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Klopf J, Zagrapan B, Brandau A, Lechenauer P, Candussi CJ, Rossi P, Celem ND, Ziegler M, Fuchs L, Hayden H, Krenn CG, Eilenberg W, Neumayer C, Brostjan C. Circulating monocyte populations as biomarker for abdominal aortic aneurysms: a single-center retrospective cohort study. Front Immunol 2024; 15:1418625. [PMID: 39139559 PMCID: PMC11319298 DOI: 10.3389/fimmu.2024.1418625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/05/2024] [Indexed: 08/15/2024] Open
Abstract
Background Abdominal aortic aneurysm (AAA) development is driven by inflammation, in particular myeloid cells, which represent attractive biomarker candidates. Yet to date, the maximum aortic diameter is the only clinically applied predictor of AAA progression and indicator for surgical repair. We postulated that aortic inflammation is reflected in a systemic change of monocyte populations, which we investigated regarding marker potential in AAA diagnosis and prognosis. Methods We conducted a single-center retrospective cohort study in a diagnostic setting, measuring monocyte subsets by flow cytometry in peripheral blood samples of 47 AAA patients under surveillance, matched with 25 healthy controls and 25 patients with peripheral artery disease (PAD). In a prognostic setting, we acquired longitudinal data of 60 AAA patients including aneurysm growth assessment by computed tomography at 6-month intervals. Results Blood levels of total monocytes, CD16+ monocytes and particularly intermediate monocytes were significantly increased in AAA patients versus healthy individuals and were also elevated compared to PAD patients. The combination of intermediate monocyte and D-dimer blood levels outperformed the individual diagnostic marker values. Additionally, the elevated concentrations of total monocytes, intermediate monocytes, and monocyte-platelet aggregates (MPA) were suited to predict rapid AAA progression over short-term periods of six months. Of note, MPA were identified as independent predictor of AAA disease progression in multivariable analysis. Conclusion Circulating monocyte subsets are elevated in AAA patients and support diagnosis and prediction of aneurysm progression. Monocyte subsets and D-dimer reflect different hallmarks (inflammation and hemostasis) of AAA pathology and when combined, may serve as improved biomarker.
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Affiliation(s)
- Johannes Klopf
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Branislav Zagrapan
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Annika Brandau
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Peter Lechenauer
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Catharina J. Candussi
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Patrick Rossi
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Nihan Dide Celem
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Michael Ziegler
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Lukas Fuchs
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Hubert Hayden
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Claus G. Krenn
- Intensive Care Medicine and Pain Medicine, Department of Anesthesia, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery, University Hospital Vienna, Medical University of Vienna, Vienna, Austria
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Alexander KC, Ikonomidis JS, Akerman AW. New Directions in Diagnostics for Aortic Aneurysms: Biomarkers and Machine Learning. J Clin Med 2024; 13:818. [PMID: 38337512 PMCID: PMC10856211 DOI: 10.3390/jcm13030818] [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: 12/22/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
This review article presents an appraisal of pioneering technologies poised to revolutionize the diagnosis and management of aortic aneurysm disease, with a primary focus on the thoracic aorta while encompassing insights into abdominal manifestations. Our comprehensive analysis is rooted in an exhaustive survey of contemporary and historical research, delving into the realms of machine learning (ML) and computer-assisted diagnostics. This overview draws heavily upon relevant studies, including Siemens' published field report and many peer-reviewed publications. At the core of our survey lies an in-depth examination of ML-driven diagnostic advancements, dissecting an array of algorithmic suites to unveil the foundational concepts anchoring computer-assisted diagnostics and medical image processing. Our review extends to a discussion of circulating biomarkers, synthesizing insights gleaned from our prior research endeavors alongside contemporary studies gathered from the PubMed Central database. We elucidate the prevalent challenges and envisage the potential fusion of AI-guided aortic measurements and sophisticated ML frameworks with the computational analyses of pertinent biomarkers. By framing current scientific insights, we contemplate the transformative prospect of translating fundamental research into practical diagnostic tools. This narrative not only illuminates present strides, but also forecasts promising trajectories in the clinical evaluation and therapeutic management of aortic aneurysm disease.
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Affiliation(s)
| | | | - Adam W. Akerman
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.C.A.); (J.S.I.)
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Zagrapan B, Klopf J, Celem ND, Brandau A, Rossi P, Gordeeva Y, Szewczyk AR, Liu L, Ahmadi-Fazel D, Najarnia S, Fuchs L, Hayden H, Loewe C, Eilenberg W, Neumayer C, Brostjan C. Diagnostic Utility of a Combined MPO/D-Dimer Score to Distinguish Abdominal Aortic Aneurysm from Peripheral Artery Disease. J Clin Med 2023; 12:7558. [PMID: 38137627 PMCID: PMC10743483 DOI: 10.3390/jcm12247558] [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: 10/25/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) and peripheral artery disease (PAD) share pathophysiological mechanisms including the activation of the fibrinolytic and innate immune system, which explains the analysis of D-dimer and myeloperoxidase (MPO) in both conditions. This study evaluates the diagnostic marker potential of both variables separately and as a combined MPO/D-dimer score for identifying patients with AAA versus healthy individuals or patients with PAD. Plasma levels of MPO and D-dimer were increased in PAD and AAA compared to healthy controls (median for MPO: 13.63 ng/mL [AAA] vs. 11.74 ng/mL [PAD] vs. 9.16 ng/mL [healthy], D-dimer: 1.27 μg/mL [AAA] vs. 0.58 μg/mL [PAD] vs. 0.38 μg/mL [healthy]). The combined MPO/D-dimer score (median 1.26 [AAA] vs. -0.19 [PAD] vs. -0.93 [healthy]) showed an improved performance in distinguishing AAA from PAD when analysed using the receiver operating characteristic curve (area under the curve) for AAA against the pooled data of healthy controls + PAD: 0.728 [MPO], 0.749 [D-dimer], 0.801 [score]. Diagnostic sensitivity and specificity ranged at 82.9% and 70.2% (for score cut-off = 0). These findings were confirmed for a separate collective of AAA patients with 35% simultaneous PAD. Thus, evaluating MPO together with D-dimer in a simple score may be useful for diagnostic detection and the distinction of AAA from athero-occlusive diseases like PAD.
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Affiliation(s)
- Branislav Zagrapan
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Johannes Klopf
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Nihan Dide Celem
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Annika Brandau
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Patrick Rossi
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Yulia Gordeeva
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Alexandra Regina Szewczyk
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Linda Liu
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Diana Ahmadi-Fazel
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Sina Najarnia
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Lukas Fuchs
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Hubert Hayden
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Christian Loewe
- Department for Bioimaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria;
| | - Wolf Eilenberg
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Christoph Neumayer
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Christine Brostjan
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Muller M, Labrouche-Colomer S, Bérard X, Biais M, James C, Roullet S. Study of Thrombotic Complications After Open Abdominal Aortic Aneurysm Surgery With Or Without Infection. Eur J Vasc Endovasc Surg 2023; 66:286-287. [PMID: 37225054 DOI: 10.1016/j.ejvs.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Mélissa Muller
- Service d'anesthésie-réanimation Pellegrin Tripode, CHU de Bordeaux, Bordeaux, France.
| | | | - Xavier Bérard
- Service de chirurgie vasculaire et générale, CHU de Bordeaux, Bordeaux, France
| | - Matthieu Biais
- Service d'anesthésie-réanimation Pellegrin Tripode, CHU de Bordeaux, Bordeaux, France
| | - Chloé James
- Service d'hématologie biologique, CHU de Bordeaux, Bordeaux, France
| | - Stéphanie Roullet
- Hôpital Paul Brousse, AP-HP Université Paris Saclay, Service d'Anesthésie-Réanimation, Villejuif, France
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Grønbæk SK, Høgh J, Knudsen AD, Pham MHC, Sigvardsen PE, Fuchs A, Kühl JT, Køber L, Gerstoft J, Benfield T, Ostrowski SR, Kofoed KF, Nielsen SD. Aortic aneurysms and markers of platelet activation, hemostasis, and endothelial disruption in people living with HIV. Front Immunol 2023; 14:1115894. [PMID: 36817421 PMCID: PMC9933775 DOI: 10.3389/fimmu.2023.1115894] [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: 12/04/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction People living with HIV (PLWH) are at twice the risk of developing cardiovascular diseases and have more than four times higher odds of aortic aneurysm (AA) than the uninfected population. However, biomarkers of AA in PLWH are yet to be discovered. We aimed to investigate whether circulating biomarkers reflecting platelet activation, hemostasis and endothelial disruption, i.e. sCD40L, D-dimer, syndecan-1, and thrombomodulin, were associated with AA in PLWH. Methods Five hundred seventy one PLWH from the Copenhagen Comorbidity in HIV Infection (COCOMO) study ≥40 years of age with an available contrast-enhanced CT scan as well as available biomarker analyses were included. The biomarkers were analyzed on thawed plasma. For each biomarker, we defined high level as a concentration in the upper quartile and low level as a concentration below the upper quartile. For D-dimer, the cut-off was defined as the lower limit of detection. Using unadjusted and adjusted logistic and linear regression models, we analyzed associations between AA and sCD40L, D-dimer, syndecan-1, and thrombomodulin, respectively in PLWH. Results PLWH had median (IQR) age 52 years (47-60), 88% were male, median (IQR) time since HIV diagnosis was 15 years (8-23), and 565 (99%) were currently on antiretroviral treatment. High level of sCD40L was associated with lower odds of AA in both unadjusted (odds ratio, OR, 0.23 (95% CI 0.07-0.77; P=0.017)) and adjusted models (adjusted OR, aOR, 0.23 (95% CI 0.07-0.78; P=0.019)). Detectable level of D-dimer was associated with higher odds of AA in both unadjusted (OR 2.76 (95% CI 1.34-5.67; P=0.006)) and adjusted models (aOR 2.22 (95% CI 1.02-4.85; P=0.045)). Conclusions SCD40L was associated with lower odds of AA whereas D-dimer was independently associated with higher odds of AA in PLWH. This calls for further investigations into specific biomarkers to aid early diagnosis of AA in PLWH.
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Affiliation(s)
- Sylvester Klöcker Grønbæk
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,*Correspondence: Susanne Dam Nielsen, ; Sylvester Klöcker Grønbæk,
| | - Julie Høgh
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Huy Cuong Pham
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per Ejlstrup Sigvardsen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,*Correspondence: Susanne Dam Nielsen, ; Sylvester Klöcker Grønbæk,
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Cai H, Pan B, Xu J, Liu S, Wang L, Wu K, Yang P, Huang J, Wang W. D-Dimer Is a Diagnostic Biomarker of Abdominal Aortic Aneurysm in Patients With Peripheral Artery Disease. Front Cardiovasc Med 2022; 9:890228. [PMID: 35722121 PMCID: PMC9203886 DOI: 10.3389/fcvm.2022.890228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEtiology and risk factors of peripheral artery disease (PAD) include age, smoking, and hypertension, etc. , which are shared by an abdominal aortic aneurysm (AAA). Concomitance with AAA in patients with PAD is not rare but is easily overlooked in the clinical situation, though management strategies are altered totally. This study aims to investigate diagnostic biomarkers for the prediction of AAA in patients with PAD.MethodsA total of 684 patients diagnosed with AAA and/or PAD were enrolled and analyzed retrospectively. Each patient with PAD and AAA was gender and age-matched. Demographic data, medical history, and serum laboratory test profiles were obtained. Statistical analysis was performed to determine diagnostic biomarkers of AAA in patients with PAD.ResultsFirstly, 320 patients with PAD-only and 320 patients with AAA-only were compared. Levels of bilirubin and D-Dimer were decreased, while the incidence of diabetes mellitus, levels of fibrinogen, and platelet count were increased significantly in patients with PAD-only compared with those in patients with AAA-only (P < 0.001). Next, 364 patients with PAD (44 patients with AAA) and 364 patients with AAA (44 patients with PAD) were compared. Multivariate logistic regression analysis confirmed the differential distribution of bilirubin, D-dimer, fibrinogen, and platelet count between patients with AAA and patients with PAD (P < 0.05). Receiver operator curves (ROC) showed that the area under the curve (AUC) of total bilirubin, direct bilirubin, D-dimer, fibrinogen, and platelet count was 0.6113, 0.5849, 0.7034, 0.6473, and 0.6785, respectively. Finally, to further validate the predictive efficacy of mentioned markers, a multivariable logistics regression analysis was performed between the PAD only group and the PAD with AAA group. The results suggested increased levels of D-dimer in the PAD with AAA group compared to the PAD only group (OR: 2.630, 95% CI:1.639–4.221; P < 0.001). In particular, the Youden index suggested that the cut-off value of D-dimer for predicting AAA in patients with PAD was 0.675 mg/L with a sensitivity of 76.9% and a specificity of 84.9% (AUC = 0.8673; 95% CI, 0.8106–0.9240, P < 0.001). In all 364 patients with PAD, 41.46% patients were diagnosed AAA when D-dimer is >0.675 mg/L, while only 3.55% patients were diagnosed AAA when D-dimer ≤ 0.675 mg/L.ConclusionsPAD and AAA exert different clinical and serum profiles; D-dimer (>0.675 mg/L) is a reliable biomarker for the prediction of AAA in patients with PAD.
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Affiliation(s)
- Huoying Cai
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Baihong Pan
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
| | - Shuai Liu
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Wang
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Kemin Wu
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Pu Yang
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jianhua Huang
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Wang
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Wei Wang
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Hemostatic Biomarkers and Volumetry Help to Identify High-Risk Abdominal Aortic Aneurysms. Life (Basel) 2022; 12:life12060823. [PMID: 35743854 PMCID: PMC9225361 DOI: 10.3390/life12060823] [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: 04/29/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Predicting the progression of small aneurysms is a main challenge in abdominal aortic aneurysm (AAA) management. The combination of circulating biomarkers and image techniques might provide an alternative for risk stratification. We evaluated the association of plasma TAT complexes (TAT) and D-dimer with AAA severity in 3 groups of patients: group 1, without AAA (n = 52), group 2, AAA 40−50 mm (n = 51) and group 3, AAA > 50 mm (n = 50). TAT (p < 0.001) and D-dimer (p < 0.001) were increased in patients with AAA (groups 2 and 3) vs. group 1. To assess the association between baseline TAT and D-dimer concentrations, and AAA growth, aortic diameter and volume (volumetry) were measured by computed tomography angiography (CTA) in group 2 at recruitment (baseline) and 1-year after inclusion. Baseline D-dimer and TAT levels were associated with AAA diameter and volume variations at 1-year independently of confounding factors (p ≤ 0.044). Additionally, surgery incidence, recorded during a 4-year follow-up in group 2, was associated with larger aneurysms, assessed by aortic diameter and volumetry (p ≤ 0.036), and with elevated TAT levels (sub-hazard ratio 1.3, p ≤ 0.029), while no association was found for D-dimer. The combination of hemostatic parameters and image techniques might provide valuable tools to evaluate AAA growth and worse evolution.
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Neutrophils as Regulators and Biomarkers of Cardiovascular Inflammation in the Context of Abdominal Aortic Aneurysms. Biomedicines 2021; 9:biomedicines9091236. [PMID: 34572424 PMCID: PMC8467789 DOI: 10.3390/biomedicines9091236] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/22/2022] Open
Abstract
Neutrophils represent up to 70% of circulating leukocytes in healthy humans and combat infection mostly by phagocytosis, degranulation and NETosis. It has been reported that neutrophils are centrally involved in abdominal aortic aneurysm (AAA) pathogenesis. The natural course of AAA is growth and rupture, if left undiagnosed or untreated. The rupture of AAA has a very high mortality and is currently among the leading causes of death worldwide. The use of noninvasive cardiovascular imaging techniques for patient screening, surveillance and postoperative follow-up is well established and recommended by the current guidelines. Neutrophil-derived biomarkers may offer clinical value to the monitoring and prognosis of AAA patients, allowing for potential early therapeutic intervention. Numerous promising biomarkers have been studied. In this review, we discuss neutrophils and neutrophil-derived molecules as regulators and biomarkers of AAA, and our aim was to specifically highlight diagnostic and prognostic markers. Neutrophil-derived biomarkers may potentially, in the future, assist in determining AAA presence, predict size, expansion rate, rupture risk, and postoperative outcome once validated in highly warranted future prospective clinical studies.
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10
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Sidloff DA, Saratzis A, Thompson J, Katsogridakis E, Bown MJ. Editor's Choice - Infra-Renal Aortic Diameter and Cardiovascular Risk: Making Better Use of Abdominal Aortic Aneurysm Screening Outcomes. Eur J Vasc Endovasc Surg 2021; 62:38-45. [PMID: 33985908 DOI: 10.1016/j.ejvs.2021.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Aortic diameter (AD), used traditionally for abdominal aortic aneurysm (AAA) screening may have a role in assessing cardiovascular risk. Unfortunately, AD estimates for those without AAA are underutilised, whilst cardiovascular risk is sub-optimally managed in those with AAA. Our objective was to examine the association between AD measurements and future cardiovascular risk. METHODS Retrospective analysis of three databases of male participants screened for aortic aneurysm disease. Imaging and clinical data were obtained from three independent sources: 1) the Multi-centre Aneurysm Screening Study (MASS) trial (n = 26 882 men); 2) the 2013/14 cohort of the English NHS AAA Screening Programme (NAAASP) (n = 237 441 men) linked with NHS hospital admission and death registry data; and 3) the Framingham Heart Study (FHS) offspring cohort (n = 649). Associations between maximal aortic diameter, as measured on ultrasound or computed tomography, and cardiovascular outcomes were examined. RESULTS Cardiovascular mortality in the MASS trial, was higher in men with AAA at 13 years of follow up, compared to those without (Hazard Ratio [HR] 2.22, 95% CI 1.97-2.50, p < .001). Contemporary risk of major adverse cardiovascular events in the NAAASP was highest in those with an AAA (HR 2.91, 95% CI 2.00-4.25), whilst, extremes of aortic diameter were associated with increased risk for cardiovascular events. Aortic diameter was an independent risk factor for cardiovascular events in the FHS dataset. CONCLUSION Irrespective of the diagnosis of AAA, men attending for AAA screening who are found to have an abnormal aortic diameter are at high risk of future cardiovascular events. This currently unutilised data from AAA screening programmes has the potential to improve preventative management of cardiovascular risk.
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Affiliation(s)
- David A Sidloff
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - John Thompson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Emmanuel Katsogridakis
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom.
| | - Matt J Bown
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
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11
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MicroRNAs in ascending thoracic aortic aneurysms. Biosci Rep 2021; 40:225830. [PMID: 32678444 PMCID: PMC7385583 DOI: 10.1042/bsr20200218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/07/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023] Open
Abstract
Thoracic Aortic Aneurysm (TAA) is characterized by the dilation of the aorta and is fatal if not diagnosed and treated appropriately. The underlying genetic mechanisms have not been completely delineated, so better knowledge of the physiopathology of TAAs is needed to improve detection and therapy. MicroRNAs (miRNAs) regulate gene expression post-transcriptionally and are known to be involved in cardiovascular diseases (CVDs). The current study aimed to identify miRNAs that can be used as possible biomarkers for the early diagnosis of patients with ascending TAAs (ATAAs). MiRNA expression was profiled by NanoString nCounter technology using 12 samples including tissue and pre- and post-surgical plasma from ATAA patients. Four miRNAs were selected and further validated by real time polymerase chain reaction (RT-PCR) in 22 plasma samples from which three miRNAs (hsa-miR140-5p, hsa-miR-191-5p and hsa-miR-214-3p) showed significant expression level differences between the two types of plasma samples. Further analyses of the corresponding predicted target genes by these miRNAs, revealed two genes (Myotubularin-related protein 4 (MTMR4) and Phosphatase 1 catalytic subunit β (PPP1CB)) whose expression was inversely correlated with the expression of their respective miRNAs. Overall, in this pilot study, we identified three miRNAs that might serve as potential biomarkers and therapeutic targets in ATAA.
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12
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Toczek J, Boodagh P, Sanzida N, Ghim M, Salarian M, Gona K, Kukreja G, Rajendran S, Wei L, Han J, Zhang J, Jung JJ, Graham M, Liu X, Sadeghi MM. Computed tomography imaging of macrophage phagocytic activity in abdominal aortic aneurysm. Theranostics 2021; 11:5876-5888. [PMID: 33897887 PMCID: PMC8058712 DOI: 10.7150/thno.55106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Inflammation plays a major role in the pathogenesis of several vascular pathologies, including abdominal aortic aneurysm (AAA). Evaluating the role of inflammation in AAA pathobiology and potentially outcome in vivo requires non-invasive tools for high-resolution imaging. We investigated the feasibility of X-ray computed tomography (CT) imaging of phagocytic activity using nanoparticle contrast agents to predict AAA outcome. Methods: Uptake of several nanoparticle CT contrast agents was evaluated in a macrophage cell line. The most promising agent, Exitron nano 12000, was further characterized in vitro and used for subsequent in vivo testing. AAA was induced in Apoe-/- mice through angiotensin II (Ang II) infusion for up to 4 weeks. Nanoparticle biodistribution and uptake in AAA were evaluated by CT imaging in Ang II-infused Apoe-/- mice. After imaging, the aortic tissue was harvested and used from morphometry, transmission electron microscopy and gene expression analysis. A group of Ang II-infused Apoe-/- mice underwent nanoparticle-enhanced CT imaging within the first week of Ang II infusion, and their survival and aortic external diameter were evaluated at 4 weeks to address the value of vessel wall CT enhancement in predicting AAA outcome. Results: Exitron nano 12000 showed specific uptake in macrophages in vitro. Nanoparticle accumulation was observed by CT imaging in tissues rich in mononuclear phagocytes. Aortic wall enhancement was detectable on delayed CT images following nanoparticle administration and correlated with vessel wall CD68 expression. Transmission electron microscopy ascertained the presence of nanoparticles in AAA adventitial macrophages. Nanoparticle-induced CT enhancement on images obtained within one week of AAA induction was predictive of AAA outcome at 4 weeks. Conclusions: By establishing the feasibility of CT-based molecular imaging of phagocytic activity in AAA, this study links the inflammatory signal on early time point images to AAA evolution. This readily available technology overcomes an important barrier to cross-sectional, longitudinal and outcome studies, not only in AAA, but also in other cardiovascular pathologies and facilitates the evaluation of modulatory interventions, and ultimately upon clinical translation, patient management.
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Affiliation(s)
- Jakub Toczek
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Parnaz Boodagh
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Nowshin Sanzida
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Mean Ghim
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Mani Salarian
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Kiran Gona
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Gunjan Kukreja
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Saranya Rajendran
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Linyan Wei
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Jinah Han
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Jiasheng Zhang
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Jae-Joon Jung
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
| | - Morven Graham
- CCMI Electron Microscopy Core Facility, Yale University School of Medicine, New Haven, CT (USA)
| | - Xinran Liu
- CCMI Electron Microscopy Core Facility, Yale University School of Medicine, New Haven, CT (USA)
| | - Mehran M. Sadeghi
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (USA)
- Veterans Affairs Connecticut Healthcare System, West Haven, CT (USA)
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13
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Rouer M, Monnot A, Fuda M, Pochulu B, Palmier M, Thomas P, Benadiba L, Plissonnier D. Post-EVAR Thrombus Density on Late Non-Contrast CT Scans Predicts Successful Aneurysm Exclusion. Vasc Endovascular Surg 2020; 55:239-244. [PMID: 33342395 DOI: 10.1177/1538574420980621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The incidence of type II endoleaks (ELII) after endovascular aneurysm repair (EVAR) ranges from 10-44%. Aneurysm thrombus density after EVAR could predict successful aneurysm exclusion. MATERIALS AND METHODS Twenty-seven patients with an abdominal aortic aneurysm (AAA) who had a CT scan within the first 45 days (early group) post-surgery or after 7 months (late group) were included. Thrombus density was analyzed on non-contrast enhanced CT scans. RESULTS A total of 5/13 (38%) patients in the early group had an ELII and 9/14 (64.3%) in the late group had a persistent ELII since surgery. In the early group, thrombus density was similar in patients with or without an ELII (mean: 39.9 ± 4.8 vs. 41.9 ± 3.4, p = 0.7; median: 38.7 ± 4.8 vs. 39.7 ± 3.1, p = 0.8). In patients with an ELII, there was no difference in thrombus density at 45 days and after 7 months (mean: 39.9 ± 4.8 vs. 40.2 ± 2.1, p = 0.9; median: 38.7 ± 4.8 vs. 38 ± 2.6, p = 0.9). In patients without an ELII, thrombus density was significantly higher at 45 days than after 7 months (mean: 41.9 ± 3.44 vs. 25.7 ± 2.0, p = 0.005; median: 39.7 ± 3.11 vs. 24.4 ± 1.5, p = 0.004). In patients with an ELII, thrombus density was significantly higher after 7 months than in patients without an ELII (mean: 40.2 ± 2.1 vs. 25.7 ± 2.0. p = 0.001; median: 38 ± 2.6 vs. 24.4 ± 1.5, p = 0.003). CONCLUSION Low thrombus density after EVAR on late unenhanced CT scans predicts aneurysm exclusion.
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Affiliation(s)
- Martin Rouer
- Department of Vascular Surgery, 55474HPVA, Ramsay Générale de Santé, France
| | - Antoine Monnot
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Michelangelo Fuda
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Bruno Pochulu
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Mickael Palmier
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Pascale Thomas
- Department of Vascular Surgery, Clinique Saint Hilaire, Rouen, France
| | - Laurent Benadiba
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
| | - Didier Plissonnier
- Department of Vascular Surgery, 55052Rouen University Hospital, Rouen, France
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14
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DeRoo E, Zhou T, Liu B. The Role of RIPK1 and RIPK3 in Cardiovascular Disease. Int J Mol Sci 2020; 21:E8174. [PMID: 33142926 PMCID: PMC7663726 DOI: 10.3390/ijms21218174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular diseases, including peripheral arterial and venous disease, myocardial infarction, and stroke, are the number one cause of death worldwide annually. In the last 20 years, the role of necroptosis, a newly identified form of regulated necrotic cell death, in cardiovascular disease has come to light. Specifically, the damaging role of two kinase proteins pivotal in the necroptosis pathway, Receptor Interacting Protein Kinase 1 (RIPK1) and Receptor Interacting Protein Kinase 3 (RIPK3), in cardiovascular disease has become a subject of great interest and importance. In this review, we provide an overview of the current evidence supporting a pathologic role of RIPK1 and RIPK3 in cardiovascular disease. Moreover, we highlight the evidence behind the efficacy of targeted RIPK1 and RIPK3 inhibitors in the prevention and treatment of cardiovascular disease.
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Affiliation(s)
| | | | - Bo Liu
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; (E.D.); (T.Z.)
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15
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Polok K, Górka J, Fronczek J, Iwaniec T, Górka K, Szczeklik W. Perioperative cardiovascular complications rate and activity of coagulation and fibrinolysis among patients undergoing vascular surgery for peripheral artery disease and abdominal aortic aneurysm. Vascular 2020; 29:134-142. [PMID: 32600160 DOI: 10.1177/1708538120937127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare preoperative coagulation and fibrinolysis activity and incidence of perioperative complications between patients undergoing vascular procedures for peripheral artery disease and abdominal aortic aneurysm. METHODS This is a substudy of a prospective observational cohort study (VISION; NCT00512109) in which we recruited patients aged ≥45 years, undergoing surgery for peripheral artery disease and abdominal aortic aneurysm. Blood samples were obtained 24 h preoperatively to measure platelet count, concentrations of coagulation coagulation (fibrinogen, factor VIII, von Willebrand factor:Ristocetin cofactor, antithrombin III), fibrinolysis (dimer D, plasmin-antiplasmin complexes, tissue plasminogen activator) markers and level of soluble CD40 ligand. Incidence of myocardial infarction, stroke, and death (composite endpoint) was assessed in 30-day follow-up. RESULTS The study group included 131 patients at the mean age of 68.3 years among whom reason for surgery was peripheral artery disease in 77 patients (58.8%) and abdominal aortic aneurysm in 54 patients (41.2%). Peripheral artery disease group was characterized by higher platelet count (250.5 versus 209.5 (×103/µl), p = 0.001), concentrations of fibrinogen (5.4 versus 4.1 (g/l), p < 0.001), factor VIII (176.9 versus 141.9 (%), p < 0.001), von Willebrand factor:Ristocetin cofactor (188.9 versus 152.3 (%), p = 0.009), and soluble CD40 ligand (9016.0 versus 7936.6 (pg/ml), p = 0.005). The dimer D level was higher (808.0 versus 2590.5 (ng/ml), p < 0.001) in the abdominal aortic aneurysm group. Incidence of major cardiovascular events (death, myocardial infarction, stroke) within 30 days from surgery did not differ between the groups (39.0% versus 29.6%, p = 0.27). CONCLUSIONS The study suggests higher activation of coagulation and relatively lower fibrinolytic activity in peripheral artery disease group compared to patients undergoing surgery for abdominal aortic aneurysm without a significant difference in cardiovascular outcomes.
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Affiliation(s)
- Kamil Polok
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.,Department of Pulmonology, II Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Górka
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Teresa Iwaniec
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Górka
- Department of Pulmonology, II Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
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16
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von Kodolitsch Y, Demolder A, Girdauskas E, Kaemmerer H, Kornhuber K, Muino Mosquera L, Morris S, Neptune E, Pyeritz R, Rand-Hendriksen S, Rahman A, Riise N, Robert L, Staufenbiel I, Szöcs K, Vanem TT, Linke SJ, Vogler M, Yetman A, De Backer J. Features of Marfan syndrome not listed in the Ghent nosology – the dark side of the disease. Expert Rev Cardiovasc Ther 2020; 17:883-915. [DOI: 10.1080/14779072.2019.1704625] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yskert von Kodolitsch
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Anthony Demolder
- Center for Medical Genetics and Department of Cardiology, Ghent University Hospital, VASCERN HTAD European Reference Centre, Ghent, Belgium
| | - Evaldas Girdauskas
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich of the Free State of Bavaria, Munich
| | - Katharina Kornhuber
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich of the Free State of Bavaria, Munich
| | - Laura Muino Mosquera
- Department of Pediatric Cardiology and Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Shaine Morris
- Department of Pediatrics-Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Enid Neptune
- Division of Pulmonary and Critical Care Medicine and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reed Pyeritz
- Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Svend Rand-Hendriksen
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Alexander Rahman
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover
| | - Nina Riise
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Leema Robert
- Department of Clinical Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ingmar Staufenbiel
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover
| | - Katalin Szöcs
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Thy Thy Vanem
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Stephan J. Linke
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Ophthalmological practice at the University Clinic Hamburg-Eppendorf, zentrumsehstärke, Hamburg, Germany
| | - Marina Vogler
- German Marfan Association, Marfan Hilfe Deutschland e.V, Eutin, Germany
| | - Anji Yetman
- Vascular Medicine, Children’s Hospital and Medical Center, Omaha, USA
| | - Julie De Backer
- Center for Medical Genetics and Department of Cardiology, Ghent University Hospital, VASCERN HTAD European Reference Centre, Ghent, Belgium
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17
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Fan YN, Ke X, Yi ZL, Lin YQ, Deng BQ, Shu XR, Yang DH, Liao ZY, Nie RQ. Plasma D-dimer as a predictor of intraluminal thrombus burden and progression of abdominal aortic aneurysm. Life Sci 2020; 240:117069. [PMID: 31751582 DOI: 10.1016/j.lfs.2019.117069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM Intraluminal thrombus (ILT) is presented in most abdominal aortic aneurysms (AAAs) and is suggested to promote AAA expansion. D-dimer, a breakdown product in the thrombus remodeling, may have prognostic value for AAA. This study investigated the interrelation between plasma D-dimer level, ILT volume, AAA size and progression. MAIN METHODS This was a retrospective observational study that involved 181 patients with infra-renal AAA. They were divided into small and large AAA groups according to AAA diameter. 24 of them had repeated abdominal computed tomography angiography (CTA) scan and were divided into slow-growing and fast-growing AAA groups according to the median value of AAA growth rate. Baseline and follow-up plasma D-dimer level, maximum diameter of AAA, total infra-renal aortic volume and ILT volume were analyzed. KEY FINDINGS Plasma D-dimer level was positively correlated with ILT volume (R = 0.382, P < 0.001) and maximum diameter of AAA (R = 0.442, P < 0.001). Increasing value of plasma D-dimer was positively associated with the accelerated growth rate of AAA (R = 0.720, P < 0.01). ILT volume showed positive correlation with maximum diameter (R = 0.859, P < 0.001) and growth rate of AAA (R = 0.490, P < 0.05). After adjusting the baseline ILT volume, the positive correlations remained to be statistically significant between plasma D-dimer level and AAA size (R = 0.200, P < 0.05), as well as increasing value of plasma D-dimer and growth rate of AAA (R = 0.642, P < 0.05). SIGNIFICANCE Plasma D-dimer level reflected ILT burden in AAAs. Plasma D-dimer level and ILT volume were positively correlated with AAA size. Increasing value of plasma D-dimer and baseline ILT volume could be predictors of AAA progression.
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Affiliation(s)
- Ying-Nan Fan
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Xiao Ke
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Zhi-Long Yi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Yong-Qing Lin
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Bing-Qing Deng
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Xiao-Rong Shu
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Da-Hao Yang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Zhi-Yong Liao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Ru-Qiong Nie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
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18
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Kornhuber KTI, Seidel H, Pujol C, Meierhofer C, Röschenthaler F, Pressler A, Stöckl A, Nagdyman N, Neidenbach RC, von Hundelshausen P, Halle M, Holdenrieder S, Ewert P, Kaemmerer H, Hauser M. Hemostatic abnormalities in adult patients with Marfan syndrome. Cardiovasc Diagn Ther 2019; 9:S209-S220. [PMID: 31737529 DOI: 10.21037/cdt.2019.08.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Aortic root ectasia might induce hemostatic disorders in patients with Marfan syndrome (MFS) via altered blood flow and rheology. The aim of this study was to explore the hemostasis in patients with MFS compared with healthy controls. Methods In this cross-sectional case-control study we included patients with verified MFS (n=51) and sex- and age-matched healthy controls (n=50). Main criteria were the aortic root in echocardiography and cardiac magnetic resonance imaging (MRI), and the coagulation status. Results When compared with healthy controls, patients with MFS showed significantly increased diameters of the aortic roots (43.0±7.72 vs. 28.8±3.74 mm, P<0.001) and aortic Z-scores (4.36±2.77 vs. 0.948±1.09, P<0.001), considerably higher values of Multiplate® tests (e.g., MP-ADP: 878.4±201.7 vs. 660.4±243.6 AU*min, P<0.001) and PFA-100® tests (PFA Col/ADP: 102.5±45.5 vs. 91.1±46.2 s, P<0.05), PTT (30.0±3.91 vs. 28.7±2.50 s, P<0.05) and D-dimers (0.488±0.665 vs. 0.254±0.099 mg/L, P<0.001). In MFS von Willebrand factor (VWF) activity (81.9%±41.8% vs. 106.3%±41.5%, P<0.05) and antigen (93.8%±43.9% vs. 118.8%±47.8%, P<0.05) and factor VIII activity (108.9%±29.6% vs. 126.7%±28.4%, P<0.05) were reduced. Significant positive correlations were found between aortic diameters and D-dimers (all P<0.05), as well as PFA Col/ADP (all P<0.01) in MFS patients. Factor VIII activity correlated significantly negatively with the diameter of the aortic root in MFS (r=-0.55, P<0.05). Conclusions In conclusion, our study reveals hemostatic deviations in patients with MFS. Further studies are necessary to understand the causal relationship and the exact pathomechanism.
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Affiliation(s)
- Katharina T I Kornhuber
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Heide Seidel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Claudia Pujol
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Christian Meierhofer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Franz Röschenthaler
- Institute of Laboratory Medicine, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Axel Pressler
- Outpatients' Clinic for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Alexander Stöckl
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Rhoia C Neidenbach
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Philipp von Hundelshausen
- Institute for Cardiovascular Prevention, Faculty of Medicine, Ludwig Maximilian University, Munich, Germany
| | - Martin Halle
- Outpatients' Clinic for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Michael Hauser
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
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19
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Prognostic value of D-dimer and markers of coagulation for stratification of abdominal aortic aneurysm growth. Blood Adv 2019; 2:3088-3096. [PMID: 30442686 DOI: 10.1182/bloodadvances.2017013359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) is associated with high morbidity and mortality and is an established cause of unbalanced hemostasis. A number of hemostatic biomarkers have been associated with AAA; however, the utility of hemostatic biomarkers in AAA diagnosis and prognosis is unclear. The aim of the present study was to characterize the potential prognostic value of D-dimer and markers of altered hemostasis in a large cohort of patients with AAAs characterized by either fast or slow aneurysm growth (frequency matched for baseline diameter) and subaneurysmal dilations. We measured plasma concentrations of thrombin-antithrombin (TAT) complex, platelet factor 4 (PF4), and D-dimer in 352 patients with either fast-growing AAAs (>2 mm/y), slow-growing AAAs (<2 mm/y), subaneurysmal aortic dilations, or nonaneurysmal aortas. Plasma D-dimer and TAT were significantly elevated in both AAA and subaneurysmal dilation patients compared with controls. Individuals with D-dimer levels ≥500 ng/mL had 3.09 times the odds of subaneurysms, 6.23 times the odds of slow-growing AAAs, and 7.19 times the odds of fast-growing AAAs than individuals with D-dimer level <500 ng/mL. However, no differences in D-dimer concentration were noted between fast- and slow-growing aneurysms. Plasma D-dimer and TAT were strong independent predictors of AAA growth rate with multivariate analysis revealing a 500-ng/mL increase in D-dimer or 1-µg/mL increase in TAT led to additional 0.21-mm and 0.24-mm changes in aortic diameter per year, respectively. Rising levels of plasma TAT, in addition to D-dimer, may predict disease progression and aneurysm growth in patients with AAA or subaneurysmal dilation.
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20
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Rašiová M, Koščo M, Špak Ľ, Moščovič M, Židzik J, Slabá E, Habalová V, Farkašová Ľ, Hudák M, Tkáč I. Higher preprocedural fibrinogen levels are associated with aneurysm sac regression after EVAR. VASA 2019; 48:347-354. [DOI: 10.1024/0301-1526/a000783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Summary. Background: The aim of our study was to determine the diameter of the aneurysm sac 24 months after endovascular abdominal aortic aneurysm repair (EVAR); to identify factors associated with sac regression, and to determine the impact of sac regression on all-cause mortality during long-term follow-up. Patients and methods: We conducted a retrospective review of prospectively collected data from patients treated with EVAR between January, 2010 and July, 2016. Sac regression was defined as at least 5 mm decrease in aneurysm diameter in relation to the preprocedural diameter seen on computed tomography angiography. Sociodemographic information, comorbidities, treatment, laboratory parameters, selected anatomical and genetic factors were all analysed to determine their impact on sac regression. Results: During the study period, 124 patients with mean age of 71.2 ± 7.2 years met the inclusion criteria. Sac regression was found in 45.2% of patients. Higher preprocedural fibrinogen was found in patients with sac regression in comparison with patients with stable sac or sac expansion (3.84 g/l vs 3.47 g/l; p = 0.028). In multivariate analysis after adjustment for age, hypertension, sex, smoking, dyslipidaemia, volume and percentage of intraluminal thrombus higher fibrinogen was associated with an increased probability of sac regression (OR 2.47; 95% CI 1.29–4.72; p = 0.006). Persistent type II endoleak was associated with significantly lower probability of sac regression in univariate and multivariate analysis after adjustment for age, hypertension, sex, smoking and dyslipidaemia (OR 0.26; 95% CI 0.10–0.66; p = 0.004). Higher age was a significant predictor of sac regression in multivariate analysis after adjustment for hypertension, sex, smoking and dyslipidaemia (OR 1.07; 95% CI 1.02–1.14; p = 0.012). No difference was found between patient subgroups with and without sac regression in all-cause mortality during follow-up. Conclusions: Higher preprocedural fibrinogen, absence of persistent type II endoleak and higher age were predictive factors of aneurysm sac regression post-EVAR.
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Affiliation(s)
- Mária Rašiová
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
- Faculty of Medicine, Department of Internal Medicine 4, Šafárik University, Slovakia
| | - Martin Koščo
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
| | - Ľubomír Špak
- Department of Interventional Angiology, Štefan Kukura Hospital, Michalovce, Slovakia
| | - Matej Moščovič
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
| | - Jozef Židzik
- Faculty of Medicine, Department of Medicine Biology, Šafárik University, Slovakia
| | - Eva Slabá
- Faculty of Medicine, Department of Medicine Biology, Šafárik University, Slovakia
| | - Viera Habalová
- Faculty of Medicine, Department of Medicine Biology, Šafárik University, Slovakia
| | - Ľudmila Farkašová
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
| | - Marek Hudák
- Faculty of Medicine, Angiology Clinic, East Slovak Institute of Cardiovascular Diseases, Šafárik University, Slovakia
| | - Ivan Tkáč
- Faculty of Medicine, Department of Internal Medicine 4, Šafárik University, Slovakia
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21
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Potential Medication Treatment According to Pathological Mechanisms in Abdominal Aortic Aneurysm. J Cardiovasc Pharmacol 2019; 71:46-57. [PMID: 28953105 DOI: 10.1097/fjc.0000000000000540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a vascular disease with high mortality. Because of the lack of effective medications to stop or reverse the progression of AAA, surgical operation has become the most predominant recommendation of treatment for patients. There are many potential mechanisms, including inflammation, smooth muscle cell apoptosis, extracellular matrix degradation, oxidative stress, and so on, involving in AAA pathogenesis. According to those mechanisms, some potential therapeutic drugs have been proposed and tested in animal models and even in clinical trials. This review focuses on recent advances in both pathogenic mechanisms and potential pharmacologic therapies of AAA.
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22
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Cameron SJ, Russell HM, Owens AP. Antithrombotic therapy in abdominal aortic aneurysm: beneficial or detrimental? Blood 2018; 132:2619-2628. [PMID: 30228233 PMCID: PMC6302498 DOI: 10.1182/blood-2017-08-743237] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/10/2018] [Indexed: 12/13/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative vascular pathology resulting in significant morbidity and mortality in older adults due to rupture and sudden death. Despite 150 000 new cases and nearly 15 000 deaths annually, the only approved treatment of AAA is surgical or endovascular intervention when the risk for aortic rupture is increased. The goal of the scientific community is to develop novel pharmaceutical treatment strategies to reduce the need for surgical intervention. Because most clinically relevant AAAs contain a complex structure of fibrin, inflammatory cells, platelets, and red blood cells in the aneurysmal sac known as an intraluminal thrombus (ILT), antithrombotic therapies have emerged as potential pharmaceutical agents for the treatment of AAA progression. However, the efficacy of these treatments has not been shown, and the effects of shrinking the ILT may be as detrimental as they are beneficial. This review discusses the prospect of anticoagulant and antiplatelet (termed collectively as antithrombotic) therapies in AAA. Herein, we discuss the role of the coagulation cascade and platelet activation in human and animal models of AAA, the composition of ILT in AAA, a possible role of the ILT in aneurysm stabilization, and the implications of antithrombotic drugs in AAA treatment.
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Affiliation(s)
- Scott J Cameron
- Department of Medicine (Cardiology) and
- Department of Surgery (Cardiac Surgery), University of Rochester School of Medicine, Rochester, NY; and
| | - Hannah M Russell
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
| | - A Phillip Owens
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
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23
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Kapetanios DM, Karkos CD, Papazoglou KO. Changes in circulating markers of coagulation and fibrinolysis after EVAR. INT ANGIOL 2018; 37:444-450. [DOI: 10.23736/s0392-9590.18.04046-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Identification of Potential Plasma Biomarkers for Abdominal Aortic Aneurysm Using Tandem Mass Tag Quantitative Proteomics. Proteomes 2018; 6:proteomes6040043. [PMID: 30340394 PMCID: PMC6313917 DOI: 10.3390/proteomes6040043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022] Open
Abstract
Plasma biomarkers that identify abdominal aortic aneurysm (AAA) rupture risk would greatly assist in stratifying patients with small aneurysms. Identification of such biomarkers has hitherto been unsuccessful over a range of studies using different methods. The present study used an alternative proteomic approach to find new, potential plasma AAA biomarker candidates. Pre-fractionated plasma samples from twelve patients with AAA and eight matched controls without aneurysm were analyzed by mass spectrometry applying a tandem mass tag (TMT) technique. Eight proteins were differentially regulated in patients compared to controls, including decreased levels of the enzyme bleomycin hydrolase. The down-regulation of this enzyme was confirmed in an extended validation study using an enzyme-linked immunosorbent assay (ELISA). The TMT-based proteomic approach thus identified novel potential plasma biomarkers for AAA.
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25
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Yokoyama U, Arakawa N, Ishiwata R, Yasuda S, Minami T, Goda M, Uchida K, Suzuki S, Matsumoto M, Koizumi N, Taguri M, Hirano H, Yoshimura K, Ogino H, Masuda M, Ishikawa Y. Proteomic analysis of aortic smooth muscle cell secretions reveals an association of myosin heavy chain 11 with abdominal aortic aneurysm. Am J Physiol Heart Circ Physiol 2018; 315:H1012-H1018. [DOI: 10.1152/ajpheart.00329.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a life-threatening disease, and no disease-specific circulating biomarkers for AAA screening are currently available. We have identified a smooth muscle cell (SMC)-specific biomarker for AAA. We cultured aneurysmal tunica media that were collected from eight patients undergoing elective open-repair surgeries. Secreted proteins in culture medium were subjected to liquid chromatography/tandem mass spectrometry. Myosin heavy chain 11 (myosin-11) was identified as a SMC-specific protein in the tunica media-derived secretions of all patients. We then examined myosin-11 protein concentrations by ELISA in plasma samples from patients with AAA ( n = 35) and age-matched healthy control subjects ( n = 34). Circulating myosin-11 levels were significantly higher in patients with AAA than control subjects. The area under the receiver-operating characteristic curve (AUC) of myosin-11 was 0.77, with a specificity of 65% at a sensitivity of 91%. Multivariate logistic regression analysis showed a significant association between the myosin-11 level and presence of AAA. When the myosin-11 level was combined with hypertension, it improved the prediction of AAA (AUC 0.88) more than hypertension per se. We then investigated the correlation between aortic diameter and circulating myosin-11 levels using AAA serum samples from patients undergoing endovascular aneurysm repair ( n = 20). Circulating myosin-11 levels were significantly correlated with maximum aortic diameter. Furthermore, changes in myosin-11 concentrations from the baseline 12 mo after endovascular aneurysm repair were associated with those in aortic diameter. These data suggest that circulating levels of myosin-11, which is a SMC-specific myosin isoform, may be useful as a biomarker for AAA. NEW & NOTEWORTHY Extensive studies have revealed that inflammation- or proteolysis-related proteins are proposed as biomarkers for abdominal aortic aneurysm (AAA). Changes in these protein concentrations are not specific for smooth muscle, which is a major part of AAA pathologies. Hence, no disease-specific circulating markers for AAA are currently available. We found, using secretome-based proteomic analysis on human AAA tunica media, that myosin heavy chain 11 was associated with AAA. Circulating myosin heavy chain 11 may be a new tissue-specific AAA marker.
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Affiliation(s)
- Utako Yokoyama
- Cardiovascular Research Institute, Yokohama City University, Yokohama, Japan
| | - Noriaki Arakawa
- Department of Medical Life Science, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Japan
- Division of Medicinal Safety Science, National Institute of Health Sciences, Kawasaki, Japan
| | - Ryo Ishiwata
- Cardiovascular Research Institute, Yokohama City University, Yokohama, Japan
| | - Shota Yasuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tomoyuki Minami
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Motohiko Goda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinichi Suzuki
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masataka Matsumoto
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Nobusato Koizumi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Hisashi Hirano
- Advanced Medical Research Center, Yokohama City University, Yokohama, Japan
| | - Koichi Yoshimura
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
- Graduate School of Health and Welfare, Yamaguchi Prefectural University, Yamaguchi, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Munetaka Masuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiro Ishikawa
- Cardiovascular Research Institute, Yokohama City University, Yokohama, Japan
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26
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Botnar RM, Brangsch J, Reimann C, Janssen CHP, Razavi R, Hamm B, Makowski MR. In Vivo Molecular Characterization of Abdominal Aortic Aneurysms Using Fibrin-Specific Magnetic Resonance Imaging. J Am Heart Assoc 2018; 7:e007909. [PMID: 29848500 PMCID: PMC6015382 DOI: 10.1161/jaha.117.007909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/24/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The incidence of abdominal aortic aneurysms (AAAs) will significantly increase during the next decade. Novel biomarkers, besides diameter, are needed for a better characterization of aneurysms and the estimation of the risk of rupture. Fibrin is a key protein in the formation of focal hematoma associated with the dissection of the aortic wall and the development of larger thrombi during the progression of AAAs. This study evaluated the potential of a fibrin-specific magnetic resonance (MR) probe for the in vivo characterization of the different stages of AAAs. METHODS AND RESULTS AAAs spontaneously developed in ApoE-/- mice following the infusion of angiotensin-II (Ang-II, 1 μg/kg-1·per minute). An established fibrin-specific molecular MR probe (EP2104R, 10 μmol/kg-1) was administered after 1 to 4 weeks following Ang-II infusion (n=8 per group). All imaging experiments were performed on a clinical 3T Achieva MR system with a microscopy coil (Philips Healthcare, Netherlands). The development of AAA-associated fibrin-rich hematoma and thrombi was assessed. The high signal generated by the fibrin probe enabled high-resolution MR imaging for an accurate assessment and quantification of the relative fibrin composition of focal hematoma and thrombi. Contrast-to-noise-ratios (CNRs) and R1-relaxation rates following the administration of the fibrin probe were in good agreement with ex vivo immunohistomorphometry (R2=0.83 and 0.85) and gadolinium concentrations determined by inductively coupled plasma mass spectroscopy (R2=0.78 and 0.72). CONCLUSIONS The fibrin-specific molecular MR probe allowed the delineation and quantification of changes in fibrin content in early and advanced AAAs. Fibrin MRI could provide a novel in vivo biomarker to improve the risk stratification of patients with aortic aneurysms.
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MESH Headings
- Angiotensin II
- Animals
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/chemically induced
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/genetics
- Aortic Aneurysm, Abdominal/metabolism
- Disease Models, Animal
- Fibrin/metabolism
- Magnetic Resonance Imaging
- Male
- Mice, Inbred C57BL
- Mice, Knockout, ApoE
- Molecular Imaging/methods
- Predictive Value of Tests
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Affiliation(s)
- René M Botnar
- Division of Imaging Sciences, King's College London, London, United Kingdom
- BHF Centre of Excellence, King's College London, London, United Kingdom
- Wellcome Trust and EPSRC Medical Engineering Center, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre, King's College London, London, United Kingdom
| | | | | | | | - Reza Razavi
- Division of Imaging Sciences, King's College London, London, United Kingdom
- BHF Centre of Excellence, King's College London, London, United Kingdom
- Wellcome Trust and EPSRC Medical Engineering Center, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre, King's College London, London, United Kingdom
| | - Bernd Hamm
- Department of Radiology, Charite, Berlin, Germany
| | - Marcus R Makowski
- Division of Imaging Sciences, King's College London, London, United Kingdom
- Department of Radiology, Charite, Berlin, Germany
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27
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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28
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Wang Y, Shen G, Wang H, Yao Y, Sun Q, Jing B, Liu G, Wu J, Yuan C, Liu S, Liu X, Li S, Li H. Association of high sensitivity C-reactive protein and abdominal aortic aneurysm: a meta-analysis and systematic review. Curr Med Res Opin 2017; 33:2145-2152. [PMID: 28699805 DOI: 10.1080/03007995.2017.1354825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the association of high sensitivity C-reactive protein (hsCRP) with the presence of abdominal aortic aneurysm (AAA). METHODS Medline, Cochrane, Embase, and Google Scholar databases were searched until 22 June 2016 using the keywords predictive factors, biomarkers, abdominal aortic aneurysm, prediction, high sensitivity C-reactive protein, and hsCRP. Prospective studies, retrospective studies, and cohort studies were included. RESULTS Twelve case-control studies were included in the meta-analysis with a total of 8345 patients (1977 in the AAA group and 6368 in the control group). The pooled results showed that AAA patients had higher hsCRP value than the control group (difference in means = 1.827, 95% CI = 0.010 to 3.645, p = .049). Subgroup analysis found AAA patients with medium or small aortic diameter (<50 mm) had higher hsCRP plasma levels than the control group (difference in means = 1.301, 95% CI = 0.821 to 1.781, p < .001). In patients with large aortic diameter (≥50 mm), no difference was observed in hsCRP levels between the AAA and control groups (difference in means = 1.769, 95% CI = -1.387 to 4.925, p = .272). Multi-regression analysis found the difference in means of hsCRP plasma levels between AAA and control groups decreased as aortic diameter increased (slope = -0.04, p < .001), suggesting that hsCRP levels may be inversely associated with increasing aneurysm size. CONCLUSIONS Our findings suggest that hsCRP levels may possibly be used as a diagnostic biomarker for AAA patients with medium or small aortic diameter but not for AAA patients with large aortic diameter. The correlation between serum hsCRP level and AAA aneurysm is not conclusive due to the small number of included articles and between-study heterogeneity.
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Affiliation(s)
- Yunpeng Wang
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Guanghui Shen
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Haiyang Wang
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Ye Yao
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Qingfeng Sun
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Bao Jing
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Gaoyan Liu
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Jia Wu
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Chao Yuan
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Siqi Liu
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Xinyu Liu
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Shiyong Li
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Haocheng Li
- a Department of Vascular Surgery , The First Affiliated Hospital of Harbin Medical University , Harbin , China
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29
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Is there a role for biomarkers in thoracic aortic aneurysm disease? Gen Thorac Cardiovasc Surg 2017; 67:12-19. [PMID: 29080094 DOI: 10.1007/s11748-017-0855-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022]
Abstract
Thoracic aortic aneurysm (TAA) represents a major cause of mortality and morbidity in Western countries. The natural history of TAA is indolent, with patients usually being asymptomatic until a catastrophic event such as rupture or dissection ensues. As such, early diagnosis is crucial and the search is ongoing for a biomarker that can indicate the presence of TAA with sufficient accuracy to act as a screening tool. To date, no such marker has been developed for the diagnosis of non-familial or 'sporadic' TAA. However, our increased understanding of the pathogenesis of both familial and sporadic TAA has suggested potential candidates for diagnostic biomarkers. Many markers/pathways have been shown to have differential activity levels or expression in the aortic tissue of TAA. However, priority is given to markers that have shown differential levels in blood plasma, as blood tests represent the easiest route for mass screening for TAA. This review aims to evaluate the efficacy of clinical tests already in use in diagnosing TAA, explore novel proposed biomarkers and identify key areas of future interest.
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Ghulam Q, Bredahl K, Lönn L, Rouet L, Sillesen H, Eiberg J. Follow-up on Small Abdominal Aortic Aneurysms Using Three Dimensional Ultrasound: Volume Versus Diameter. Eur J Vasc Endovasc Surg 2017; 54:439-445. [DOI: 10.1016/j.ejvs.2017.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
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Circulating biomarkers are not associated with endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2017; 67:770-777. [PMID: 28843790 DOI: 10.1016/j.jvs.2017.06.090] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/07/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Endoleak is a common complication of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) but can be detected only through prolonged follow-up with repeated aortic imaging. This study examined the potential for circulating matrix metalloproteinase 9 (MMP9), osteoprotegerin (OPG), D-dimer, homocysteine (HCY), and C-reactive protein (CRP) to act as diagnostic markers for endoleak in AAA patients undergoing elective EVAR. METHODS Linear mixed-effects models were constructed to assess differences in AAA diameter after EVAR between groups of patients who did and did not develop endoleak during follow-up, adjusting for potential confounders. Circulating MMP9, OPG, D-dimer, HCY, and CRP concentrations were measured in preoperative and postoperative plasma samples. The association of these markers with endoleak diagnosis was assessed using linear mixed effects adjusted as before. The potential for each marker to diagnose endoleak was assessed using receiver operating characteristic curves. RESULTS Seventy-five patients were included in the study, 24 of whom developed an endoleak during follow-up. Patients with an endoleak had significantly larger AAA sac diameters than those who did not have an endoleak. None of the assessed markers showed a significant association with endoleak. This was confirmed through receiver operating characteristic curve analyses indicating poor diagnostic ability for all markers. CONCLUSIONS Circulating concentrations of MMP9, OPG, D-dimer, HCY, and CRP were not associated with endoleak in patients undergoing EVAR in this study.
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Vele E, Kurtcehajic A, Zerem E, Maskovic J, Alibegovic E, Hujdurovic A. Plasma D-dimer as a predictor of the progression of abdominal aortic aneurysm. J Thromb Haemost 2016; 14:2298-2303. [PMID: 27567003 DOI: 10.1111/jth.13487] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/08/2016] [Indexed: 08/31/2023]
Abstract
Essentials D-dimer could provide important information about abdominal aortic aneurysm (AAA) progression. The greatest diameter of the infrarenal aorta and the value of plasma D-dimer were determined. AAA progression is correlated with increasing plasma D-dimer levels. The increasing value of plasma D-dimer could be a predictor of aneurysm progression. SUMMARY Background The natural course of abdominal aortic aneurysm (AAA) is mostly asymptomatic and unpredictable. D-dimer could provide potentially important information about subsequent AAA progression. Objectives The aims of this study were to establish the relationship between the progression of an abdominal aortic aneurysm (AAA) and plasma D-dimer concentration over a 12-month period and determine the value of plasma D-dimer in patients with sub-aneurysmal aortic dilatation. Patients/Methods This was a prospective observational study that involved 33 patients with an AAA, 30 patients with sub-aneurysmal aortic dilatation and 30 control subjects. The greatest diameter of the infrarenal aorta, which was assessed by ultrasound, and the value of plasma D-dimer were determined for all subjects at baseline assessment, as well as after 12 months for those with an AAA. Results A positive correlation was found between the diameter of an AAA and plasma D-dimer concentration at the baseline and the control measurement stages. There was a strong positive correlation between AAA progression and increasing plasma D-dimer concentration over a 12-month period. Among patients with sub-aneurysmal aortic dilatation (n = 30), the value of plasma D-dimer was higher compared with matched controls (n = 30). Conclusions There is a strongly positive correlation between AAA progression and increasing plasma D-dimer concentration. The value of plasma D-dimer is higher in patients with sub-aneurysmal aortic dilatation than in control subjects.
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Affiliation(s)
- E Vele
- Department of Surgery, Cantonal Hospital 'Dr. Safet Mujic', Mostar, Bosnia and Herzegovina
| | - A Kurtcehajic
- Department of Internal Medicine, Medical Center 'Plava Poliklinika', Tuzla, Bosnia and Herzegovina
| | - E Zerem
- Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - J Maskovic
- Department of Radiology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - E Alibegovic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - A Hujdurovic
- Department of Internal Medicine, Medical Center 'Plava Poliklinika', Tuzla, Bosnia and Herzegovina
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Abstract
PURPOSE OF REVIEW Abdominal aortic aneurysm (AAA) is a pathological condition of permanent dilation that portends the potentially fatal consequence of aortic rupture. This review emphasizes recent advances in mechanistic insight into aneurysm pathogenesis and potential pharmacologic therapies that are on the horizon for AAAs. RECENT FINDINGS An increasing body of evidence demonstrates that genetic factors, including 3p12.3, DAB2IP, LDLr, LRP1, matrix metalloproteinase (MMP)-3, TGFBR2, and SORT1 loci, are associated with AAA development. Current human studies and animal models have shown that many leukocytes and inflammatory mediators, such as IL-1, IL-17, TGF-β, and angiotensin II, are involved in the pathogenesis of AAAs. Leukocytic infiltration into aortic media leads to smooth muscle cell depletion, generation of reactive oxygen species, and extracellular matrix fragmentation. Preclinical investigations into pharmacological therapies for AAAs have provided intriguing insight into the roles of microRNAs in regulating many pathological pathways in AAA development. Several large clinical trials are ongoing, seeking to translate preclinical findings into therapeutic options. SUMMARY Recent studies have identified many potential mechanisms involved in AAA pathogenesis that provide insight into the development of a medical treatment for this disease.
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Kotani Y, Toyofuku M, Tamura T, Shimada K, Matsuura Y, Tawa H, Uchikawa M, Higashi S, Fujimoto J, Yagita K, Sato F, Atagi Y, Hamasaki T, Tsujimoto T, Chishiro T. Validation of the diagnostic utility of D-dimer measurement in patients with acute aortic syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:223-231. [PMID: 27257263 DOI: 10.1177/2048872616652261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the validity of D-dimer measurements for the diagnosis of acute aortic syndrome in patients admitted to hospital with acute chest pain. METHODS A retrospective observational study design was used. Consecutive patients ( n=887) admitted to a tertiary hospital with acute chest pain (acute aortic syndrome, 123; acute pulmonary embolism, 29; and other disease, 735) from the emergency department between January 2011 and April 2014 were assessed to validate the diagnostic value of D-dimer measurements. RESULTS The D-dimer level was significantly increased in patients with acute aortic syndrome (median (interquartile range) 4.9 (2.0-17.4) µg/ml) compared with control patients (median (interquartile range) 0.6 (0.3-1.4) µg/ml; p<0.001). At a cut-off point of 0.5 μg/ml, the sensitivity for acute aortic syndrome was 0.97 (95% confidence interval 0.92-0.99) and was similar to that for acute pulmonary embolism (0.97 (0.82-0.99)). The age-adjusted D-dimer cut-off point, defined as age × 0.01 μg/ml in patients ⩾50 years, successfully reduced the number of false-positive diagnoses by 13%, while still retaining a high sensitivity (0.96 (0.91-0.99)). The five false-negative diagnoses of acute aortic syndrome included three patients with intramural haematoma, one patient with a penetrating aortic ulcer and one patient with an impending aortic rupture. A combination of probability assessment and the D-dimer approach reduced the number of false-negatives from five patients to two patients. CONCLUSIONS This study demonstrated that the D-dimer test can distinguish acute aortic syndrome from other diseases presenting with acute chest pain with high sensitivity and modest specificity. Using the D-dimer approach presents limitations with some subtypes of acute aortic syndrome, such as intramural haematoma.
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Affiliation(s)
- Yuki Kotani
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Mamoru Toyofuku
- 2 Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Takashi Tamura
- 2 Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Kotaro Shimada
- 3 Department of Radiology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Yushi Matsuura
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Hiroyuki Tawa
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Munehiro Uchikawa
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Sonoko Higashi
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Jumpei Fujimoto
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Kaoru Yagita
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Fumitaka Sato
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Yuichiro Atagi
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Toshiaki Hamasaki
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Toshihide Tsujimoto
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Takao Chishiro
- 1 Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Japan
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Abstract
Advances in mass spectrometry technology and bioinformatics using clinical human samples have expanded quantitative proteomics in cardiovascular research. There are two major proteomic strategies: namely, "gel-based" or "gel-free" proteomics coupled with either "top-down" or "bottom-up" mass spectrometry. Both are introduced into the proteomic analysis using plasma or serum sample targeting 'biomarker" searches of aortic aneurysm and tissue samples, such as from the aneurysmal wall, calcific aortic valve, or myocardial tissue, investigating pathophysiological protein interactions and post-translational modifications. We summarize the proteomic studies that analyzed human samples taken during cardiovascular surgery to investigate disease processes, in order to better understand the system-wide changes behind known molecular factors and specific signaling pathways.
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Affiliation(s)
- Teiji Oda
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Ken-ichi Matsumoto
- Department of Biosignaling and Radioisotope Experiment, Interdisciplinary Center for Science Research, Organization for Research, Shimane University, Izumo, Shimane, Japan
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Bruno RR, Donner-Banzhoff N, Söllner W, Frieling T, Müller C, Christ M. The Interdisciplinary Management of Acute Chest Pain. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:768-79; quiz 780. [PMID: 26585188 PMCID: PMC4660855 DOI: 10.3238/arztebl.2015.0768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/10/2015] [Accepted: 09/10/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute chest pain of non-traumatic origin is a common reason for presentation to physician's offices and emergency rooms. Coronary heart disease is the cause in up to 25% of cases. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goal-oriented management is mandatory. METHODS This review is based on pertinent articles and guidelines retrieved by a selective search in PubMed. RESULTS History-taking, physical examination, and a 12-lead electrocardiogram (ECG) are the first steps in the differential diagnostic process and generally allow the identification of features signifying a high risk of lifethreatening illness. If the ECG reveals ST-segment elevation, cardiac catheterization is indicated. The timedependent measurement of highly sensitive troponin values is a reliable test for the diagnosis or exclusion of acute myocardial infarction. A wide variety of other potential causes (e.g., vascular, musculoskeletal, gastroenterologic, or psychosomatic) must be identified from the history if they are to be treated appropriately. Elderly patients need special attention. CONCLUSION Acute chest pain is a major diagnostic challenge for the physician. Common errors are traceable to non-recognition of important causes and to an inadequate diagnostic work-up. Future studies should be designed to help optimize the interdisciplinary management of patients with chest pain.
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Affiliation(s)
- Raphael R Bruno
- Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuernberg
| | | | - Wolfgang Söllner
- Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University, Nuernberg
| | - Thomas Frieling
- Department of Gastroenterology, Hepatology, Neurogastroenterology, Infectiology, Hematology and Oncology, HELIOS Hospital Krefeld
| | - Christian Müller
- Department of Cardiology, University Hospital Basel, Switzerland
| | - Michael Christ
- Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuernberg
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Soomro AY, Guerchicoff A, Nichols DJ, Suleman J, Dangas GD. The current role and future prospects of D-dimer biomarker. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 2:175-84. [PMID: 27533759 DOI: 10.1093/ehjcvp/pvv039] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/23/2015] [Indexed: 11/14/2022]
Abstract
D-dimers have been discovered as by-products of fibrinolysis. In situations where the fundamental pathology is associated with increased thrombolytic activity, D-dimer assays could serve an integral role in the clinical workup, and have an already established role in the diagnosis of clinical disorders of venous thromboembolism, and disseminated intravascular coagulation. However, there is growing literature suggesting that this is not the only clinical scenario where D-dimers may be of significance. They may also become an important biomarker in coronary and carotid artery atherosclerosis and aortic diseases. Being a non-invasive and quick means of diagnosis, D-dimers are a cost-effective tool used for diagnosing diseases. With the future being steered in the direction of preventive cardiology, it is imperative for clinicians to understand how to effectively utilize biomarkers in order to diagnose disorders. In this context, we review D-dimer's origin, current clinical utility, and potential future applications.
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Affiliation(s)
- Armaghan Y Soomro
- Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Alejandra Guerchicoff
- Cardiac Research Foundation, NY111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Dru J Nichols
- Cardiac Research Foundation, NY111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Javed Suleman
- Mount Sinai Hospital, 1 Gustave L. Levy Place # 504, New York, NY 10029, USA
| | - George D Dangas
- Cardiac Research Foundation, NY111 East 59th Street, 12th Floor, New York, NY 10022, USA Mount Sinai Hospital, 1 Gustave L. Levy Place # 504, New York, NY 10029, USA
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Owens AP, Edwards TL, Antoniak S, Geddings JE, Jahangir E, Wei WQ, Denny JC, Boulaftali Y, Bergmeier W, Daugherty A, Sampson UK, Mackman N. Platelet Inhibitors Reduce Rupture in a Mouse Model of Established Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2015; 35:2032-2041. [PMID: 26139462 PMCID: PMC4552620 DOI: 10.1161/atvbaha.115.305537] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/17/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Rupture of abdominal aortic aneurysms causes a high morbidity and mortality in the elderly population. Platelet-rich thrombi form on the surface of aneurysms and may contribute to disease progression. In this study, we used a pharmacological approach to examine a role of platelets in established aneurysms induced by angiotensin II infusion into hypercholesterolemic mice. APPROACH AND RESULTS Administration of the platelet inhibitors aspirin or clopidogrel bisulfate to established abdominal aortic aneurysms dramatically reduced rupture. These platelet inhibitors reduced abdominal aortic platelet and macrophage recruitment resulting in decreased active matrix metalloproteinase-2 and matrix metalloproteinase-9. Platelet inhibitors also resulted in reduced plasma concentrations of platelet factor 4, cytokines, and components of the plasminogen activation system in mice. To determine the validity of these findings in human subjects, a cohort of aneurysm patients were retrospectively analyzed using developed and validated algorithms in the electronic medical record database at Vanderbilt University. Similar to mice, administration of aspirin or P2Y12 inhibitors was associated with reduced death among patients with abdominal aortic aneurysm. CONCLUSIONS These results suggest that platelets contribute to abdominal aortic aneurysm progression and rupture.
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Affiliation(s)
- A. Phillip Owens
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Todd L Edwards
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
- Division of Epidemiology, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
| | - Silvio Antoniak
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Julia E. Geddings
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Eiman Jahangir
- Department of Cardiovascular Diseases John Ochsner Heart and Vascular Institute Ochsner Clinical School - The University of Queensland School of Medicine New Orleans, LA 70115 Phone: 504-392-3131
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
| | - Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
| | - Yacine Boulaftali
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Wolfgang Bergmeier
- Department of Biochemistry and Biophysics, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Alan Daugherty
- Saha Cardiovascular Research Center University of Kentucky Lexington, KY 40536 Phone: 859-323-3512
| | - Uchechukwu K.A. Sampson
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
| | - Nigel Mackman
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
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Piechota-Polanczyk A, Jozkowicz A, Nowak W, Eilenberg W, Neumayer C, Malinski T, Huk I, Brostjan C. The Abdominal Aortic Aneurysm and Intraluminal Thrombus: Current Concepts of Development and Treatment. Front Cardiovasc Med 2015; 2:19. [PMID: 26664891 PMCID: PMC4671358 DOI: 10.3389/fcvm.2015.00019] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/10/2015] [Indexed: 01/09/2023] Open
Abstract
The pathogenesis of the abdominal aortic aneurysm (AAA) shows several hallmarks of atherosclerotic and atherothrombotic disease, but comprises an additional, predominant feature of proteolysis resulting in the degradation and destabilization of the aortic wall. This review aims to summarize the current knowledge on AAA development, involving the accumulation of neutrophils in the intraluminal thrombus and their central role in creating an oxidative and proteolytic environment. Particular focus is placed on the controversial role of heme oxygenase 1/carbon monoxide and nitric oxide synthase/peroxynitrite, which may exert both protective and damaging effects in the development of the aneurysm. Treatment indications as well as surgical and pharmacological options for AAA therapy are discussed in light of recent reports.
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Affiliation(s)
- Aleksandra Piechota-Polanczyk
- Department of Surgery, Medical University of Vienna , Vienna , Austria ; Department of Biochemistry, Medical University of Lodz , Lodz , Poland
| | - Alicja Jozkowicz
- Department of Medical Biotechnology, Jagiellonian University , Krakow , Poland
| | - Witold Nowak
- Department of Medical Biotechnology, Jagiellonian University , Krakow , Poland
| | - Wolf Eilenberg
- Department of Surgery, Medical University of Vienna , Vienna , Austria
| | | | - Tadeusz Malinski
- Department of Chemistry and Biochemistry, Ohio University , Athens, OH , USA
| | - Ihor Huk
- Department of Surgery, Medical University of Vienna , Vienna , Austria
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Bailey MA, Aggarwal R, Bridge KI, Griffin KJ, Iqbal F, Phoenix F, Purdell-Lewis J, Thomas T, Johnson AB, Ariëns RAS, Scott DJA, Ajjan RA. Aspirin therapy is associated with less compact fibrin networks and enhanced fibrinolysis in patients with abdominal aortic aneurysm. J Thromb Haemost 2015; 13:795-801. [PMID: 25660763 DOI: 10.1111/jth.12872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Thrombotic changes in fibrin networks contribute to increased cardiovascular risk in patients with abdominal aortic aneurysm (AAA). Given that aspirin modulates the fibrin network, we aimed to determine if aspirin therapy is associated with changes in ex-vivo fibrin clot characteristics in AAA patients and also conducted an exploratory analysis of 5-year mortality in these individuals. METHODS We recruited 145 male patients, divided into controls (aortic diameter < 3 cm, n = 49), AAA not taking aspirin (AAA-Asp, n = 50) and AAA on 75 mg day(-1) aspirin (AAA+Asp, n = 46), matched for aneurysm size. Characteristics of clots made from plasma and plasma-purified fibrinogen were investigated using turbidimetric analysis, permeation studies, and confocal and electron microscopy. Plasma fibrinogen, D-dimer and inflammatory marker levels were also measured. RESULTS Maximum absorbance (MA) of plasma clots from controls was lower than that of AAA patients not on aspirin (AAA-Asp) at 0.30 ± 0.01 and 0.38 ± 0.02 au, respectively (P = 0.002), whereas aspirin-treated subjects had MA similar to controls (0.31 ± 0.02 P = 0.9). Plasma clot lysis time displayed an identical pattern at 482 ± 15, 597 ± 24 and 517 ± 27 s for control, AAA-Asp and AAA+Asp (P = 0.001 and P = 0.8). The lysis time of clots made from purified fibrinogen of AAA-Asp was longer than that of AAA+Asp patients (756 ± 47 and 592 ± 52 s, respectively; P = 0.041). Permeation studies and confocal and electron microscopy showed increased clot density in AAA-Asp compared with the AAA+Asp group. Mortality in AAA-Asp and AAA+Asp was similar, despite increased cardiovascular risk in the latter group, and both exhibited higher mortality than controls. CONCLUSION Aspirin improves fibrin clot characteristics in patients with AAA, which may have important clinical implications.
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Affiliation(s)
- M A Bailey
- Division of Cardiovascular & Diabetes Research, School of Medicine, The Leeds Institute of Cardiovascular & Metabolic Medicine, The University of Leeds, Leeds, UK; The Leeds Vascular Institute, The Leeds General Infirmary, Leeds, UK
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Stather PW, Sylvius N, Sidloff DA, Dattani N, Verissimo A, Wild JB, Butt HZ, Choke E, Sayers RD, Bown MJ. Identification of microRNAs associated with abdominal aortic aneurysms and peripheral arterial disease. Br J Surg 2015; 102:755-66. [PMID: 25832031 DOI: 10.1002/bjs.9802] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/16/2014] [Accepted: 02/09/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND MicroRNAs are crucial in the regulation of cardiovascular disease and represent potential therapeutic targets to decrease abdominal aortic aneurysm (AAA) expansion. The aim of this study was to identify circulating microRNAs associated with AAA. METHODS Some 754 microRNAs in whole-blood samples from 15 men with an AAA and ten control subjects were quantified using quantitative reverse transcriptase-PCR. MicroRNAs demonstrating a significant association with AAA were validated in peripheral blood and plasma samples of men in the following groups (40 in each): healthy controls, controls with peripheral arterial disease (PAD), men with a small AAA (30-54 mm), those with a large AAA (over 54 mm), and those following AAA repair. MicroRNA expression was also assessed in aortic tissue. RESULTS Twenty-nine differentially expressed microRNAs were identified in the discovery study. Validation study revealed that let-7e (fold change (FC) -1·80; P = 0·001), miR-15a (FC -2·24; P < 0·001) and miR-196b (FC -2·26; P < 0·001) were downregulated in peripheral blood from patients with an AAA, and miR-411 was upregulated (FC 5·90; P = 0·001). miR-196b was also downregulated in plasma from the same individuals (FC -3·75; P = 0·029). The same miRNAs were similarly expressed differentially in patients with PAD compared with healthy controls. Validated and predicted microRNA targets identified through miRWalk revealed that these miRNAs were all regulators of AAA-related genes (vascular cell adhesion molecule 1, intercellular cell adhesion molecule 1, DAB2 interacting protein, α1-antitrypsin, C-reactive protein, interleukin 6, osteoprotegerin, methylenetetrahydrofolate reductase, tumour necrosis factor α). CONCLUSION In this study, circulating levels of let-7e, miR-15a, miR-196b and miR-411 were differentially expressed in men with an AAA compared with healthy controls, but also differentially expressed in men with PAD. Modulation of these miRNAs and their target genes may represent a new therapeutic pathway to affect the progression of AAA and atherosclerosis.
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Affiliation(s)
- P W Stather
- Departments of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Stather PW, Sidloff DA, Dattani N, Gokani VJ, Choke E, Sayers RD, Bown MJ. Meta-analysis and meta-regression analysis of biomarkers for abdominal aortic aneurysm. Br J Surg 2014; 101:1358-72. [DOI: 10.1002/bjs.9593] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/05/2014] [Accepted: 05/19/2014] [Indexed: 12/30/2022]
Abstract
Abstract
Background
Many studies have investigated the systemic and local expression of biomarkers in patients with abdominal aortic aneurysm (AAA). The natural history of AAA varies between patients, and predictors of the presence and diameter of AAA have not been determined consistently. The aim of this study was to perform a systematic review, meta-analysis and meta-regression of studies comparing biomarkers in patients with and without AAA, with the aim of summarizing the association of identified markers with both AAA presence and size.
Methods and results
Literature review identified 106 studies suitable for inclusion. Meta-analysis demonstrated a significant difference between matrix metalloproteinase (MMP) 9, tissue inhibitor of matrix metalloproteinase 1, interleukin (IL) 6, C-reactive protein (CRP), α1-antitrypsin, triglycerides, lipoprotein(a), apolipoprotein A and high-density lipoprotein in patients with and without AAA. Although meta-analysis was not possible for MMP-2 in aortic tissue, tumour necrosis factor α, osteoprotegerin, osteopontin, interferon γ, intercellular cell adhesion molecule 1 and vascular cell adhesion molecule 1, systematic review suggested an increase in these biomarkers in patients with AAA. Meta-regression analysis identified a significant positive linear correlation between aortic diameter and CRP level.
Conclusion
A wide variety of biomarkers are dysregulated in patients with AAA, but their clinical value is yet to be established. Future research should focus on the most relevant biomarkers of AAA, and how they could be used clinically.
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Affiliation(s)
- P W Stather
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - D A Sidloff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - N Dattani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - V J Gokani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - E Choke
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - R D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - M J Bown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Unit, University of Leicester, Leicester, UK
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