51
|
Katakol S, Baker TJ, Bian Z, Lu Y, Spahlinger G, Hatt CR, Burris NS. Fully automated pipeline for measurement of the thoracic aorta using joint segmentation and localization neural network. J Med Imaging (Bellingham) 2023; 10:051810. [PMID: 37915405 PMCID: PMC10617550 DOI: 10.1117/1.jmi.10.5.051810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/14/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose Diagnosis and surveillance of thoracic aortic aneurysm (TAA) involves measuring the aortic diameter at various locations along the length of the aorta, often using computed tomography angiography (CTA). Currently, measurements are performed by human raters using specialized software for three-dimensional analysis, a time-consuming process, requiring 15 to 45 min of focused effort. Thus, we aimed to develop a convolutional neural network (CNN)-based algorithm for fully automated and accurate aortic measurements. Approach Using 212 CTA scans, we trained a CNN to perform segmentation and localization of key landmarks jointly. Segmentation mask and landmarks are subsequently used to obtain the centerline and cross-sectional diameters of the aorta. Subsequently, a cubic spline is fit to the aortic boundary at the sinuses of Valsalva to avoid errors related inclusions of coronary artery origins. Performance was evaluated on a test set of 60 scans with automated measurements compared against expert manual raters. Result Compared to training separate networks for each task, joint training yielded higher accuracy for segmentation, especially at the boundary (p < 0.001 ), but a marginally worse (0.2 to 0.5 mm) accuracy for landmark localization (p < 0.001 ). Mean absolute error between human and automated was ≤ 1 mm at six of nine standard clinical measurement locations. However, higher errors were noted in the aortic root and arch regions, ranging between 1.4 and 2.2 mm, although agreement of manual raters was also lower in these regions. Conclusion Fully automated aortic diameter measurements in TAA are feasible using a CNN-based algorithm. Automated measurements demonstrated low errors that are comparable in magnitude to those with manual raters; however, measurement error was highest in the aortic root and arch.
Collapse
Affiliation(s)
- Sudeep Katakol
- University of Michigan, Department of Electrical and Computer Engineering, Ann Arbor, Michigan, United States
- University of Michigan, Department of Radiology, Ann Arbor, Michigan, United States
| | - Timothy J. Baker
- University of Michigan, Department of Radiology, Ann Arbor, Michigan, United States
| | - Zhangxing Bian
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
| | - Yanglong Lu
- University of Michigan, Department of Radiology, Ann Arbor, Michigan, United States
| | - Greg Spahlinger
- University of Michigan, Department of Radiology, Ann Arbor, Michigan, United States
| | | | - Nicholas S. Burris
- University of Michigan, Department of Radiology, Ann Arbor, Michigan, United States
| |
Collapse
|
52
|
Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
53
|
Gerontas A, Avgerinos D, Charitakis K, Maragou H, Drosatos K. 1821-2021: Contributions of physicians and researchers of Greek descent in the advancement of clinical and experimental cardiology and cardiac surgery. Front Cardiovasc Med 2023; 10:1231762. [PMID: 37600045 PMCID: PMC10436502 DOI: 10.3389/fcvm.2023.1231762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
While the role of Greeks in the development of early western medicine is well-known and appreciated, the contributions of modern Greek medical practitioners are less known and often overlooked. On the occasion of the 200-year anniversary of the Greek War of Independence, this review article sheds light onto the achievements of modern scientists of Greek descent in the development of cardiology, cardiac surgery, and cardiovascular research, through a short history of the development of these fields and of the related institutions in Greece. In the last decades, the Greek cardiology and Cardiac Surgery communities have been active inside and outside Greece and have a remarkable presence internationally, particularly in the United States. This article highlights the ways in which Greek cardiology and cardiovascular research has been enriched by absorbing knowledge produced in international medical centers, academic institutes and pharmaceutical industries in which generations of Greek doctors and researchers trained prior to their return to the homeland; it also highlights the achievements of medical practitioners and researchers of Greek descent who excelled abroad, producing ground-breaking work that has left a permanent imprint on global medicine.
Collapse
Affiliation(s)
- Apostolos Gerontas
- School of Applied Natural Sciences, Coburg University, Coburg, Germany
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Dimitrios Avgerinos
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
| | - Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, TX, United States
| | - Helena Maragou
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Konstantinos Drosatos
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
- Metabolic Biology Laboratory, Cardiovascular Center, Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| |
Collapse
|
54
|
Debeij GP, Parikh S, Delhaas T, Bidar E, Reesink KD. Evidence in Clinical Studies for the Role of Wall Thickness in Ascending Thoracic Aortic Aneurysms: A Scoping Review. Bioengineering (Basel) 2023; 10:882. [PMID: 37627767 PMCID: PMC10451294 DOI: 10.3390/bioengineering10080882] [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: 05/14/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Ascending thoracic aortic aneurysm is a chronic degenerative pathology characterized by dilatation of this segment of the aorta. Clinical guidelines use aortic diameter and growth rate as predictors of rupture and dissection. However, these guidelines neglect the effects of tissue remodeling, which may affect wall thickness. The present study aims to systematically review observational studies to examine to what extent wall thickness is considered and measured in clinical practice. METHODS Using PubMed and Web of Science, studies were identified with data on ascending aortic wall thickness, morphology, aortic diameter, and measurement techniques. RESULTS 15 included studies report several methods by which wall thickness is measured. No association was observed between wall thickness and aortic diameter across included studies. Wall thickness values appear not materially different between aneurysmatic aortas and non-aneurysmal aortas. CONCLUSIONS The effects on and consequences of wall thickness changes during ATAA formation are ill-defined. Wall thickness values for aneurysmatic aortas can be similar to aortas with normal diameters. Given the existing notion that wall thickness is a determinant of mechanical stress homeostasis, our review exposes a clear need for consistent as well as clinically applicable methods and studies to quantify wall thickness in ascending aortic aneurysm research.
Collapse
Affiliation(s)
- Gijs P. Debeij
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Shaiv Parikh
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Koen D. Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The Netherlands
| |
Collapse
|
55
|
Hu H, Wu Z. An Evidenced-Based Review of Emergency Target Blood Pressure Management for Acute Aortic Dissection. Emerg Med Int 2023; 2023:8392732. [PMID: 37521720 PMCID: PMC10374381 DOI: 10.1155/2023/8392732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/19/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Objective To summarize the best evidence of emergency target blood pressure management for acute aortic dissection and provide guidance for evidence-based practice of emergency target blood pressure management. Methods According to the "6S" evidence pyramid model, the evidence of emergency target blood pressure management of acute aortic dissection in various foreign databases and websites of professional associations from January 1, 2010, to August 1, 2022, was retrieved, including clinical decision-making, guidelines, expert consensus, systematic reviews, randomized controlled trials, cohort studies, and case series. Two researchers used the corresponding document quality evaluation tools to evaluate the documents and extracted and summarized the evidence of documents above grade B. Results A total of 17 articles were included, including 6 clinical decision-making articles, 5 guidelines, 2 expert consensus articles, 1 systematic review article, 1 randomized controlled trial article, 1 cohort study article, and 1 case series article, forming 36 best evidences, including 9 topics, which are target value setting, management strategy, disease observation, medical history collection, monitoring methods, vasoactive drugs, nonvasoactive drugs, related examinations, and patient education. Conclusion The best evidence summarized provides a reference for doctors and nurses in the emergency department to manage the emergency target blood pressure of patients with acute aortic dissection. It is recommended that doctors and nurses in the emergency department follow the best evidence summarized to develop individualized target blood pressure management plan for patients.
Collapse
Affiliation(s)
- Hankui Hu
- Department of Vascular Surgery, West China Hospital, 37 Guoxue Alley, Chengdu 610041, Sichuan, China
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, 37 Guoxue Alley, Chengdu 610041, Sichuan, China
| |
Collapse
|
56
|
Chen Y, Ouyang T, Yin Y, Fang C, Tang CE, Luo F, Luo J. The prognosis of patients with postoperative hyperglycemia after Stanford type A aortic dissection surgery and construction of prediction model for postoperative hyperglycemia. Front Endocrinol (Lausanne) 2023; 14:1063496. [PMID: 37484957 PMCID: PMC10357292 DOI: 10.3389/fendo.2023.1063496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Objective The mortality of type A aortic dissection (TAAD) is extremely high. The effect of postoperative hyperglycemia (PHG) on the prognosis of TAAD surgery is unclear. This study aims to investigate the prognosis of patients with PHG after TAAD surgery and construct prediction model for PHG. Methods Patients underwent TAAD surgery from January 2016 to December 2020 in Xiangya Hospital were collected. A total of 203 patients were included and patients were divided into non PHG group and PHG group. The occurrence of postoperative delirium, cardiac complications, spinal cord complication, cerebral complications, acute kidney injury (AKI), hepatic dysfunction, hypoxemia, and in-hospital mortality were compared between two groups. Data from MIMIC-IV database were further applied to validate the relationship between PHG and clinical outcomes. The prediction model for PHG was then constructed using Extreme Gradient Boosting (XGBoost) analysis. The predictive value of selected features was further validated using patient data from MIMIC-IV database. Finally, the 28-days survival rate of patient with PHG was analyzed using data from MIMIC-IV database. Results There were 86 patients developed PHG. The incidences of postoperative AKI, hepatic dysfunction, and in-hospital mortality were significant higher in PHG group. The ventilation time after surgery was significant longer in PHG group. Data from MIMIC-IV database validated these results. Neutrophil, platelet, lactic acid, weight, and lymphocyte were selected as features for prediction model. The values of AUC in training and testing set were 0.8697 and 0.8286 respectively. Then, five features were applied to construct another prediction model using data from MIMIC-IV database and the value of AUC in the new model was 0.8185. Finally, 28-days survival rate of patients with PHG was significantly lower and PHG was an independent risk factor for 28-days mortality after TAAD surgery. Conclusion PHG was significantly associated with the occurrence of AKI, hepatic dysfunction, increased ventilation time, and in-hospital mortality after TAAD surgery. The feature combination of neutrophil, platelet, lactic acid, weight, and lymphocyte could effectively predict PHG. The 28-days survival rate of patients with PHG was significantly lower. Moreover, PHG was an independent risk factor for 28-days mortality after TAAD surgery.
Collapse
Affiliation(s)
- Yubin Chen
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tianyu Ouyang
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yue Yin
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Cheng Fang
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Can-e Tang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- The Institute of Medical Science Research, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fanyan Luo
- Department of Cardiac Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingmin Luo
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
57
|
Marelli S, Micaglio E, Taurino J, Salvi P, Rurali E, Perrucci GL, Dolci C, Udugampolage NS, Caruso R, Gentilini D, Trifiro' G, Callus E, Frigiola A, De Vincentiis C, Pappone C, Parati G, Pini A. Marfan Syndrome: Enhanced Diagnostic Tools and Follow-up Management Strategies. Diagnostics (Basel) 2023; 13:2284. [PMID: 37443678 DOI: 10.3390/diagnostics13132284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Marfan syndrome (MFS) is a rare inherited autosomic disorder, which encompasses a variety of systemic manifestations caused by mutations in the Fibrillin-1 encoding gene (FBN1). Cardinal clinical phenotypes of MFS are highly variable in terms of severity, and commonly involve cardiovascular, ocular, and musculoskeletal systems with a wide range of manifestations, such as ascending aorta aneurysms and dissection, mitral valve prolapse, ectopia lentis and long bone overgrowth, respectively. Of note, an accurate and prompt diagnosis is pivotal in order to provide the best treatment to the patients as early as possible. To date, the diagnosis of the syndrome has relied upon a systemic score calculation as well as DNA mutation identification. The aim of this review is to summarize the latest MFS evidence regarding the definition, differences and similarities with other connective tissue pathologies with severe systemic phenotypes (e.g., Autosomal dominant Weill-Marchesani syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome) and clinical assessment. In this regard, the management of MFS requires a multidisciplinary team in order to accurately control the evolution of the most severe and potentially life-threatening complications. Based on recent findings in the literature and our clinical experience, we propose a multidisciplinary approach involving specialists in different clinical fields (i.e., cardiologists, surgeons, ophthalmologists, orthopedics, pneumologists, neurologists, endocrinologists, geneticists, and psychologists) to comprehensively characterize, treat, and manage MFS patients with a personalized medicine approach.
Collapse
Affiliation(s)
- Susan Marelli
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Emanuele Micaglio
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Jacopo Taurino
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Paolo Salvi
- Istituto Auxologico Italiano, Cardiology Unit, IRCCS, 20133 Milan, Italy
| | - Erica Rurali
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Gianluca L Perrucci
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Claudia Dolci
- Laboratory of Functional Anatomy of the Stomatognathic System (LAFAS), Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | | | - Rosario Caruso
- Clinical Research Service, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Bioinformatics and Statistical Genomics Unit, Istituto Auxologico Italiano IRCCS, Cusano Milanino, University of Milano-Bicocca, 20095 Milan, Italy
| | - Giuliana Trifiro'
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Edward Callus
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- Clinical Psychology Service, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
- Association "Bambini Cardiopatici nel Mondo" Non-Governmental Organization (NGO), 20123 Milan, Italy
| | - Carlo De Vincentiis
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Carlo Pappone
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Institute of Molecular and Translational Cardiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, Cardiology Unit, IRCCS, 20133 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Alessandro Pini
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 Milan, Italy
| |
Collapse
|
58
|
Qi Z, Tang R, Wang QG, Zeng YF, Tan L, Tang H. Global trends in research of acute type a aortic dissection: A bibliometric analysis from 2002 to 2022. Heliyon 2023; 9:e17955. [PMID: 37501968 PMCID: PMC10368776 DOI: 10.1016/j.heliyon.2023.e17955] [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: 03/27/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
Background Acute type A aortic dissection (ATAAD) is life-threatening and needs urgent and highly invasive surgery. So far, there is no comprehensive review of the status quo of ATAAD studies. Therefore, this study aimed to quantify and identify the global trends of ATAAD research over the past two decades through bibliometric analysis and to provide reference for clinical practice, research funding allocation, and decision-making. Methods The original research articles and reviews related to ATAAD research were downloaded from the Web of Science Core Collection on March 19, 2023. CiteSpace (6.2.1) and VOSviewer (1.6.18) were used for bibliometric analysis of the number of publications by each country, institution, and authors and the establishment of knowledge maps. The raw data collected were examined using the Online Analysis Platform of Bibliometric to assess the collaboration of countries in the field. Results The number of documents on ATAAD research increased continuously. A total of 1,943 publications published from 2002 to 2022 from 66 countries/regions were identified: 637 (32.78%) were conducted in China and 360 (18.53%) in the United States; 152 (cited frequency 941) were conducted by Capital Medical University and 107 (cited frequency 370) by Fujian Medical University. The Journal of Cardiac Surgery was the most frequently published journal (143 publications, cited frequency 695). The highest citation and co-cited journal was the Annals of Thoracic Surgery (cited frequency 3,888, co-cited frequency 6,224). We identified 8,050 authors among which Lizhong Sun (61 publications, cited frequency 721) had the largest number of publications, and Nienaber Christoph A (cited frequency 1,536, co-cited frequency 392) was co-cited most often. Meanwhile, the most common keywords were acute type A aortic dissection (occurrences, 1,211), surgery (occurrences, 657), repair (occurrences, 404), and management (occurrences, 386). The earliest and latest used keywords were "axillary artery" (average publication year: 2011.23) and "inflammation" (average publication year: 2019.09), respectively. The keyword "surgical treatment" (strength 12.31) and the co-cited reference "Evangelista A, 2018, Circulation" (strength 28.55) had the highest citation bursts. The keywords "impact" and "acute kidney injury" remained high citation bursts. The co-cited references with the largest and smallest size clusters were "cerebral protection" (#0, size = 126) and "pregnancy" (#12, size = 11). The reference "Hagan PG, 2000, JAMA" (cited frequency, 350) had the highest co-citations. Conclusions The bibliometric and visualized analysis generated objective evidence for a comprehensive understanding and evaluation of ATAAD research.
Collapse
Affiliation(s)
- Zhen Qi
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ri Tang
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiu-Guo Wang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Fan Zeng
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ling Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hao Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
59
|
Papadopoulou E, Bouzarelou D, Tsaousis G, Papathanasiou A, Vogiatzi G, Vlachopoulos C, Miliou A, Papachristou P, Prappa E, Servos G, Ritsatos K, Seretis A, Frogoudaki A, Nasioulas G. Application of next generation sequencing in cardiology: current and future precision medicine implications. Front Cardiovasc Med 2023; 10:1202381. [PMID: 37424920 PMCID: PMC10327645 DOI: 10.3389/fcvm.2023.1202381] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Inherited cardiovascular diseases are highly heterogeneous conditions with multiple genetic loci involved. The application of advanced molecular tools, such as Next Generation Sequencing, has facilitated the genetic analysis of these disorders. Accurate analysis and variant identification are required to maximize the quality of the sequencing data. Therefore, the application of NGS for clinical purposes should be limited to laboratories with a high level of technological expertise and resources. In addition, appropriate gene selection and variant interpretation can result in the highest possible diagnostic yield. Implementation of genetics in cardiology is imperative for the accurate diagnosis, prognosis and management of several inherited disorders and could eventually lead to the realization of precision medicine in this field. However, genetic testing should also be accompanied by an appropriate genetic counseling procedure that clarifies the significance of the genetic analysis results for the proband and his family. In this regard, a multidisciplinary collaboration among physicians, geneticists, and bioinformaticians is imperative. In the present review, we address the current state of knowledge regarding genetic analysis strategies employed in the field of cardiogenetics. Variant interpretation and reporting guidelines are explored. Additionally, gene selection procedures are accessed, with a particular emphasis on information concerning gene-disease associations collected from international alliances such as the Gene Curation Coalition (GenCC). In this context, a novel approach to gene categorization is proposed. Moreover, a sub-analysis is conducted on the 1,502,769 variation records with submitted interpretations in the Clinical Variation (ClinVar) database, focusing on cardiology-related genes. Finally, the most recent information on genetic analysis's clinical utility is reviewed.
Collapse
Affiliation(s)
| | | | | | | | - Georgia Vogiatzi
- Third Department of Cardiology, Sotiria Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- Unit of Inherited Cardiac Conditions and Sports Cardiology, First Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antigoni Miliou
- Unit of Inherited Cardiac Conditions and Sports Cardiology, First Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Efstathia Prappa
- Second Department of Cardiology, Arrhythmia Unit, Evangelismos General Hospital of Athens, Athens, Greece
| | - Georgios Servos
- Pediatric Cardiology Unit, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Konstantinos Ritsatos
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Aristeidis Seretis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Alexandra Frogoudaki
- Second Department of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
60
|
Lee J, Lim HA, Hong SB, Kim DY, Kim YH, Kim HW. Granulomatous inflammation mimicking a hematoma around the replaced ascending aorta in magnetic resonance imaging: a case report. J Cardiothorac Surg 2023; 18:191. [PMID: 37312122 DOI: 10.1186/s13019-023-02298-y] [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: 03/12/2023] [Accepted: 05/27/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Granulomatous inflammation results from various causes including infections and allergic reactions. It can appear as high signal intensity in T2-weighted or contrast-enhanced T1-weighted magnetic resonance imaging (MRI). Here, we describe a case of granulomatous inflammation looking like a hematoma on an ascending aortic graft in MRI. CASE PRESENTATION A 75-year-old female was undergoing assessment for chest pain. She had a history of hemi-arch replacement for aortic dissection 10 years earlier. The initial chest computed tomography and subsequent chest MRI were suggestive of a hematoma, implying a pseudoaneurysm of the thoracic aorta, which is associated with high mortality in reoperation. Through redo median sternotomy, severe adhesion was found in the retrosternal space. A sac in the pericardial space contained yellowish and pus-like material, confirming that there was no hematoma around the ascending aortic graft. The pathologic finding was chronic necrotizing granulomatous inflammation. Microbiological tests including polymerase chain reaction analysis were negative. CONCLUSION Our experience indicates that an MRI finding of a hematoma at the site long after cardiovascular surgery suggests that there may be granulomatous inflammation.
Collapse
Affiliation(s)
- June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Hyun Ah Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| |
Collapse
|
61
|
Tisi S, Creamer AW, Dickson J, Horst C, Quaife S, Hall H, Verghese P, Gyertson K, Bowyer V, Levermore C, Hacker AM, Teague J, Farrelly L, Nair A, Devaraj A, Hackshaw A, Hurst JR, Janes S. Prevalence and clinical characteristics of non-malignant CT detected incidental findings in the SUMMIT lung cancer screening cohort. BMJ Open Respir Res 2023; 10:e001664. [PMID: 37321665 PMCID: PMC10277548 DOI: 10.1136/bmjresp-2023-001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Pulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prevalence of non-malignant incidental findings within a lung cancer screening cohort and investigated the morbidity and relevant risk factors associated with incidental findings. We quantified the primary and secondary care referrals generated by our protocol. METHODS The SUMMIT study (NCT03934866) is a prospective observational cohort study to examine the performance of delivering a low-dose CT (LDCT) screening service to a high-risk population. Spirometry, blood pressure, height/weight and respiratory history were assessed as part of a Lung Health Check. Individuals at high risk of lung cancer were offered an LDCT and returned for two further annual visits. This analysis is a prospective evaluation of the standardised reporting and management protocol for incidental findings developed for the study on the baseline LDCT. RESULTS In 11 115 participants included in this analysis, the most common incidental findings were coronary artery calcification (64.2%) and emphysema (33.4%). From our protocolised management approach, the number of participants requiring review for clinically relevant findings in primary care was 1 in 20, and the number potentially requiring review in secondary care was 1 in 25. CONCLUSIONS Incidental findings are common in lung cancer screening and can be associated with reported symptoms and comorbidities. A standardised reporting protocol allows systematic assessment and standardises onward management.
Collapse
Affiliation(s)
- Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Andrew W Creamer
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jennifer Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anne-Marie Hacker
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jonathon Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield NHS Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Samuel Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| |
Collapse
|
62
|
Chen D, Schonberger AR, Ye K, Levsky JM. Coronary Calcium Predicts All-Cause Mortality in Suspected Acute Aortic Syndrome. Radiol Cardiothorac Imaging 2023; 5:e220188. [PMID: 37404788 PMCID: PMC10316301 DOI: 10.1148/ryct.220188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/28/2023] [Accepted: 04/28/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To determine long-term clinical outcomes in patients with suspected acute aortic syndrome (AAS) and evaluate the prognostic value of coronary calcium burden as assessed with CT aortography in this symptomatic population. MATERIALS AND METHODS A retrospective cohort of all patients who underwent emergency CT aortography from January 2007 through January 2012 for suspected AAS was assembled. A medical record survey tool was used to evaluate subsequent clinical events over 10 years of follow-up. Events included death, aortic dissection, myocardial infarction, cerebrovascular accident, and pulmonary embolism. Coronary calcium scores were computed from original images using a validated simple 12-point ordinal method and categorized into none, low (1-3), moderate (4-6), or high (7-12) groupings. Survival analysis with Kaplan-Meier curves and Cox proportional hazard modeling was performed. RESULTS The study cohort comprised 1658 patients (mean age, 60 years ± 16 [SD]; 944 women), with 595 (35.9%) developing a clinical event over a median follow-up of 6.9 years. Patients with high coronary calcium demonstrated the highest mortality rate (adjusted hazard ratio = 2.36; 95% CI: 1.65, 3.37). Patients with low coronary calcium demonstrated lower mortality, but rates were still almost twice as high compared with patients with no detectable calcium (adjusted hazard ratio = 1.89; 95% CI: 1.41, 2.53). Coronary calcium was a strong predictor of major adverse cardiovascular events (P < .001), which persisted after adjustment for common significant comorbidities. CONCLUSION Patients with suspected AAS had a high rate of subsequent clinical events, including death. CT aortography-based coronary calcium scores strongly and independently predicted all-cause mortality.Keywords: Acute Aortic Syndrome, Coronary Artery Calcium, CT Aortography, Major Adverse Cardiovascular Events, Mortality Supplemental material is available for this article. © RSNA, 2023See also commentary by Weir-McCall and Shambrook in this issue.
Collapse
|
63
|
Ohle R, McIsaac S, Van Drusen M, Regis A, Montpellier O, Ludgate M, Bodunde O, Savage DW, Yadav K. Evaluation of the Canadian Clinical Practice Guidelines Risk Prediction Tool for Acute Aortic Syndrome: The RIPP Score. Emerg Med Int 2023; 2023:6636800. [PMID: 37275621 PMCID: PMC10234704 DOI: 10.1155/2023/6636800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Acute aortic syndrome (AAS) is a rare clinical syndrome with a high mortality rate. The Canadian clinical practice guideline for the diagnosis of AAS was developed in order to reduce the frequency of misdiagnoses. As part of the guideline, a clinical decision aid was developed to facilitate clinician decision-making (RIPP score). The aim of this study is to validate the diagnostic accuracy of this tool and assess its performance in comparison to other risk prediction tools that have been developed. Methods This was a historical case-control study. Consecutive cases and controls were recruited from three academic emergency departments from 2002-2020. Cases were identified through an admission, discharge, or death certificated diagnosis of acute aortic syndrome. Controls were identified through presenting complaint of chest, abdominal, flank, back pain, and/or perfusion deficit. We compared the clinical decision tools' C statistic and used the DeLong method to test for the significance of these differences and report sensitivity and specificity with 95% confidence intervals. Results We collected data on 379 cases of acute aortic syndrome and 1340 potential eligible controls; 379 patients were randomly selected from the final population. The RIPP score had a sensitivity of 99.7% (98.54-99.99). This higher sensitivity resulted in a lower specificity (53%) compared to the other clinical decision aids (63-86%). The DeLong comparison of the C statistics found that the RIPP score had a higher C statistic than the ADDRS (-0.0423 (95% confidence interval -0.07-0.02); P < 0.0009) and the AORTAs score (-0.05 (-0.07 to -0.02); P = 0.0002), no difference compared to the Lovy decision tool (0.02 (95% CI -0.01-0.05 P < 0.25)) and decreased compared to the Von Kodolitsch decision tool (0.04 (95% CI 0.01-0.07 P < 0.008)). Conclusion The Canadian clinical practice guideline's AAS clinical decision aid is a highly sensitive tool that uses readily available clinical information. It has the potential to improve diagnosis of AAS in the emergency department.
Collapse
Affiliation(s)
- Robert Ohle
- The Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Sarah McIsaac
- Department of Critical Care, Department of Anaesthesia, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Madison Van Drusen
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Aaron Regis
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Owen Montpellier
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Mackenzie Ludgate
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Oluwadamilola Bodunde
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - David W. Savage
- Clinical Sciences Division, Nortner Ontario School of Medicine University, Thunder Bay, Ontario, Canada
| | - Krishan Yadav
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
64
|
Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
|
65
|
Saddic L, Escopete S, Zilberberg L, Kalsow S, Gupta D, Egbhali M, Parker S. 17 β-estradiol impedes aortic root dilation and rupture in male Marfan mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.09.540071. [PMID: 37215011 PMCID: PMC10197695 DOI: 10.1101/2023.05.09.540071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Marfan syndrome causes a hereditary form of thoracic aortic aneurysms with dilation of the aortic root. Human and animal models suggest a worse phenotype for males compared to females with respect to aneurysm size and risk of dissection. In this study we examine the effects of 17 β-estradiol on aortic dilation and rupture in a Marfan mouse model. Marfan male mice were administered 17 β-estradiol and the growth in aortic root size along with the risk of aortic rupture or dissection with the addition of angiotensin II was measured. Transcriptomic profiling was used to identify enriched pathways from 17 β-estradiol treatment. Aortic smooth muscle cells were then treated with cytokines in order to validate the mechanism of 17 β-estradiol protection. We show that 17 β-estradiol decreased the size and rate of aortic root dilation and improved survival from rupture and dissection after treatment with angiotensin II. The Marfan transcriptome was enriched in inflammatory genes and the addition of 17 β-estradiol modulated a set of genes that function through TNFα mediated NF-κB signaling. These included many proteins known to play a role in the phenotypic shift of aortic smooth muscle cells from a contractile to a more inflammatory-like state such as Vcam-1, Mcp-1, Lgals3, Il-6, Il-1b, and C3. In addition, 17 β-estradiol suppressed the induction of these TNFα induced genes in aortic smooth muscle cells in vitro and this effect appears to be NF-κB dependent. In conclusion, 17 β-estradiol protects against the dilation and rupture of aortic roots in Marfan male mice through the inhibition of TNFα -NF-κB signaling and thus prevents the phenotypic switch of aortic smooth muscle cells from a contractile to an inflammatory state.
Collapse
Affiliation(s)
- Louis Saddic
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sean Escopete
- Cedars-Sinai Medical Center, Smidt Heart Institute, Department of Cardiology, Los Angeles, California
| | - Lior Zilberberg
- Cedars-Sinai Medical Center, Smidt Heart Institute, Department of Cardiology, Los Angeles, California
| | - Shannon Kalsow
- Cedars-Sinai Medical Center, Smidt Heart Institute, Department of Cardiology, Los Angeles, California
| | - Divya Gupta
- Cedars-Sinai Medical Center, Smidt Heart Institute, Department of Cardiology, Los Angeles, California
| | - Mansoureh Egbhali
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sarah Parker
- Cedars-Sinai Medical Center, Smidt Heart Institute, Department of Cardiology, Los Angeles, California
| |
Collapse
|
66
|
Ahmad N, Andev R, Verdiyeva A, Dubey S. Single centre experience of 120 patients with non-infectious aortitis: Clinical features, treatment and complications. Autoimmun Rev 2023; 22:103354. [PMID: 37142195 DOI: 10.1016/j.autrev.2023.103354] [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: 04/10/2023] [Accepted: 04/29/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Aortitis is an important form of vasculitis with significant risk of complications. Very few studies have provided detailed clinical phenotyping across the whole disease spectrum. Our primary aim was to look the clinical features, management strategies and complications associated with non-infectious aortitis. METHODS A retrospective review was performed on patients with diagnosis of noninfectious aortitis at the Oxford University hospitals NHS Foundation Trust. Clinicopathologic features were recorded including demographics, presentation, aetiology, laboratory, imaging findings, histopathology, complications, treatment, and outcome. RESULTS We report the data on 120 patients (59% females). Systemic inflammatory response syndrome constituted the most common presentation (47.5%). 10.8% were diagnosed following a vascular complication (dissection or aneurysm). All patients (n = 120) had raised inflammatory markers (median ESR 70.0 mm/h and CRP 68.0 mg/L). Isolated aortitis subgroup (15%) had significantly higher likelihood of presenting with vascular complications and challenging to diagnose due to non-specific symptoms. Prednisolone (91.5%) and methotrexate (89.8%) were the most used treatment. 48.3% developed vascular complications during the disease course including ischaemic complications (25%), aortic dilatation and aneurysms (29.2%) and dissection (4.2%). Risk of dissection was higher in the isolated aortitis subgroup at 16.6% compared to all other types of aortitis at 1.96%. CONCLUSION Risk of vascular complications is high in non-infectious aortitis patients during disease course, hence early diagnosis and appropriate management is key. DMARDs such as Methotrexate appear to be effective, nonetheless there remain gaps in evidence for longer-term management of relapsing disease. Dissection risk seems much higher for patients with isolated aortitis.
Collapse
Affiliation(s)
- N Ahmad
- Department of Rheumatology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - R Andev
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, United Kingdom; Rheumatology Department, Nuffield Orthopaedic Centre, Oxford OX3 7LD, United Kingdom
| | - A Verdiyeva
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford OX3 7LD, United Kingdom
| | - S Dubey
- Consultant Rheumatologist, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom.
| |
Collapse
|
67
|
Lee M, Kim YW, Lee D, Kim TY, Lee S, Seo JS, Lee JH. The D-Dimer to Troponin Ratio Is a Novel Marker for the Differential Diagnosis of Thoracic Acute Aortic Syndrome from Non-ST Elevation Myocardial Infarction. J Clin Med 2023; 12:jcm12093054. [PMID: 37176495 PMCID: PMC10179683 DOI: 10.3390/jcm12093054] [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: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Thoracic acute aortic syndrome (AAS) and non-ST elevation myocardial infarction (NSTEMI) have similar clinical presentations, making them difficult to differentiate. This study aimed to identify useful biomarkers for the differential diagnosis of thoracic AAS and NSTEMI. METHODS This was a retrospective observational study. PARTICIPANTS consecutive adult patients who visited the emergency department for acute chest pain between January 2015 and December 2021 diagnosed with thoracic AAS or NSTEMI. Clinical variables, including D-dimer (μg/mL) and high-sensitivity troponin T (ng/mL, hs-TnT) levels, were compared between the groups. RESULTS A total of 52 (30.1%) and 121 (69.9%) patients were enrolled in the thoracic AAS and NSTEMI groups, respectively. Logistic regression analysis revealed that the D-dimer to hs-TnT (D/T) ratio (odds ratio (OR), 1.038; 95% confidence interval (CI), 1.020-1.056; p < 0.001) and the thrombolysis in myocardial infarction (TIMI) score (OR, 0.184; 95% CI, 0.054-0.621; p = 0.006) were associated with thoracic AAS. The D/T ratio had an area under the receiver operating characteristic curve (AUC) of 0.973 (95% CI, 0.930-0.998), and the optimal cutoff value was 81.3 with 91.4% sensitivity and 96.2% specificity. The TIMI score had an AUC of 0.769 (95% CI, 0.644-0.812), and the optimal cutoff value was 1.5 with 96.7% sensitivity and 38.5% specificity. CONCLUSION the D/T ratio may be a simple and useful parameter for differentiating thoracic AAS from NSTEMI.
Collapse
Affiliation(s)
- Minsik Lee
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
- Department of Emergency Medicine, Kangwon National University College of Medicine, Chuncheon 24341, Republic of Korea
| | - Yong Won Kim
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
| | - Dayeon Lee
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
| | - Tae-Youn Kim
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
| | - Sanghun Lee
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
| | - Jun Seok Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
| | - Jeong Hun Lee
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
| |
Collapse
|
68
|
Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
69
|
Wu X, Li Y, Zhao Y, Zhu Y, Wang S, Ma Q, Liu D, Gao B, Wei S, Wang W. Efficacy of left subclavian artery revascularization strategies during thoracic endovascular aortic repair in patients with type B dissection: A single-center experience of 105 patients. Front Cardiovasc Med 2023; 10:1084851. [PMID: 37077745 PMCID: PMC10106686 DOI: 10.3389/fcvm.2023.1084851] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundLeft subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR) is necessary to reduce postoperative complications in patients with Stanford type B aortic dissection and an insufficient proximal anchoring area. However, the efficacy and safety of different LSA revascularization strategies remain unclear. Here, we compared these strategies to provide a clinical basis for selecting an appropriate LSA revascularization method.MethodsIn this study, we included 105 patients with type B aortic dissection who were treated using TEVAR combined with LSA reconstruction in the Second Hospital of Lanzhou University from March 2013 to 2020. They were divided into four groups according to the method used for LSA reconstruction, namely, carotid subclavian bypass (CSB; n = 41), chimney graft (CG; n = 29), single-branched stent graft (SBSG; n = 21), and physician-made fenestration (PMF; n = 14) groups. Finally, we collected and analyzed the baseline, perioperative, operative, postoperative, and follow-up data of the patients.ResultsThe treatment success rate was 100% in all the groups, and CSB + TEVAR was the most commonly used procedure in emergency settings compared with the other three procedures (P < 0.05). The estimated blood loss, contrast agent volume, fluoroscopic time, operation time, and limb ischemia symptoms during the follow-up were significantly different in the four groups (P < 0.05). Pairwise comparison among groups indicated that the estimated blood loss and operation time in the CSB group were the highest (adjusted P < 0.0083; P < 0.05). The contrast agent volume and fluoroscopy duration were the highest in the SBSG groups, followed by PMF, CG, and CSB groups. The incidence of limb ischemia symptoms was the highest in the PMF group (28.6%) during the follow-up. The incidence of complications (except limb ischemia symptoms) during the perioperative and follow-up periods was similar among the four groups (P > 0.05) The median follow-up time of CSB, CG, SBSG, and PMF groups was significantly different (P < 0.05), and the CSB group had the longest follow-up.ConclusionOur single-center experience suggested that the PMF technique increased the risk of limb ischemia symptoms. The other three strategies effectively and safely restored LSA perfusion in patients with type B aortic dissection and had comparable complications. Overall, different LSA revascularization techniques have their advantages and disadvantages.
Collapse
Affiliation(s)
- Xiangyang Wu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yinglu Zhao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yilin Zhu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Shixiong Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Qi Ma
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Debin Liu
- Department of Cardiac Surgery, Hainan General Hospital, Hainan, China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Shilin Wei
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Correspondence: Weifan Wang Shilin Wei
| | - Weifan Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Correspondence: Weifan Wang Shilin Wei
| |
Collapse
|
70
|
Teng B, Chen Z, Ao Y, Zhao Y, Li F, Fu Q, Zhang W, Wang Z. One year follow-up outcomes of endovascular treatment for aortic dissection with a partial micropore stent graft in which fixation of the stent is done in zone 0: A pivotal trial first in human. Eur J Radiol 2023; 161:110720. [PMID: 36774671 DOI: 10.1016/j.ejrad.2023.110720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to verify the efficacy and safety of the treatment for patients diagnosed with DeBakey type I and type III thoracic aortic dissections using a partial micropore stent graft. METHODS We conducted a retrospective analysis of 32 patients who suffered from thoracic aortic dissection and underwent endovascular repair using a partial micropore stent graft at our center between December 2018 and January 2020. RESULTS The technical success rate for 32 patients was 100 %, while no 30-day mortality was observed. In the 30 patients finished follow-ups, 30 (mean: 1 per patient) micropore stents were implanted, while the openings of 90 (mean: 3 per patient) aortic arch branches were covered by the stents. After more than 12 months follow-up, 26 (86.7 %) of the 30 patients presented with a complete thrombosis in the false lumen, and 4 (13.3 %) patients presented with a partial thrombosis in the false lumen. All 90 aortic arch branches were patent. No aortic arch branch artery stenosis or occlusion was observed. CONCLUSIONS The outcomes obtained during 12 months of follow-up suggested that performing endovascular repair for thoracic aortic dissection patients with a partial micropore stent graft is safe and effective, maintaining the patency of aortic arch branch vessels.
Collapse
Affiliation(s)
- Biyun Teng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Zhen Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Yuxiang Ao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Qining Fu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Wei Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Zhe Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
71
|
Papakonstantinou NA, Rorris FP, Antonopoulos CN, Theodosis A, Argiriou M, Charitos C. Ascending Aorta Dissection Before 5.5 cm Diameter; "It Wasn't Raining When Noah Built the Ark". Heart Lung Circ 2023; 32:379-386. [PMID: 36476395 DOI: 10.1016/j.hlc.2022.10.020] [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: 04/22/2022] [Revised: 08/01/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of this study was to compare mean maximum ascending aortic diameter at the time of acute aortic dissection with the current surgical threshold for elective ascending aortic operations on non-syndromic thoracic aortic aneurysms. MATERIAL AND METHODS All consecutive non-syndromic adult patients admitted for acute type A aortic dissection in a single tertiary centre were prospectively enrolled from April 2020 to March 2021. The primary endpoint was the difference between mean maximum aortic diameter at the time of dissection and the 5.5 cm threshold for elective repair. Secondary endpoints included 30-day/in-hospital mortality, aortic length and comparison with normal controls, length/height ratio index, "actual" preoperative Euroscore II and "predicted" Euroscore II if electively operated. RESULTS Among 31 patients ageing 67.3±12.03 years on average, mean maximum aortic diameter at the time of dissection was 5.13±0.66 cm, significantly lower than the guidelines-derived surgical threshold of 5.5 cm (p=0.004). Mean aortic length was 11±1.47 cm, also significantly longer compared normal controls reported in the literature (p<0.001). The 30-day/in-hospital mortality was 35.5%. Mean length/height ratio index was 6.18±0.76 cm/m. Finally, mean "actual" preoperative Euroscore II was 10.43±4.07 which was significantly higher than the 1.47±0.57 "predicted" Euroscore II (p<0.05). CONCLUSIONS The maximum aortic diameter at the time of acute type A aortic dissection of non-syndromic cases was significantly lower than the current recommendation for elective repair. Lowering of the current diameter-based surgical threshold of 5.5 cm may be profitable in terms of prevention, but further investigations should be undertaken. Length-based thresholds could also add to timely aortic dissection prevention.
Collapse
Affiliation(s)
- Nikolaos A Papakonstantinou
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada.
| | - Filippos-Paschalis Rorris
- Cardiovascular and Thoracic Surgery Department. General Hospital of Athens "Evangelismos'', Athens, Greece
| | - Constantine N Antonopoulos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Antonios Theodosis
- 2(nd) Department of Radiology, 'Attikon' General University Hospital, Athens, Greece
| | - Mihalis Argiriou
- Cardiovascular and Thoracic Surgery Department. General Hospital of Athens "Evangelismos'', Athens, Greece
| | - Christos Charitos
- Cardiovascular and Thoracic Surgery Department. General Hospital of Athens "Evangelismos'', Athens, Greece
| |
Collapse
|
72
|
Brown JA, Sultan I. Commentary: Delaying the inevitable? Interventions for medically managed, uncomplicated type B aortic dissection. J Thorac Cardiovasc Surg 2023; 165:966-969. [PMID: 33972114 DOI: 10.1016/j.jtcvs.2021.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| |
Collapse
|
73
|
Chou E, Pirruccello JP, Ellinor PT, Lindsay ME. Genetics and mechanisms of thoracic aortic disease. Nat Rev Cardiol 2023; 20:168-180. [PMID: 36131050 DOI: 10.1038/s41569-022-00763-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/09/2022]
Abstract
Aortic disease has many forms including aortic aneurysm and dissection, aortic coarctation or abnormalities in aortic function, such as loss of aortic distensibility. Genetic analysis in humans is one of the most important experimental approaches in uncovering disease mechanisms, but the relative infrequency of thoracic aortic disease compared with other cardiovascular conditions such as coronary artery disease has hindered large-scale identification of genetic associations. In the past decade, advances in machine learning technology coupled with large imaging datasets from biobank repositories have facilitated a rapid expansion in our capacity to measure and genotype aortic traits, resulting in the identification of dozens of genetic associations. In this Review, we describe the history of technological advances in genetic discovery and explain how newer technologies such as deep learning can rapidly define aortic traits at scale. Furthermore, we integrate novel genetic observations provided by these advances into our current biological understanding of thoracic aortic disease and describe how these new findings can contribute to strategies to prevent and treat aortic disease.
Collapse
Affiliation(s)
- Elizabeth Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | - James P Pirruccello
- Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T Ellinor
- Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Mark E Lindsay
- Harvard Medical School, Boston, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA.
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
74
|
Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100575. [PMID: 39129804 PMCID: PMC11307585 DOI: 10.1016/j.jscai.2022.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
|
75
|
Agdamag AC, Patel P, Duval S, Konety S. Agreement of Proximal Thoracic Aorta Size by Two-Dimensional Transthoracic Echocardiography and Magnetic Resonance Angiography. Am J Cardiol 2023; 193:28-33. [PMID: 36863269 DOI: 10.1016/j.amjcard.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 03/04/2023]
Abstract
There is currently a lack of uniformity in methods of aortic diameter measurements across different imaging modalities. In this study, we sought to evaluate the accuracy of transthoracic echocardiography (TTE) in comparison with magnetic resonance angiography (MRA) for the measurement of proximal thoracic aorta diameters. This is a retrospective analysis of 121 adult patients at our institution who had TTE and electrocardiogram (ECG)-gated MRA performed within 90 days of each other between 2013 and 2020. Measurements were made at the level of sinuses of Valsalva (SoV), sinotubular junction (STJ), and ascending aorta (AA) using leading edge-to-leading edge (LE) convention for TTE and inner-edge-to-inner-edge (IE) convention for MRA. Agreement was assessed using Bland-Altman methods. Intra- and interobserver variability were assessed by intraclass correlation. The average age of patients in the cohort was 62 years, and 69% of patients were male. The prevalence of hypertension, obstructive coronary artery disease, and diabetes was 66%, 20%, and 11%, respectively. The mean aortic diameter by TTE was SoV 3.8 ± 0.5 cm, STJ 3.5 ± 0.4 cm, and AA 4.1 ± 0.6 cm. The TTE-derived measurements were larger than the MRA ones by 0.2 ± 2 mm, 0.8 ± 2 mm, and 0.4 ± 3 mm at the level of SoV, STJ, and AA, respectively, but the differences were not statistically significant. There were no significant differences in the aorta measurements by TTE compared with MRA, when stratified by gender. In conclusion, transthoracic echocardiogram-derived proximal aorta measurements are comparable to MRA measurements. Our study validates current recommendations that TTE is an acceptable modality for screening and serial imaging of the proximal aorta.
Collapse
Affiliation(s)
- Arianne Clare Agdamag
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Suma Konety
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
| |
Collapse
|
76
|
Wu J, Wu Y, Li F, Zhuang D, Cheng Y, Chen Z, Yang J, Liu J, Li X, Fan R, Sun T. Natural history of isolated abdominal aortic dissection: A prospective cohort study. Front Cardiovasc Med 2023; 10:1002832. [PMID: 36910543 PMCID: PMC9996307 DOI: 10.3389/fcvm.2023.1002832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives Isolated abdominal aortic dissection (IAAD) is extremely rare, with its optimal treatment and intervention timing remaining poorly understood. We aimed to study the natural history of IAAD and facilitate better clinical decision. Methods Consecutive patients admitted to our institution from January 2016 to April 2021 were enrolled and followed up prospectively. All-cause death was taken as the primary endpoint. Results A total of 68 patients with IAAD were included. The mean age at presentation was 61.2 ± 14.8 (Range: 26.0, 93.0) years and 55 (80.9%) were male. A total of 38 (55.9%) patients were treated conservatively, 27 (39.7%) received endovascular aneurysm repair (EVAR), and 3 (4.4%) underwent open surgery. After a mean follow-up of 2.4 years (Range: 0.1, 5.5), 9 (13.2%) patients died, 8 of whom (21.0%) were treated conservatively and 1 EVAR (3.7%). Compared with EVAR/open surgery, patient treated conservatively had a much worse survival (p = 0.043). There was no significant difference between different IAAD aortic sizes regarding mortality (p = 0.220). Patients with completely thrombosed false lumen fared improved survival rate, followed by partial thrombosis and patency, respectively, although not significantly (p = 0.190). No significant difference was observed between male and female concerning survival rate (p = 0.970). Patients without symptoms had a significantly improved survival (p = 0.048). Conclusion On the basis of patients' preference and surgeons' experience, a more aggressive treatment regimen for IAAD should be considered, with EVAR being the first choice, especially for those with persistent symptoms and patent false lumen, regardless of sex, age, or aortic size.
Collapse
Affiliation(s)
- Jinlin Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanfen Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fei Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Donglin Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunqing Cheng
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zerui Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jue Yang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jie Liu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Li
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruixin Fan
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tucheng Sun
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
77
|
Patel K, Maestas CM, Petrechko O, Boja H, Blankenship JC. Failure of Guidelines and Consensus Statements to Recommend Follow-up for Chronic Cardiovascular Conditions. Heart Lung 2023; 59:128-138. [PMID: 36801547 DOI: 10.1016/j.hrtlng.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Many cardiac conditions require long-term clinical follow-up to monitor progression of disease and tolerance and adherence to therapies. Providers are often unsure as to the frequency of clinical follow-up and who should provide the follow-up. In the absence of formal guidance, patients may be seen more frequently than necessary - thereby limiting clinic space for other patients, or not frequently enough, potentially leading to undetected progression of disease. OBJECTIVES To determine the extent to which guidelines (GL)/consensus statements (CS) provide guidance about appropriate follow-up for common cardiovascular conditions. METHODS We identified 31 chronic cardiovascular disease conditions for which long-term (beyond 1 year) follow-up is indicated and used PubMed and professional society websites to identify all relevant GL/CS (n = 33) regarding these chronic cardiac conditions. RESULTS Of the 31 cardiac conditions reviewed, GL/CS contained no recommendation or vague recommendation for long-term follow-up for 7 of the conditions. Of the 24 conditions with recommendations for follow-up, 3 had recommendations for imaging follow-up only without mention of clinical follow-up. Of the 33 GL/CS reviewed, 17 made any recommendations about long-term follow-up. When recommendations were made regarding follow-up, they were often vague, using terminology such as "as needed". CONCLUSIONS Half of GL/CS fail to provide recommendations for clinical follow-up of common cardiovascular conditions. Writing groups for GL/CS should adopt a standard of routinely including recommendations for follow-up including specific advice about level of expertise needed (eg, primary care physician, cardiologist), need for imaging or testing, and frequency of follow-up.
Collapse
Affiliation(s)
- Krishna Patel
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Camila M Maestas
- University of Virginia Health Science Center, Charlottesville, VA
| | - Oksana Petrechko
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | | | | |
Collapse
|
78
|
Regional and directional delamination properties of healthy human ascending aorta and sinotubular junction. J Mech Behav Biomed Mater 2023; 138:105603. [PMID: 36512974 DOI: 10.1016/j.jmbbm.2022.105603] [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: 11/15/2021] [Revised: 07/23/2022] [Accepted: 11/20/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE Acute type A aortic dissection (AD) is a catastrophic event associated with high mortality. Biomechanics can provide an understanding of the forces that lead the initial intimal tear to propagate, resulting in aortic dissection. We previously studied the material properties of normal human aortic roots. In this study, our objective was to determine the regional and directional delamination properties of healthy human ascending aorta (AscAo) and sinotubular junction (STJ). RESULTS From 19 healthy donor hearts, total 107 samples from the AscAo and STJ were collected and tested along the circumferential and longitudinal directions. Specimens were subjected to uniaxial peeling testing with a manually created tear in the medial layer. The lateral AscAo subregion (greater curvature) had significantly lower delamination strength and dissection energy than anterior, medial, and posterior subregions in the longitudinal direction. Regionally, the delamination strength at AscAo was significantly lower than at STJ overall (p = 0.02) and in circumferential direction (p = 0.02) only. Directionally, the delamination strength at AscAo overall and in the anterior AscAo was significant lower in circumferential direction than longitudinal direction. Dissection energy demonstrated similar regional and directional trend as delamination strength. In addition, both dissection energy and delamination strength were correlated positively with thickness and negatively with age in the AscAo. In addition, the dissection energy was negatively related to stiffness at physiologic mean blood pressure. CONCLUSIONS The greater curvature of the AscAo had the lowest delamination strength and dissection energy suggesting that region was most vulnerable to dissection propagation distally. Increased thickness of AscAo would be protective of dissection propagation while propagation would be more likely with increased AscAo stiffness.
Collapse
|
79
|
Vacirca A, Tenorio ER, Mesnard T, Sulzer T, Baghbani-Oskouei A, Mirza AK, Huang Y, Oderich GS. Technical tips and clinical experience with the Gore Thoracic Branch Endoprosthesis®. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:18-25. [PMID: 36534126 DOI: 10.23736/s0021-9509.22.12564-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has been widely accepted as a treatment option in patients with thoracic aortic aneurysms and dissections who have suitable anatomy. It is estimated that up to 60% of patients treated by TEVAR require extension of the repair into the distal aortic arch across Ishimaru zone 2. In these patients, coverage of the left subclavian artery (LSA) without revascularization has been associated with increased risk of arm ischemia, stroke, and spinal cord injury. The Gore Thoracic Branch Endoprosthesis (TBE, WL Gore, Flagstaff, AZ, USA) is the first off-the-shelf thoracic branch stent-graft approved by the Federal Drug Administration for treatment of distal aortic arch lesions requiring extension of the proximal seal into zone 2. This article summarizes the technical pitfalls and clinical outcomes of the TBE® device in zone 2.
Collapse
Affiliation(s)
- Andrea Vacirca
- Advanced Aortic Research Program, McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Medical Plaza, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emanuel R Tenorio
- Advanced Aortic Research Program, McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Medical Plaza, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas Mesnard
- Advanced Aortic Research Program, McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Medical Plaza, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Titia Sulzer
- Advanced Aortic Research Program, McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Medical Plaza, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aidin Baghbani-Oskouei
- Advanced Aortic Research Program, McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Medical Plaza, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aleem K Mirza
- Advanced Aortic Research Program, McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Medical Plaza, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ying Huang
- Advanced Aortic Research Program, McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Medical Plaza, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gustavo S Oderich
- Advanced Aortic Research Program, McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Medical Plaza, University of Texas Health Science Center at Houston, Houston, TX, USA -
| |
Collapse
|
80
|
Yerokun BA, Vallabhajosyula P, Vekstein AM, Grau-Sepulveda MV, Benrashid E, Xian Y, Ranney DN, Jung SH, Jacobs JP, Badhwar V, Thourani VH, Bavaria JE, Hughes GC. Long-term outcomes of aortic root operations in the United States among Medicare beneficiaries. J Thorac Cardiovasc Surg 2023; 165:554-565.e6. [PMID: 33814173 DOI: 10.1016/j.jtcvs.2021.02.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The best method of aortic root repair in older patients remains unknown given a lack of comparative effectiveness of long-term outcomes data. The objective of this study was to compare long-term outcomes of different surgical approaches for aortic root repair in Medicare patients using The Society of Thoracic Surgeons Adult Cardiac Surgery Database-Centers for Medicare & Medicaid Services-linked data. METHODS A retrospective cohort study was performed by querying the Society of Thoracic Surgeons Adult Cardiac Surgery Database for patients aged 65 years or more who underwent elective aortic root repair with or without aortic valve replacement. Primary long-term end points were mortality, any stroke, and aortic valve reintervention. Short-term outcomes and long-term survival were compared among each root repair strategy. Additional risk factors for mortality after aortic root repair were assessed with a multivariable Cox proportional hazards model. RESULTS A total of 4173 patients aged 65 years or more underwent elective aortic root repair. Patients were stratified by operative strategy: mechanical Bentall, stented bioprosthetic Bentall, stentless bioprosthetic Bentall, or valve-sparing root replacement. Mean follow-up was 5.0 (±4.6) years. Relative to mechanical Bentall, stented bioprosthetic Bentall (adjusted hazard ratio, 0.80; confidence interval, 0.66-0.97) and stentless bioprosthetic Bentall (adjusted hazard ratio, 0.70; confidence interval, 0.59-0.84) were associated with better long-term survival. In addition, stentless bioprosthetic Bentall (adjusted hazard ratio, 0.64; confidence interval, 0.47-0.80) and valve-sparing root replacement (adjusted hazard ratio, 0.51; confidence interval, 0.29-0.90) were associated with lower long-term risk of stroke. Aortic valve reintervention risk was 2-fold higher after valve-sparing root replacement compared with other operative strategies. CONCLUSIONS In the Medicare population, there was poorer late survival and greater late stroke risk for patients undergoing mechanical Bentall and a higher rate of reintervention for valve-sparing root replacement. Bioprosthetic Bentall may be the procedure of choice in older patients undergoing aortic root repair, particularly in the era of transcatheter aortic valve replacement.
Collapse
Affiliation(s)
- Babatunde A Yerokun
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Prashanth Vallabhajosyula
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Ehsan Benrashid
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ying Xian
- Duke Clinical Research Institute, Durham, NC
| | - David N Ranney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Sin-Ho Jung
- Duke Clinical Research Institute, Durham, NC
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, Ga
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| |
Collapse
|
81
|
Mu X, Liu S, Wang Z, Jiang K, McClintock T, Stromberg AJ, Tezanos AV, Lee ES, Curci JA, Gong MC, Guo Z. Androgen aggravates aortic aneurysms via suppressing PD-1 in mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.22.525073. [PMID: 36711644 PMCID: PMC9882344 DOI: 10.1101/2023.01.22.525073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Androgen has long been recognized for its pivotal role in the sexual dimorphism of cardiovascular diseases, including aortic aneurysms, a devastating vascular disease with a higher prevalence and mortality rate in men than women. However, the molecular mechanism by which androgen mediates aortic aneurysms is largely unknown. Here, we report that male but not female mice develop aortic aneurysms in response to aldosterone and high salt (Aldo-salt). We demonstrate that both androgen and androgen receptors (AR) are crucial for the sexually dimorphic response to Aldo-salt. We identify T cells expressing programmed cell death protein 1 (PD-1), an immune checkpoint molecule important in immunity and cancer immunotherapy, as a key link between androgen and aortic aneurysms. We show that intraperitoneal injection of anti-PD-1 antibody reinstates Aldo-salt-induced aortic aneurysms in orchiectomized mice. Mechanistically, we demonstrate that AR binds to the PD-1 promoter to suppress its expression in the spleen. Hence, our study reveals an important but unexplored mechanism by which androgen contributes to aortic aneurysms by suppressing PD-1 expression in T cells. Our study also suggests that cancer patients predisposed to the risk factors of aortic aneurysms may be advised to screen for aortic aneurysms during immune checkpoint therapy.
Collapse
|
82
|
Short- to mid-term outcomes after transcatheter aortic valve replacement in patients with ascending aorta dilation: a single-centre retrospective analysis. BMC Cardiovasc Disord 2023; 23:31. [PMID: 36650444 PMCID: PMC9847094 DOI: 10.1186/s12872-023-03063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Ascending aorta dilation (AAD) is frequently associated with aortic stenosis (AS). This study investigated the procedural and clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with AAD for tricuspid AS. METHODS This is a single-centre retrospective study that included patients with tricuspid AS and who underwent TAVR between January 1, 2018 and December 31, 2021. A total of 239 patients met the inclusion criteria. The ascending aortic diameter was measured on computed tomography (CT) scans before TAVR, and AAD was identified as a maximal ascending aortic diameter of ≥ 40 mm. The outcomes were in line with the Valve Academy Research Consortium (VARC)-3 criteria. RESULTS Self-expandable (SE) valves were used in 88.7% of the total cohort (89.0% in the AAD group and 88.6% in the non-AAD group). Seventy-three patients (30.5%) were diagnosed with concomitant AAD (mean age 73.7 ± 7.3 years, 57.5% male). The median ascending aortic diameter was 36.0 mm (interquartile range [IQR]: 34.0-37.0 mm) in the non-AAD group and 44.0 mm (IQR: 42.0-46.0 mm) in the AAD group (p < 0.001). The baseline characteristics were comparable across the groups. No significant difference was observed in cumulative all-cause mortality at 30 days (2.4% vs. 1.4%, p = 0.609), 1 year (9.2% vs. 5.0%, p = 0.191), or 3 years (13.1% vs. 9.5%, p = 0.201) between the non-AAD and AAD groups. The device success rate was not different between the non-AAD and AAD groups (74.7% vs. 82.2%, p = 0.205). The multivariable analysis identified prior percutaneous coronary intervention, prior stroke, and length of intensive care unit as independent predictors of 3-year all-cause mortality among the total cohort. CONCLUSION AAD does not appear to be associated with the procedural and mid-term clinical outcomes in patients undergoing TAVR.
Collapse
|
83
|
Zerebrale Protektion und Kanülierungstechniken im Rahmen der Aortenbogenchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2023. [DOI: 10.1007/s00398-022-00552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
84
|
Kumar P, Bhatia M, Arora N. Computed Tomographic Evaluation of Congenital Left Ventricular Outflow Obstruction. Curr Cardiol Rev 2023; 19:31-49. [PMID: 37231752 PMCID: PMC10636799 DOI: 10.2174/1573403x19666230525144602] [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: 08/29/2022] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Congenital left ventricular outflow obstruction represents a multilevel obstruction with several morphological forms. It can involve the subvalvular, valvar, or supravalvular portion of the aortic valve complex, and may coexist. Computed tomography (CT) plays an important supplementary role in the evaluation of patients with congenital LVOT obstruction. Unlike transthoracic echocardiography and cardiovascular magnetic resonance (CMR) imaging, it is not bounded by a small acoustic window, needs for anaesthesia or sedation, and metallic devices. Current generations of CT scanners with excellent spatial and temporal resolution, high pitch scanning, wide detector system, dose reduction algorithms, and advanced 3-dimensional postprocessing techniques provide a high-quality alternative to CMR or diagnostic cardiac catheterization. Radiologists performing CT in young children should be familiar with the advantages and disadvantages of CT and with the typical morphological imaging features of congenital left ventricular outflow obstruction.
Collapse
Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
- Convener, Cardiac Imaging, Cardiological Society of India, Kolkata, 700054, India
| | - Natisha Arora
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
| |
Collapse
|
85
|
Madani MH, Turner VL, Hallett RL, Willemink MJ, Murillo H, Chin AS, Berry GJ, Fleischmann D. Limited Aortic Intimal Tears: CT Imaging Features and Clinical Characteristics. Radiol Cardiothorac Imaging 2022; 4:e220155. [PMID: 36601454 PMCID: PMC9806729 DOI: 10.1148/ryct.220155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/11/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
Limited aortic intimal tear is an uncommon lesion of the dissection spectrum. The lesion has several imaging features that are not well known, including asymmetric aortic contour abnormalities, filling defects, and various morphologic patterns, such as linear, L-shaped, T-shaped, and stellate configurations. Hemorrhage of the aortic wall may also be present in patients with this rare entity. This imaging essay reviews the CT imaging findings and clinical characteristics of patients with limited intimal tears. Keywords: Aorta, CT © RSNA, 2022.
Collapse
|
86
|
Detection of acute thoracic aortic dissection based on plain chest radiography and a residual neural network (Resnet). Sci Rep 2022; 12:21884. [PMID: 36536152 PMCID: PMC9763432 DOI: 10.1038/s41598-022-26486-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Acute thoracic aortic dissection is a life-threatening disease, in which blood leaking from the damaged inner layer of the aorta causes dissection between the intimal and adventitial layers. The diagnosis of this disease is challenging. Chest x-rays are usually performed for initial screening or diagnosis, but the diagnostic accuracy of this method is not high. Recently, deep learning has been successfully applied in multiple medical image analysis tasks. In this paper, we attempt to increase the accuracy of diagnosis of acute thoracic aortic dissection based on chest x-rays by applying deep learning techniques. In aggregate, 3,331 images, comprising 716 positive images and 2615 negative images, were collected from 3,331 patients. Residual neural network 18 was used to detect acute thoracic aortic dissection. The diagnostic accuracy of the ResNet18 was observed to be 90.20% with a precision of 75.00%, recall of 94.44%, and F1-score of 83.61%. Further research is required to improve diagnostic accuracy based on aorta segmentation.
Collapse
|
87
|
|
88
|
Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Collapse
|
89
|
Bonaca MP, Olin JW. ACC/AHA Aortic Disease Guidelines: What Was Simple Is Now Complex-Moving to Multidisciplinary Teams, Specialized Centers. J Am Coll Cardiol 2022; 80:2353-2355. [PMID: 36480976 DOI: 10.1016/j.jacc.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Marc P Bonaca
- Cardiovascular Division, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Jeffrey W Olin
- The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai Health, New York, New York, USA
| |
Collapse
|
90
|
Tanaka H, Naito K, Kobayashi S, Komatsu K. Multiple deep femoral artery aneurysms with Loeys-Dietz syndrome. J Vasc Surg Cases Innov Tech 2022; 9:101071. [PMID: 36747603 PMCID: PMC9898784 DOI: 10.1016/j.jvscit.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
A 60-year-old man with Loeys-Dietz syndrome (LDS) underwent surgery for multiple left deep femoral artery aneurysms (DFAAs). An intraoperative graft replacement was performed from the common femoral artery to the distal DFAAs; the superficial femoral artery was sutured to the graft. DFAAs in association with LDS and the occurrence of multiple DFAAs are rare. To the best of our knowledge, no studies have reported their coexistence. Graft replacement was decided as the optimal treatment for our patient. However, treatment should be considered on a patient-by-patient basis. Therefore, a lower limb arterial examination should accompany the screening of patients with LDS.
Collapse
Affiliation(s)
- Haruki Tanaka
- Department of Cardiovascular Surgery, Suwa Red Cross Hospital, Suwa, Japan
| | - Kazuki Naito
- Department of Cardiovascular Surgery, Suwa Red Cross Hospital, Suwa, Japan
| | - Shota Kobayashi
- Department of Diagnostic Pathology, Suwa Red Cross Hospital, Suwa, Japan
| | - Kazunori Komatsu
- Department of Cardiovascular Surgery, Suwa Red Cross Hospital, Suwa, Japan,Correspondence: Kazunori Komatsu, MD, Department of Cardiovascular Surgery, Suwa Red Cross Hospital, 5-11-50, Kogandori, Suwa 392-8510, Japan
| |
Collapse
|
91
|
Multimodality imaging and 3D-printing of a thoraco-abdominal aortic aneurysm eroding into the spine. Radiol Case Rep 2022; 18:657-660. [PMID: 36504879 PMCID: PMC9727147 DOI: 10.1016/j.radcr.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
A rare case of a previously treated thoraco-abdominal aortic aneurysm eroding into the thoracic spine is described. Initially, several follow-up CT angiography scans showed an increasing aneurysm sack, but no endoleak could be depicted. Then, a new rapidly developing erosion into the thoracic spine was noted. MRI imaging excluded any other underlying infectious or malignant process. Additional contrast-enhanced ultrasound excluded an endoleak. A 3D-printed model of the aneurysm and spine and cinematic renderings were created to improve visualization. She underwent relining of the thoracic stent graft. Follow-up imaging showed a stable aneurysm size and no progression of the vertebral erosions.
Collapse
|
92
|
Roach J, Cha S. Monitoring During Vascular Surgery. Anesthesiol Clin 2022; 40:645-655. [PMID: 36328620 DOI: 10.1016/j.anclin.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Vascular surgical patients present unique challenges for anesthesiologists, because of their medical vulnerabilities as well as their tendency for rapid intraoperative hemodynamic changes. Intraoperative monitors have been used for decades to reduce adverse outcomes, improve mortality, and create optimal surgical conditions. Understanding the indications and appropriate management of monitoring modalities is essential for optimizing patient care, and preventing harm associated with misinterpretation. We aim to review monitoring technologies used in complex vascular procedures, as well as the current guidelines, clinical trial outcomes, and basic mechanisms of each monitoring modality.
Collapse
Affiliation(s)
- Joshua Roach
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 2440 North Berkshire Road, Charlottesville, VA 22901, USA.
| | - Stephanie Cha
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 6216, Baltimore, MD 21287, USA
| |
Collapse
|
93
|
Lester LC, Kostibas MP. Anesthetic Management for Open Thoracoabdominal and Abdominal Aortic Aneurysm Repair. Anesthesiol Clin 2022; 40:705-718. [PMID: 36328624 DOI: 10.1016/j.anclin.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Open thoracoabdominal and abdominal aortic aneurysm repairs are some of the most challenging cases for anesthesiologists because of the potential for rapid blood loss combined with clamping and reperfusion, potential use of left heart bypass, the potential need for lung isolation, and potential placement and management of a spinal drain. In addition, patients often present with other significant comorbidities and a detailed understanding of the disease process, the complex physiology throughout the case, and the intricacies of organ protection are critical.
Collapse
Affiliation(s)
- Laeben Chola Lester
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6212, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Megan P Kostibas
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6212, 1800 Orleans Street, Baltimore, MD 21287, USA.
| |
Collapse
|
94
|
Liang NL, Dake MD, Fischbein MP, Bavaria JE, Desai ND, Oderich GS, Singh MJ, Fillinger M, Suckow BD, Matsumura JS, Patel HJ, Makaroun MS. Midterm Outcomes of Endovascular Repair of Aortic Arch Aneurysms with the Gore Thoracic Branch Endoprosthesis. Eur J Vasc Endovasc Surg 2022; 64:639-645. [PMID: 35970335 DOI: 10.1016/j.ejvs.2022.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 07/17/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Aortic aneurysms involving aortic arch vessels are anatomically unsuitable for standard thoracic endovascular repair (TEVAR) without cervical debranching of the arch vessels. Three year outcomes of a single branched thoracic endograft following previous publication of peri-operative and one year outcomes are reported. METHODS This was a multicentre feasibility trial of the GORE TAG Thoracic Branch Endoprosthesis (TBE), a thoracic endovascular graft incorporating a single retrograde branch for aortic arch vessel perfusion. The first study arm enrolled patients with an intact descending thoracic aortic aneurysm extending to the distal arch with left subclavian artery (LSA) incorporation (zone 2). The second arm enrolled patients with arch aneurysms requiring incorporation of the left carotid or innominate artery (zone 0/1) and extra-anatomic surgical revascularisation of the remaining aortic arch vessels. Outcomes at three years are reported. RESULTS The cohort comprised 40 patients (31 zone 2, nine zone 0/1). The majority were male (52%). Mean follow up was 1 408 ± 552 days in the zone 2 and 1 187 ± 766 days in the zone 0/1 cohort. During three year follow up there was no device migration, fracture, or aortic rupture in either arm. In the zone 2 arm, freedom from re-intervention was 97% at one and three years but there were two side branch occlusions. Two patients had aneurysm enlargement > 5 mm without documented endoleak or re-intervention. Freedom from death at one and three years was 90% and 84%. In the zone 0/1 arm there were no re-interventions, loss of branch patency, or aneurysm enlargement at three years. Cerebrovascular events occurred in three patients during follow up: two unrelated to the device or procedure, and one of unknown relationship. Two patients in this arm died during the follow up period, both unrelated to the procedure or the aneurysm. CONCLUSION Initial three year results of the TBE device for endovascular repair of arch aneurysms show favourable patency and durability with low rates of graft related complications.
Collapse
Affiliation(s)
- Nathan L Liang
- Division of Vascular Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.
| | - Michael D Dake
- Department of Medical Imaging, University of Arizona Health System, Tucson, AZ, USA
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University Hospitals, Palo Alto, CA, USA
| | - Joseph E Bavaria
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nimesh D Desai
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gustavo S Oderich
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Centre at Houston, McGovern Medical School, Houston, TX, USA
| | - Michael J Singh
- Division of Vascular Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Mark Fillinger
- Section of Vascular of Surgery, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
| | - Bjoern D Suckow
- Section of Vascular of Surgery, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
| | - Jon S Matsumura
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Centre, Ann Arbor, MI, USA
| | - Michel S Makaroun
- Division of Vascular Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| |
Collapse
|
95
|
Ebeling C, Cheruku S. Anesthetic Management for Endovascular Repair of Thoracic and Abdominal Aortic Aneurysms. Anesthesiol Clin 2022; 40:719-735. [PMID: 36328625 DOI: 10.1016/j.anclin.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aortic aneurysms-both abdominal and thoracic-are a significant cause of death and disability in the United States. Endovascular aneurysm repair has since become the preferred operative treatment of most thoracic and abdominal aneurysms because of a lower rate of complications and better outcomes compared with the open approach. Patients who present for endovascular aneurysm repair often have comorbid conditions related to their aortic pathology. These conditions should be evaluated and optimized before the procedure.
Collapse
Affiliation(s)
- Callie Ebeling
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Mail Code 9068, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Sreekanth Cheruku
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Mail Code 9068, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| |
Collapse
|
96
|
Lyne SA, Ruediger C, Lester S, Chapman PT, Shanahan EM, Hill CL, Stamp L. Giant cell arteritis: A population-based retrospective cohort study exploring incidence and clinical presentation in Canterbury, Aotearoa New Zealand. Front Med (Lausanne) 2022; 9:1057917. [PMID: 36482913 PMCID: PMC9723338 DOI: 10.3389/fmed.2022.1057917] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND/AIM To determine the epidemiology and clinical features of giant cell arteritis (GCA) in Canterbury, Aotearoa New Zealand, with a particular focus on extra-cranial large vessel disease. METHODS Patients with GCA were identified from radiology and pathology reports, outpatient letters and inpatient hospital admissions in the Canterbury New Zealand from 1 June 2011 to 31 May 2016. Data was collected retrospectively based on review of electronic medical records. RESULTS There were 142 cases of GCA identified. 65.5% of cases were female with a mean age of 74.2 years. The estimated population incidence for biopsy-proven GCA was 10.5 per 100,000 people over the age of 50 and incidence peaked between 80 and 84 years of age. 10/142 (7%) people were diagnosed with large vessel GCA, often presenting with non-specific symptoms and evidence of vascular insufficiency including limb claudication, vascular bruits, blood pressure and pulse discrepancy, or cerebrovascular accident. Those with limited cranial GCA were more likely to present with the cardinal clinical features of headache and jaw claudication. Patients across the two groups were treated similarly, but those with large vessel disease had greater long-term steroid burden. Rates of aortic complication were low across both groups, although available follow-up data was limited. CONCLUSION This study is the first of its kind to describe the clinical characteristics of large vessel GCA in a New Zealand cohort. Despite small case numbers, two distinct subsets of disease were recognized, differentiating patients with cranial and large vessel disease. Our results suggest that utilization of an alternative diagnostic and therapeutic approach may be needed to manage patients with large vessel disease.
Collapse
Affiliation(s)
- Suellen A. Lyne
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Department of Rheumatology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Carlee Ruediger
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Susan Lester
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Peter T. Chapman
- Department of Rheumatology, Te Whatu Ora Waitematā, Christchurch, New Zealand
| | - Ernst Michael Shanahan
- Department of Rheumatology, Flinders Medical Centre, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Catherine L. Hill
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lisa Stamp
- Department of Rheumatology, Te Whatu Ora Waitematā, Christchurch, New Zealand
- School of Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
97
|
Kamaltdinov RR, Akhmetzianov RV, Bredikhin RA, Dzhordzhikiya RK. Outpatient management of patients after surgical operations for acute aortic dissection of type A. AMBULATORNAYA KHIRURGIYA = AMBULATORY SURGERY (RUSSIA) 2022. [DOI: 10.21518/1995-1477-2022-19-2-44-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute aortic dissection of type A is still one of the most difficult diseases faced by doctors of all specialties. The current review is based on an analysis of current literature data and clinical guidelines. It covers various aspects of outpatient patient management and focuses on conservative therapy. The lack of an adequate diagnostic algorithm often leads to complications and, ultimately, death. The dynamic nature of the disease, the variability of clinical manifestations and the course of the pathological process require special attention. Both short-term and long-term survival of the patient depends on careful observation. Postoperative management of patients with acute aortic dissection of type A is entirely entrusted to the outpatient unit, which, due to the absence of the main aspects of the strategy in modern clinical recommendations, is not always prepared for the curation of this complex cohort of patients. The lack of experience in managing this pathology by outpatient hospital doctors causes significant difficulties in interpreting instrumental diagnostic methods, which leads to further erroneous tactics with the development of long-term complications. Due to the lack of a unified scheme of drug therapy, the question of prescribing drugs in these patients, who often receive a fairly large range of medications for concomitant pathology, remains open. These factors contribute to polyprogmasia or vice versa – insufficient volume of drug therapy, which further leads to the progression of the disease. As a result of insufficient emphasis on the basics of outpatient management of this cohort of patients, a whole complex of problems arises, leading to unsatisfactory treatment results and increased healthcare costs for their subsequent solution. The purpose of the review is to highlight the main problems of this issue from the point of view of evidence-based medicine.
Collapse
Affiliation(s)
- R. R. Kamaltdinov
- Kazan State Medical University; Interregional Clinical Diagnostic Center
| | - R. V. Akhmetzianov
- Kazan State Medical University; Interregional Clinical Diagnostic Center
| | - R. A. Bredikhin
- Kazan State Medical University; Interregional Clinical Diagnostic Center
| | | |
Collapse
|
98
|
Bhat S, Bir S, Schreve F, Bergin CJ, Jones PG, Waqanivavalagi SWFR. Ethnic Disparities in CT Aortography Use for Diagnosing Acute Aortic Syndrome. Radiol Cardiothorac Imaging 2022; 4:e220018. [PMID: 36601460 PMCID: PMC9806728 DOI: 10.1148/ryct.220018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
Purpose To determine whether CT aortography was performed in proportion to patient risk for acute aortic syndrome (AAS) and incidence of AAS for different ethnic groups. Materials and Methods All atraumatic thoracic aorta CT aortographic examinations performed in adults (age > 15 years) suspected of having AAS between January 2009 and December 2019 at Auckland City Hospital (New Zealand) were included. Patients were risk stratified using the aortic dissection detection risk score (ADD-RS). The primary outcomes were the ratio of CT aortography rates to rates of positive CT aortographic examinations and the incidence of AAS. Population census data were used to determine age-standardized incidence of AAS in the emergency department (ED). Results In total, 1646 CT aortographic examinations were performed in 1543 patients (mean age, 62 years ± 16 [SD]; 877 male patients). Māori (34% [68 of 203]) and Pacific Islanders (35% [80 of 229]) were more likely to be at high risk of AAS (ADD-RS > 1) compared with patients from other ethnic groups (25% [308 of 1214]); in the ED catchment population, age-standardized AAS incidence was significantly higher in Māori (6.9 per 100 000 person-years [95% CI: 4.3, 10.4]) and Pacific Islanders (5.3 [95% CI: 3.4, 7.8]) than in other ethnic groups (2.3 [95% CI: 1.8, 2.8]). Despite this higher incidence, disproportionately fewer CT aortographic examinations were requested in the ED for Māori (9.2 CT aortographic examinations per AAS diagnosis) and Pacific Islanders (9.2 CT aortographic examinations per AAS diagnosis) compared with other ethnic groups (13.8 CT aortographic examinations per AAS diagnosis). Conclusion Māori and Pacific Islanders were at disproportionately higher risk of AAS but had fewer requested CT aortographic examinations compared with other ethnic groups. This increased risk of AAS in Pacific Islander and indigenous Māori patients should be considered by clinicians when investigating AAS.Keywords: Ethnicity, Māori, Pacific Islander, Aortic Dissection Detection Risk Score, Acute Aortic Syndrome, Aortic Dissection, CT Angiography Supplemental material is available for this article. © RSNA, 2022.
Collapse
|
99
|
Liu H, Qian SC, Han L, Zhang YY, Wu Y, Hong L, Yang JN, Zhong JS, Wang YQ, Wu DK, Fan GL, Chen JQ, Zhang SQ, Peng XX, Tang ZW, Hamzah AW, Shao YF, Li HY, Zhang HJ. Circulating biomarker-based risk stratifications individualize arch repair strategy of acute Type A aortic dissection via the XGBoosting algorithm. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:587-599. [PMID: 36710897 PMCID: PMC9779759 DOI: 10.1093/ehjdh/ztac068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/22/2022] [Indexed: 11/27/2022]
Abstract
Aims The incremental usefulness of circulating biomarkers from different pathological pathways for predicting mortality has not been evaluated in acute Type A aortic dissection (ATAAD) patients. We aim to develop a risk prediction model and investigate the impact of arch repair strategy on mortality based on distinct risk stratifications. Methods and results A total of 3771 ATAAD patients who underwent aortic surgery retrospectively included were randomly divided into training and testing cohorts at a ratio of 7:3 for the development and validation of the risk model based on multiple circulating biomarkers and conventional clinical factors. Extreme gradient boosting was used to generate the risk models. Subgroup analyses were performed by risk stratifications (low vs. middle-high risk) and arch repair strategies (proximal vs. extensive arch repair). Addition of multiple biomarkers to a model with conventional factors fitted an ABC risk model consisting of platelet-leucocyte ratio, mean arterial pressure, albumin, age, creatinine, creatine kinase-MB, haemoglobin, lactate, left ventricular end-diastolic dimension, urea nitrogen, and aspartate aminotransferase, with adequate discrimination ability {area under the receiver operating characteristic curve (AUROC): 0.930 [95% confidence interval (CI) 0.906-0.954] and 0.954, 95% CI (0.930-0.977) in the derivation and validation cohort, respectively}. Compared with proximal arch repair, the extensive repair was associated with similar mortality risk among patients at low risk [odds ratio (OR) 1.838, 95% CI (0.559-6.038); P = 0.316], but associated with higher mortality risk among patients at middle-high risk [OR 2.007, 95% CI (1.460-2.757); P < 0.0001]. Conclusion In ATAAD patients, the simultaneous addition of circulating biomarkers of inflammatory, cardiac, hepatic, renal, and metabolic abnormalities substantially improved risk stratification and individualized arch repair strategy.
Collapse
Affiliation(s)
- Hong Liu
- Corresponding authors. Tel: +86 025 68303804, Fax: +86 025 68303574, (Y.-F.S.); Tel: +08668303101, Fax: +86 025 68303574, (H.L.); Tel: +86 010 64412431, Fax: +86 010 64412431, (H.-Y.L.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Al-Wajih Hamzah
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Yong-Feng Shao
- Corresponding authors. Tel: +86 025 68303804, Fax: +86 025 68303574, (Y.-F.S.); Tel: +08668303101, Fax: +86 025 68303574, (H.L.); Tel: +86 010 64412431, Fax: +86 010 64412431, (H.-Y.L.)
| | - Hai-Yang Li
- Corresponding authors. Tel: +86 025 68303804, Fax: +86 025 68303574, (Y.-F.S.); Tel: +08668303101, Fax: +86 025 68303574, (H.L.); Tel: +86 010 64412431, Fax: +86 010 64412431, (H.-Y.L.)
| | - Hong-Jia Zhang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | | |
Collapse
|
100
|
Solomon MD, Leong T, Sung SH, Lee C, Allen JG, Huh J, LaPunzina P, Lee H, Mason D, Melikian V, Pellegrini D, Scoville D, Sheikh AY, Mendoza D, Naderi S, Sheridan A, Hu X, Cirimele W, Gisslow A, Leung S, Padilla K, Bloom M, Chung J, Topic A, Vafaei P, Chang R, Miller DC, Liang DH, Go AS. Association of Thoracic Aortic Aneurysm Size With Long-term Patient Outcomes: The KP-TAA Study. JAMA Cardiol 2022; 7:1160-1169. [PMID: 36197675 PMCID: PMC9535537 DOI: 10.1001/jamacardio.2022.3305] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
Importance The risk of adverse events from ascending thoracic aorta aneurysm (TAA) is poorly understood but drives clinical decision-making. Objective To evaluate the association of TAA size with outcomes in nonsyndromic patients in a large non-referral-based health care delivery system. Design, Setting, and Participants The Kaiser Permanente Thoracic Aortic Aneurysm (KP-TAA) cohort study was a retrospective cohort study at Kaiser Permanente Northern California, a fully integrated health care delivery system insuring and providing care for more than 4.5 million persons. Nonsyndromic patients from a regional TAA safety net tracking system were included. Imaging data including maximum TAA size were merged with electronic health record (EHR) and comprehensive death data to obtain demographic characteristics, comorbidities, medications, laboratory values, vital signs, and subsequent outcomes. Unadjusted rates were calculated and the association of TAA size with outcomes was evaluated in multivariable competing risk models that categorized TAA size as a baseline and time-updated variable and accounted for potential confounders. Data were analyzed from January 2018 to August 2021. Exposures TAA size. Main Outcomes and Measures Aortic dissection (AD), all-cause death, and elective aortic surgery. Results Of 6372 patients with TAA identified between 2000 and 2016 (mean [SD] age, 68.6 [13.0] years; 2050 female individuals [32.2%] and 4322 male individuals [67.8%]), mean (SD) initial TAA size was 4.4 (0.5) cm (828 individuals [13.0% of cohort] had initial TAA size 5.0 cm or larger and 280 [4.4%] 5.5 cm or larger). Rates of AD were low across a mean (SD) 3.7 (2.5) years of follow-up (44 individuals [0.7% of cohort]; incidence 0.22 events per 100 person-years). Larger initial aortic size was associated with higher risk of AD and all-cause death in multivariable models, with an inflection point in risk at 6.0 cm. Estimated adjusted risks of AD within 5 years were 0.3% (95% CI, 0.3-0.7), 0.6% (95% CI, 0.4-1.3), 1.5% (95% CI, 1.2-3.9), 3.6% (95% CI, 1.8-12.8), and 10.5% (95% CI, 2.7-44.3) in patients with TAA size of 4.0 to 4.4 cm, 4.5 to 4.9 cm, 5.0 to 5.4 cm, 5.5 to 5.9 cm, and 6.0 cm or larger, respectively, in time-updated models. Rates of the composite outcome of AD and all-cause death were higher than for AD alone, but a similar inflection point for increased risk was observed at 6.0 cm. Conclusions and Relevance In a large sociodemographically diverse cohort of patients with TAA, absolute risk of aortic dissection was low but increased with larger aortic sizes after adjustment for potential confounders and competing risks. Our data support current consensus guidelines recommending prophylactic surgery in nonsyndromic individuals with TAA at a 5.5-cm threshold.
Collapse
Affiliation(s)
- Matthew D. Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Thomas Leong
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - J. Geoff Allen
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Joseph Huh
- Department of Cardiothoracic Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Paul LaPunzina
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Hon Lee
- Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Duncan Mason
- Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Vicken Melikian
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Daniel Pellegrini
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - David Scoville
- Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Ahmad Y. Sheikh
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Dorinna Mendoza
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Sahar Naderi
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Ann Sheridan
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Xinge Hu
- Department of Cardiology, Kaiser Permanente Fremont Medical Center, Fremont, California
| | - Wendy Cirimele
- Department of Cardiothoracic Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Anne Gisslow
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Sandy Leung
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Kristine Padilla
- Department of Cardiothoracic Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Michael Bloom
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Josh Chung
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Adrienne Topic
- Department of Cardiology, WellSpan Health Good Samaritan Hospital, Lebanon, Pennsylvania
| | - Paniz Vafaei
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Robert Chang
- Department of Cardiothoracic Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - D. Craig Miller
- Department of Cardiovascular Surgery, Stanford University School of Medicine, Stanford, California
| | - David H. Liang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Department of Epidemiology, University of California, San Francisco
- Department of Biostatistics, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
| |
Collapse
|