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Goyal A, Fatima L, Jain H, Tariq MD, Mushtaq F, Suheb MZK, Lu E, Khan R, Sohail AH. Comparison of Outcomes Between Right and Left Upper Extremity Access in Endovascular Aortic Repair for Patients with Thoracoabdominal and Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis. Cardiol Rev 2024:00045415-990000000-00278. [PMID: 38814082 DOI: 10.1097/crd.0000000000000734] [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] [Indexed: 05/31/2024]
Abstract
Traditionally, left-sided upper extremity (LUE) access has been preferred in patients undergoing endovascular aortic repair (EVAR) to manage aortic aneurysms and decrease the risk of cerebrovascular adverse events. Recently, right-sided upper extremity access (RUE) has gained popularity owing to its greater maneuverability and ergonomics. However, synthesized data comparing the safety and efficacy of RUE and LUE accesses are limited. A comprehensive literature search was conducted on various databases from inception to September 2023 to retrieve all studies that compared RUE and LUE access in EVAR. Data on stroke, 30-day mortality, technical success, access-site complications, total time required for fluoroscopy, and contrast agent requirement were extracted, pooled, and analyzed. Forest plots were generated using a random-effects model on review manager by pooling the risk ratios (RRs) and standard mean differences (SMDs). Ten observational studies with a total of 3994 patients were included in our analysis with 1186 patients in the RUE and 2808 patients in the LUE access groups. EVAR using RUE access was associated with a significantly lower amount of contrast agent requirement than the LUE access group [SMD, -0.23; 95% confidence interval (CI), -0.45 to -0.02; P = 0.03]. There was no significant difference between the 2 groups in terms of the risk of stroke (RR, 1.62; 95% CI, 0.81-3.22; P = 0.17), 30-day mortality (RR, 1.42; 95% CI, 0.50-4.06; P = 0.51), rate of technical success (RR, 0.98; 95% CI, 0.95-1.01; P = 0.18), risk of access-site complications (RR, 1.00; 95% CI, 0.72-1.39; P = 0.99), and total time required for fluoroscopy (SMD, 0.07; 95% CI, -0.39 to 0.26; P = 0.69). The use of RUE access in EVAR appears to be comparable to LUE access in terms of the risk of stroke, access-related complications, all-cause mortality, technical success rate, and fluoroscopy duration. The RUE group required a lower volume of contrast agent.
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Affiliation(s)
- Aman Goyal
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Muhammad Daoud Tariq
- Department of Internal Medicine, Foundation University Medical College, Islamabad, Pakistan
| | - Fiza Mushtaq
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Eileen Lu
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rozi Khan
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM
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Klessinger D, Mamazhakypov A, Glaeser S, Emig R, Peyronnet R, Meier L, Proelss K, Marenne K, Smolka C, Grundmann S, Pankratz F, Esser PR, Moser M, Zhou Q, Esser JS. Divergent and Compensatory Effects of BMP2 and BMP4 on the VSMC Phenotype and BMP4's Role in Thoracic Aortic Aneurysm Development. Cells 2024; 13:735. [PMID: 38727271 PMCID: PMC11083443 DOI: 10.3390/cells13090735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Vascular smooth muscle cells (VSMCs) play a key role in aortic aneurysm formation. Bone morphogenetic proteins (BMPs) have been implicated as important regulators of VSMC phenotype, and dysregulation of the BMP pathway has been shown to be associated with vascular diseases. The aim of this study was to investigate for the first time the effects of BMP-4 on the VSMC phenotype and to understand its role in the development of thoracic aortic aneurysms (TAAs). Using the angiotensin II (AngII) osmotic pump model in mice, aortas from mice with VSMC-specific BMP-4 deficiency showed changes similar to AngII-infused aortas, characterised by a loss of contractile markers, increased fibrosis, and activation of matrix metalloproteinase 9. When BMP-4 deficiency was combined with AngII infusion, there was a significantly higher rate of apoptosis and aortic dilatation. In vitro, VSMCs with mRNA silencing of BMP-4 displayed a dedifferentiated phenotype with activated canonical BMP signalling. In contrast, BMP-2-deficient VSMCs exhibited the opposite phenotype. The compensatory regulation between BMP-2 and BMP-4, with BMP-4 promoting the contractile phenotype, appeared to be independent of the canonical signalling pathway. Taken together, these results demonstrate the impact of VSMC-specific BMP-4 deficiency on TAA development.
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MESH Headings
- Animals
- Male
- Mice
- Angiotensin II/pharmacology
- Aortic Aneurysm, Thoracic/metabolism
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/genetics
- Apoptosis/drug effects
- Bone Morphogenetic Protein 2/metabolism
- Bone Morphogenetic Protein 4/metabolism
- Disease Models, Animal
- Mice, Inbred C57BL
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Phenotype
- Signal Transduction
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Affiliation(s)
- Daniel Klessinger
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Argen Mamazhakypov
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, 79104 Freiburg im Breisgau, Germany;
| | - Sophie Glaeser
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Ramona Emig
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany; (R.E.); (R.P.)
- CIBSS Centre for Integrative Biological Signalling Studies, Faculty of Biology, University of Freiburg, 79104 Freiburg im Breisgau, Germany
| | - Remi Peyronnet
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany; (R.E.); (R.P.)
| | - Lena Meier
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Kora Proelss
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Katia Marenne
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Christian Smolka
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Sebastian Grundmann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Franziska Pankratz
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Philipp R. Esser
- Allergy Research Group, Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany;
| | - Martin Moser
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
| | - Qian Zhou
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
- Division of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Jennifer S. Esser
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany (C.S.); (S.G.); (F.P.); (M.M.); (Q.Z.)
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Rustum S, Lübeck S, Beckmann E, Wilhelmi M, Haverich A, Shrestha ML. Open surgical replacement of the descending aorta: single-center experience. Indian J Thorac Cardiovasc Surg 2023; 39:137-144. [PMID: 36785612 PMCID: PMC9918630 DOI: 10.1007/s12055-022-01443-x] [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: 05/25/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 01/04/2023] Open
Abstract
Background This study presents a single center's experience and analyzes clinical outcomes following elective open surgical descending aortic replacement. Methods Between January 2000 and August 2019, 96 patients with mean age 64 years (range, 49.5-71 years) (62.5% (n=60) male) underwent elective descending aortic replacement due to aneurysm (n=60) or chronic dissection (n=36). Marfan syndrome was present in 12 patients (12.5%). Results In-hospital mortality rate was 3.1% (n= 3. 2 in the aneurysm group, 1 in the dissection group). New-onset renal insufficiency postoperatively with (creatinine ≥ 2.5 mg/dl) manifested in 10 patients (10.8%). One patient (1%) suffered from stroke, and paraplegia developed in 1 pts (1%). The median follow-up time was 7 years (IQR: 2.5-13 years). The 5- and 10-year survival rates were 70.8% and 50.7% respectively. We did not observe any early or late prosthetic graft infection. The Cox proportional hazards regression analysis identified age (HR: 1.044, 95% CI: 1.009-1.080, p-value: 0.014), diabetes (HR: 2.544, 95% CI: 1.009-6.413, p-value: 0.048), and chronic obstructive pulmonary disease (COPD) (HR: 2.259, 95% CI: 1.044-4.890, p-value: 0.039) as risk factors for late mortality. Conclusions This study showed that the elective open surgical replacement of the descending aorta can be achieved with excellent outcomes in terms of perioperative mortality and morbidity. Prosthetic graft is not a problem with open surgical descending aortic replacement, even in the long term. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01443-x.
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Affiliation(s)
- Saad Rustum
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sebastian Lübeck
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Erik Beckmann
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Mathias Wilhelmi
- Center for Competence for Cardiovascular Implants, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Malakh Lal Shrestha
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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4
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Shibahashi K, Matsunaga H, Ishida T, Sugiyama K, Hamabe Y. A new screening model for quantitative risk assessment of blunt thoracic aortic injury. Eur J Trauma Emerg Surg 2022; 48:4607-4614. [DOI: 10.1007/s00068-022-01925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
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5
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Diletta L, Enrico R, Germano M. Thoracoabdominal aortic aneurysm in connective tissue disorder patients. Indian J Thorac Cardiovasc Surg 2022; 38:146-156. [PMID: 35463710 PMCID: PMC8980973 DOI: 10.1007/s12055-021-01324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022] Open
Abstract
Connective tissue disorders (CTDs) are a group of genetically triggered diseases in which the primary defect involves collagen and elastin protein assembly with potential vascular degenerations such as thoracoabdominal aortic aneurysm (TAAA) and dissection. These most commonly include Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, and familial thoracic aortic aneurysm and dissection. Open surgical repair represents the standard approach in this specific group of patients. Extensive aortic replacements are generally performed in order to reduce long-term complications caused by the progressive dilatation of the remnant aortic segments. In the last decades, endovascular interventions have emerged as a valid alternative in patients affected by degenerative TAAA. However, in patients with CTD, this approach presents higher rates of reinterventions and postoperative complications with a disputable long-term durability, and it is nowadays performed for very selective indications such as severe comorbidities and urgent/emergent settings. Despite a deeper knowledge of the pathophysiological mechanisms involved in CTD, improvements in medical therapy, and a multidisciplinary approach fully involved in the management of these usually frailer patients, this specific group still represents a challenge. Further dedicated studies addressing mid-term and long-term outcomes in this selected population are needed.
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Affiliation(s)
- Loschi Diletta
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Rinaldi Enrico
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Melissano Germano
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
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6
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Al Mulhim ON. Huge Thoracic Aortic Aneurysm Presenting with Jaundice: A Case Report. Vasc Health Risk Manag 2022; 18:1-4. [PMID: 35046660 PMCID: PMC8762516 DOI: 10.2147/vhrm.s346041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Thoracic aortic aneurysms (TAA) are encountered frequently in the emergency department with an obscure presentation. Most of these aneurysms are incidentally discovered while doing routine imaging studies. This report describes a case of unusual presentation of TAAs. Case Presentation A 37-year-old male presented to the emergency department with jaundice, shortness of breath, abdominal swelling, and lower limb edema, which worsened during the previous month. The patient was worked up and diagnosed with an ascending aortic aneurysm measuring 6.9 cm associated with severe aortic insufficiency and heart failure. Conclusion TAA is a life-threatening condition with indistinct signs and symptoms. A high index of suspicion and early implementation of radiological studies are prerequisites to reach a diagnosis.
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7
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Jia H, Kang L, Lu S, Chen Z, Shen J, Huang B, Zou Y, Sun Y. Circulating soluble receptor of advanced glycation end product is associated with bicuspid aortic aneurysm progression via NF-κB pathway. Interact Cardiovasc Thorac Surg 2021; 34:274-282. [PMID: 34648622 PMCID: PMC8766214 DOI: 10.1093/icvts/ivab242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Patients with bicuspid aortic valve (BAV) have a high risk of aortic dilation and adverse vascular events. Previous studies had reported soluble receptor for advanced glycation end products (sRAGE) to compete with receptor of advanced glycation end products (RAGE) for ligand binding and inhibit the activation of nuclear-factor kappa-B (NF-κB) pathway and matrix metalloproteinases (MMP) transcription. Thus, sRAGE serum levels may contribute to the clinical diagnosis and monitoring of ascending aorta aneurysm in patients with BAV. METHODS To eliminate the confounding factors, 44 patients with BAV were divided into 3 subgroups according to the diameter of ascending aorta, and 20 patients with tricuspid aortic valve and normal-sized ascending aorta were selected as a control group. Protein levels and gene transcription of several variates were evaluated in the tissue and serum samples from these patients. Human aortic smooth muscle cells were treated with AGE-BSA in gradient concentrations, and changes in phenotype and protein and mRNA levels were detected. RESULTS Serum levels of sRAGE in the 3 BAV groups were obviously higher than those in the tricuspid aortic valve group, although there was negative correlation between the serum sRAGE levels and ascending aortic diameters among patients with BAV. Transcript expression levels of RAGE and NF-κBp65 mRNA were increased in the 3 BAV groups and RAGE/NF-κB pathway was activated with the progression of ascending aortic aneurysm. Abnormal activation of RAGE/NF-κB pathway was observed in AGE-BSA-treated human aortic smooth muscle cells. CONCLUSIONS Our study has shown a trend in serum levels of sRAGE among patients with BAV, and that the cellular and extracellular pathological processes are quite serious even in the normal-sized or slightly dilated aorta. Together, the findings indicated that sRAGE may be used as a biomarker to predict aneurysm expansion rates and the risk of adverse vascular events.
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Affiliation(s)
- Hao Jia
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Le Kang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuyang Lu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenhang Chen
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinqiang Shen
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ben Huang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunzeng Zou
- Central Laboratory of Cardiovascular Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongxin Sun
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Harky A, Sokal PA, Hasan K, Papaleontiou A. The Aortic Pathologies: How Far We Understand It and Its Implications on Thoracic Aortic Surgery. Braz J Cardiovasc Surg 2021; 36:535-549. [PMID: 34617429 PMCID: PMC8522328 DOI: 10.21470/1678-9741-2020-0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thoracic aortic diseases contribute to a major part of cardiac surgeries. The severity of pathologies varies significantly from emergency and life-threatening to conservatively managed conditions. Life-threatening conditions include type A aortic dissection and rupture. Aortic aneurysm is an example of a conservatively managed condition. Pathologies that affect the arterial wall can have a profound impact on the presentation of such cases. Several risk factors have been identified that increase the risk of emergency presentations such as connective tissue disease, hypertension, and vasculitis. The understanding of aortic pathologies is essential to improve management and clinical outcomes.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,School of Medicine, University of Liverpool, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Khubbaib Hasan
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
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9
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Zhang B, Wang Y, Guo J, Zhang G, Yang B. Nomogram to differentiate between aortic dissection and non-ST segment elevation acute coronary syndrome: a retrospective cohort study. Cardiovasc Diagn Ther 2021; 11:457-466. [PMID: 33968623 DOI: 10.21037/cdt-20-935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Aortic dissection (AD) and non-ST segment elevation acute coronary syndrome (ACS) are two of the most life-threatening diseases encountered in the emergency department (ED), but there are no rapid and reliable tools for differentiation. The purpose of this study is to develop and validate a nomogram that incorporates both the clinical characteristics and bedside laboratory tests available to differentiate between AD and non-ST segment elevation ACS (NSTE-ACS). Methods Between January 2016 and July 2018, patients with AD and NSTE-ACS were enrolled and divided into training and validation groups. The least absolute shrinkage and selection operator (LASSO) regression model was used to select the factors with significant value of predicting the diagnosis of AD. A nomogram was built on the basis of multivariable logistic regression analysis. Area under the curve (AUC) of receiver operating characteristic (ROC) curve and the calibration curve were used to assess the performance of the nomogram. Decision curve analysis was performed to assess the clinical utility of the nomogram. Results A final cohort of 263 patients (94 patients with AD and 169 patients with NSTE-ACS) were enrolled. Six variables were incorporated in the nomogram: pain severity, tearing pain, pulse asymmetry, electrocardiogram (ECG), D-dimer level and troponin I level. The AUC of the nomogram to predict the probability of AD was 0.919 (95% CI, 0.876-0.962) in the training group and 0.938 (95% CI, 0.888-0.989) in the validation group. The calibration curve demonstrated a good consistency between the actual clinical results and the predicted outcomes. The decision curve analysis indicated that the nomogram had higher overall net benefits in predicting AD in both the training group and the validation group. Conclusions We developed and validated a predictive nomogram that could be used as a tool to differentiate AD from NSTE-ACS rapidly and accurately.
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Affiliation(s)
- Baowei Zhang
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Cardiology, the affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Yingying Wang
- Department of Cardiology, the affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Junfang Guo
- Department of Cardiology, the affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Guohui Zhang
- Department of Cardiology, the affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Bing Yang
- Center of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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10
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Portugal MFC, Teivelis MP, da Silva MFA, Fioranelli A, Szlejf C, Amaro-Júnior E, Wolosker N. Epidemiological Analysis of 5,595 Procedures of Endovascular Correction of Isolated Descending Thoracic Aortic Disease Over 12 Years in the Public Health System in Brazil. Clinics (Sao Paulo) 2021; 76:e2890. [PMID: 34287481 PMCID: PMC8266170 DOI: 10.6061/clinics/2021/e2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES In Brazil, descending thoracic aorta disease, including aneurysms and dissections, is managed preferentially by endovascular treatment, owing to its feasibility and good results. In this study, we analyzed endovascular treatment of isolated descending thoracic aortic disease cases in the Brazilian public health system over a 12-year period. METHODS Public data from procedures performed from 2008 to 2019 were extracted using web scraping techniques to assess procedure type frequency (elective or urgency), mortality, and governmental costs. RESULTS A total of 5,595 procedures were analyzed, the vast majority of which were urgent procedures (61.82% vs. 38.18%). In-hospital mortality was lower for elective than for urgent surgeries (4.96 vs.10.32% p=0.008). An average of R$16,845.86 and R$20,012.04 was paid per elective and emergency procedure, respectively, with no statistical difference (p=0.095). CONCLUSION Elective procedures were associated with lower mortality than urgent procedures. There was no statistically significant difference between elective and urgent procedures regarding costs.
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Affiliation(s)
| | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- Faculdade Israelita de Ciencias da Saude Albert Einstein, Sao Paulo, SP, BR
| | | | - Alexandre Fioranelli
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- Faculdade Israelita de Ciencias da Saude Albert Einstein, Sao Paulo, SP, BR
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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11
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Hu Z, Christodoulou AG, Wang N, Shaw JL, Song SS, Maya MM, Ishimori ML, Forbess LJ, Xiao J, Bi X, Han F, Li D, Fan Z. Magnetic resonance multitasking for multidimensional assessment of cardiovascular system: Development and feasibility study on the thoracic aorta. Magn Reson Med 2020; 84:2376-2388. [PMID: 32301164 DOI: 10.1002/mrm.28275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To develop an MR multitasking-based multidimensional assessment of cardiovascular system (MT-MACS) with electrocardiography-free and navigator-free data acquisition for a comprehensive evaluation of thoracic aortic diseases. METHODS The MT-MACS technique adopts a low-rank tensor image model with a cardiac time dimension for phase-resolved cine imaging and a T2 -prepared inversion-recovery dimension for multicontrast assessment. Twelve healthy subjects and 2 patients with thoracic aortic diseases were recruited for the study at 3 T, and both qualitative (image quality score) and quantitative (contrast-to-noise ratio between lumen and wall, lumen and wall area, and aortic strain index) analyses were performed in all healthy subjects. The overall image quality was scored based on a 4-point scale: 3, excellent; 2, good; 1, fair; and 0, poor. Statistical analysis was used to test the measurement agreement between MT-MACS and its corresponding 2D references. RESULTS The MT-MACS images reconstructed from acquisitions as short as 6 minutes demonstrated good or excellent image quality for bright-blood (2.58 ± 0.46), dark-blood (2.58 ± 0.50), and gray-blood (2.17 ± 0.53) contrast weightings, respectively. The contrast-to-noise ratios for the three weightings were 49.2 ± 12.8, 20.0 ± 5.8 and 2.8 ± 1.8, respectively. There were good agreements in the lumen and wall area (intraclass correlation coefficient = 0.993, P < .001 for lumen; intraclass correlation coefficient = 0.969, P < .001 for wall area) and strain (intraclass correlation coefficient = 0.947, P < .001) between MT-MACS and conventional 2D sequences. CONCLUSION The MT-MACS technique provides high-quality, multidimensional images for a comprehensive assessment of the thoracic aorta. Technical feasibility was demonstrated in healthy subjects and patients with thoracic aortic diseases. Further clinical validation is warranted.
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Affiliation(s)
- Zhehao Hu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Anthony G Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
| | - Nan Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Jaime L Shaw
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marcel M Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mariko L Ishimori
- Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lindsy J Forbess
- Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jiayu Xiao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Fei Han
- Siemens Healthcare, Los Angeles, California
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
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12
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Zhang D, Lin Y, Liu Y, Zhang X, Jiang C. Clinical analysis of aortic dissection with sudden coma and paraplegia as the main symptoms. J Int Med Res 2020; 48:300060519895843. [PMID: 32216512 PMCID: PMC7133407 DOI: 10.1177/0300060519895843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to investigate the clinical characteristics of patients with aortic dissection presenting with neurological symptoms as the initial symptoms. Methods Clinical characteristics, radiological abnormalities, and prognosis were analyzed in two female patients with aortic dissection. The main clinical symptoms were sudden coma and paraplegia. A detailed clinical examination was performed and computed tomography scans were evaluated. Results The initial symptoms of the patients involved the nervous system. Chest and abdominal computed tomography scans were performed to confirm the diagnosis of aortic dissection. Both patients died. Conclusion Patients who present with nervous system symptoms as the first symptoms of aortic dissection, which lead to misdiagnosis and missing the diagnosis, are rare. Improvement in the understanding of this disease is required to ensure that patients receive a timely diagnosis in the early stages.
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Affiliation(s)
- Dongwei Zhang
- Department of Neurology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Yinuo Lin
- Department of Neurology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Yuehui Liu
- Department of Neurology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Xinhong Zhang
- Department of Neurology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Caixia Jiang
- Department of Neurology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
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13
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Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J 2019; 39:739-749d. [PMID: 29106452 DOI: 10.1093/eurheartj/ehx319] [Citation(s) in RCA: 200] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/13/2017] [Indexed: 01/16/2023] Open
Abstract
Acute aortic syndromes (AAS) encompass a constellation of life-threatening medical conditions including classic acute aortic dissection (AAD), intramural haematoma, and penetrating atherosclerotic aortic ulcer. Given the non-specific symptoms and physical signs, a high clinical index of suspicion is necessary to detect the disease before irreversible lethal complications occur. In order to reduce the diagnostic time delay, a comprehensive flowchart for decision-making based on pre-test sensitivity of AAS has been designed by the European Society of Cardiology guidelines on aortic diseases and should be thus applied in the emergency scenario. When the definitive diagnosis is made, prompt and appropriate therapeutic interventions should be undertaken if indicated by a highly specialized aortic team. Urgent surgery for AAD involving the ascending aorta (Type A) and medical therapy alone for AAD not involving the ascending aorta (Type B) are typically recommended. In complicated Type B AAD, thoracic endovascular aortic repair (TEVAR) is generally indicated. On the other hand, in uncomplicated Type B AAD, pre-emptive TEVAR rather than medical therapy alone to prevent late complications, while intuitive, requires further study in randomized cohorts. Finally, it should be highlighted that there is an urgent need to increase awareness of AAS worldwide, including dedicated education/prevention programmes, and to improve diagnostic and therapeutic strategies, outcomes, and lifelong surveillance.
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Affiliation(s)
| | - Troy M LaBounty
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48105, USA
| | - Kim A Eagle
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48105, USA
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14
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Shyu HN, Li PH, Liu SK, Chiang YY. Complete atrioventricular block during thoracic endovascular aortic repair. Ann Card Anaesth 2019; 22:325-327. [PMID: 31274499 PMCID: PMC6639873 DOI: 10.4103/aca.aca_68_18] [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] [Indexed: 11/04/2022] Open
Abstract
Acute coronary syndrome (ACS) and acute aortic syndrome (AAS) are both life-threatening emergencies. We report a case of ACS with thoracic aneurysm. Thoracic endovascular aortic repair (TEVAR) was arranged. However, perioperative complete atrioventricular block occurred and soon progressed to ST-elevation myocardial infarction. In the case of chest discomfort with elevated troponin I and thoracic aneurysm, it is of tremendous importance to cope with both ACS and the possible AAS. In the era of hybrid operation room, coronary catheterization and intervention first followed by TEVAR may provide timely and more comprehensive treatment.
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Affiliation(s)
- Hao-Nung Shyu
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Po-Han Li
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shih-Kai Liu
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Ying Chiang
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung, Taiwan
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15
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Siddiqui MA, Mittal PK, Little BP, Miller FH, Akduman EI, Ali K, Sartaj S, Moreno CC. Secondary Hypertension and Complications: Diagnosis and Role of Imaging. Radiographics 2019; 39:1036-1055. [DOI: 10.1148/rg.2019180184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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16
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Kauhanen SP, Hedman M, Kariniemi E, Jaakkola P, Vanninen R, Saari P, Liimatainen T. Aortic dilatation associates with flow displacement and increased circumferential wall shear stress in patients without aortic stenosis: A prospective clinical study. J Magn Reson Imaging 2019; 50:136-145. [PMID: 30659686 DOI: 10.1002/jmri.26655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The relationship between blood flow characteristics and ascending aortic (AA) dilatation has not been studied in patients with a tricuspid aortic valve (TAV) without aortic stenosis. PURPOSE To evaluate whether 4D flow characteristics determined in MRI are related to AA dilatation by comparing dilated AA and nondilated AA subjects with TAV. STUDY TYPE Prospective. POPULATION Twenty patients with dilated AA and 20 age-matched patients with nondilated AA. FIELD STRENGTH/SEQUENCE 1.5T/4D flow, 2D flow, and anatomic images. ASSESSMENT Altogether, 16 different 4D flow parameters were assessed in 10 planes in the thoracic aorta. Intra- and interobserver reproducibility were analyzed. STATISTICAL TESTS Independent t-test for normally distributed and the Mann-Whitney test for skewed distributed parameters were used. A paired-samples t-test was used to compare 2D and 4D flow parameters. Intraclass correlation coefficient (ICC) was used in intra- and interobserver reproducibility analysis. RESULTS Aortic flow was displaced from the centerline of the aorta in the proximal and tubular planes. Flow displacement (FD) was greatest in the proximal plane of AA and was higher in dilated AA (4.5%, range 3.0-5.8%) than in nondilated AA (2.0%, 1.0-3.0%, P < 0.001). Total wall shear stress (WSS) values were 1.3 ± 0.4 times higher on the displaced side than on the opposite side of the aorta (P < 0.01). The circumferential WSS (WSSC ) ratio to total WSS was greater in dilated AA, being 0.48 ± 0.11 vs. 0.32 ± 0.09 in the inner curvature of the proximal AA (P < 0.001) and 0.37 ± 0.11 vs. 0.26 ± 0.07 in the whole aortic ring in the distal AA (P < 0.001). Depending on 4D flow parameters, reproducibility varied from excellent (ICC = 0.923) to very low (ICC = 0.204). DATA CONCLUSION The present study demonstrates that 4D flow measurements help to visualize the pathological flow patterns related to aortic dilatation. Flow displacement and an increased WSSc/WSS ratio are significantly associated with AA dilatation. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:136-145.
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Affiliation(s)
- S Petteri Kauhanen
- School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Elina Kariniemi
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Pekka Jaakkola
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Timo Liimatainen
- Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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17
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Li Y, Yang N, Zhou X, Bian X, Qiu G, Zhang M, Lin H, Li D. LncRNA and mRNA interaction study based on transcriptome profiles reveals potential core genes in the pathogenesis of human thoracic aortic dissection. Mol Med Rep 2018; 18:3167-3176. [PMID: 30066903 PMCID: PMC6102671 DOI: 10.3892/mmr.2018.9308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/02/2018] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to determine the potential core genes in the pathogenesis of human thoracic aortic dissection (TAD) by analyzing microarray profiles of long non‑coding (lnc)‑RNAs between TAD and normal thoracic aorta (NTA). The differentially expressed lncRNA profiles of the aorta tissues between TAD patients (TAD group, n=6) and age‑matched donors with aortic diseases (NTA group, n=6) were analyzed by lncRNAs microarray. Gene ontology (GO), pathway and network analyses were used to further investigate candidate lncRNAs and mRNAs. Differentially expressed lncRNAs and mRNAs were validated by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR). In total, the present study identified 765 lncRNAs and 619 mRNAs with differential expression between TAD and NTA (fold change >2.0, P<0.01). GO analysis demonstrated that the differentially upregulated lncRNAs are associated with cell differentiation, homeostasis, cell growth and angiogenesis. Kyoto Encyclopedia of Gene and Genomes pathway analysis demonstrated that the differentially downregulated lncRNAs are mainly associated with arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy and dilated cardiomyopathy. To reduce the lncRNAs for further investigation and to enrich those potentially involved in TAD, a total of 16 candidate lncRNAs with a significant expression (fold change >4, P<0.01) were selected, that were associated with an annotated protein‑coding gene through the GO term and scientific literatures. Then a set of significantly expressed lncRNAs [purinergic receptor P2X7 (P2RX7), hypoxia inducing factor (HIF)‑1A‑AS2, AX746823, RP11‑69I8.3 and RP11‑536K7.5) and the corresponding mRNAs (P2RX7, cyclin dependent kinase inhibitor 2B, HIF‑1A, runt‑related transcription factor 1, connective tissue growth factor and interleukin 2 receptor a chain] were confirmed using RT‑qPCR. The present study revealed that the expression profiles of lncRNAs and mRNAs in aorta tissues from TAD were significantly altered. These results may provide important insights into the pathogenesis of TAD disease.
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Affiliation(s)
- Yang Li
- Department of General Surgery, Beijing Yuho Rehabilitation Hospital of Integrated Chinese and Western Medicine, Beijing 100039, P.R. China
| | - Nan Yang
- Department of Stomatology, PLA 309th Hospital, Beijing 100091, P.R. China
| | - Xianbao Zhou
- Department of General Surgery, Beijing Yuho Rehabilitation Hospital of Integrated Chinese and Western Medicine, Beijing 100039, P.R. China
| | - Xuezhi Bian
- Department of General Surgery, Beijing Yuho Rehabilitation Hospital of Integrated Chinese and Western Medicine, Beijing 100039, P.R. China
| | - Genqiang Qiu
- Department of General Surgery, Beijing Yuho Rehabilitation Hospital of Integrated Chinese and Western Medicine, Beijing 100039, P.R. China
| | - Mo Zhang
- Department of Orthopedics, Beijing Yuho Rehabilitation Hospital of Integrated Chinese and Western Medicine, Beijing 100039, P.R. China
| | - Huagang Lin
- Department of Orthopedics, Beijing Yuho Rehabilitation Hospital of Integrated Chinese and Western Medicine, Beijing 100039, P.R. China
| | - Dingfeng Li
- Department of Orthopedics, Beijing Yuho Rehabilitation Hospital of Integrated Chinese and Western Medicine, Beijing 100039, P.R. China
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18
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Providing Culturally Competent Acute Care Physical Therapy for a Complex Medical Patient of Amish Heritage. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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19
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Trinh B, Dubin I, Rahman O, Ferreira Botelho MP, Naro N, Carr JC, Collins JD, Barker AJ. Aortic Volumetry at Contrast-Enhanced Magnetic Resonance Angiography: Feasibility as a Sensitive Method for Monitoring Bicuspid Aortic Valve Aortopathy. Invest Radiol 2017; 52:216-222. [PMID: 27861233 PMCID: PMC5339069 DOI: 10.1097/rli.0000000000000332] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Bicuspid aortic valve patients can develop thoracic aortic aneurysms and therefore require serial imaging to monitor aortic growth. This study investigates the reliability of contrast-enhanced magnetic resonance angiography (CEMRA) volumetry compared with 2-dimensional diameter measurements to identify thoracic aortic aneurysm growth. MATERIALS AND METHODS A retrospective, institutional review board-approved, and Health Insurance Portability and Accountability Act-compliant study was conducted on 20 bicuspid aortic valve patients (45 ± 8.9 years, 20% women) who underwent serial CEMRA with a minimum imaging follow-up of 11 months. Magnetic resonance imaging was performed at 1.5 T with electrocardiogram-gated, time-resolved CEMRA. Independent observers measured the diameter at the sinuses of Valsalva (SOVs) and mid ascending aorta (MAA) as well as ascending aorta volume between the aortic valve annulus and innominate branch. Intraobserver/interobserver coefficient of variation (COV) and intraclass correlation coefficient (ICC) were computed to assess reliability. Growth rates were calculated and assessed by Student t test (P < 0.05, significant). The diameter of maximal growth (DMG), defined as the diameter at SOV or MAA with the faster growth rate, was recorded. RESULTS The mean time of follow-up was 2.6 ± 0.82 years. The intraobserver COV was 0.01 for SOV, 0.02 for MAA, and 0.02 for volume (interobserver COV: 0.02, 0.03, 0.04, respectively). The ICC was 0.83 for SOV, 0.86 for MAA, 0.90 for DMG, and 0.95 for volume. Average aortic measurements at baseline and (follow-up) were 42 ± 3 mm (42 ± 3 mm, P = 0.11) at SOV, 46 ± 4 mm (47 ± 4 mm, P < 0.05) at MAA, and 130 ± 23 mL (144 ± 24 mL, P < 0.05). Average size changes were 0.2 ± 0.6 mm/y (1% ± 2%) at SOV, 0.5 ± 0.8 mm/y (1% ± 2%) at MAA, 0.7 ± 0.7 mm/y (2% ± 2%) at DMG, and 6 ± 3 mL/y (4% ± 3%) with volumetry. CONCLUSIONS Three-dimensional CEMRA volumetry exhibited a larger effect when examining percentage growth, a better ICC, and a marginally lower COV. Volumetry may be more sensitive to growth and possibly less affected by error than diameter measurements.
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Affiliation(s)
- Brian Trinh
- Northwestern University, Feinberg School of Medicine
| | - Iram Dubin
- UCLA Medical Center, Department of Radiology
| | - Ozair Rahman
- Northwestern University, Feinberg School of Medicine Department of Radiology
| | | | - Nicholas Naro
- Northwestern University, Feinberg School of Medicine
| | - James C Carr
- Northwestern University, Feinberg School of Medicine Department of Radiology
| | - Jeremy D Collins
- Northwestern University, Feinberg School of Medicine Department of Radiology
| | - Alex J Barker
- Northwestern University, Feinberg School of Medicine Department of Radiology
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