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Parker J, Coey J, Alambrouk T, Lakey SM, Green T, Brown A, Maxwell I, Ripley DP. Evaluating a Novel AI Tool for Automated Measurement of the Aortic Root and Valve in Cardiac Magnetic Resonance Imaging. Cureus 2024; 16:e59647. [PMID: 38832163 PMCID: PMC11146459 DOI: 10.7759/cureus.59647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Objective Evaluating an artificial intelligence (AI) tool (AIATELLA, version 1.0; AIATELLA Oy, Helsinki, Finland) in interpreting cardiac magnetic resonance (CMR) imaging to produce measurements of the aortic root and valve by comparison of accuracy and efficiency with that of three National Health Service (NHS) cardiologists. Methods AI-derived aortic root and valve measurements were recorded alongside manual measurements from three experienced NHS consultant cardiologists (CCs) over three separate sites in the northeast part of the United Kingdom. The study utilised a comprehensive dataset of CMR images, with the intraclass correlation coefficient (ICC) being the primary measure of concordance between the AI and the cardiologist assessments. Patient imaging was anonymised and blinded at the point of transfer to a secure data server. Results The study demonstrates a high level of concordance between AI assessment of the aortic root and valve with NHS cardiologists (ICC of 0.98). Notably, the AI delivered results in 2.6 seconds (+/- 0.532) compared to a mean of 334.5 seconds (+/- 61.9) by the cardiologists, a statistically significant improvement in efficiency without compromising accuracy. Conclusion AI's accuracy and speed of analysis suggest that it could be a valuable tool in cardiac diagnostics, addressing the challenges of time-consuming and variable clinician-based assessments. This research reinforces AI's role in optimising the patient journey and improving the efficiency of the diagnostic pathway.
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Affiliation(s)
- Jack Parker
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, GBR
- Imaging, AIATELLA Oy, Helsinki, FIN
- Imaging, AIATELLA Ltd., Newcastle upon Tyne, GBR
| | - James Coey
- School of Medicine, St. George's University, Newcastle upon Tyne, GBR
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, GBR
- Imaging, AIATELLA Oy, Helsinki, FIN
| | - Tarek Alambrouk
- School of Medicine, St. George's University, Newcastle upon Tyne, GBR
| | - Samuel M Lakey
- Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Thomas Green
- Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Alexander Brown
- Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Ian Maxwell
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, GBR
| | - David P Ripley
- Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, GBR
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Lv Z, Pan T, Zhang H, Wang Y, Matniyaz Y, Tang Y, Lu L, Wang D. Safety and efficacy of ketorolac in improving the prognosis of acute type A aortic dissection patients: a protocol of a randomized, double-blinded, and placebo-controlled study. Trials 2024; 25:250. [PMID: 38600561 PMCID: PMC11005260 DOI: 10.1186/s13063-024-08093-x] [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: 12/11/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Acute type A aortic dissection (aTAAD) is a critical and life-threatening condition. Previous research has demonstrated that the use of ketorolac not only reduces the progression, incidence, and severity of aortic aneurysms in animal models, but also decreases postoperative mortality and complications in patients undergoing open abdominal aortic aneurysm replacement. However, there is a lack of studies investigating the efficacy of ketorolac in treating aTAAD in humans. Therefore, we conducted a study to evaluate the safety and efficacy of ketorolac in patients with aTAAD. Our hypothesis was that ketorolac treatment for aTAAD patients would meet safety indicators and effectively improve patient prognosis. METHODS/DESIGN This study is a single-center, randomized, double-blinded, and placebo-controlled study. A total of 120 patients with aTAAD will be recruited and will be randomized into the ketorolac group and placebo group with a ratio of 1:1. Ketorolac tromethamine 60 mg per 2 ml will be intramuscularly injected within 2 h before surgery, followed by intramuscular injections of 30 mg per 1 ml BID. on the first and second postoperative days in the Ketorolac group, while 0.9% saline will be administered at the same dose, dosage form, and time in the placebo group. This study aims to evaluate the safety and efficacy of ketorolac in improving the prognosis of aTAAD. The primary endpoint is the composite endpoint event concerning drug-related adverse events. Secondary endpoints include drug-related adverse events, laboratory examination of blood, diagnostic imaging tests, clinical biomarkers, etc. DISCUSSION: This study has been approved by the Medical Ethics Committee of Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical College (approval number: 2023-197-02). This study is designed to evaluate the safety and efficacy of ketorolac in patients with aTAAD. All participating patients will sign an informed consent form, and the trial results will be published in international peer-reviewed journals. TRIAL REGISTRATION The Chinese Clinical Trial Registry ( http://www.chictr.org.cn ) ChiCTR2300074394. Registered on 4 October 2023.
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Affiliation(s)
- Zhikang Lv
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Tuo Pan
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Haitao Zhang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Yapeng Wang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Yusanjian Matniyaz
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yuxian Tang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lichong Lu
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Dongjin Wang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Ding F, Zhang Z, Qiao G, Fan T. Early Prone Position Ventilation in the Efficacy for Severe Hypoxemia and Neurological Complications Following Acute Type A Aortic Dissection (TAAD) Surgery. Int J Neurosci 2024:1-9. [PMID: 38497468 DOI: 10.1080/00207454.2024.2327408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/02/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To analyze the efficacy of early prone position ventilation in the treatment of severe hypoxemia after surgery for acute type A aortic dissection (TAAD). METHODS The patients were divided into a control group and a treatment group. Parameters assessed included blood gas analysis indicators [arterial oxygen partial pressure (PaO2). RESULTS (1) Blood gas analysis: Before treatment, there was no significant difference in PaO2, SpO2, and OI levels between the two groups; after treatment, the PaO2, SpO2, and OI levels in both groups significantly increased compared to pre-treatment, with a more pronounced improvement in the treatment group than in the control group (p < 0.05). (2) Hemodynamics: Before treatment, there was no significant difference in MAP and HR levels between the two groups; after treatment, the MAP levels increased significantly in both groups compared to pre-treatment, while HR levels decreased significantly, with no significant difference between the groups. (3) Prognosis recovery: MV time, ICU stay, and total hospital stay were significantly lower in the treatment group than in the control group; the 30-day mortality rate was 14.58% in the control group and 12.50% in the treatment group, with no significant difference in 30-day mortality rate between the groups. CONCLUSION Early prone position ventilation has shown promising application in the treatment of severe hypoxemia after TAAD surgery. Compared to traditional supine position ventilation, the use of early prone position ventilation can further improve blood gas analysis indicators in patients, and shorten MV time, ICU stay, and total hospital stay, thereby accelerating patient recovery.
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Affiliation(s)
- Fuyan Ding
- Department of Vascular Diseases Intensive Care Unit of Heart Center of Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Zhidong Zhang
- Department of Vascular Surgery of Heart Center of Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Gang Qiao
- Department of Vascular Surgery of Heart Center of Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Taibing Fan
- Center of Children's Heart Diseases of Heart Center of Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
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Yue J, Qi YF, Zhang WB, Liu SH, Chen H, Li ZZ, Wu HF. Single Nucleotide Polymorphisms Mutation of Tropoelastin Gene Affects Tropoelastin mRNA and Elastin Expressions in Human Aortic Smooth Muscle Cells. DNA Cell Biol 2023; 42:735-745. [PMID: 38011321 DOI: 10.1089/dna.2023.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
We aimed to explore the effects of single nucleotide polymorphisms (SNPs) in tropoelastin gene on tropoelastin mRNA and elastin expressions in human aortic smooth muscle cells (HASMCs). Two SNP loci, rs2071307 (G/A) and rs1785598 (G/C), were selected to construct recombinant lentivirus vectors carrying wild-type and mutant tropoelastin gene. Recombinant plasmids including pWSLV-02-ELN, pWSLV-02-ELN-mut1, and pWSLV-02-ELN-mut2 were constructed, before being amplified by polymerase chain reaction (PCR) and sequenced. The prepared plasmids and the packaging plasmids (pVSV-G and psPAX2) were cotransfected into HEK293T cells to obtain recombinant lentiviruses carrying tropoelastin gene. Afterward, HASMCs were infected with recombinant lentiviruses, and the positive cells sorted by flow cytometry were amplified. Four stable HASMCs cell lines including pWSLV-02-ELN, pWSLV-02-ELN-mut1, pWSLV-02-ELN-mut2, and pWSLV-02 vector were constructed. The expressions of tropoelastin mRNA and elastin in HASMCs were detected by real-time quantitative reverse transcription-PCR and western blot, respectively. Recombinant plasmids including pWSLV-02-ELN-mut1, pWSLV-02-ELN-mut2, and pWSLV-02-ELN were successfully constructed. Recombinant lentiviruses carrying tropoelastin gene were obtained via lentivirus packaging. After infection for 24 h, 3 days and 5 days in HASMCs, tropoelastin mRNA expressions in pWSLV-02-ELN-mut1 and pWSLV-02-ELN-mut2 groups were significantly lower than that of pWSLV-02-ELN group. Besides, after infection for 24 h, 3 days, and 5 days, elastin levels in pWSLV-02-ELN-mut1 and pWSLV-02-ELN-mut2 groups were significantly lower than that in pWSLV-02-ELN group. In conclusion, SNPs mutation of tropoelastin gene affected the expression of tropoelastin mRNA and elastin, suggesting that the polymorphisms of rs2071307 and rs17855988 in tropoelastin gene might be important factors for AD development.
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Affiliation(s)
- Jie Yue
- Department of Vascular Surgery, Hainan General Hospital, Haikou, People's Republic of China
- Department of Vascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - You-Fei Qi
- Department of Vascular Surgery, Hainan General Hospital, Haikou, People's Republic of China
- Department of Vascular Surgery, Hainan Affiliated Hospital of Hainan Medical University, Haikou, People's Republic of China
| | - Wen-Bo Zhang
- Department of Vascular Surgery, Hainan General Hospital, Haikou, People's Republic of China
- Department of Vascular Surgery, Hainan Affiliated Hospital of Hainan Medical University, Haikou, People's Republic of China
| | - Sa-Hua Liu
- Department of Vascular Surgery, Hainan General Hospital, Haikou, People's Republic of China
- Department of Vascular Surgery, Hainan Affiliated Hospital of Hainan Medical University, Haikou, People's Republic of China
| | - Hao Chen
- Department of Vascular Surgery, Hainan General Hospital, Haikou, People's Republic of China
- Department of Vascular Surgery, Hainan Affiliated Hospital of Hainan Medical University, Haikou, People's Republic of China
| | - Zhen-Zhen Li
- Department of Vascular Surgery, Hainan General Hospital, Haikou, People's Republic of China
- Department of Vascular Surgery, Hainan Affiliated Hospital of Hainan Medical University, Haikou, People's Republic of China
| | - Hong-Fei Wu
- Department of Vascular Surgery, Hainan General Hospital, Haikou, People's Republic of China
- Department of Vascular Surgery, Hainan Affiliated Hospital of Hainan Medical University, Haikou, People's Republic of China
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Lo Piccolo F, Hinck D, Segeroth M, Sperl J, Cyriac J, Yang S, Rapaka S, Bremerich J, Sauter AW, Pradella M. Impact of retraining a deep learning algorithm for improving guideline-compliant aortic diameter measurements on non-gated chest CT. Eur J Radiol 2023; 168:111093. [PMID: 37716024 DOI: 10.1016/j.ejrad.2023.111093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE/OBJECTIVE Reliable detection of thoracic aortic dilatation (TAD) is mandatory in clinical routine. For ECG-gated CT angiography, automated deep learning (DL) algorithms are established for diameter measurements according to current guidelines. For non-ECG gated CT (contrast enhanced (CE) and non-CE), however, only a few reports are available. In these reports, classification as TAD is frequently unreliable with variable result quality depending on anatomic location with the aortic root presenting with the worst results. Therefore, this study aimed to explore the impact of re-training on a previously evaluated DL tool for aortic measurements in a cohort of non-ECG gated exams. METHODS & MATERIALS A cohort of 995 patients (68 ± 12 years) with CE (n = 392) and non-CE (n = 603) chest CT exams was selected which were classified as TAD by the initial DL tool. The re-trained version featured improved robustness of centerline fitting and cross-sectional plane placement. All cases were processed by the re-trained DL tool version. DL results were evaluated by a radiologist regarding plane placement and diameter measurements. Measurements were classified as correctly measured diameters at each location whereas false measurements consisted of over-/under-estimation of diameters. RESULTS We evaluated 8948 measurements in 995 exams. The re-trained version performed 8539/8948 (95.5%) of diameter measurements correctly. 3765/8948 (42.1%) of measurements were correct in both versions, initial and re-trained DL tool (best: distal arch 655/995 (66%), worst: Aortic sinus (AS) 221/995 (22%)). In contrast, 4456/8948 (49.8%) measurements were correctly measured only by the re-trained version, in particular at the aortic root (AS: 564/995 (57%), sinotubular junction: 697/995 (70%)). In addition, the re-trained version performed 318 (3.6%) measurements which were not available previously. A total of 228 (2.5%) cases showed false measurements because of tilted planes and 181 (2.0%) over-/under-segmentations with a focus at AS (n = 137 (14%) and n = 73 (7%), respectively). CONCLUSION Re-training of the DL tool improved diameter assessment, resulting in a total of 95.5% correct measurements. Our data suggests that the re-trained DL tool can be applied even in non-ECG-gated chest CT including both, CE and non-CE exams.
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Affiliation(s)
- Francesca Lo Piccolo
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Daniel Hinck
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Martin Segeroth
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Jonathan Sperl
- Siemens Healthineers, Siemensstraße 1, 91301 Forchheim, Germany.
| | - Joshy Cyriac
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Shan Yang
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Saikiran Rapaka
- Siemens Healthineers, 755 College Rd E, Princeton, NJ 08540, United States.
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Alexander W Sauter
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Radiology, Kantonsspital Baden, Im Ergel 1, 5404 Baden, Switzerland; Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 7207 Tuebingen, Germany.
| | - Maurice Pradella
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
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Li J, Qu X, Jia X, Gong Y, Zhou T, Wang X. Thoracic Endovascular Aortic Repair versus Optimal Medical Treatment in Patients with Type B Intramural Hematoma: A Meta-Analysis. Ann Thorac Cardiovasc Surg 2023; 29:177-184. [PMID: 36792204 PMCID: PMC10466118 DOI: 10.5761/atcs.ra.22-00219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE We intended to study the effect of thoracic endovascular aortic repair (TEVAR) and optimal medical treatment (OMT) on type B intramural hematoma (BIMH). METHODS We searched PubMed, EMbase, Cochrane Library, and China National Knowledge Infrastructure databases that compared TEVAR and OMT in patients with BIMH. Two authors independently assessed the risk of bias using the Newcastle-Ottawa Scale. The rate ratio (RR) and 95% confidence interval were used to calculate the outcome. The primary endpoints were aortic-related death and regression/resolution. Secondary endpoints were all-cause death, progression to dissection, and secondary intervention. RESULTS Eight observational studies were included in the analysis. TEVAR reduced aortic-related death (RR 0.22, 95% CI 0.08-0.56, P = 0.002, I² = 24%) and promoted hematoma regression/resolution (RR 1.48, 95% CI 1.05-2.10, P <0.05, I² = 71%) compared to OMT. Moreover, TEVAR was associated with a reduction in progression to dissection (RR 0.32, 95% CI 0.13-0.81, P <0.02, I² = 39%) and secondary intervention (RR 0.18, 95% CI 0.09-0.37, P <0.00001, I² = 38%) compared to OMT. However, all-cause death has no significant difference between the two groups (RR 0.45, 95% CI 0.17-1.19, P = 0.11, I² = 58%). CONCLUSIONS The results of this meta-analysis suggested that TEVAR is an effective treatment for BIMH, which can delay the progression of intramural hematoma and promotes regression/resolution. More research about indications of TEVAR is still needed.
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Affiliation(s)
- Jingyuan Li
- College of Life Science and Biopharmaceutical, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Xiaoyu Qu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Xiu Jia
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yinghui Gong
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Tienan Zhou
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Xiaozeng Wang
- College of Life Science and Biopharmaceutical, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
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Wei C, Li J, Du E, Miao Y, Li P, Guan W. Clinical and imaging differences between Stanford Type B intramural hematoma-like lesions and classic aortic dissection. BMC Cardiovasc Disord 2023; 23:378. [PMID: 37507680 PMCID: PMC10386763 DOI: 10.1186/s12872-023-03413-6] [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: 03/19/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Intramural hematoma (IMH) and Aortic dissection (AD) have overlapping features. The aim of this study was to explore the differences between them by comparing the clinical manifestations and imaging features of patients with acute Stanford type B IMH-like lesions and acute Stanford type B AD (ATBAD). METHODS This study retrospectively analysed the clinical and computed tomography angiography (CTA) imaging data of 42 IMH-like lesions patients with ulcer-like projection (ULP) and 38 ATBAD patients, and compared their clinical and imaging features. RESULTS (1) The IMH-like lesions patients were older than the ATBAD patients (64.2 ± 11.5 vs. 50.9 ± 12.2 years, P < 0.001). The D-dimer level in the IMH-like lesions group was significantly higher than that in the ATBAD group (11.2 ± 3.6 vs. 9.2 ± 4.5 mg/L, P < 0.05). The incidence rate of back pain was significantly higher in the ATBAD group than in the IMH-like lesions group (71.1% vs. 26.2%, P < 0.05). (2) The ULPs of IMH-like lesions and the intimal tears of ATBAD were concentrated in zone 4 of the descending thoracic aorta. The ULPs of IMH-like lesions and the intimal tears of ATBAD were mainly in the upper quadrant outside the lumen (64.3% vs. 65.8%, P > 0.05). (3) The maximum diameter of the ULPs in IMH-like lesions was smaller than that of the intimal tears in ATBAD (7.4 ± 3.4 vs. 10.8 ± 6.8 mm, P = 0.005). The lumen compression ratio in the ULPs plane and the maximum compression ratio of the aortic lumen in the IMH-like lesions group were smaller than that in the ADBAD group (P < 0.05). Fewer aortic segments were involved in IMH-like lesions patients than in ATBAD patients (5.6 ± 2.2 vs. 7.1 ± 1.9 segments, P < 0.005). The IMH-like lesions group had less branch involvement than that of the ATBAD group (P < 0.001). CONCLUSION The degree of intimal tears, lumen compression ratio, extent of lesion involvement, and impact on branch arteries in ATBAD are more severe than that of IMH-like lesions. But for the ULPs of IMH-like lesions and intimal tears of ATBAD, they have astonishing similarities in the location of the partition and the lumen quadrant, we have reason to believe that intimal tear is the initial factor in the pathogenesis of this kind of disease, and their clinical and imaging manifestations overlap, but the severity is different. Concerning similarities between these two conditions, these two may be a spectrum of one disease.
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Affiliation(s)
- Chuanbin Wei
- The Third Clinical College of Xinxiang Medical University, Xinxiang, China
| | - Jinping Li
- Department of Radiology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Enhui Du
- The Third Clinical College of Xinxiang Medical University, Xinxiang, China
| | - Yulu Miao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Pinpin Li
- Department of Radiology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Wenhua Guan
- Department of Radiology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
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Puppo Moreno AM, Bravo-Gil N, Méndez-Vidal C, Adsuar Gómez A, Gómez Ruiz FT, Jiménez De Juan C, Fernández García RM, Martín Bermúdez R, López Sánchez JM, Martín Sastre S, Fernández Caro M, Gallego P, Borrego S. Genetic profile in patients with complicated acute aortic syndrome: the GEN-AOR study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:434-443. [PMID: 36307044 DOI: 10.1016/j.rec.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/10/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Genetic testing is becoming increasingly important for diagnosis and personalized treatments in aortopathies. Here, we aimed to genetically diagnose a group of acute aortic syndrome (AAS) patients consecutively admitted to an intensive care unit and to explore the clinical usefulness of AAS-associated variants during treatment decision-making and family traceability. METHODS We applied targeted next-generation sequencing, covering 42 aortic diseases genes in AAS patients with no signs consistent with syndromic conditions. Detected variants were segregated by Sanger sequencing in available family members. Demographic features, risk factors and clinical symptoms were statistically analyzed by Fisher or Fisher-Freeman-Halton Exact tests, to assess their relationship with genetic results. RESULTS Analysis of next-generation sequencing data in 73 AAS patients led to the detection of 34 heterozygous candidate variants in 14 different genes in 32 patients. Family screening was performed in 31 relatives belonging to 9 families. We found 13 relatives harboring the family variant, of which 10 showed a genotype compatible with the occurrence of AAS. Statistical tests revealed that the factors associated with a positive genetic diagnosis were the absence of hypertension, lower age, family history of AAS and absence of pain. CONCLUSIONS Our findings broaden the spectrum of the genetic background for AAS. In addition, both index patients and studied relatives benefited from the results obtained, establishing the most appropriate level of surveillance for each group. Finally, this strategy could be reinforced by the use of stastistically significant clinical features as a predictive tool for the hereditary character of AAS. CLINICALTRIALS gov (Identifier: NCT04751058).
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Affiliation(s)
- Antonio M Puppo Moreno
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Seville, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Seville, Spain.
| | - Nereida Bravo-Gil
- Departamento de Medicina Maternofetal, Genética y Reproducción, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Seville, Spain
| | - Cristina Méndez-Vidal
- Departamento de Medicina Maternofetal, Genética y Reproducción, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Seville, Spain
| | - Alejandro Adsuar Gómez
- Departamento de Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - F Tadeo Gómez Ruiz
- Departamento de Cirugía Vascular, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Carlos Jiménez De Juan
- Departamento de Medicina Interna, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Raquel M Fernández García
- Departamento de Medicina Maternofetal, Genética y Reproducción, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Seville, Spain
| | | | | | - Sara Martín Sastre
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Manuel Fernández Caro
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Pastora Gallego
- Departamento de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Salud Borrego
- Departamento de Medicina Maternofetal, Genética y Reproducción, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Seville, Spain
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9
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Yang M. Acute Lung Injury in aortic dissection : new insights in anesthetic management strategies. J Cardiothorac Surg 2023; 18:147. [PMID: 37069575 PMCID: PMC10109228 DOI: 10.1186/s13019-023-02223-3] [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: 11/02/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
Acute aortic dissection (AAD) is a severe cardiovascular disease characterized by rapid progress and a high mortality rate. The incidence of acute aortic dissection is approximately 5 to 30 per 1 million people worldwide. In clinical practice, about 35% of AAD patients are complicated with acute lung injury (ALI). AAD complicated with ALI can seriously affect patients' prognosis and even increase mortality. However, the pathogenesis of AAD combined with ALI remains largely unknown. Given the public health burden of AAD combined with ALI, we reviewed the anesthetic management advances and highlighted potential areas for clinical practice.
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Affiliation(s)
- Ming Yang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China.
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10
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Carrel T, Sundt TM, von Kodolitsch Y, Czerny M. Acute aortic dissection. Lancet 2023; 401:773-788. [PMID: 36640801 DOI: 10.1016/s0140-6736(22)01970-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/04/2022] [Accepted: 09/27/2022] [Indexed: 01/13/2023]
Abstract
Although substantial progress has been made in the prevention, diagnosis, and treatment of acute aortic dissection, it remains a complex cardiovascular event, with a high immediate mortality and substantial morbidity in individuals surviving the acute period. The past decade has allowed a leap forward in understanding the pathophysiology of this disease; the existing classifications have been challenged, and the scientific community moves towards a nomenclature that is likely to unify the current definitions according to morphology and function. The most important pathophysiological pathway, namely the location and extension of the initial intimal tear, which causes a disruption of the media layer of the aortic wall, together with the size of the affected aortic segments, determines whether the patient should undergo emergency surgery, an endovascular intervention, or receive optimal medical treatment. The scientific evidence for the management and follow-up of acute aortic dissection continues to evolve. This Seminar provides a clinically relevant overview of potential prevention, diagnosis, and management of acute aortic dissection, which is the most severe acute aortic syndrome.
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Affiliation(s)
- Thierry Carrel
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts' General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yskert von Kodolitsch
- Department of Vascular Medicine, German Aortic Center, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany; Faculty of Medicine, Albert Ludwig University Freiburg, Freiburg, Germany
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11
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Perone F, Guglielmo M, Coceani M, La Mura L, Dentamaro I, Sabatino J, Gimelli A. The Role of Multimodality Imaging Approach in Acute Aortic Syndromes: Diagnosis, Complications, and Clinical Management. Diagnostics (Basel) 2023; 13:diagnostics13040650. [PMID: 36832136 PMCID: PMC9954850 DOI: 10.3390/diagnostics13040650] [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: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Acute aortic syndromes are life-threatening conditions with high morbidity and mortality. The principal pathological feature is acute wall damage with possible evolution towards aortic rupture. Accurate and timely diagnosis is mandatory to avoid catastrophic consequences. Indeed, misdiagnosis with other conditions mimicking acute aortic syndromes is associated with premature death. In this view, cardiovascular imaging is necessary for the correct diagnosis and management. Echocardiography, computed tomography, magnetic resonance imaging, and aortography allow for diagnosis, guarantee immediate treatment, and detect associated complications. Multimodality imaging is essential in the diagnostic work-up to confirm or rule out acute aortic syndromes. The aim of this review is to highlight the contemporary evidence on the role of single cardiovascular imaging techniques and multimodality imaging in the diagnosis and management of acute aortic syndromes.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Michele Coceani
- Diagnostic and Interventional Cardiology Unit, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80133 Naples, Italy
| | - Ilaria Dentamaro
- Cardiology Department and Cardiovascular Imaging Laboratory, Hospital Miulli, 70124 Bari, Italy
| | - Jolanda Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Correspondence:
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12
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Zhang Z, Lin F, He Z, Wang H, Zhu X, Cheng T. Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience. Front Surg 2023; 9:1071600. [PMID: 36684296 PMCID: PMC9849559 DOI: 10.3389/fsurg.2022.1071600] [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: 10/16/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Objective To compare the clinical characteristics of Stanford type B aortic intramural hematoma (IMH) and Stanford type B aortic dissection (AD), and to identify the differences between thoracic endovascular aortic repair (TEVAR) and medical management (MM) in the Stanford type B IMH patients. Methods A retrospective observational study was conducted in patients treated between January 2015 and December 2016. The clinical characteristics and CT images of patients with type B IMH and type B AD were compared, and the clinical characteristics and CT images of patients in the type B IMH group who were treated with TEVAR and MM were compared. Results A total of 176 patients were included in this study, including 62 patients of type B IMH and 114 patients of type B AD. Five patients died in the IMH group and three in the AD group. The proximal hematoma or entry tear in both groups was mainly located in the descending aorta, and the proportion of the iliac artery involved in the AD group was significantly higher than that in the IMH group (31.6% vs. 8.1% P < 0.05). There were 50 MM patients and 12 TEVAR patients in the IMH group. No death occurred in the TEVAR group, while five patients in the MM group died. Seven patients in the MM group had disease progression vs. 12 in the TEVAR group (P < 0.05). The patients in the TEVAR group had more intima lesions than those in the MM group (83.3% vs. 30.0%, P < 0.05). TEVAR group involved more iliac artery hematoma than MM group (33.3% vs. 2.0%, P < 0.05). The maximum thickness of hematoma in TEVAR group was 14.9 ± 3.4 mm, which was significantly larger than that of MM group (10.2 ± 2.8 mm) (P < 0.05). Conclusion In the diagnosis of IMH, patients' symptoms and high-risk signs of CTA should be paid attention to. TEVAR therapy should be actively considered on the basis of effective medical management when there are intima lesions (ULP/PAU), increased aortic diameter and hematoma thickness, extensive hematoma involvement, and pleural effusion.
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Affiliation(s)
- Zhigong Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Correspondence: Zhigong Zhang
| | - Feng Lin
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Anhui Public Health Clinical Center, Hefei, China
| | - Zhipeng He
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haoran Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingyang Zhu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Anhui Public Health Clinical Center, Hefei, China
| | - Tingting Cheng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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13
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Puppo Moreno AM, Bravo-Gil N, Méndez-Vidal C, Adsuar Gómez A, Gómez Ruiz FT, Jiménez De Juan C, Fernández García RM, Martín Bermúdez R, López Sánchez JM, Martín Sastre S, Fernández Caro M, Gallego P, Borrego S. Perfil genético asociado a pacientes con síndrome aórtico agudo complicado: el estudio GEN-AOR. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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14
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Zhu H, Bu H. Hybrid Surgical Technology: Suturing and Ballooning of Stent in Aortic Dissection. Ann Thorac Surg 2023; 115:286-287. [PMID: 35216994 DOI: 10.1016/j.athoracsur.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Hong Zhu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008 China
| | - Haisong Bu
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, 410008 China.
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15
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Carrel T, Sromicki J, Schmiady M, Aser R, Ouda A, Vogt PR. Aortic wrapping is life-saving in high-risk acute aortic dissection and intramural haematoma. Interact Cardiovasc Thorac Surg 2022; 35:6751791. [PMID: 36205640 PMCID: PMC9580516 DOI: 10.1093/icvts/ivac254] [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: 07/29/2022] [Revised: 09/14/2022] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential alternative to medical treatment or conventional repair in patients aged >80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively.
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Affiliation(s)
- Thierry Carrel
- Corresponding author. Clinic for Cardiac Surgery, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland. Tel: +41 44 244 47 29; e-mail: (T. Carrel)
| | - Juri Sromicki
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
| | - Martin Schmiady
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
| | - Raed Aser
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
| | - Ahmed Ouda
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
| | - Paul Robert Vogt
- Department of Cardiac Surgery, Clinic for Cardiac Surgery, University Hospital, Zürich, Switzerland
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