic value from clinical research. Chin Med J (Engl) 2024; 137:257-269. [PMID: 37620283 PMCID: PMC10836883 DOI: 10.1097/cm9.0000000000002719] [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: 02/11/2023] [Indexed: 08/26/2023] Open
Abstract
ABSTRACT Aortic dissection is a life-threatening condition for which diagnosis mainly relies on imaging examinations, while reliable biomarkers to detect or monitor are still under investigation. Recent advances in technologies provide an unprecedented opportunity to yield the identification of clinically valuable biomarkers, including proteins, ribonucleic acids (RNAs), and deoxyribonucleic acids (DNAs), for early detection of pathological changes in susceptible patients, rapid diagnosis at the bedside after onset, and a superior therapeutic regimen primarily within the concept of personalized and tailored endovascular therapy for aortic dissection.
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Affiliation(s)
- Yufei Zhao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute,Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute,Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian 361015, China
| | - Lixin Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute,Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian 361015, China
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Chen H, Li Y, Li Z, Shi Y, Zhu H. Diagnostic biomarkers and aortic dissection: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:497. [PMID: 37817089 PMCID: PMC10563263 DOI: 10.1186/s12872-023-03448-9] [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: 02/22/2023] [Accepted: 08/14/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Aortic dissection (AD) is a serious and fatal vascular disease. The earlier the condition of AD patients can be assessed precisely, the more scientifically controlled the patient's condition will be. Therefore, timely and accurate diagnosis is significant for AD. Blood biomarker testing as a method of liquid biopsy can improve the diagnostic efficiency of AD. This study conducted a systematic review of the current blood diagnostic biomarkers of AD. METHODS The PubMed, Cochrane Library, Web of Science, and Embase electronic databases were systematically searched from inception to January 1, 2023, using the terms "aortic dissection", "serum", "plasma" and "diagnosis". Stata 12.0 software was used to perform Random effects meta-analysis was performed using Stata 12.0 software to determine the effect sizes and corresponding 95% confidence intervals. Then, a summary receiver operator characteristic (SROC) curve was drawn, and the area under the ROC curve (AUC) was calculated. RESULTS D-dimer had the best sensitivity and AUC for AD, with values of 0.96 (95% CI: 0.93-0.98) and 0.95 (95% CI: 0.93-0.97), respectively. The sensitivity and AUC values for D-dimer with a cut-off value of 500 ng/mL were 0.97 (95% CI: 0.95-0.99) and 0.94 (95% CI: 0.92-0.96), respectively. In contrast, microRNA had a better specificity value for AD, at 0.79 (95% CI: 0.73-0.83). CONCLUSIONS D-dimer and microRNA have good accuracy in the diagnosis of AD, but the specificity of D-dimer is worse, and studies of microRNA are insufficient. The combination of different biomarkers can improve the diagnostic accuracy. Other blood biomarkers are related to the pathological progression of AD and can be selected according to pathological progress.
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Affiliation(s)
- Hongjian Chen
- Department of Infection Disease, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yunjie Li
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zheqian Li
- Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yanli Shi
- Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Haobo Zhu
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Morello F, Bima P, Castelli M, Nazerian P. Acute aortic syndromes: An internist's guide to the galaxy. Eur J Intern Med 2022; 106:45-53. [PMID: 36229285 DOI: 10.1016/j.ejim.2022.10.003] [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: 06/23/2022] [Revised: 09/05/2022] [Accepted: 10/05/2022] [Indexed: 11/03/2022]
Abstract
Acute aortic syndromes (AASs) are severe conditions defined by dissection, hemorrhage, ulceration or rupture of the thoracic aorta. AASs share etiological and pathophysiological features, including long-term aortic tissue degeneration and mechanisms of acute aortic damage. The clinical signs and symptoms of AASs are unspecific and heterogeneous, requiring large differential diagnosis. When evaluating a patient with AAS-compatible symptoms, physicians need to integrate clinical probability assessment, bedside imaging techniques such as point-of-care ultrasound, and blood test results such as d-dimer. The natural history of AASs is dominated by engagement of ischemic, coagulative and inflammatory pathways at large, causing multiorgan damage. Medical treatment, multiorgan monitoring and outcome prognostication are therefore paramount, with internal medicine playing a key role in non-surgical management of AASs.
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Affiliation(s)
- Fulvio Morello
- S.C. Medicina d'Urgenza U (MECAU), A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; Dipartimento di Scienze Mediche, Università degli Studi di Torino, Italy
| | - Paolo Bima
- S.C. Medicina d'Urgenza U (MECAU), A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matteo Castelli
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
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Yuan X, Mitsis A, Nienaber CA. Current Understanding of Aortic Dissection. Life (Basel) 2022; 12:1606. [PMID: 36295040 PMCID: PMC9605578 DOI: 10.3390/life12101606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023] Open
Abstract
The aorta is the largest artery in the body, delivering oxygenated blood from the left ventricle to all organs. Dissection of the aorta is a lethal condition caused by a tear in the intimal layer of the aorta, followed by blood loss within the aortic wall and separation of the layers to full dissection. The aorta can be affected by a wide range of causes including acute conditions such as trauma and mechanical damage; and genetic conditions such as arterial hypertension, dyslipidaemia, and connective tissue disorders; all increasing the risk of dissection. Both rapid diagnostic recognition and advanced multidisciplinary treatment are critical in managing aortic dissection patients. The treatment depends on the severity and location of the dissection. Open surgical repair is the gold standard of treatment for dissections located to the proximal part of the aorta and the arch, while endovascular interventions are recommended for most distal or type B aortic dissections. In this review article, we examine the epidemiology, pathophysiology, contemporary diagnoses, and management of aortic dissection.
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Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Strovolos 2029, Cyprus
| | - Christoph A. Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
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Targeted Inhibition of Matrix Metalloproteinase-8 Prevents Aortic Dissection in a Murine Model. Cells 2022; 11:cells11203218. [PMID: 36291087 PMCID: PMC9600539 DOI: 10.3390/cells11203218] [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: 08/16/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Aortic dissection (AD) is a lethal aortic pathology without effective medical treatments since the underlying pathological mechanisms responsible for AD remain elusive. Matrix metalloproteinase-8 (MMP8) has been previously identified as a key player in atherosclerosis and arterial remodeling. However, the functional role of MMP8 in AD remains largely unknown. Here, we report that an increased level of MMP8 was observed in 3-aminopropionitrile fumarate (BAPN)-induced murine AD. AD incidence and aortic elastin fragmentation were markedly reduced in MMP8-knockout mice. Importantly, pharmacologic inhibition of MMP8 significantly reduced the AD incidence and aortic elastin fragmentation. We observed less inflammatory cell accumulation, a lower level of aortic inflammation, and decreased smooth muscle cell (SMC) apoptosis in MMP8-knockout mice. In line with our previous observation that MMP8 cleaves Ang I to generate Ang II, BAPN-treated MMP8-knockout mice had increased levels of Ang I, but decreased levels of Ang II and lower blood pressure. Additionally, we observed a decreased expression level of vascular cell adhesion molecule-1 (VCAM1) and a reduced level of reactive oxygen species (ROS) in MMP8-knockout aortas. Mechanistically, our data show that the Ang II/VCAM1 signal axis is responsible for MMP8-mediated inflammatory cell invasion and transendothelial migration, while MMP8-mediated SMC inflammation and apoptosis are attributed to Ang II/ROS signaling. Finally, we observed higher levels of aortic and serum MMP8 in patients with AD. We therefore provide new insights into the molecular mechanisms underlying AD and identify MMP8 as a potential therapeutic target for this life-threatening aortic disease.
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7
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Ma S, Xu Q, Hu Q, Huang L, Wu D, Lin G, Chen X, Luo W. Post-operative uric acid: a predictor for 30-days mortality of acute type A aortic dissection repair. BMC Cardiovasc Disord 2022; 22:411. [PMID: 36109723 PMCID: PMC9479398 DOI: 10.1186/s12872-022-02749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hyperuricemia is associated with aortic dissection and cardiovascular diseases. The implication of high serum uric acid (UA) level after acute aortic dissection repair remains unknown. The aim of this study is to explore the role of peri-operative serum UA level in predicting 30-days mortality with acute type A aortic dissection (AAAD) patients, who underwent surgery. Methods This study retrospectively enrolled 209 consecutive patients with AAAD, who underwent surgery in Xiangya Hospital from 2017 to 2020. Post-operative laboratory examinations were measured within 24 h after surgery. Univariate analysis and logistic regression analysis were used for predictor finding. Results 209 consecutive AAAD patients were included, 14.3% (n = 30) were dead within 30 days after surgery. By univariate analysis, we found AAAD repair patients with 30-days mortality had a higher prevalence of cerebral malperfusion, lower pre-operative fibrinogen, longer cardiopulmonary bypass and aortic crossclamp time, and higher post-operative day 1 (POD1) creatinine and urea levels. Both pre-operative (433.80 ± 152.59 vs. 373.46 ± 108.31 mmol/L, p = 0.038) and POD1 (559.78 ± 162.23 vs. 391.29 ± 145.19 mmol/L, p < 0.001) UA level were higher in mortality group than in survival group. In regression model, only cerebral malperfusion (OR, 7.938, 95% CI 1.252–50.323; p = 0.028) and POD1 UA level (OR, 2.562; 95% CI 1.635–4.014; p < 0.001) were independent predictors of 30-days mortality in AAAD repair patients. According to the ROC curve, the POD1 UA level provided positive value for 30-days mortality in AAAD repair patients with 0.799 areas under the curve. The optimum cutoff value selected by ROC curve was 500.15 mmol/L, with a sensitivity of 65% and a specificity of 86%. Conclusion Pre- and post-operative hyperuricemia are potentially associated with worsened outcomes in AAAD surgery patients. The POD1 UA level has a predictive role in 30-days mortality in AAAD repair patients.
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Tracking an Elusive Killer: State of the Art of Molecular-Genetic Knowledge and Laboratory Role in Diagnosis and Risk Stratification of Thoracic Aortic Aneurysm and Dissection. Diagnostics (Basel) 2022; 12:diagnostics12081785. [PMID: 35892496 PMCID: PMC9329974 DOI: 10.3390/diagnostics12081785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 02/08/2023] Open
Abstract
The main challenge in diagnosing and managing thoracic aortic aneurysm and dissection (TAA/D) is represented by the early detection of a disease that is both deadly and “elusive”, as it generally grows asymptomatically prior to rupture, leading to death in the majority of cases. Gender differences exist in aortic dissection in terms of incidence and treatment options. Efforts have been made to identify biomarkers that may help in early diagnosis and in detecting those patients at a higher risk of developing life-threatening complications. As soon as the hereditability of the TAA/D was demonstrated, several genetic factors were found to be associated with both the syndromic and non-syndromic forms of the disease, and they currently play a role in patient diagnosis/prognosis and management-guidance purposes. Likewise, circulating biomarker could represent a valuable resource in assisting the diagnosis, and several studies have attempted to identify specific molecules that may help with risk stratification outside the emergency department. Even if promising, those data lack specificity/sensitivity, and, in most cases, they need more testing before entering the “clinical arena”. This review summarizes the state of the art of the laboratory in TAA/D diagnostics, with particular reference to the current and future role of molecular-genetic testing.
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Qi F, Liu Y, Zhang K, Zhang Y, Xu K, Zhou M, Zhao H, Zhu S, Chen J, Li P, Du J. Artificial Intelligence Uncovers Natural MMP Inhibitor Crocin as a Potential Treatment of Thoracic Aortic Aneurysm and Dissection. Front Cardiovasc Med 2022; 9:871486. [PMID: 35463768 PMCID: PMC9019136 DOI: 10.3389/fcvm.2022.871486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic aortic aneurysm and dissection (TAAD) is a lethal cardiovascular condition without effective pharmaceutical therapy. Identifying novel drugs that target the key pathogenetic components is an urgent need. Bioinformatics analysis of pathological studies indicated “extracellular matrix organization” as the most significant functional pathway related to TAAD, in which matrix metallopeptidase (MMP) 2 and MMP9 ranked above other proteases. MMP1-14 were designated as the prototype molecules for docking against PubChem Compound Database using Surflex-Dock, and nine natural compounds were identified. Using a generic MMP activity assay and an aminopropionitrile (BAPN)-induced TAAD mouse model, we identified crocin as an effective MMP inhibitor, suppressing the occurrence and rupture of TAAD. Biolayer interferometry and AI/bioinformatics analyses indicated that crocin may inhibit MMP2 activity by direct binding. Possible binding sites were investigated. Overall, the integration of artificial intelligence and functional experiments identified crocin as an MMP inhibitor with strong therapeutic potential.
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Affiliation(s)
- Feiran Qi
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Yan Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Kunlin Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yanzhenzi Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Ke Xu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Mei Zhou
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Huinan Zhao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Shuolin Zhu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Jianxin Chen
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jianxin Chen
| | - Ping Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Ping Li
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Jie Du
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Siller RA, Skubic JJ, Almeda JL, Villarreal JF, Kaplan AE. Candida pericarditis presenting with cardiac tamponade and multiple organ failure after combined damage control thoracotomy and laparotomy with splenectomy in a trauma patient: Case report and review of literature. Trauma Case Rep 2021; 37:100564. [PMID: 34917734 PMCID: PMC8669452 DOI: 10.1016/j.tcr.2021.100564] [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] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and required antifungals and surgical reintervention with thoracotomy for drainage. A literature search of the reported cases demonstrates that Candida pericarditis is indeed a rare but fatal condition if not identified and treated appropriately. This article discusses the difficulties we encountered while recognizing the disorder in our patient and proposes a guideline to adequately treat the condition in an effective and timely manner. Candida pericarditis poses a special challenge for the physician since its correct diagnosis and management requires a multidisciplinary approach.
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Affiliation(s)
- R A Siller
- University of Texas at Rio Grande Valley - General Surgery Residency at Doctors Hospital at Renaissance, 5321 S, McColl Road, Edinburg, TX 78569, United States of America
| | - J J Skubic
- DHR Health Surgery Institute, Department of Trauma and Critical Care, 1100 E. Dove Ave, Suite 201, McAllen, TX 78504, United States of America
| | - J L Almeda
- DHR Health Transplant Institute, Hepatobiliary, Pancreas and Organ Transplantation Center, 5540 Raphael Drive, Edinburg, TX 78539, United States of America
| | - J F Villarreal
- DHR Health Heart Institute, 224 Lindberg Ave, McAllen, TX 78501, United States of America
| | - A E Kaplan
- Pulmonary Sleep Center of the Rio Grande Valley, 5300 N, McColl Rd, McAllen, TX 78504, United States of America
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11
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Yang Y, Jiao X, Li L, Hu C, Zhang X, Pan L, Yu H, Li J, Chen D, Du J, Qin Y. Increased Circulating Angiopoietin-Like Protein 8 Levels Are Associated with Thoracic Aortic Dissection and Higher Inflammatory Conditions. Cardiovasc Drugs Ther 2020; 34:65-77. [PMID: 32034642 PMCID: PMC7093348 DOI: 10.1007/s10557-019-06924-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose Thoracic aortic dissection (TAD) is characterized by an inflammatory response. Angiopoietin-like protein 8 (ANGPTL8) is a hormone involved in the regulation of lipid metabolism and inflammation. However, the relationship between ANGPTL8 and TAD remains unknown. Methods This case-control study included 78 TAD patients and 72 controls. The aortic diameter was evaluated by computed tomography and used to assess TAD severity. Circulating ANGPTL8 levels were measured by enzyme-linked immunosorbent assay. Associations of ANGPTL8 with TAD were determined by multivariate logistic regression. Results Serum ANGPTL8 levels were significantly higher in TAD patients compared with controls (562.50 ± 20.84 vs. 419.70 ± 22.65 pg/mL, respectively; P < 0.001). After adjusting for confounding factors, circulating ANGPTL8 levels were an independent risk factor for TAD (odds ratio = 1.587/100 pg ANGPTL8, 95% confidence interval [CI] = 1.121–2.247, P < 0.001) and positively associated with diameter (β = 1.081/100 pg ANGPTL8, 95% CI = 0.075–2.086, P = 0.035) and high-sensitivity C-reactive protein (hs-CRP) (β = 0.845/100 pg ANGPTL8, 95% CI = 0.020–1.480, P = 0.009). The area under the curve (AUC) on receiver operating characteristic (ROC) analysis of the combination of ANGPTL8, hs-CRP, and D-dimer was 0.927, and the specificity and sensitivity were 98.46% and 79.49%, respectively. ANGPTL8 was significantly increased in TAD tissue compared with controls. In vitro, ANGPTL8 was increased in angiotensin II (AngII)-treated macrophages and vascular smooth muscle cells (VSMCs), while ANGPTL8 siRNA-mediated knockdown decreased inflammatory factors in AngII-treated macrophages and decreased apoptosis in AngII-treated VSMCs. Conclusion ANGPTL8 is associated with TAD occurrence and development, which may involve pro-inflammatory effects on macrophages. ANGPTL8 combined with D-dimer and hs-CRP might be a useful clinical predictor of TAD. Trial Registration ChiCTR-COC-17010792 http://www.chictr.org.cn/showproj.aspx?proj=18288 Electronic supplementary material The online version of this article (10.1007/s10557-019-06924-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yunyun Yang
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, China
| | - Xiaolu Jiao
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, China
| | - Linyi Li
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, China
| | - Chaowei Hu
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, China
| | - Xiaoping Zhang
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, China
| | - Lili Pan
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Huahui Yu
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, China
| | - Juan Li
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, China
| | - Dong Chen
- Department of Pathology, Beijing An Zhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jie Du
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yanwen Qin
- Key Laboratory of Remodeling-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China. .,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, China.
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12
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Matrix metalloproteinases and acute aortic dissection: Et Tu, Brute? Interact Cardiovasc Thorac Surg 2020; 30:465-476. [PMID: 31808522 DOI: 10.1093/icvts/ivz286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To summarize the present evidence for the association of matrix metalloproteinases (MMPs) with acute aortic dissection (AAD), we performed the first meta-analysis of all currently available case-control studies comparing circulating MMP levels between AAD patients and control subjects. METHODS To identify all studies investigating the levels of circulating MMPs in AAD patients, PubMed and Web of Science were searched up to July 2019. The levels of MMPs in AAD patients and control subjects were extracted from each study, and the standardized mean differences (SMDs) in MMP levels were generated. The study-specific estimates were combined in the random-effects model. RESULTS Twelve studies enrolling a total of 458 AAD patients and 711 control subjects were identified and included. Pooled analyses demonstrated no significant differences in MMP-1 (4 studies; P = 0.21), MMP-2 (5 studies; P = 0.62) and MMP-3 levels (2 studies; P = 0.94) between AAD patients and control subjects; and significantly higher MMP-8 (2 studies; SMD 2.11; P = 0.020), MMP-9 (9 studies; SMD 1.54; P < 0.001) and MMP-12 levels (2 studies; SMD 1.33; P < 0.001) in AAD patients than in control subjects. CONCLUSION High circulating MMP-9 levels are associated with AAD, and MMP-8 and MMP-12 levels may be related to AAD.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Tomo Ando
- Division of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
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13
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Ferrera C, Vilacosta I, Cabeza B, Cobiella J, Martínez I, Saiz-Pardo Sanz M, Bustos A, Serrano FJ, Maroto L. Diagnosing Aortic Intramural Hematoma: Current Perspectives. Vasc Health Risk Manag 2020; 16:203-213. [PMID: 32606717 PMCID: PMC7292252 DOI: 10.2147/vhrm.s193967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/07/2020] [Indexed: 01/16/2023] Open
Abstract
Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.
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Affiliation(s)
- Carlos Ferrera
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Beatriz Cabeza
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Cobiella
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Isaac Martínez
- Department of Vascular Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ana Bustos
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Luis Maroto
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
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14
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Guo T, Zhou X, Zhu A, Peng W, Zhong Y, Chai X. The Role of Serum Tenascin-C in Predicting In-Hospital Death in Acute Aortic Dissection. Int Heart J 2019; 60:919-923. [PMID: 31257330 DOI: 10.1536/ihj.18-462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tenascin-C (TNC) is involved in aortic disease pathophysiology. This study aims to evaluate TNC's value for predicting in-hospital death in acute aortic dissection (AD).We prospectively enrolled consecutive patients with suspected acute AD within 48 hours from symptom onset. Serum TNC and C-reactive protein (CRP) levels were examined on admission. Their baseline clinical characteristics and serum D-Dimer (DD) were collected. The endpoint was in-hospital death from AD.In the study cohort,78 survivors and 31 non-survivors with acute AD were enrolled. Compared to survivors, elevated median levels of serum TNC (141.10 pg/mL versus 75.30 pg/mL, P < 0.001), DD (8.74 μg/mL versus 4.58 μg/mL, P < 0.001), and CRP (19.20 mg/L versus 13.40 mg/L, P < 0.001) were found in non-survivors. Multiple logistic regressions revealed TNC, DD, and CRP were independent predictors of in-hospital death from acute AD. The OR and 95% CI were 1.038, 1.017-1.055; 1.084, 1.009-1.165 and 1.386, 1.107-1.643, respectively. Furthermore, TNC's sensitivity and specificity in predicting in-hospital death in acute AD were 83.87% and 83.33%. The combination of TNC and DD can improve the sensitivity and specificity to 90.30% and 88.46%.TNC is a valuable biomarker for predicting in-hospital death from acute AD. The combination of TNC and DD can improve predictions of in-hospital death from acute AD.
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Affiliation(s)
- Tao Guo
- Department of Emergency, Second Xiangya Hospital, Emergency Medicine and Difficult Disease Institute, Central South University
| | | | - Aiqun Zhu
- Department of Emergency, Second Xiangya Hospital, Emergency Medicine and Difficult Disease Institute, Central South University
| | - Wen Peng
- Department of Emergency, Second Xiangya Hospital, Emergency Medicine and Difficult Disease Institute, Central South University
| | - Yuanjun Zhong
- Department of Emergency, Second Xiangya Hospital, Emergency Medicine and Difficult Disease Institute, Central South University
| | - Xiangping Chai
- Department of Emergency, Second Xiangya Hospital, Emergency Medicine and Difficult Disease Institute, Central South University
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15
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Li T, Jing JJ, Yang J, Sun LP, Gong YH, Xin SJ, Yuan Y. Serum levels of matrix metalloproteinase 9 and toll-like receptor 4 in acute aortic dissection: a case-control study. BMC Cardiovasc Disord 2018; 18:219. [PMID: 30497388 PMCID: PMC6267890 DOI: 10.1186/s12872-018-0958-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/19/2018] [Indexed: 12/21/2022] Open
Abstract
Background Matrix metalloproteinase 9 (MMP9) and Toll-like receptor 4 (TLR4) play important roles in aortic pathophysiology. However, there is lacking research on serum TLR4 levels in acute aortic dissection (AAD) patients, and the performance of serum MMP9 and TLR4 for the diagnosis of AAD is still unknown. This study aimed to evaluate the serum levels of MMP9 and TLR4 in AAD patients, identify their associations with circulating C-reactive protein (CRP) and D-dimer, which are well-known classical biomarkers of AAD, and further explore the potential diagnostic role of MMP9 and TLR4 in AAD. Methods Serum levels of MMP9 and TLR4 were measured by enzyme-linked immunosorbent assay (ELISA) in 88 AAD patients and 88 controls. The clinical test related information was collected from patients’ electronic medical records. Results Serum MMP9 and TLR4 levels were significantly higher in AAD patients than those in healthy controls in the general and stratified comparisons. Either serum MMP9 or TLR4 was independently associated with the risk of AAD (all p < 0.001). There was a positive significant association between serum MMP9 and TLR4 (r = 0.518, p < 0.001). Both MMP9 and TLR4 levels were statistically correlated with circulating CRP, but not D-dimer. Based on receiver-operating characteristic (ROC) analysis, the area under the curves (AUCs) of MMP9 and TLR4 alone for the diagnosis of AAD were 0.810 and 0.799 with optimal cut-off points of 379.47 ng/ml and 7.83 ng/ml, respectively. Moreover, a combination of serum MMP9 and TLR4 increased the AUC to 0.89 with a sensitivity of 60.2% and specificity of 94.3%. Conclusions Serum MMP9 and TLR4 could be potential biomarkers for identifying AAD, while the combined diagnostic value was higher in safely ruling out AAD.
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Affiliation(s)
- Tan Li
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, No.155 NanjingBei Street, Heping District, Shenyang, Liaoning Province, 110001, China.,Department of Cardiovascular Ultrasound, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Jing-Jing Jing
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, No.155 NanjingBei Street, Heping District, Shenyang, Liaoning Province, 110001, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Li-Ping Sun
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, No.155 NanjingBei Street, Heping District, Shenyang, Liaoning Province, 110001, China
| | - Yue-Hua Gong
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, No.155 NanjingBei Street, Heping District, Shenyang, Liaoning Province, 110001, China
| | - Shi-Jie Xin
- Department of Vascular and Thyroid Surgery, the First Hospital of China Medical University, No.155 NanjingBei Street, Heping District, Shenyang, Liaoning Province, 110001, China.
| | - Yuan Yuan
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, No.155 NanjingBei Street, Heping District, Shenyang, Liaoning Province, 110001, China.
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16
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Mechanical stretch aggravates aortic dissection by regulating MAPK pathway and the expression of MMP-9 and inflammation factors. Biomed Pharmacother 2018; 108:1294-1302. [PMID: 30372831 DOI: 10.1016/j.biopha.2018.09.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 12/11/2022] Open
Abstract
This study aimed to explore whether mechanical stretch aggravated aortic dissection through regulating MAPK pathway, MMP-9, and inflammation factors. We first established aortic dissection model rats. Mechanical stretch (3 g) was exerted on vascular ring of aortic dissection which was also treated by inhibitors of MAPK pathway (SB203580, SP600125, and U0126). HE and Masson staining showed that aortic dissection severity with 3 g tension was worse than that without tension (0 g); after the treatments of diverse inhibitors, the fracture and breakage of the elastic fibers decreased. The expression of MMP-9, TNF-α, IL-1β) p38/p-p38, JNK1/p-JNK1, and ERK1/2/p-ERK1/2 were determined by immunohistochemical analysis, RT-PCR, and western blot. No matter whether tension was exerted or inhibitors were added, there was no change in the expression of p38, JNK1, and ERK1/2. However, compared to the 0 g group, the expression of MMP-9, TNF-α, IL-1β, p-p38, p-JNK1, and p-ERK1/2 was significantly upregulated in the 3 g group (P < 0.05). In both 0 g and 3 g groups, the expression of MMP-9, TNF-α, IL-1β, p-p38, p-JNK1, and p-ERK1/2 was remarkably downregulated after inhibitors treatment (P < 0.05). In conclusion, mechanical stretch aggravated aortic dissection by regulating the MAPK pathway and the consequent expression of MMP-9 and inflammation factors.
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17
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Ohle R, Kareemi HK, Wells G, Perry JJ. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. Acad Emerg Med 2018; 25:397-412. [PMID: 29265487 DOI: 10.1111/acem.13360] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/22/2017] [Accepted: 12/01/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Acute aortic dissection is a life-threatening condition due to a tear in the aortic wall. It is difficult to diagnose and if missed carries a significant mortality. METHODS We conducted a librarian-assisted systematic review of PubMed, MEDLINE, Embase, and the Cochrane database from 1968 to July 2016. Titles and abstracts were reviewed and data were extracted by two independent reviewers (agreement measured by kappa). Studies were combined if low clinical and statistical heterogeneity (I2 < 30%). Study quality was assessed using the QUADAS-2 tool. Bivariate random effects meta analyses using Revman 5 and SAS 9.3 were performed. RESULTS We identified 792 records: 60 were selected for full text review, nine studies with 2,400 participants were included (QUADAS-2 low risk of bias, κ = 0.89 [for full-text review]). Prevalence of aortic dissection ranged from 21.9% to 76.1% (mean ± SD = 39.1% ± 17.1%). The clinical findings increasing probability of aortic dissection were 1) neurologic deficit (n = 3, specificity = 95%, positive likelihood ratio [LR+] = 4.4, 95% confidence interval [CI] = 3.3-5.7, I2 = 0%) and 2) hypotension (n = 4, specificity = 95%, LR+ = 2.9 95% CI = 1.8-4.6, I2 = 42%), and decreasing probability were the absence of a widened mediastinum (n = 4, sensitivity = 76%-95%, negative likelihood ratio [LR-] = 0.14-0.60, I2 = 93%) and an American Heart Association aortic dissection detection (AHA ADD) risk score < 1 (n = 1, sensitivity = 91%, LR- = 0.22, 95% CI = 0.15-0.33). CONCLUSIONS Suspicion for acute aortic dissection should be raised with hypotension, pulse, or neurologic deficit. Conversely, a low AHA ADD score decreases suspicion. Clinical gestalt informed by high- and low-risk features together with an absence of an alternative diagnosis should drive investigation for acute aortic dissection.
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Affiliation(s)
- Robert Ohle
- Department of Emergency Medicine; Ottawa Hospital Research Institute; University of Ottawa; Ottawa Ontario
| | | | - George Wells
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa Ontario
- Cardiovascular Research Methods Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - Jeffrey J. Perry
- Cardiovascular Research Methods Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
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18
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Ohle R, Um J, Anjum O, Bleeker H, Luo L, Wells G, Perry JJ. High Risk Clinical Features for Acute Aortic Dissection: A Case-Control Study. Acad Emerg Med 2018; 25:378-387. [DOI: 10.1111/acem.13356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Robert Ohle
- Department of Emergency Medicine, the Ottawa Hospital Research Institute; University of Ottawa; Ottawa Ontario
| | - Justin Um
- Department of Undergraduate Medicine; University of Ottawa; Ottawa Ontario
| | - Omar Anjum
- Department of Undergraduate Medicine; University of Ottawa; Ottawa Ontario
| | - Helena Bleeker
- Department of Undergraduate Medicine; University of Ottawa; Ottawa Ontario
| | - Lindy Luo
- Department of Undergraduate Medicine; University of Ottawa; Ottawa Ontario
| | - George Wells
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa Ontario
- Cardiovascular Research Methods Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - Jeffrey J. Perry
- Department of Emergency Medicine, the Ottawa Hospital Research Institute; University of Ottawa; Ottawa Ontario
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19
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Luo CY, Roan JN. Re-visiting D-dimers and fibrin degradation products for the diagnosis of acute aortic dissection. J Thorac Dis 2017; 9:1744-1747. [PMID: 28839953 DOI: 10.21037/jtd.2017.06.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chwan-Yau Luo
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Cardiovascular Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jun-Neng Roan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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20
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Kotani Y, Toyofuku M, Tamura T, Shimada K, Matsuura Y, Tawa H, Uchikawa M, Higashi S, Fujimoto J, Yagita K, Sato F, Atagi Y, Hamasaki T, Tsujimoto T, Chishiro T. Validation of the diagnostic utility of D-dimer measurement in patients with acute aortic syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:223-231. [PMID: 27257263 DOI: 10.1177/2048872616652261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the validity of D-dimer measurements for the diagnosis of acute aortic syndrome in patients admitted to hospital with acute chest pain. METHODS A retrospective observational study design was used. Consecutive patients ( n=887) admitted to a tertiary hospital with acute chest pain (acute aortic syndrome, 123; acute pulmonary embolism, 29; and other disease, 735) from the emergency department between January 2011 and April 2014 were assessed to validate the diagnostic value of D-dimer measurements. RESULTS The D-dimer level was significantly increased in patients with acute aortic syndrome (median (interquartile range) 4.9 (2.0-17.4) µg/ml) compared with control patients (median (interquartile range) 0.6 (0.3-1.4) µg/ml; p<0.001). At a cut-off point of 0.5 μg/ml, the sensitivity for acute aortic syndrome was 0.97 (95% confidence interval 0.92-0.99) and was similar to that for acute pulmonary embolism (0.97 (0.82-0.99)). The age-adjusted D-dimer cut-off point, defined as age × 0.01 μg/ml in patients ⩾50 years, successfully reduced the number of false-positive diagnoses by 13%, while still retaining a high sensitivity (0.96 (0.91-0.99)). The five false-negative diagnoses of acute aortic syndrome included three patients with intramural haematoma, one patient with a penetrating aortic ulcer and one patient with an impending aortic rupture. A combination of probability assessment and the D-dimer approach reduced the number of false-negatives from five patients to two patients. CONCLUSIONS This study demonstrated that the D-dimer test can distinguish acute aortic syndrome from other diseases presenting with acute chest pain with high sensitivity and modest specificity. Using the D-dimer approach presents limitations with some subtypes of acute aortic syndrome, such as intramural haematoma.
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Affiliation(s)
- Yuki Kotani
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Mamoru Toyofuku
- 2 Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Takashi Tamura
- 2 Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Kotaro Shimada
- 3 Department of Radiology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Yushi Matsuura
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Hiroyuki Tawa
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Munehiro Uchikawa
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Sonoko Higashi
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Jumpei Fujimoto
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Kaoru Yagita
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Fumitaka Sato
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Yuichiro Atagi
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Toshiaki Hamasaki
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Toshihide Tsujimoto
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Takao Chishiro
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
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21
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Diagnostic test accuracy of D-dimer for acute aortic syndrome: systematic review and meta-analysis of 22 studies with 5000 subjects. Sci Rep 2016; 6:26893. [PMID: 27230962 PMCID: PMC4882530 DOI: 10.1038/srep26893] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/10/2016] [Indexed: 11/08/2022] Open
Abstract
Diagnostic test accuracy of D-dimer for acute aortic dissection (AAD) has not been evaluated by meta-analysis with the bivariate model methodology. Four databases were electrically searched. We included both case-control and cohort studies that could provide sufficient data concerning both sensitivity and specificity of D-dimer for AAD. Non-English language articles and conference abstract were allowed. Intramural hematoma and penetrating aortic ulcer were regarded as AAD. Based on 22 eligible articles consisting of 1140 AAD subjects and 3860 non-AAD subjects, the diagnostic odds ratio was 28.5 (95% CI 17.6-46.3, I(2) = 17.4%) and the area under curve was 0.946 (95% CI 0.903-0.994). Based on 833 AAD subjects and 1994 non-AAD subjects constituting 12 studies that used the cutoff value of 500 ng/ml, the sensitivity was 0.952 (95% CI 0.901-0.978), the specificity was 0.604 (95% CI 0.485-0.712), positive likelihood ratio was 2.4 (95% CI 1.8-3.3), and negative likelihood ratio was 0.079 (95% CI 0.036-0.172). Sensitivity analysis using data of three high-quality studies almost replicated these results. In conclusion, D-dimer has very good overall accuracy. D-dimer <500 ng/ml largely decreases the possibility of AAD. D-dimer >500 ng/ml moderately increases the possibility of AAD.
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Morello F, Ravetti A, Nazerian P, Liedl G, Veglio MG, Battista S, Vanni S, Pivetta E, Montrucchio G, Mengozzi G, Rinaldi M, Moiraghi C, Lupia E. Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes: A Diagnostic Accuracy and Observational Outcome Study. Medicine (Baltimore) 2016; 95:e2776. [PMID: 26871831 PMCID: PMC4753927 DOI: 10.1097/md.0000000000002776] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
In acute aortic syndromes (AAS), organ malperfusion represents a key event impacting both on diagnosis and outcome. Increased levels of plasma lactate dehydrogenase (LDH), a biomarker of malperfusion, have been reported in AAS, but the performance of LDH for the diagnosis of AAS and the relation of LDH with outcome in AAS have not been evaluated so far.This was a bi-centric prospective diagnostic accuracy study and a cohort outcome study. From 2008 to 2014, patients from 2 Emergency Departments suspected of having AAS underwent LDH assay at presentation. A final diagnosis was obtained by aortic imaging. Patients diagnosed with AAS were followed-up for in-hospital mortality.One thousand five hundred seventy-eight consecutive patients were clinically eligible, and 999 patients were included in the study. The final diagnosis was AAS in 201 (20.1%) patients. Median LDH was 424 U/L (interquartile range [IQR] 367-557) in patients with AAS and 383 U/L (IQR 331-460) in patients with alternative diagnoses (P < 0.001). Using a cutoff of 450 U/L, the sensitivity of LDH for AAS was 44% (95% confidence interval [CI] 37-51) and the specificity was 73% (95% CI 69-76). Overall in-hospital mortality for AAS was 23.8%. Mortality was 32.6% in patients with LDH ≥ 450 U/L and 16.8% in patients with LDH < 450 U/L (P = 0.006). Following stratification according to LDH quartiles, in-hospital mortality was 12% in the first (lowest) quartile, 18.4% in the second quartile, 23.5% in the third quartile, and 38% in the fourth (highest) quartile (P = 0.01). LDH ≥ 450 U/L was further identified as an independent predictor of death in AAS both in univariate and in stepwise logistic regression analyses (odds ratio 2.28, 95% CI 1.11-4.66; P = 0.025), in addition to well-established risk markers such as advanced age and hypotension. Subgroup analysis showed excess mortality in association with LDH ≥ 450 U/L in elderly, hemodynamically stable and in nonsurgically treated patients.Plasma LDH constitutes a biomarker of poor outcome in patients with AAS. LDH is a rapid and universally available assay that could be used to improve risk stratification and to individualize treatment in patient groups where options are controversial.
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Affiliation(s)
- Fulvio Morello
- From the S.C. Medicina d'Urgenza (FM, AR, MGV, SB, EP, CM, EL) and Laboratory of Biochemical Chemistry (GMengozzi), A.O.U. Città della Salute e della Scienza, Torino, Italy; Emergency Department, A.O.U. Careggi, Firenze, Italy (PN, GL, SV); and Cancer Epidemiology Unit (EP), Department of Medical Sciences (GMontrucchio, EL), and Division of Cardiac Surgery, Department of Surgical Sciences (MR), Università degli Studi di Torino, Torino, Italy
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Nazerian P, Giachino F, Vanni S, Veglio MG, Castelli M, Lison D, Bitossi L, Moiraghi C, Grifoni S, Morello F. Diagnostic performance of the aortic dissection detection risk score in patients with suspected acute aortic dissection. EUROPEAN HEART JOURNAL: ACUTE CARDIOVASCULAR CARE 2014; 3:373-381. [DOI: 10.1177/2048872614527010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Peiman Nazerian
- Emergency Department, Careggi University Hospital, Firenze, Italy
| | | | - Simone Vanni
- Emergency Department, Careggi University Hospital, Firenze, Italy
| | - Maria G Veglio
- Emergency Department, Molinette University Hospital, Torino, Italy
| | - Matteo Castelli
- Emergency Department, Careggi University Hospital, Firenze, Italy
| | - Davide Lison
- Emergency Department, Molinette University Hospital, Torino, Italy
| | - Luca Bitossi
- Emergency Department, Careggi University Hospital, Firenze, Italy
| | - Corrado Moiraghi
- Emergency Department, Molinette University Hospital, Torino, Italy
| | - Stefano Grifoni
- Emergency Department, Careggi University Hospital, Firenze, Italy
| | - Fulvio Morello
- Emergency Department, Molinette University Hospital, Torino, Italy
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24
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Goldberg SA, Kharbanda B, Pepe PE. Year in review 2013: Critical Care--out-of-hospital cardiac arrest, traumatic injury, and other emergency care conditions. Crit Care 2014; 18:593. [PMID: 25672494 PMCID: PMC4330928 DOI: 10.1186/s13054-014-0593-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this review, we discuss articles published in 2013 contributing to the existing literature on the management of out-of-hospital cardiac arrest and the evaluation and management of several other emergency conditions, including traumatic injury. The utility of intravenous medications, including epinephrine and amiodarone, in the management of cardiac arrest is questioned, as are cardiac arrest termination-of-resuscitation rules. Articles discussing mode of transportation in trauma are evaluated, and novel strategies for outcome prediction in traumatic injury are proposed. Diagnostic strategies, including computerized tomography scan for the diagnosis of smoke inhalation injury and serum biomarkers for the diagnosis of post-cardiac arrest syndrome and acute aortic dissection, are also explored. Although many of the articles discussed raise more questions than they answer, they nevertheless provide ample opportunity for further investigation.
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Affiliation(s)
- Scott A Goldberg
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115 USA
| | - Bryan Kharbanda
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115 USA
| | - Paul E Pepe
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115 USA
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25
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Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RSV, Vrints CJM. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2873-926. [PMID: 25173340 DOI: 10.1093/eurheartj/ehu281] [Citation(s) in RCA: 2808] [Impact Index Per Article: 280.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Morello F, Piler P, Novak M, Kruzliak P. Biomarkers for diagnosis and prognostic stratification of aortic dissection: challenges and perspectives. Biomark Med 2014; 8:931-41. [DOI: 10.2217/bmm.14.38] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aortic dissection (AD) is a severe vascular disease associated with major morbidity and mortality. The diagnosis of AD requires the performance of urgent aortic imaging exams such as computed tomography angiography, but the decision to perform these exams now essentially relies on clinical judgment. Several studies have identified a range of potential biomarkers stemming from the aortic extracellular matrix (matrix metalloproteinases, TGF-β, soluble elastin fragments), vascular smooth muscle cells (smooth muscle myosin heavy chain, creatine kinase, calponin), coagulation (d-dimer, platelets) and inflammation (C-reactive protein), whose circulating levels increase in patients affected by AD. Biomarkers of AD could be potentially used to screen patients with compatible symptoms, to identify patients at higher risk of AD, to rule out AD in patients with non-high clinical probability of AD and/or to obtain prognostic stratification of affected patients. This review will summarize available data and discuss present and future perspectives of circulating biomarkers for the diagnosis and prognostic stratification of AD.
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Affiliation(s)
- Fulvio Morello
- Emergency Department, A.O. Città della Salute e della Scienza, Molinette Hospital, Turin, Italy
| | - Pavel Piler
- Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne's Faculty Hospital & Masaryk University, Pekarska 53; 656 91 Brno, Czech Republic
- Centre of Cardiovascular Surgery & Transplantation, Brno, Czech Republic
| | - Miroslav Novak
- Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne's Faculty Hospital & Masaryk University, Pekarska 53; 656 91 Brno, Czech Republic
| | - Peter Kruzliak
- Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne's Faculty Hospital & Masaryk University, Pekarska 53; 656 91 Brno, Czech Republic
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27
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Nazerian P, Morello F, Vanni S, Bono A, Castelli M, Forno D, Gigli C, Soardo F, Carbone F, Lupia E, Grifoni S. Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection. Int J Cardiol 2014; 175:78-82. [PMID: 24838058 DOI: 10.1016/j.ijcard.2014.04.257] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute aortic dissection (AD) represents a diagnostic conundrum. Validated algorithms are particularly needed to identify patients where AD could be ruled out without aortic imaging. We evaluated the diagnostic accuracy of a strategy combining the aortic dissection detection (ADD) risk score with D-dimer, a sensitive biomarker of AD. METHODS Patients from two clinical centers with suspected AD were prospectively enrolled in a registry, from January 2008 to March 2013. The ADD risk score was calculated by retrospective blinded chart review. For D-dimer, a cutoff of 500 ng/ml was applied. RESULTS AD was diagnosed in 233 of 1035 (22.5%) patients. The ADD risk score was 0 in 322 (31.1%), 1 in 508 (49.1%) and >1 in 205 (19.8%) patients. The sensitivity and the failure rate of D-dimer were 100% and 0% in patients with ADD score 0, versus 97.5% (95% CI 91.4-99.6%) and 4.2% (95% CI 0.7-12.5%) in patients with ADD risk score >1. In patients with ADD risk score ≤ 1, the sensitivity and the failure rate of D-dimer were 98.7% (95% CI 95.3-99.8%) and 0.8% (95% CI 0.1-2.6%). The diagnostic efficiency of D-dimer in patients with ADD risk score 0 and ≤ 1 was 8.9% (95% CI 7.2-10.7%) and 23.6% (95% CI 21.1-26.2%) respectively. CONCLUSIONS In a large cohort of patients with suspected AD, the presence of ADD risk score 0 or ≤ 1 combined with a negative D-dimer accurately and efficiently ruled out AD.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Fulvio Morello
- Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy.
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Alessia Bono
- Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Matteo Castelli
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Daniela Forno
- Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Chiara Gigli
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Flavia Soardo
- Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Federica Carbone
- Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Enrico Lupia
- Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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Song Y, Xie Y, Liu F, Zhao C, Yu R, Ban S, Ye Q, Wen J, Wan H, Li X, Ma R, Meng Z. Expression of matrix metalloproteinase-12 in aortic dissection. BMC Cardiovasc Disord 2013; 13:34. [PMID: 23642232 PMCID: PMC3660235 DOI: 10.1186/1471-2261-13-34] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 04/30/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Aortic dissection(AD) is an acute process of large blood vessels characterized by dangerous pathogenic conditions and high disability and high mortality. The pathogenesis of AD remains debated. Matrix metalloproteinase-12 (MMP-12) participates in many pathological processes such as abdominal aortic aneurysm, atherosclerosis, emphysema and cancer. However, this elastase has rarely been assessed in the presence of AD. The aim of the present study was to investigate the expression of MMP-12 in aortic tissue so as to offer a better understanding of the possible mechanisms of AD. METHODS The protein expression levels of MMP-12 were analyzed and compared in aorta tissue and the blood serum samples by reverse transcription polymerase chain reaction(RT-PCR), Western blotting, immuno-histochemistry, fluorescence resonance energy transfer ( FRET ) activity assay and enzyme-linked immuno sorbent assay ( ELISA ), respectively. Ascending aorta tissue specimens were obtained from 12 patients with an acute Stanford A-dissection at the time of aortic replacement, and from 4 patients with coronary artery disease (CAD) undergoing coronary artery bypass surgery. Meanwhile, serum samples were harvested from 15 patients with an acute Stanford A-dissection and 10 healthy individuals who served as the control group. RESULTS MMP-12 activity could be detected in both AD and CAD groups, but the level in the AD group was higher than those in the CAD group (P < 0.05). MMP-12 proteolysis existed in both serum samples of the AD and healthy groups, and the activity level in the AD group was clearly higher than in the healthy group (P < 0.05). For AD patients, MMP-12 activity in serum was higher than in the aorta wall (P < 0.05). MMP-12 activity in the aortic wall tissue can be inhibited by MMP inhibitor v (P < 0.05). CONCLUSION The present study directly demonstrates that MMP-12 proteolytic activity exists within the aorta specimens and blood samples from aortic dissection patients. MMP-12 might be of potential relevance as a clinically diagnostic tool and therapeutic target in vascular injury and repair.
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Affiliation(s)
- Yi Song
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
- The Department of Cardiovascular Surgery, The Second Hospital of Yunnan Province, Kunming, 650032, China
| | - Yuehui Xie
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
- Department of Computer Science, The Faculty of Basic Medicine, Kunming Medical University, Kunming, 650031, China
| | - Feng Liu
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
| | - Chong Zhao
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
| | - Rui Yu
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
| | - Shao Ban
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
| | - Qiufang Ye
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
| | - Jianxion Wen
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
| | - Haibo Wan
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
| | - Xiang Li
- The Department of Cardiovascular Surgery, The Second Hospital of Yunnan Province, Kunming, 650032, China
| | - Runwei Ma
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
- The Department of Cardiovascular Surgery, The Second Hospital of Yunnan Province, Kunming, 650032, China
| | - Zhaohui Meng
- Laboratory of Molecular Cardiology, Department of Cardiology; The First Affiliated Hospital Of Kunming Medical University, Kunming, 650032, China
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