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Lorenz V, Muzzi L, Neri E. Diabetes is not a negative prognostic factor for 30-days mortality after surgery for acute type A aortic dissection. Cardiovasc Endocrinol Metab 2024; 13:e0306. [PMID: 38903248 PMCID: PMC11188906 DOI: 10.1097/xce.0000000000000306] [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: 04/07/2024] [Accepted: 05/13/2024] [Indexed: 06/22/2024]
Abstract
Background The correlation between diabetes and aortic dissection is not fully understood yet, although in literature many studies have suggested that there may be an association between the two conditions. The purpose of this study is to evaluate whether diabetes represents a short- and long-term risk factor for mortality from type A acute aortic dissection. Materials and methods A total of 340 patients with the diagnosis of type A acute aortic dissection underwent aortic surgery between January 2002 and March 2023. The sample was divided into 2 cohorts according to the presence of diabetes (n = 34) or not (n = 306). Results The mean age was 66 (±12.4) years and 60.9% were male. The primary endpoint was 30-day mortality. Hospital mortality was 12 (35.3%) for the diabetes group and 70 (22.9%) for nondiabetes group (P = 0.098). Overall survival at 10 years was 48.3% [95% confidence interval (CI): 41.6-54.7%], while the 10-year survival for people with diabetes was 29.5% (95% CI: 13.2-47.9%) and for nondiabetes group 50.6% (95% CI: 43.4-57.3%) (Log-rank, P = 0.024). Conclusion Diabetes was not found to be a risk factor associated with 30-day mortality in patients undergoing surgery for type A acute aortic dissection. It was a risk factor for long-term survival, but this may be related to diabetes complications.
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Affiliation(s)
- Veronica Lorenz
- Cardiac Surgery - Aortic Unit, University of Study of Siena, Siena Italy
| | - Luigi Muzzi
- Cardiac Surgery - Aortic Unit, University of Study of Siena, Siena Italy
| | - Eugenio Neri
- Cardiac Surgery - Aortic Unit, University of Study of Siena, Siena Italy
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Waldron C, Zafar MA, Ziganshin BA, Weininger G, Grewal N, Elefteriades JA. Evidence Accumulates: Patients with Ascending Aneurysms Are Strongly Protected from Atherosclerotic Disease. Int J Mol Sci 2023; 24:15640. [PMID: 37958625 PMCID: PMC10650782 DOI: 10.3390/ijms242115640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Ascending thoracic aortic aneurysms may be fatal upon rupture or dissection and remain a leading cause of death in the developed world. Understanding the pathophysiology of the development of ascending thoracic aortic aneurysms may help reduce the morbidity and mortality of this disease. In this review, we will discuss our current understanding of the protective relationship between ascending thoracic aortic aneurysms and the development of atherosclerosis, including decreased carotid intima-media thickness, low-density lipoprotein levels, coronary and aortic calcification, and incidence of myocardial infarction. We also propose several possible mechanisms driving this relationship, including matrix metalloproteinase proteins and transforming growth factor-β.
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Affiliation(s)
- Christina Waldron
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Mohammad A. Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Bulat A. Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
- Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, 420012 Kazan, Russia
| | - Gabe Weininger
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - John A. Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT 06519, USA; (C.W.); (M.A.Z.); (B.A.Z.)
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Zafar MA, Ziganshin BA, Li Y, Ostberg NP, Rizzo JA, Tranquilli M, Mukherjee SK, Elefteriades JA. "Big Data" Analyses Underlie Clinical Discoveries at the Aortic Institute. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2023; 96:427-440. [PMID: 37780996 PMCID: PMC10524815 DOI: 10.59249/lndz2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
This issue of the Yale Journal of Biology and Medicine (YJBM) focuses on Big Data and precision analytics in medical research. At the Aortic Institute at Yale New Haven Hospital, the vast majority of our investigations have emanated from our large, prospective clinical database of patients with thoracic aortic aneurysm (TAA), supplemented by ultra-large genetic sequencing files. Among the fundamental clinical and scientific discoveries enabled by application of advanced statistical and artificial intelligence techniques on these clinical and genetic databases are the following: From analysis of Traditional "Big Data" (Large data sets). 1. Ascending aortic aneurysms should be resected at 5 cm to prevent dissection and rupture. 2. Indexing aortic size to height improves aortic risk prognostication. 3. Aortic root dilatation is more malignant than mid-ascending aortic dilatation. 4. Ascending aortic aneurysm patients with bicuspid aortic valves do not carry the poorer prognosis previously postulated. 5. The descending and thoracoabdominal aorta are capable of rupture without dissection. 6. Female patients with TAA do more poorly than male patients. 7. Ascending aortic length is even better than aortic diameter at predicting dissection. 8. A "silver lining" of TAA disease is the profound, lifelong protection from atherosclerosis. From Modern "Big Data" Machine Learning/Artificial Intelligence analysis: 1. Machine learning models for TAA: outperforming traditional anatomic criteria. 2. Genetic testing for TAA and dissection and discovery of novel causative genes. 3. Phenotypic genetic characterization by Artificial Intelligence. 4. Panel of RNAs "detects" TAA. Such findings, based on (a) long-standing application of advanced conventional statistical analysis to large clinical data sets, and (b) recent application of advanced machine learning/artificial intelligence to large genetic data sets at the Yale Aortic Institute have advanced the diagnosis and medical and surgical treatment of TAA.
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Affiliation(s)
- Mohammad A Zafar
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Yupeng Li
- Department of Political Sciences and Economics, Rowan University, Glassboro, NJ USA
| | - Nicolai P Ostberg
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - John A Rizzo
- Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Maryann Tranquilli
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Sandip K Mukherjee
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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4
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Velasco JJ, Li Y, Ziganshin BA, Zafar MA, Rizzo JA, Ma D, Zang H, Kalyanasundaram A, Elefteriades JA. KIF6 Trp719Arg Genetic Variant Increases Risk for Thoracic Aortic Dissection. Genes (Basel) 2023; 14:genes14020252. [PMID: 36833179 PMCID: PMC9956195 DOI: 10.3390/genes14020252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND KIF6 (kinesin family member 6), a protein coded by the KIF6 gene, serves an important intracellular function to transport organelles along microtubules. In a pilot study, we found that a common KIF6 Trp719Arg variant increased the propensity of thoracic aortic aneurysms (TAA) to suffer dissection (AD). The present study aims for a definite investigation of the predictive ability of KIF6 719Arg vis à vis AD. Confirmatory findings would enhance natural history prediction in TAA. METHODS 1108 subjects (899 aneurysm and 209 dissection patients) had KIF6 719Arg variant status determined. RESULTS The 719Arg variant in the KIF6 gene correlated strongly with occurrence of AD. Specifically, KIF6 719Arg positivity (homozygous or heterozygous) was substantially more common in dissectors (69.8%) than non-dissectors (58.5%) (p = 0.003). Odds ratios (OR) for suffering aortic dissection ranged from 1.77 to 1.94 for Arg carriers in various dissection categories. These high OR associations were noted for both ascending and descending aneurysms and for homozygous and heterozygous Arg variant patients. The rate of aortic dissection over time was significantly higher for carriers of the Arg allele (p = 0.004). Additionally, Arg allele carriers were more likely to reach the combined endpoint of dissection or death (p = 0.03). CONCLUSIONS We demonstrate the marked adverse impact of the 719Arg variant of the KIF6 gene on the likelihood that a TAA patient will suffer aortic dissection. Clinical assessment of the variant status of this molecularly important gene may provide a valuable "non-size" criterion to enhance surgical decision making above and beyond the currently used metric of aortic size (diameter).
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Affiliation(s)
- Juan J. Velasco
- Aortic Institute, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Yupeng Li
- Department of Statistics, Rowan University, Glassboro, NJ 08028, USA
| | - Bulat A. Ziganshin
- Aortic Institute, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Mohammad A. Zafar
- Aortic Institute, Yale University School of Medicine, New Haven, CT 06510, USA
| | - John A. Rizzo
- Department of Statistics, Stony Brook University, Stony Brook, NY 11794, USA
| | - Deqiong Ma
- DNA Diagnostics Laboratory, Department of Genetics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Hui Zang
- DNA Diagnostics Laboratory, Department of Genetics, Yale University School of Medicine, New Haven, CT 06510, USA
| | | | - John A. Elefteriades
- Aortic Institute, Yale University School of Medicine, New Haven, CT 06510, USA
- Correspondence:
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Jung JC, Park KH. Coronary artery disease in aortic aneurysm and dissection. Indian J Thorac Cardiovasc Surg 2021; 38:115-121. [PMID: 35463718 PMCID: PMC8980968 DOI: 10.1007/s12055-021-01265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/17/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Coexisting coronary artery disease is a significant risk factor of untoward outcomes after surgical and endovascular aortic repair. This article reviewed the data, consensus, and remaining controversy about the diagnosis and management of coexisting coronary artery disease in the patients who require intervention for aortic aneurysm and dissection. It can be summarized as follows: (1) the current guidelines generally recommend the same diagnostic algorithm, including indications of coronary artery angiography, as one for non-surgical patients; (2) they also recommend the same indications of coronary revascularization; and (3) there are minor, but important, remaining issues regarding the details of management and surgical techniques most of which are still at the discretion of individual surgeons and institutions. Because it is not likely to get large-scale investigational data about these issues, the collection of individual experiences should be promoted in future scientific meetings to build up the consensus.
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Affiliation(s)
- Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
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6
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Weininger G, Ostberg N, Shang M, Zafar M, Ziganshin BA, Liu S, Erben Y, Elefteriades JA. Lipid profiles help to explain protection from systemic atherosclerosis in patients with ascending aortic aneurysm. J Thorac Cardiovasc Surg 2021; 163:e129-e132. [PMID: 34635315 DOI: 10.1016/j.jtcvs.2021.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/23/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Gabe Weininger
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Nicolai Ostberg
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; New York University Grossman School of Medicine, New York, NY
| | - Michael Shang
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Mohammad Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - Shirley Liu
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Young Erben
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
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7
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Dolmaci OB, Legué J, Lindeman JHN, Driessen AHG, Klautz RJM, Van Brakel TJ, Siebelink HMJ, Mertens BJA, Poelmann RE, Gittenberger-de Groot AC, Grewal N. Extent of Coronary Artery Disease in Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valves. J Am Heart Assoc 2021; 10:e020080. [PMID: 34075785 PMCID: PMC8477872 DOI: 10.1161/jaha.120.020080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, which is often complicated by aortic valve stenosis (AoS). In tricuspid aortic valve (TAV), AoS strongly associates with coronary artery disease (CAD) with common pathophysiological factors. Yet, it remains unclear whether AoS in patients with BAV is also associated with CAD. This study investigated the association between the aortic valve morphological features and the extent of CAD. Methods and Results A single-center study was performed, including all patients who underwent an aortic valve replacement attributable to AoS between 2006 and 2019. Coronary sclerosis was graded on preoperative coronary angiographies using the coronary artery greater even than scoring method, which divides the coronaries in 28 segments and scores nonobstructive (20%-49% sclerosis) and obstructive coronary sclerosis (>49% sclerosis) in each segment. Multivariate analyses were performed, controlling for age, sex, and CAD risk factors. A total of 1296 patients (931 TAV and 365 BAV) were included, resulting in 548 matched patients. Patients with TAV exhibited more CAD risk factors (odds ratio [OR], 2.66; 95% CI, 1.79-3.96; P<0.001). Patients with BAV had lower coronary artery greater even than 20 (1.61±2.35 versus 3.60±2.79) and coronary artery greater even than 50 (1.24±2.43 versus 3.37±3.49) scores (P<0.001), even after correcting for CAD risk factors (P<0.001). Patients with TAV more often needed concomitant coronary revascularization (OR, 3.50; 95% CI, 2.42-5.06; P<0.001). Conclusions Patients with BAV who are undergoing surgery for AoS carry a lower cardiovascular risk profile, correlating with less coronary sclerosis and a lower incidence of concomitant coronary revascularization compared with patients with TAV.
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Affiliation(s)
- Onur B Dolmaci
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands.,Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Juno Legué
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
| | - Jan H N Lindeman
- Department of Vascular Surgery Leiden University Medical Center the Netherlands
| | - Antoine H G Driessen
- Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands.,Department of Cardiothoracic Surgery Amsterdam University Medical Center the Netherlands
| | - Thomas J Van Brakel
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
| | | | - Bart J A Mertens
- Biomedical Data Science Biostatistics Section Leiden University Medical Center the Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health Leiden University the Netherlands
| | | | - Nimrat Grewal
- Department of Cardiothoracic Surgery Leiden University Medical Center the Netherlands
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8
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Krizhanovskii C, Franco-Cereceda A. Diabetes, Incretin Therapy and Thoracic Aortic Aneurysm - What Does the Evidence Show? Curr Vasc Pharmacol 2018; 17:432-439. [PMID: 30156160 DOI: 10.2174/1570161116666180828155622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/18/2022]
Abstract
Epidemiological evidence supports a reduced prevalence of Thoracic Aortic Aneurysm (TAA) and Abdominal Aortic Aneurysm (AAA) in patients with Diabetes (DM). The mechanisms underlying this negative association are unknown. Some studies support that hyperglycemia has effects on the Extracellular Matrix (ECM), resulting in collagen cross-links and altered proteolytic activity, which ultimately counteracts aneurysm formation. However, recent experimental research indicates that incretin- based anti-diabetic therapy and Glucagon-Like Peptide-1 (GLP-1) may reduce the formation of TAA. GLP-1 is a peptide hormone, released from intestinal L-cells in response to hormonal, neural and nutrient stimuli. In addition to potentiation of meal-stimulated insulin secretion, GLP-1 signaling exerts numerous pleiotropic effects on various tissues, including protective effects on the myocardium and vascular endothelium. Recent studies also report protective effects of GLP-1 based therapy on the formation of aneurysms in animal models and direct effects of GLP-1 signaling on the molecular mechanisms suggested to influence TAA formation, including inflammation, proteolytic activity and collagen composition. In this narrative review, we present the available evidence for effects of GLP-1 on experimental aneurysm development and discuss the potential role of GLP-1 in aneurysm formation based on available data from pre-clinical and clinical studies.
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Affiliation(s)
- Camilla Krizhanovskii
- Sodertalje Hospital, Department of Internal Medicine, SE-152 86 Sodertalje, Sweden.,Sodertalje Hospital, Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Sodertalje Hospital, Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
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9
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Hashiyama N, Goda M, Uchida K, Isomatsu Y, Suzuki S, Mo M, Nishida T, Masuda M. Stanford type B aortic dissection is more frequently associated with coronary artery atherosclerosis than type A. J Cardiothorac Surg 2018; 13:80. [PMID: 29945663 PMCID: PMC6020428 DOI: 10.1186/s13019-018-0765-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between aortic dissection and coronary artery disease is not clear. The purpose of this study was to clarify the difference in the rate of coronary artery atherosclerosis between Stanford type A and type B aortic dissection by reviewing our institutional database. METHODS One hundred and forty-five patients (78 males, 67 females; mean age: 60 ± 12 years) admitted to our hospital with acute aortic dissection who underwent coronary angiography during hospitalization from 2000 through 2002 were enrolled in this study. The background characteristics, coronary risk factors, and coronary angiography findings (number of significant stenoses, stenoses according to Bogaty standards, extent index) of patients were compared between type A (Group A; n = 71) and type B dissection (Group B; N = 74). RESULTS Significantly more patients had prior histories of complications from ischemic heart disease in Group B than in Group A (P = 0.04), with no significant differences in comparison to other risk factors observed except for hypertension. Significantly (p = 0.005) more stenoses were observed in Group B (1.54 ± 0.04) than in Group A (0.38 ± 0.1). A significantly higher (P < 0.05) index score indicating the severity of coronary atherosclerosis was observed in Group B (1.49 ± 0.09) than in Group A (0.72 ± 0.07). CONCLUSIONS Stanford type B acute aortic dissection was significantly more frequently associated with coronary artery atherosclerosis than type A.
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Affiliation(s)
- Naoki Hashiyama
- Department of Cardiovascular Surgery, Yokohama Minami-kyosai Hospital, Mutsuurahigashi 1-21-1, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Motohiko Goda
- Department of Cardiovascular Surgery, Yokohama City University Hospital, Fukuura 3-9, Kanazawaku, Yokohama, 236-0004, Japan.
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yukihisa Isomatsu
- Department of Cardiovascular Surgery, Yokohama City University Hospital, Fukuura 3-9, Kanazawaku, Yokohama, 236-0004, Japan
| | - Shinichi Suzuki
- Department of Cardiovascular Surgery, Yokohama City University Hospital, Fukuura 3-9, Kanazawaku, Yokohama, 236-0004, Japan
| | - Makoto Mo
- Department of Cardiovascular Surgery, Yokohama Minami-kyosai Hospital, Mutsuurahigashi 1-21-1, Kanazawa-ku, Yokohama, 236-0037, Japan
| | - Takahiro Nishida
- Department of Cardiovascular Surgery, Yokohama Citizen's Municipal Hospital, Yokohama, Japan
| | - Munetaka Masuda
- Department of Cardiovascular Surgery, Yokohama City University Hospital, Fukuura 3-9, Kanazawaku, Yokohama, 236-0004, Japan.,Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
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10
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Curtis A, Smith T, Ziganshin BA, Elefteriades JA. Ascending Aortic Proaneurysmal Genetic Mutations with Antiatherogenic Effects. Int J Angiol 2015; 24:189-97. [PMID: 26417187 DOI: 10.1055/s-0035-1556075] [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: 10/23/2022] Open
Abstract
Thoracic aortic aneurysms are common and are associated with a high morbidity and mortality. Despite this lethal diagnosis, there is an increasing body of evidence to suggest that the diagnosis of an aneurysm, specifically in the ascending thoracic aorta, may significantly reduce the risk of developing systemic atherosclerosis. Clinical observations in the operating room have shown pristine blood vessels in patients undergoing surgery for thoracic aortic aneurysms. There is now evidence that both the carotid intima-media thickness and arterial calcification, which are early and late signs of atherosclerosis respectively, are decreased in those with thoracic aortic aneurysms. These clinical studies are supported by molecular, genetic, and pharmacological evidence. Two principle mechanisms have been identified to explain the relationship of a proaneurysmal state conferring protection from atherosclerosis. These include an excess proteolytic balance of matrix metalloproteinase activity, leading to fragmentation of elastic lamellae and disordered collagen deposition. In addition, transforming growth factor β modulates vascular smooth muscle cells, extracellular matrix, and leukocytes. This confers protection from the initial plaque formation and, later provides stability to the plaque possibly through alteration of the types I and II transforming growth factor β receptor ratio. Furthermore, studies are now beginning to establish an important role for statins and estradiol in modulating these complex pathways. In the future, as our understanding of these complex mechanisms underlying aneurysmal protection against atherosclerosis increases, corresponding therapies may be developed to offer protection from atherosclerosis.
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Affiliation(s)
- Alexander Curtis
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| | - Tanya Smith
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut ; Department of Surgical Diseases No. 2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
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11
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Rajbanshi BG, Charilaou P, Ziganshin BA, Rajakaruna C, Maryann T, Elefteriades JA. Management of Coronary Artery Disease in Patients With Descending Thoracic Aortic Aneurysms. J Card Surg 2015; 30:701-6. [DOI: 10.1111/jocs.12596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Bijoy G. Rajbanshi
- Aortic Institute at Yale-New Haven Hospital; Yale University School of Medicine; New Haven Connecticut
- Department of Cardiovascular Surgery; Shahid Gangalal National Heart Center; Kathmandu Nepal
| | - Paris Charilaou
- Aortic Institute at Yale-New Haven Hospital; Yale University School of Medicine; New Haven Connecticut
| | - Bulat A. Ziganshin
- Aortic Institute at Yale-New Haven Hospital; Yale University School of Medicine; New Haven Connecticut
- Department of Surgical Diseases # 2; Kazan State Medical University; Kazan Russia
| | - Chanaka Rajakaruna
- Aortic Institute at Yale-New Haven Hospital; Yale University School of Medicine; New Haven Connecticut
| | - Tranquilli Maryann
- Department of Cardiovascular Surgery; Shahid Gangalal National Heart Center; Kathmandu Nepal
| | - John A. Elefteriades
- Aortic Institute at Yale-New Haven Hospital; Yale University School of Medicine; New Haven Connecticut
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12
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Czerny M. A pragmatic approach in aiming to do the right things in patients with thoracic aortic pathology involving the aortic arch. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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