Current Understanding of Aortic Dissection

The Complicated Genetics behind Uncomplicated Type B Aortic Dissection

BACKGROUND

Up to 50% of uncomplicated type B aortic dissection (unTBAD) cases progress to become complicated with a mortality rate of up to 42% within 5 years of onset. Morphological and clinical parameters have previously been defined for the decision of surgical intervention in unTBAD to improve clinical outcomes. The analysis of genetic variants in this risk stratification has demonstrated a lack of evidence to influence clinical decision-making.

METHODS

A comprehensive literature review was conducted using multiple electronic databases. A selection of genes recognized in thoracic aortic aneurysms and dissections were investigated in association with clinical outcomes in type B aortic dissections.

RESULTS

Case studies highlighted the impact of variants in fibrillin-1, type III collagen, alpha-actin 2, MYH11, protein kinase cGMP-dependent type I, transforming growth factor beta 1, type I transforming growth factor β receptor, and type II transforming growth factor β receptor on clinical outcomes in type B aortic dissection. Patients who carry variants in these genes experience more rapid disease progression and benefit from surgery.

CONCLUSION

The presence of a variant in genes that underlie unTBAD etiology could impact clinical decision-making and risk stratification in unTBAD. Emerging evidence supports thoracic endovascular aortic repair for unTBAD patients who have a higher risk of developing complications. The use of genetics in the management of unTBAD patients may help to improve the adverse clinical outcomes in unTBAD.

Domain knowledge based comprehensive segmentation of Type-A aortic dissection with clinically-oriented evaluation

Type-A aortic dissection (TAAD) is a cardiac emergency in which rapid diagnosis, prognosis prediction, and surgical planning are critical for patient survival. A comprehensive understanding of the anatomic structures and related features of TAAD patients is the key to completing these tasks. However, due to the emergent nature of this disease and requirement of advanced expertise, manual segmentation of these anatomic structures is not routinely available in clinical practice. Currently, automatic segmentation of TAAD is a focus of the cardiovascular imaging research. However, existing works have two limitations: no comprehensive public dataset and lack of clinically-oriented evaluation. To address these limitations, in this paper we propose imageTAAD, the first comprehensive segmentation dataset of TAAD with clinically-oriented evaluation. The dataset is comprised of 120 cases, and each case is annotated by medical experts with 35 foreground classes reflecting the clinical needs for diagnosis, prognosis prediction and surgical planning for TAAD. In addition, we have identified four key clinical features for clinically-oriented evaluation. We also propose SegTAAD, a baseline method for comprehensive segmentation of TAAD. SegTAAD utilizes two pieces of domain knowledge: (1) the boundaries play a key role in the evaluation of clinical features, and can enhance the segmentation performance, and (2) the tear is located between TL and FL. We have conducted intensive experiments with a variety of state-of-the-art (SOTA) methods, and experimental results have shown that our method achieves SOTA performance on the ImageTAAD dataset in terms of overall DSC score, 95% Hausdorff distance, and four clinical features. In our study, we also found an interesting phenomenon that a higher DSC score does not necessarily indicate better accuracy in clinical feature extraction. All the dataset, code and trained models have been published (Xiaowei, 2024).

LncRNA BANCR/miR-15a/MAPK1 Induces Apoptosis and Increases Proliferation of Vascular Smooth Muscle Cells in Aortic Dissection by Enhancing MMP2 Expression

Aortic dissection is associated with a high mortality rate, contributing to an unfavorable prognosis. Preventive measures are more effective than therapeutic interventions for aortic dissection. While LncRNA BANCR is recognized as a functional translational regulator in various diseases, its role in aortic dissection remains unexplored. This study aims to elucidate the functions and molecular mechanisms of BANCR in aortic dissection. Vascular smooth muscle cells were isolated from dissected aortic tunica media samples and their phenotypes were compared with those of commercial vascular smooth muscle cells. BANCR expression was modulated via transient transfection (overexpression) and small interfering RNA (knockdown). The involvement of the p38 MAPK pathway was examined using the inhibitor SB202190. The competing endogenous RNA network was validated through a dual luciferase assay. Cellular phenotypes were assessed using the CCK-8 assay, scratch assay, and flow cytometry. BANCR was overexpressed in dissected aortic tissues and isolated vascular smooth muscle cells. MiR-15a-5p exhibited binding affinity to both BANCR and MAPK1. Overexpression of BANCR activated p38 phosphorylation, enhanced cell proliferation and migration, and increased apoptosis. SB202190 mitigated these BANCR-induced phenotypes by inhibiting p38 phosphorylation. Additionally, MMP2 upregulation was linked to BANCR overexpression via the p38 MAPK pathway. Suppression of BANCR expression or inhibition of p38 phosphorylation reduced MMP2 levels, thereby reversing BANCR-induced phenotypes. The LncRNA BANCR/miR-15a-5p/MAPK1 axis forms a ceRNA network that modulates MMP2 expression through the p38 MAPK signaling pathway in vascular smooth muscle cells. BANCR overexpression activates p38 MAPK phosphorylation, leading to enhanced MMP2 expression and subsequent increases in cell proliferation, migration, and apoptosis.

Prognostic prediction of long-term survival in patients with type A aortic dissection undergoing surgical repair: development of a novel prognostic index

BACKGROUND

This study developed and investigated the prognostic significance of a comprehensive biomarker for postoperative type A aortic dissection (TAAD) patients.

METHODS

A retrospective cohort of 175 TAAD patients who underwent open surgery at the First Affiliated Hospital of Chongqing Medical University, China, between September 2017 to December 2020, was included in the analysis. The least absolute shrinkage and selection operator (LASSO) method was employed to select indicators, thereby constructing a comprehensive biomarker, termed the comprehensive physiological response indicator (CPRI). The prognostic significance of the CPRI was assessed employing the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression model were applied to identify independent prognostic factors for TAAD. A prognostic nomogram was constructed based on the CPRI and other nine blood and clinical indicators. The predictive performance of prognostic models and individual indicators was evaluated by determining the area under the curve (AUC) of the receiver operating characteristic (ROC) analysis.

RESULTS

A comprehensive prognostic biomarker (CPRI) was developed, incorporating cardiac troponin T (cTnT), red blood cell count (RBC), white blood cell count (WBC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC). In the cohort of type A aortic dissection (TAAD) patients who underwent open surgery, those with lower preoperative CPRI values exhibited significantly poorer overall survival, with a HR of 2.325 (95% CI: 1.126-4.802) in a multivariate Cox regression analysis. The CPRI was identified as an independent prognostic factor for TAAD patients. Additionally, a nomogram constructed based on the CPRI demonstrated superior predictive accuracy compared to other models, with an area under the curve (AUC) of 0.874 versus 0.592, 0.514, and 0.577 for the respective models.

CONCLUSION

Our study suggested that CPRI may be a useful comprehensive prognostic biomarker for predicting the long-term survival of TAAD patients. The nomogram based on CPRI can be considered a valuable tool to identify high risk TAAD patients with poor prognosis.

Neurovascular Complications of Acute Aortic Syndrome

Acute aortic syndromes (AAS) such as aortic dissection, intramural hematoma, and penetrating aortic ulcer pose significant neurovascular risks, affecting patient outcomes. This review examines the incidence, clinical presentation, and outcomes of neurovascular complications in AAS patients. Common complications include stroke, spinal cord ischemia, and transient ischemic attacks, with stroke being the most prevalent. Managing aortic dissection necessitates careful blood pressure control to prevent dissection progression while avoiding compromised cerebral and spinal perfusion. Carotid involvement, particularly dissection, increases stroke and transient ischemic attack risks. Emergency surgical interventions, though essential to prevent rupture or repair dissection, carry risks of perioperative neurovascular complications. The use of electroencephalography and transcranial Doppler can aid in the early detection and monitoring of neurovascular events. We discuss the pros and cons of certain blood pressure medications in the acute treatment of aortic dissection. A multidisciplinary approach involving cardiovascular surgeons, neurologists, and critical care specialists is vital for optimizing outcomes and mitigating risks. Early recognition and management of neurovascular complications are crucial, and further research is needed to develop targeted prevention and treatment strategies.

Diabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for type A aortic dissection: insight from the national readmission database

BACKGROUND

Previous studies have reported a protective effect of type 2 diabetes on the incidence and progression of aortic aneurysms. We investigated whether this protective effect extends to aortic dissections.

METHODS

Data from the US Nationwide Readmission Database (2016-2019) were analyzed. Patients admitted for open surgery repair of acute type A aortic dissection (TAAD) were initially analyzed (index group). Those discharged alive were followed for up to 30 days (readmission group). The co-primary outcomes were in-hospital and 30-day mortality.

RESULTS

Between 2016 and 2019, 7,324 patients were admitted for open surgical repair of acute TAAD, of whom 965 (13.2%) had diabetes. Patients with diabetes were older and had a higher prevalence of obesity, hypertension, smoking, dyslipidemia, and chronic kidney disease (CKD). 15.2% of patients with diabetes and 14.6% without diabetes died; hence, diabetes did not have a significant impact on in-hospital mortality (adjusted odd ratio [aOR] = 1.02 [0.84-1.24]). Similarly, diabetes was not associated with a higher adjusted risk of atrial fibrillation (aOR = 1.03 [0.89-1.20]), stroke (aOR = 0.83 [0.55-1.26]), cardiogenic shock (aOR = 1.18 [0.98-1.42]), but increased the risk of acute renal failure (aOR = 1.20 [1.04-1.39]). Within 30 days of discharge, 154 (15.9%) patients with diabetes and 952 (15%) from the non-diabetes group were readmitted. Readmitted patients with diabetes were older and had a higher prevalence of cardiovascular comorbidities. We didn't observe any significant difference in the adjusted risk of 30-day mortality between the diabetes and non-diabetes groups (adjusted hazard ratio [aHR] = 0.81 [0.41-1.60]). However, diabetes was associated with a lower risk of readmission (aHR = 0.81 [0.68-0.97]). Age was the most significant predictor of all outcomes. CKD was the most significant predictor of 30-day mortality, with the risk increasing five-fold in patients with diabetes (HR = 5.58 [2.58-6.62]. Cardiovascular-related conditions were the most common causes of readmission in both groups. However, respiratory-related conditions were more prevalent in the diabetes group compared to the non-diabetes group (19.5% vs. 13%, respectively, p = 0.032).

CONCLUSIONS

Diabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for Type A aortic dissection.

Ventricular fibrillation arrest in aortic dissection presenting as myocardial injury

An acute aortic dissection can be a tremendously fatal vascular condition if not managed promptly. However, the symptom profile of aortic dissections can be ambiguous to numerous conditions which are more common and greater pursued by clinicians before suspicion of dissection is made. The case presented in this study is of a 61-year-old male who arrives to the emergency department for concern of new-onset chest pain which progresses into ventricular fibrillation arrest prior to diagnosis of aortic dissection. This case report profiles the mimicking possibility of aortic dissection to present as acute myocardial injury, and the utility of models use to differentiate the workup between aortic dissections and acute coronary syndromes.

Sex-related differences in clinical characteristics and in-hospital outcomes of patients in acute type A aortic dissection

OBJECTIVE

The aim of this study was to investigate sex-related differences in the clinical characteristics and hospital outcomes of patients undergoing surgery for acute type A aortic dissection (AAAD).

METHODS

This study was a retrospective study. Patients who underwent surgery for AAAD at the Department of Cardiac Surgery, Fujian Medical University Union Hospital, from January 2014 to March 2023 were consecutively included. Data was extracted from electronic medical records. The primary outcome measure was in-hospital mortality, and secondary outcome measures included new-onset postoperative arrhythmia (POA), acute kidney injury (AKI), hepatic dysfunction, neurological complications, gastrointestinal hemorrhage, ICU length of stay, and hospital length of stay. Patients were divided into two groups based on sex, and data analysis was performed using SPSS 25.0 software.

RESULTS

A total of 1137 subjects were included, with 863 males (75.9%) and 274 females (24.1%). There were statistically significant differences in age and BMI between the two groups (P < 0.05). There was no statistically significant difference in the incidence of pain at the onset between the two groups, but chest tightness in females was higher than in males (22.6% vs. 13.8%). Regarding primary outcomes, the in-hospital mortality rate was 11.1% for males and 10.6% for females (P = 0.803). There were no statistically significant differences between the groups in ICU days, length of hospitalization, neurological complications, or liver dysfunction (P > 0.05). The rate of POA in females was 4.7%, higher than in males (2.2%), but AKI and gastrointestinal hemorrhage were both higher in males than in females (P < 0.05). Multivariate analysis showed that age, white blood cell (WBC) counts, lactic acid, operation duration and prolonged mechanical ventilation (PMV) increased the risk of in-hospital mortality in male patients. Hypertension, WBC counts, lactic acid, and PMV increased the risk of in-hospital mortality in female patients.

CONCLUSION

Despite significant baseline characteristic differences between male and female AAAD patients, there were no significant differences in onset symptoms. The in-hospital mortality rates were similar between male and female patients, but the risk factors for in-hospital mortality differed.

CT Imaging Findings of Pulmonary Artery Stenosis: A Pictorial Review

Pulmonary artery stenosis represents a group of disorders involving main, branch or peripheral pulmonary arteries with pain, dyspnea, hemoptysis or even no symptoms. Early diagnosis and timely intervention are crucial for reducing mortality, but timely diagnosis is challenging due to the non-specific symptoms. Computed tomography pulmonary angiography (CTPA) is useful in the diagnosis because it can provide more details about abnormal changes in the lumen, vessel wall and adjacent mediastinal structures. Congenital and acquired pulmonary artery anomalies have some characteristics on CTPA, which can be useful for differential diagnosis. Awareness of these conditions is important for radiologists. This pictorial review provides an overview of CTPA imaging features of pulmonary artery stenosis.

Temporal Pattern Analysis of Ultrasound Surveillance Data in Vascular Connective Tissue Disorders

BACKGROUND

Ehlers-Danlos syndrome (EDS), Marfan syndrome (MFS), and Loeys-Dietz syndrome (LDS) are connective tissue disorders frequently associated with vascular aneurysm formation, dissections, and subsequent major complications. Regular imaging surveillance is recommended for these conditions. However, no guidelines currently exist regarding imaging modality or surveillance intervals.

METHODS

This retrospective single-center observational study analyzed clinical and imaging data of patients attending an outpatient clinic for vascular connective tissue disorders between August 2008 and January 2024. Imaging (1424 data points in total) and clinical data were extracted from electronic health records. Analysis primarily included a comparison of vessel diameter progression across imaging modalities, with an additional review of the clinical history of vascular events.

RESULTS

In total, 19 patients with vascular connective tissue disorders (vCTDs) underwent consultations at our outpatient clinic. Nine (47.4%) patients experienced vascular events, while two (10.5%) passed away during the study period. Multimodal imaging surveillance revealed a tendency towards arterial diameter increase. Consistent ultrasound monitoring provided more reliable diameter progression data for the same arterial segment than a combination of imaging modalities. Temporal analysis indicated a tendency for the continuous growth of the abdominal aorta, the common and internal carotid artery, and the common femoral and popliteal artery.

CONCLUSION

The study highlights the importance of standardized, modality-specific imaging protocols in monitoring patients with vCTDs. The variability in disease progression among these patients further complicates surveillance strategies, contemplating the need for individualized approaches. Further research and prospective multicenter studies are required to refine and improve monitoring protocols.

Management of compromised bilateral carotid artery flow in acute type A aortic dissection, in a neurologically intact patient

Type A aortic dissection (TAAD) is a disease that can have a cataclysmic impact on a patient's life, and early surgical intervention is crucial for survival. Cerebral malperfusion occurs in 6-14% of TAAD patients, primarily from partial or complete blockage of the arch vessels by the dissection flap, and hypoxic brain injury secondary to tamponade or shock and/or brain embolism from thrombosis of the false lumen. Management protocols for concomitant carotid arterial dissection in TAAD patients are inconsistent in the current literature. Through this case report, we have tried to describe our easily replicable strategies to manage bilateral carotid artery involvement in TAAD, avoiding total circulatory arrest (TCA), in a neurologically intact patient with good neurological outcome.

Diabetes and aortic dissection: unraveling the role of 3-hydroxybutyrate through mendelian randomization

BACKGROUND

In observational and experimental studies, diabetes has been reported as a protective factor for aortic dissection. 3-Hydroxybutyrate, a key constituent of ketone bodies, has been found to favor improvements in cardiovascular disease. However, whether the protective effect of diabetes on aortic dissection is mediated by 3-hydroxybutyrate is unclear. We aimed to investigate the causal effects of diabetes on the risk of aortic dissection and the mediating role of 3-hydroxybutyrate in them through two-step Mendelian randomization.

MATERIALS AND METHODS

We performed a two-step Mendelian randomization to investigate the causal connections between diabetes, 3-hydroxybutyrate, and aortic dissection and calculate the mediating effect of 3-hydroxybutyrate. Publicly accessible data for Type 1 diabetes, Type 2 diabetes, dissection of aorta and 3-hydroxybutyrate were obtained from genome-wide association studies. The association between Type 1 diabetes and dissection of aorta, the association between Type 2 diabetes and dissection of aorta, and mediation effect of 3-hydroxybutyrate were carried out separately.

RESULTS

The IVW method showed that Type 1 diabetes was negatively associated with the risk of aortic dissection (OR 0.912, 95% CI 0.836-0.995), The weighted median, simple mode and weighted mode method showed consistent results. The mediated proportion of 3-hydroxybutyrate on the relationship between Type 1 diabetes and dissection of aorta was 24.80% (95% CI 5.12-44.47%). The IVW method showed that Type 2 diabetes was negatively associated with the risk of aortic dissection (OR 0.763, 95% CI 0.607-0.960), The weighted median, simple mode and weighted mode method showed consistent results. 3-Hydroxybutyrate does not have causal mediation effect on the relationship between Type 2 diabetes and dissection of aorta.

CONCLUSION

Mendelian randomization study revealed diabetes as a protective factor for dissection of aorta. The protective effect of type 1 diabetes on aortic dissection was partially mediated by 3-hydroxybutyrate, but type 2 diabetes was not 3-hydroxybutyrate mediated.

Unraveling the Enigma of Aortic Dissection: From Genetics to Innovative Therapies

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.

Evaluation of the Value of Histological Examination for the Prediction of Genetic Thoracic Proximal Aortopathies

Background: Heritable connective tissue disorders are often accompanied by an increased risk for thoracic aortic aneurysm and dissection (TAAD). Profound knowledge of the underlying pathology may have an impact on individual treatment, systematic follow-up, and early detection by the screening of offspring. The aim of this study, based in a single high-volume tertiary center, was an analysis of the diagnostic validity of histopathologic findings in patients with TAAD due to these findings' accuracy in diagnosing heritable connective tissue disorders. Methods: Therefore, genetic testing by next-generation sequencing (NGS) was performed to evaluate the correlations. In total, 65 patients with TAAD undergoing surgical treatment before the age of 60 years or with age up to 80 years if they had offspring at the time of the procedure were included in the analysis. Results: In our cohort, no certain correlation of histological findings to the results of genetic diagnostics in patients with clinically relevant aortic pathology could be shown. Patients with histopathologic findings for heritable connective tissue disorder and a positive gene variant were 11.6 years younger than patients without mutation and without histological evidence for connective tissue disorder. Conclusions: Genetic clarification is useful to define the specific genotype of the disease of the aortic wall in the case of non-specific histological characteristics.

Cardiovascular toxicities following the use of tyrosine kinase inhibitors in hepatocellular cancer patients: a retrospective, pharmacovigilance study

BACKGROUND

Cardiac adverse events (AEs) are common in tyrosine kinase inhibitors(TKIs). This study explored the cardiac AEs of TKIs through the Food and Drug Administration's Adverse Event Reporting System (FAERS).

METHODS

Disproportionality analysis and Bayesian analysis were utilized for data mining of the suspected cardiac AEs of TKIs, based on FAERS data from January 2004 to December 2021.

RESULTS

A total of 4708 cardiac AEs reports of sorafenib, regorafenib, lenvatinib, and cabozantinib were identified. Hypertension accounts for the most reported cardiac AE. Lenvatinib appears to induce cardiac failure with the highest signals strength [ROR = 7.7 (3.46,17.17)]. Acute myocardial infarction was detected in lenvatinib [ROR = 7.91 (5.64,11.09)] and sorafenib [ROR = 2.22 (1.74, 2.84)]. Acute coronary syndrome was detected in lenvatinib [ROR = 11.57 (6.84, 19.58)] and sorafenib [ROR = 2.81 (1.87,4.24)]. Atrial fibrillation was detected in sorafenib [ROR = 1.82 (1.55,2.14)] and regorafenib [ROR = 1.36 (1.03,1.81)]. Meanwhile, aortic dissections were detected in sorafenib [ROR = 5.08 (3.31,7.8)] and regorafenib [ROR = 3.39 (1.52,7.56)]. Most patients developed hypertension and cardiac failure within 30 days of initiating TKI treatments. Patients taking lenvatinib had an increased incidence of developing acute coronary syndrome after 180 days of treatment.

CONCLUSION

Analysis of FAERS data provides a precise profile on the characteristics of cardiac AEs associated with different TKI regimens. Distinct monitoring and appropriate management are needed in the care of TKI recipients.

Correlation of the serum cell division cycle 42 with CD4+ T cell subsets and in-hospital mortality in Stanford type B aortic dissection patients

Objective

Cell division cycle 42 (CDC42) regulates CD4+ T-cell differentiation and participates in vascular stiffness and atherosclerosis and is involved in the progression of Stanford type B aortic dissection (TBAD). This study aimed to explore the correlation between serum CDC42 level and CD4+ T cell subsets and in-hospital mortality in TBAD patients.

Methods

Serum CDC42 and peripheral blood T-helper (Th) 1, Th2, and Th17 cells were detected in 127 TBAD patients by enzyme-linked immunosorbent assay and flow cytometry, respectively. Serum CDC42 was also quantified in 30 healthy controls.

Results

Serum CDC42 was decreased in TBAD patients vs. healthy controls (median [interquartile range (IQR)]: 418.0 (228.0-761.0) pg/ml vs. 992.0 (716.3-1,445.8) pg/ml, P < 0.001). In TBAD patients, serum CDC42 was negatively correlated with Th17 cells (P = 0.001), but not Th1 (P = 0.130) or Th2 cells (P = 0.098). Seven (5.5%) patients experienced in-hospital mortality. Serum CDC42 was reduced in patients who experienced in-hospital mortality vs. those who did not (median (IQR): 191.0 (145.0-345.0) pg/ml vs. 451.5 (298.3-766.8) pg/ml, P = 0.006). By receiver operating characteristic analysis, serum CDC42 showed a good ability for estimating in-hospital mortality [area under curve = 0.809, 95% confidence interval (CI) = 0.662-0.956]. By the multivariate logistic regression analysis, elevated serum CDC42 [odd ratio (OR) = 0.994, 95% CI = 0.998-1.000, P = 0.043] was independently correlated with lower risk of in-hospital mortality, while higher age (OR = 1.157, 95% CI = 1.017-1.316, P = 0.027) was an independent factor for increased risk of in-hospital mortality.

Conclusion

Serum CDC42 negatively associates with Th17 cells and is independently correlated with decreased in-hospital mortality risk in TBAD patients.

A Comprehensive Retrospective Study on the Mechanisms of Cyclic Mechanical Stretch-Induced Vascular Smooth Muscle Cell Death Underlying Aortic Dissection and Potential Therapeutics for Preventing Acute Aortic Aneurysm and Associated Ruptures

Acute aortic dissection (AAD) and associated ruptures are the leading causes of death in cardiovascular diseases (CVDs). Hypertension is a prime risk factor for AAD. However, the molecular mechanisms underlying AAD remain poorly understood. We previously reported that cyclic mechanical stretch (CMS) leads to the death of rat aortic smooth muscle cells (RASMCs). This review focuses on the mechanisms of CMS-induced vascular smooth muscle cell (VSMC) death. Moreover, we have also discussed the potential therapeutics for preventing AAD and aneurysm ruptures.

Prevalence of Genetic Variants and Deep Phenotyping in Patients with Thoracic Aortic Aneurysm and Dissection: A Cross-Sectional Single-Centre Cohort Study

BACKGROUND

There is a paucity of evidence on people with thoracic aortic aneurysm and dissection. We aimed to determine the prevalence of genetic variants and their associations with phenotypes.

METHODS

In this cross-sectional single-centre cohort study of consecutive patients who underwent endovascular or open-surgical repair of thoracic aortic aneurysm and dissection, genetic analysis was performed using four-stage Next Generation Sequencing, and findings were confirmed with Sanger sequencing. We collected personal and family history on comorbidities, clinical examination, anthropometrics, skeletal deformities, joint function, and ophthalmological measures. Cardiovascular risk and phenotype scores were calculated.

RESULTS

Ninety-five patients were eligible (mean age 54 ± 9 years, 70% males, 56% aortic dissection). One-fifth had a family history of aortic disease. Furthermore, 95% and 54% had a phenotype score of ≤5 and ≤2, respectively. There were no significant differences in the distribution of phenotype characteristics according to age, sex, aortic pathology, or performed invasive procedures. Genetic variants of uncertain significance were detected in 40% of patients, with classic mutations comprising 18% of all variants. We observed no significant association with cardiovascular and phenotype scores but with higher joint function scores (p = 0.015).

CONCLUSION

Genetic variants are highly present in clinically relevant aortic pathologies. Variants appear to play a larger role than previously described. The different variants do not correlate with specific phenotypes, age, pathology, sex, or family history.

Navigating the Unexpected: Iatrogenic Aortic Injuries during Transcatheter Aortic Valve Replacement (TAVR)

The introduction of transcatheter aortic valve replacement (TAVR) has undeniably changed the landscape of valvular heart disease management over the last two decades. A reduction in complications through improvements in techniques, experience, and technology has established TAVR as a safe and effective alternative to surgical aortic valve replacement. However, it is important to consider the potential risks associated with TAVR and ways in which life-threatening complications can be identified and managed in a timely fashion. In this article, we review some catastrophic iatrogenic aortic injuries that are described in the literature and present a case of an acute iatrogenic type A aortic dissection that occurred during a transcatheter aortic valve replacement (TAVR). After valve deployment, a routine neurologic examination noted the new onset of a left-sided facial droop and upper extremity weakness. Urgent imaging revealed an extensive type A aortic dissection, and the patient was taken to the operating room for surgical repair. The coordination of our multidisciplinary team allowed for prompt recognition of her neurologic symptoms, urgent imaging, and timely transport to the operating room, all of which contributed to the successful management of this life-threatening procedural complication.

Intimal Injury Potentially Plays a Key Role in the Formation of Carotid Artery Dissection: A Novel Animal Model Establishing

Research on the pathophysiological mechanism of carotid artery dissection and its clinical translation is limited due to the lack of effective animal models to simulate the occurrence of this condition. Assuming that intimal injury is an important factor in the formation of carotid dissection, we established a novel method for inducing carotid dissection models by scraping the carotid intima using a fine needle. Scraping the carotid intima with fine needles can induce the rapid formation of carotid dissection. Magnetic resonance imaging and hematoxylin-eosin staining suggest the presence of false lumens and mural hematomas in the vessels. Our model-induction technique, inspired by iatrogenic catheter-induced artery dissections (carotid, coronary, aortic), significantly mimics the pathological process of clinical carotid dissection. The results suggest that mechanical injury may be a significant cause of carotid dissection and that intimal injury is a major factor in the formation of arterial dissections. This approach will provide assistance in the understanding of medically induced arterial dissection.