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Mansouri M, Therasse E, Montagnon E, Zhan YO, Lessard S, Roy A, Boucher LM, Steinmetz O, Aslan E, Tang A, Chartrand-Lefebvre C, Soulez G. CT analysis of aortic calcifications to predict abdominal aortic aneurysm rupture. Eur Radiol 2024; 34:3903-3911. [PMID: 37999728 DOI: 10.1007/s00330-023-10429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) rupture prediction based on sex and diameter could be improved. The goal was to assess whether aortic calcification distribution could better predict AAA rupture through machine learning and LASSO regression. METHODOLOGY In this retrospective study, 80 patients treated for a ruptured AAA between January 2001 and August 2018 were matched with 80 non-ruptured patients based on maximal AAA diameter, age, and sex. Calcification volume and dispersion, morphologic, and clinical variables were compared between both groups using a univariable analysis with p = 0.05 and multivariable analysis through machine learning and LASSO regression. We used AUC for machine learning and odds ratios for regression to measure performance. RESULTS Mean age of patients was 74.0 ± 8.4 years and 89% were men. AAA diameters were equivalent in both groups (80.9 ± 17.5 vs 79.0 ± 17.3 mm, p = 0.505). Ruptured aneurysms contained a smaller number of calcification aggregates (18.0 ± 17.9 vs 25.6 ± 18.9, p = 0.010) and were less likely to have a proximal neck (45.0% vs 76.3%, p < 0.001). In the machine learning analysis, 5 variables were associated to AAA rupture: proximal neck, antiplatelet use, calcification number, Euclidian distance between calcifications, and standard deviation of the Euclidian distance. A follow-up LASSO regression was concomitant with the findings of the machine learning analysis regarding calcification dispersion but discordant on calcification number. CONCLUSION There might be more to AAA calcifications that what is known in the present literature. We need larger prospective studies to investigate if indeed, calcification dispersion affects rupture risk. CLINICAL RELEVANCE STATEMENT Ruptured aneurysms are possibly more likely to have their calcification volume concentrated in a smaller geographical area. KEY POINTS • Abdominal aortic aneurysm (AAA) rupture prediction based on sex and diameter could be improved. • For a given calcification volume, AAAs with well-distributed calcification clusters could be less likely to rupture. • A machine learning model including AAA calcifications better predicts rupture compared to a model based solely on maximal diameter and sex alone, although it might be prone to overfitting.
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Affiliation(s)
- Mohamed Mansouri
- Department of Radiology, McGill University Health Center (MUHC), Montréal, Québec, Canada
- Department of Diagnostic Radiology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Eric Therasse
- Department of Radiology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
- Laboratory of Clinical Imaging Processing, Centre Hospitalier de L'Université de Montréal (CHUM) Research Center (CRCHUM), Montréal, Québec, Canada
| | - Emmanuel Montagnon
- Laboratory of Clinical Imaging Processing, Centre Hospitalier de L'Université de Montréal (CHUM) Research Center (CRCHUM), Montréal, Québec, Canada
| | - Ying Olivier Zhan
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Simon Lessard
- Laboratory of Clinical Imaging Processing, Centre Hospitalier de L'Université de Montréal (CHUM) Research Center (CRCHUM), Montréal, Québec, Canada
| | - Aubert Roy
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Louis-Martin Boucher
- Department of Radiology, McGill University Health Center (MUHC), Montréal, Québec, Canada
- Department of Diagnostic Radiology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Oren Steinmetz
- Department of Vascular Surgery, McGill University Health Center (MUHC), Montréal, Québec, Canada
- Department of Vascular Surgery, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Emre Aslan
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - An Tang
- Department of Radiology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
- Laboratory of Clinical Imaging Processing, Centre Hospitalier de L'Université de Montréal (CHUM) Research Center (CRCHUM), Montréal, Québec, Canada
| | - Carl Chartrand-Lefebvre
- Department of Radiology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
- Laboratory of Clinical Imaging Processing, Centre Hospitalier de L'Université de Montréal (CHUM) Research Center (CRCHUM), Montréal, Québec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada.
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada.
- Laboratory of Clinical Imaging Processing, Centre Hospitalier de L'Université de Montréal (CHUM) Research Center (CRCHUM), Montréal, Québec, Canada.
- Institute of Biomedical Engineering, Université de Montréal, Montréal, Québec, Canada.
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2
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Li B, Khan H, Shaikh F, Zamzam A, Abdin R, Qadura M. Identification and Evaluation of Blood-Based Biomarkers for Abdominal Aortic Aneurysm. J Proteome Res 2024. [PMID: 38647339 DOI: 10.1021/acs.jproteome.4c00254] [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: 04/25/2024]
Abstract
INTRODUCTION Blood-based biomarkers for abdominal aortic aneurysm (AAA) have been studied individually; however, we considered a panel of proteins to investigate AAA prognosis and its potential to improve predictive accuracy. MATERIALS AND METHODS Using a prospectively recruited cohort of patients with/without AAA (n = 452), we conducted a prognostic study to develop a model that accurately predicts AAA outcomes using clinical features and circulating biomarker levels. Serum concentrations of 9 biomarkers were measured at baseline, and the cohort was followed for 2 years. The primary outcome was major adverse aortic event (MAAE; composite of rapid AAA expansion [>0.5 cm/6 months or >1 cm/12 months], AAA intervention, or AAA rupture). Using 10-fold cross-validation, we trained a random forest model to predict 2 year MAAE using (1) clinical characteristics, (2) biomarkers, and (3) clinical characteristics and biomarkers. RESULTS Two-year MAAE occurred in 114 (25%) patients. Two proteins were significantly elevated in patients with AAA compared with those without AAA (angiopoietin-2 and aggrecan), composing the protein panel. For predicting 2 year MAAE, our random forest model achieved area under the receiver operating characteristic curve (AUROC) 0.74 using clinical features alone, and the addition of the 2-protein panel improved performance to AUROC 0.86. CONCLUSIONS Using a combination of clinical/biomarker data, we developed a model that accurately predicts 2 year MAAE.
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Affiliation(s)
- Ben Li
- Department of Surgery, University of Toronto, Toronto M5T 1P5, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto M5B 1W8, Canada
- Institute of Medical Science, University of Toronto, Toronto M5S 1A8, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto M5G 2C8, Canada
| | - Hamzah Khan
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto M5B 1W8, Canada
| | - Farah Shaikh
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto M5B 1W8, Canada
| | - Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto M5B 1W8, Canada
| | - Rawand Abdin
- Department of Medicine, McMaster University, Hamilton L8S 4L8, Canada
| | - Mohammad Qadura
- Department of Surgery, University of Toronto, Toronto M5T 1P5, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto M5B 1W8, Canada
- Institute of Medical Science, University of Toronto, Toronto M5S 1A8, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto M5B 1W8, Canada
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3
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Leach JR, Zhu C, Burris N, Hope MD. Editorial: Advances in aortic imaging. Front Cardiovasc Med 2023; 10:1137949. [PMID: 36818356 PMCID: PMC9929938 DOI: 10.3389/fcvm.2023.1137949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Joseph R. Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Joseph R. Leach ✉
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Nicolas Burris
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Michael D. Hope
- California Advanced Imaging Medical Associates, San Francisco, CA, United States
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4
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Syed MBJ, Fletcher AJ, Debono S, Forsythe RO, Williams MC, Dweck MR, Shah ASV, Macaskill MG, Tavares A, Denvir MA, Lim K, Wallace WA, Kaczynski J, Clark T, Sellers SL, Masson N, Falah O, Chalmers RTA, Tambyraja AL, van Beek EJR, Newby DE. 18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome. JACC Cardiovasc Imaging 2022; 15:1291-1304. [PMID: 35798405 DOI: 10.1016/j.jcmg.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/01/2022] [Accepted: 01/07/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute aortic syndrome is associated with aortic medial degeneration. 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) detects microscopic tissue calcification as a marker of disease activity. OBJECTIVES In a proof-of-concept study, this investigation aimed to establish whether 18F-NaF PET combined with computed tomography (CT) angiography could identify aortic medial disease activity in patients with acute aortic syndrome. METHODS Patients with aortic dissection or intramural hematomas and control subjects underwent 18F-NaF PET/CT angiography of the aorta. Aortic 18F-NaF uptake was measured at the most diseased segment, and the maximum value was corrected for background blood pool activity (maximum tissue-to-background ratio [TBRmax]). Radiotracer uptake was compared with change in aortic size and major adverse aortic events (aortic rupture, aorta-related death, or aortic repair) over 45 ± 13 months. RESULTS Aortic 18F-NaF uptake co-localized with histologically defined regions of microcalcification and elastin disruption. Compared with control subjects, patients with acute aortic syndrome had increased 18F-NaF uptake (TBRmax: 1.36 ± 0.39 [n = 20] vs 2.02 ± 0.42 [n = 47] respectively; P < 0.001) with enhanced uptake at the site of intimal disruption (+27.5%; P < 0.001). 18F-NaF uptake in the false lumen was associated with aortic growth (+7.1 mm/year; P = 0.011), and uptake in the outer aortic wall was associated with major adverse aortic events (HR: 8.5 [95% CI: 1.4-50.4]; P = 0.019). CONCLUSIONS In patients with acute aortic syndrome, 18F-NaF uptake was enhanced at sites of disease activity and was associated with aortic growth and clinical events. 18F-NaF PET/CT holds promise as a noninvasive marker of disease severity and future risk in patients with acute aortic syndrome. (18F Sodium Fluoride PET/CT in Acute Aortic Syndrome [FAASt]; NCT03647566).
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Affiliation(s)
- Maaz B J Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Alexander J Fletcher
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Samuel Debono
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark G Macaskill
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Adriana Tavares
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Martin A Denvir
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kelvin Lim
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - William A Wallace
- Department of Pathology, University of Edinburgh, Edinburgh, United Kingdom
| | - Jakub Kaczynski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tim Clark
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh. Edinburgh, United Kingdom
| | - Stephanie L Sellers
- Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, British Colombia, Canada
| | - Neil Masson
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Orwa Falah
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Roderick T A Chalmers
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Andrew L Tambyraja
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh. Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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5
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Akerele MI, Mushari NA, Forsythe RO, Syed M, Karakatsanis NA, Newby DE, Dweck MR, Tsoumpas C. Assessment of different quantification metrics of [ 18F]-NaF PET/CT images of patients with abdominal aortic aneurysm. J Nucl Cardiol 2022; 29:251-261. [PMID: 32557152 PMCID: PMC8873073 DOI: 10.1007/s12350-020-02220-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/26/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND We aim to assess the spill-in effect and the benefit in quantitative accuracy for [18F]-NaF PET/CT imaging of abdominal aortic aneurysms (AAA) using the background correction (BC) technique. METHODS Seventy-two datasets of patients diagnosed with AAA were reconstructed with ordered subset expectation maximization algorithm incorporating point spread function (PSF). Spill-in effect was investigated for the entire aneurysm (AAA), and part of the aneurysm excluding the region close to the bone (AAAexc). Quantifications of PSF and PSF+BC images using different thresholds (% of max. SUV in target regions-of-interest) to derive target-to-background (TBR) values (TBRmax, TBR90, TBR70 and TBR50) were compared at 3 and 10 iterations. RESULTS TBR differences were observed between AAA and AAAexc due to spill-in effect from the bone into the aneurysm. TBRmax showed the highest sensitivity to the spill-in effect while TBR50 showed the least. The spill-in effect was reduced at 10 iterations compared to 3 iterations, but at the expense of reduced contrast-to-noise ratio (CNR). TBR50 yielded the best trade-off between increased CNR and reduced spill-in effect. PSF+BC method reduced TBR sensitivity to spill-in effect, especially at 3 iterations, compared to PSF (P-value ≤ 0.05). CONCLUSION TBR50 is robust metric for reduced spill-in and increased CNR.
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Affiliation(s)
- Mercy I. Akerele
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL UK
| | - Nouf A. Mushari
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL UK
| | - Rachael O. Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Nicolas A. Karakatsanis
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weil Cornell Medical College of Cornell University, New York, NY USA
- Biomedical Engineering & Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - David E. Newby
- Edinburgh Imaging Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Charalampos Tsoumpas
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL UK
- Biomedical Engineering & Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Invicro, London, UK
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6
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Abdominal Aortic Aneurysm Formation with a Focus on Vascular Smooth Muscle Cells. Life (Basel) 2022; 12:life12020191. [PMID: 35207478 PMCID: PMC8880357 DOI: 10.3390/life12020191] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/29/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a lethal degenerative vascular disease that affects, mostly, the elder population, with a high mortality rate (>80%) upon rupture. It features a dilation of the aortic diameter to larger than 30 mm or more than 50%. Diverse pathological processes are involved in the development of AAA, including aortic wall inflammation, elastin breakdown, oxidative stress, smooth muscle cell (SMC) phenotypic switching and dysfunction, and extracellular matrix degradation. With open surgery being the only therapeutic option up to date, the lack of pharmaceutical treatment approach calls for identifying novel and effective targets and further understanding the pathological process of AAA. Both lifestyle and genetic predisposition have an important role in increasing the risk of AAA. Several cell types are closely related to the pathogenesis of AAA. Among them, vascular SMCs (VSMCs) are gaining much attention as a critical contributor for AAA initiation and/or progression. In this review, we summarize what is known about AAA, including the risk factors, the pathophysiology, and the established animal models of AAA. In particular, we focus on the VSMC phenotypic switching and dysfunction in AAA formation. Further understanding the regulation of VSMC phenotypic changes may provide novel therapeutic targets for the treatment or prevention of AAA.
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7
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Temme S, Yakoub M, Bouvain P, Yang G, Schrader J, Stegbauer J, Flögel U. Beyond Vessel Diameters: Non-invasive Monitoring of Flow Patterns and Immune Cell Recruitment in Murine Abdominal Aortic Disorders by Multiparametric MRI. Front Cardiovasc Med 2021; 8:750251. [PMID: 34760945 PMCID: PMC8572976 DOI: 10.3389/fcvm.2021.750251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023] Open
Abstract
The pathophysiology of the initiation and progression of abdominal aortic aneurysms (AAAs) and aortic dissections (AADs) is still unclear. However, there is strong evidence that monocytes and macrophages are of crucial importance in these processes. Here, we utilized a molecular imaging approach based on background-free 19F MRI and employed perfluorocarbon nanoemulsions (PFCs) for in situ 19F labeling of monocytes/macrophages to monitor vascular inflammation and AAA/AAD formation in angiotensin II (angII)-treated apolipoproteinE-deficient (apoE-/-) mice. In parallel, we used conventional 1H MRI for the characterization of aortic flow patterns and morphology. AngII (1 μg/kg/min) was infused into apoE-/- mice via osmotic minipumps for 10 days and mice were monitored by multiparametric 1H/19F MRI. PFCs were intravenously injected directly after pump implantation followed by additional applications on day 2 and 4 to allow an efficient 19F loading of circulating monocytes. The combination of angiographic, hemodynamic, and anatomical measurements allowed an unequivocal classification of mice in groups with developing AAAs, AADs or without any obvious aortic vessel alterations despite the exposure to angII. Maximal luminal and external diameters of the aorta were enlarged in AAAs, whereas AADs showed either a slight decrease of the luminal diameter or no alteration. 1H/19F MRI after intravenous PFC application demonstrated significantly higher 19F signals in aortae of mice that developed AAAs or AADs as compared to mice in which no aortic disorders were detected. High resolution 1H/19F MRI of excised aortae revealed a patchy pattern of the 19F signals predominantly in the adventitia of the aorta. Histological analysis confirmed the presence of macrophages in this area and flow cytometry revealed higher numbers of immune cells in aortae of mice that have developed AAA/AAD. Importantly, there was a linear correlation of the 19F signal with the total number of infiltrated macrophages. In conclusion, our approach enables a precise differentiation between AAA and AAD as well as visualization and quantitative assessment of inflammatory active vascular lesions, and therefore may help to unravel the complex interplay between macrophage accumulation, vascular inflammation, and the development and progression of AAAs and AADs.
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Affiliation(s)
- Sebastian Temme
- Department of Experimental Anesthesia, Heinrich-Heine-University, Düsseldorf, Germany.,Experimental Cardiovascular Imaging, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mina Yakoub
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Pascal Bouvain
- Experimental Cardiovascular Imaging, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Molecular Cardiology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Guang Yang
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jürgen Schrader
- Department of Molecular Cardiology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ulrich Flögel
- Experimental Cardiovascular Imaging, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Molecular Cardiology, Heinrich-Heine-University, Düsseldorf, Germany
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8
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Baolei G, Can C, Peng L, Yan S, Cheng Y, Hui T, Minzhi L, Daqiao G, Weiguo F. Molecular Imaging of Abdominal Aortic Aneurysms with Positron Emission Tomography: A Systematic Review. Eur J Vasc Endovasc Surg 2021; 62:969-980. [PMID: 34696984 DOI: 10.1016/j.ejvs.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/29/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Previous studies on the relationship between positron emission tomography (PET) images and abdominal aortic aneurysm (AAA) progression have shown contradictory results, and the objective of this study was to systematically review the role of PET in predicting AAA prognosis. DATA SOURCES PubMed, Embase, and Web of Science were searched for studies evaluating the correlation between PET imaging results and AAA growth, repair, or rupture. REVIEW METHODS Two authors independently performed the study search, data extraction, and quality assessment following a standard method. RESULTS Of the 11 studies included in this review, nine used 18F-fluorodeoxyglucose (18F-FDG) PET and computed tomography (CT) imaging, whereas the remaining two used 18F-sodium fluoride (18F-NaF) PET/CT and 18F-FDG PET/magnetic resonance imaging (MRI). Findings from the 18F-FDG PET/CT studies were contradictory. Six studies found no significant association or correlation, and two studies found a significant negative correlation between 18F-FDG uptake and AAA expansion. Additionally, one study found that the 18F-FDG uptake was statistically positively related to the expansion rate in a specific AAA subgroup whose AAAs expanded significantly. Two studies suggested that increased 18F-FDG uptake was significantly associated with AAA repair, while the other studies either found no association between 18F-FDG uptake and AAA rupture or repair or failed to report the occurrence of clinical events. One PET/CT study that used 18F-NaF as a tracer showed that an increased tracer uptake was significantly associated with AAA growth and clinical events. Finally, the 18F-FDG PET/MRI study indicated that 18F-FDG uptake was not significantly correlated with AAA expansion. CONCLUSION A definitive role for 18F-FDG PET imaging for AAA prognosis awaits further investigation, and new PET tracers such as 18F-NaF have the potential to be a promising method for predicting AAA clinical outcomes.
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Affiliation(s)
- Guo Baolei
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Chen Can
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lv Peng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shan Yan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Cheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tan Hui
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lv Minzhi
- Department of Medical Statistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo Daqiao
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Fu Weiguo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
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9
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Akerele MI, Karakatsanis NA, Forsythe RO, Dweck MR, Syed M, Aykroyd RG, Sourbron S, Newby DE, Tsoumpas C. Iterative reconstruction incorporating background correction improves quantification of [ 18F]-NaF PET/CT images of patients with abdominal aortic aneurysm. J Nucl Cardiol 2021; 28:1875-1886. [PMID: 31721093 PMCID: PMC8648624 DOI: 10.1007/s12350-019-01940-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND A confounding issue in [18F]-NaF PET/CT imaging of abdominal aortic aneurysms (AAA) is the spill in contamination from the bone into the aneurysm. This study investigates and corrects for this spill in contamination using the background correction (BC) technique without the need to manually exclude the part of the AAA region close to the bone. METHODS Seventy-two (72) datasets of patients with AAA were reconstructed with the standard ordered subset expectation maximization (OSEM) algorithm incorporating point spread function (PSF) modelling. The spill in effect in the aneurysm was investigated using two target regions of interest (ROIs): one covering the entire aneurysm (AAA), and the other covering the aneurysm but excluding the part close to the bone (AAAexc). ROI analysis was performed by comparing the maximum SUV in the target ROI (SUVmax(T)), the corrected cSUVmax (SUVmax(T) - SUVmean(B)) and the target-to-blood ratio (TBR = SUVmax(T)/SUVmean(B)) with respect to the mean SUV in the right atrium region. RESULTS There is a statistically significant higher [18F]-NaF uptake in the aneurysm than normal aorta and this is not correlated with the aneurysm size. There is also a significant difference in aneurysm uptake for OSEM and OSEM + PSF (but not OSEM + PSF + BC) when quantifying with AAA and AAAexc due to the spill in from the bone. This spill in effect depends on proximity of the aneurysms to the bone as close aneurysms suffer more from spill in than farther ones. CONCLUSION The background correction (OSEM + PSF + BC) technique provided more robust AAA quantitative assessments regardless of the AAA ROI delineation method, and thus it can be considered as an effective spill in correction method for [18F]-NaF AAA studies.
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Affiliation(s)
- Mercy I Akerele
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL, UK
| | - Nicolas A Karakatsanis
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weil Cornell Medical College of Cornell University, New York, NY, USA
| | - Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Steven Sourbron
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL, UK
| | - David E Newby
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Charalampos Tsoumpas
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL, UK.
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10
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Nana P, Dakis K, Brodis A, Spanos K, Kouvelos G. Circulating Biomarkers for the Prediction of Abdominal Aortic Aneurysm Growth. J Clin Med 2021; 10:1718. [PMID: 33923412 PMCID: PMC8072679 DOI: 10.3390/jcm10081718] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysm represents a distinct group of vascular lesions, in terms of surveillance and treatment. Screening and follow-up of patients via duplex ultrasound has been well established and proposed by current guidelines. However, serum circulating biomarkers could earn a position in individualized patient surveillance, especially in cases of aggressive AAA growth rates. A systematic review was conducted to assess the correlation of AAA expansion rates with serum circulating biomarkers. METHODS A data search of English medical literature was conducted, using PubMed, EMBASE, and CENTRAL, until 7 March 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. Studies reporting on humans, on abdominal aortic aneurysm growth rates and on serum circulating biomarkers were included. No statistical analysis was conducted. RESULTS A total of 25 studies with 4753 patients were included. Studies were divided in two broad categories: Those reporting on clinically applicable (8 studies) and those reporting on experimental (17 studies) biomarkers. Twenty-three out of 25 studies used duplex ultrasound (DUS) for following patients. Amongst clinically applicable biomarkers, D-dimers, LDL-C, HDL-C, TC, ApoB, and HbA1c were found to bear the most significant association with AAA growth rates. In terms of the experimental biomarkers, PIIINP, osteopontin, tPA, osteopontin, haptoglobin polymorphisms, insulin-like growth factor I, thioredoxin, neutrophil extracellular traps (NETs), and genetic factors, as polymorphisms and microRNAs were positively correlated with increased AAA expansion rates. CONCLUSION In the presence of future robust data, specific serum biomarkers could potentially form the basis of an individualized surveillance strategy of patients presenting with increased AAA growth rates.
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Affiliation(s)
- Petroula Nana
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41110 Larissa, Greece; (K.D.); (K.S.); (G.K.)
| | - Konstantinos Dakis
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41110 Larissa, Greece; (K.D.); (K.S.); (G.K.)
| | - Alexandros Brodis
- Department of Neurosurgery, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41110 Larissa, Greece;
| | - Konstantinos Spanos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41110 Larissa, Greece; (K.D.); (K.S.); (G.K.)
| | - George Kouvelos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41110 Larissa, Greece; (K.D.); (K.S.); (G.K.)
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11
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Shi F, Ma C, Ji C, Li M, Liu X, Han Y. Serum Lipid Oxidative Stress Products as Risk Factors Are the Candidate Predictive Biomarkers for Human Abdominal Aortic Aneurysms. Clin Appl Thromb Hemost 2021; 26:1076029620932226. [PMID: 32571088 PMCID: PMC7427010 DOI: 10.1177/1076029620932226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This research was designed to determine the association of serum lipid peroxidation products with disease severity in patients with abdominal aortic aneurysm (AAA). In total, 76 pairs of AAA cases as well as matched controls were enrolled in our research using propensity score matching (PSM). And their malondialdehyde (MDA), lipid hydroperoxide (LPO), and glutathione peroxidase (GSH-Px) levels were also detected through enzyme-linked immunosorbent assay (ELISA). Additionally, the relative clinical data of enrolled participants were extracted. The serum biomarker concentrations were measured in 76 patients with AAAs (diameter between 30 and 54 mm, n = 54; diameter ≥55 mm, n = 22) and 76 control patients from observational cohort study. After PSM adjustment for clinical variables, including age, gender, heart ratio, body mass index, smoking, hypertension, diabetes mellitus, coronary heart disease, and stroke, the serum MDA and LPO among AAA cases were remarkably increased compared with those from the normal patients. Inversely, serum GSH-Px was significantly decreased in patients with AAA compared to the control group. Besides, the serum levels of MDA and LPO were independently associated with AAA risk. Typically, there was significantly positive correlation between MDA level and LPO level (R = 0.358) but negative correlation of MDA level with GSH-Px (R = -0.203) level in patients with AAA. Meanwhile, the area under the receiver operating characteristic curve was 0.965 when MDA was used to diagnose AAA, and the optimal threshold value was 0.242 nmol/mL. Moreover, serum MDA level was significantly increased in cases with rupture AAA compared to those in selective AAA cases. Logistic regression analysis suggested that a higher serum MDA level indicated an elevated risk of AAA rupture (odds ratio = 2.536; 95% CI: 1.037-6.203; P =0.041). Our present findings suggest that serum peroxidation contents were evidently changed among AAA cases. Serum MDA and LPO concentrations could be used to predict disease severity in patients with AAA. Moreover, serum MDA may serve as the candidate biomarker for diagnosis of AAA and accurate identification of increased risks of AAA rupture.
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Affiliation(s)
- Feng Shi
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Changcheng Ma
- Department of Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chao Ji
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mu Li
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xun Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanshuo Han
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
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12
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FRZB as a key molecule in abdominal aortic aneurysm progression affecting vascular integrity. Biosci Rep 2021; 41:227068. [PMID: 33245093 PMCID: PMC7789806 DOI: 10.1042/bsr20203204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
Abdominal aortic aneurysm (AAA), when ruptured, results in high mortality. The identification of molecular pathways involved in AAA progression is required to improve AAA prognosis. The aim of the present study was to assess the key genes for the progression of AAA and their functional role. Genomic and clinical data of three independent cohorts were downloaded from the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GEO) (GSE57691, GSE7084, and GSE98278). To develop AAA diagnosis and progression-related differentially expressed genes (DEGs), we used a significance analysis of microarray (SAM). Spearman correlation test and gene set analysis were performed to identify potential enriched pathways for DEGs. Only the Frizzled-related protein (FRZB) gene and chromosome 1 open reading frame 24 (C1orf24) exhibited significant down-regulation in all analyses. With FRZB, the pathways were associated with RHO GTPase and elastin fiber formation. With C1orf24, the pathways were elastic fiber formation, extracellular matrix organization, and cell–cell communication. Since only FRZB was evolutionally conserved in the vertebrates, function of FRZB was validated using zebrafish embryos. Knockdown of frzb remarkably reduced vascular integrity in zebrafish embryos. We believe that FRZB is a key gene involved in AAA initiation and progression affecting vascular integrity.
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13
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Cabral-Pacheco GA, Garza-Veloz I, Castruita-De la Rosa C, Ramirez-Acuña JM, Perez-Romero BA, Guerrero-Rodriguez JF, Martinez-Avila N, Martinez-Fierro ML. The Roles of Matrix Metalloproteinases and Their Inhibitors in Human Diseases. Int J Mol Sci 2020; 21:E9739. [PMID: 33419373 PMCID: PMC7767220 DOI: 10.3390/ijms21249739] [Citation(s) in RCA: 577] [Impact Index Per Article: 144.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/10/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023] Open
Abstract
Matrix metalloproteinases (MMPs) are a family of zinc-dependent extracellular matrix (ECM) remodeling endopeptidases that have the capacity to degrade almost every component of the ECM. The degradation of the ECM is of great importance, since it is related to embryonic development and angiogenesis. It is also involved in cell repair and the remodeling of tissues. When the expression of MMPs is altered, it can generate the abnormal degradation of the ECM. This is the initial cause of the development of chronic degenerative diseases and vascular complications generated by diabetes. In addition, this process has an association with neurodegeneration and cancer progression. Within the ECM, the tissue inhibitors of MMPs (TIMPs) inhibit the proteolytic activity of MMPs. TIMPs are important regulators of ECM turnover, tissue remodeling, and cellular behavior. Therefore, TIMPs (similar to MMPs) modulate angiogenesis, cell proliferation, and apoptosis. An interruption in the balance between MMPs and TIMPs has been implicated in the pathophysiology and progression of several diseases. This review focuses on the participation of both MMPs (e.g., MMP-2 and MMP-9) and TIMPs (e.g., TIMP-1 and TIMP-3) in physiological processes and on how their abnormal regulation is associated with human diseases. The inclusion of current strategies and mechanisms of MMP inhibition in the development of new therapies targeting MMPs was also considered.
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Affiliation(s)
| | - Idalia Garza-Veloz
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Carretera Zacatecas-Guadalajara Km.6. Ejido la Escondida, Zacatecas 98160, Mexico; (G.AC.-P.); (C.C.-D.l.R.); (J.MR.-A.); (B.AP.-R.); (J.FG.-R.); (N.M.-A.)
| | | | | | | | | | | | - Margarita L Martinez-Fierro
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Carretera Zacatecas-Guadalajara Km.6. Ejido la Escondida, Zacatecas 98160, Mexico; (G.AC.-P.); (C.C.-D.l.R.); (J.MR.-A.); (B.AP.-R.); (J.FG.-R.); (N.M.-A.)
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14
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Akkoyun E, Kwon ST, Acar AC, Lee W, Baek S. Predicting abdominal aortic aneurysm growth using patient-oriented growth models with two-step Bayesian inference. Comput Biol Med 2020; 117:103620. [PMID: 32072970 PMCID: PMC7064358 DOI: 10.1016/j.compbiomed.2020.103620] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE For small abdominal aortic aneurysms (AAAs), a regular follow-up examination is recommended every 12 months for AAAs of 30-39 mm and every six months for AAAs of 40-55 mm. Follow-up diameters can determine if a patient follows the common growth model of the population. However, the rapid expansion of an AAA, often associated with higher rupture risk, may be overlooked even though it requires surgical intervention. Therefore, the prognosis of abdominal aortic aneurysm growth is clinically important for planning treatment. This study aims to build enhanced Bayesian inference methods to predict maximum aneurysm diameter. METHODS 106 CT scans from 25 Korean AAA patients were retrospectively obtained. A two-step approach based on Bayesian calibration was used, and an exponential abdominal aortic aneurysm growth model (population-based) was specified according to each individual patient's growth (patient-specific) and morphologic characteristics of the aneurysm sac (enhanced). The distribution estimates were obtained using a Markov Chain Monte Carlo (MCMC) sampler. RESULTS The follow-up diameters were predicted satisfactorily (i.e. the true follow-up diameter was in the 95% prediction interval) for 79% of the scans using the population-based growth model, and 83% of the scans using the patient-specific growth model. Among the evaluated geometric measurements, centerline tortuosity was a significant (p = 0.0002) predictor of growth for AAAs with accelerated and stable expansion rates. Using the enhanced prediction model, 86% of follow-up scans were predicted satisfactorily. The average prediction errors of population-based, patient-specific, and enhanced models were ±2.67, ±2.61 and ± 2.79 mm, respectively. CONCLUSION A computational framework using patient-oriented growth models provides useful tools for per-patient basis treatment and enables better prediction of AAA growth.
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Affiliation(s)
- Emrah Akkoyun
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University, Dumlupinar Bulvari #1, 06800, Cankaya, Ankara, Turkey
| | - Sebastian T Kwon
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, 757 Westwood Blvd., Los Angeles, CA, 90095, USA
| | - Aybar C Acar
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University, Dumlupinar Bulvari #1, 06800, Cankaya, Ankara, Turkey
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Seungik Baek
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI, 48824, USA.
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15
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Syed MBJ, Fletcher AJ, Forsythe RO, Kaczynski J, Newby DE, Dweck MR, van Beek EJR. Emerging techniques in atherosclerosis imaging. Br J Radiol 2019; 92:20180309. [PMID: 31502858 PMCID: PMC6849665 DOI: 10.1259/bjr.20180309] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a chronic immunomodulated disease that affects multiple vascular beds and results in a significant worldwide disease burden. Conventional imaging modalities focus on the morphological features of atherosclerotic disease such as the degree of stenosis caused by a lesion. Modern CT, MR and positron emission tomography scanners have seen significant improvements in the rapidity of image acquisition and spatial resolution. This has increased the scope for the clinical application of these modalities. Multimodality imaging can improve cardiovascular risk prediction by informing on the constituency and metabolic processes within the vessel wall. Specific disease processes can be targeted using novel biological tracers and "smart" contrast agents. These approaches have the potential to inform clinicians of the metabolic state of atherosclerotic plaque. This review will provide an overview of current imaging techniques for the imaging of atherosclerosis and how various modalities can provide information that enhances the depiction of basic morphology.
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Affiliation(s)
- Maaz BJ Syed
- British Heart Foundation Centre of Cardiovascular Science
| | | | | | | | | | - Marc R Dweck
- British Heart Foundation Centre of Cardiovascular Science
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16
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Mordi IR, Forsythe RO, Gellatly C, Iskandar Z, McBride OM, Saratzis A, Chalmers R, Chin C, Bown MJ, Newby DE, Lang CC, Huang JTJ, Choy AM. Plasma Desmosine and Abdominal Aortic Aneurysm Disease. J Am Heart Assoc 2019; 8:e013743. [PMID: 31595818 PMCID: PMC6818029 DOI: 10.1161/jaha.119.013743] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background It is recognized that factors beyond aortic size are important in predicting outcome in abdominal aortic aneurysm (AAA) disease. AAA is characterized by the breakdown of elastin within the aortic tunica media, leading to aortic dilatation and rupture. The aim of this study was to investigate the association of plasma desmosine (pDES), an elastin‐specific degradation product, with disease severity and clinical outcome in patients with AAA. Methods and Results We measured pDES and serum biomarker concentrations in 507 patients with AAAs (94% men; mean age, 72.4±6.1 years; mean AAA diameter, 48±8 mm) and 162 control subjects (100% men; mean age, 71.5±4.4 years) from 2 observational cohort studies. In the longitudinal cohort study (n=239), we explored the incremental prognostic value of pDES on AAA events. pDES was higher in patients with AAA compared with control subjects (mean±SD: 0.46±0.22 versus 0.33±0.16 ng/mL; P<0.001) and had the strongest correlation with AAA diameter (r=0.39; P<0.0001) of any serum biomarker. After adjustment for baseline AAA diameter, pDES was associated with an AAA event (hazard ratio, 2.03 per SD increase [95% CI, 1.02–4.02]; P=0.044). In addition to AAA diameter, pDES provided incremental improvement in risk stratification (continuous net reclassification improvement, 34.4% [95% CI, −10.8% to 57.5%; P=0.09]; integrated discrimination improvement, 0.04 [95% CI, 0.00–0.15; P=0.050]). Conclusions pDES concentrations predict disease severity and clinical outcomes in patients with AAA. Clinical Trial Registration http://www.isrctn.com. Unique identifier: ISRCTN76413758.
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Affiliation(s)
- Ify R Mordi
- Division of Molecular and Clinical Medicine University of Dundee Dundee United Kingdom
| | - Rachael O Forsythe
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science Edinburgh United Kingdom
| | - Corry Gellatly
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre University of Leicester Glenfield Hospital Leicester United Kingdom
| | - Zaid Iskandar
- Division of Molecular and Clinical Medicine University of Dundee Dundee United Kingdom
| | - Olivia M McBride
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science Edinburgh United Kingdom
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre University of Leicester Glenfield Hospital Leicester United Kingdom
| | - Rod Chalmers
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science Edinburgh United Kingdom
| | - Calvin Chin
- Department of Cardiovascular Science National Heart Center Singapore
| | - Matthew J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre University of Leicester Glenfield Hospital Leicester United Kingdom
| | - David E Newby
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science Edinburgh United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine University of Dundee Dundee United Kingdom
| | - Jeffrey T J Huang
- Division of Systems Medicine University of Dundee Dundee United Kingdom
| | - Anna-Maria Choy
- Division of Molecular and Clinical Medicine University of Dundee Dundee United Kingdom
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17
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Forsythe RO, Dweck MR, McBride OMB, Vesey AT, Semple SI, Shah ASV, Adamson PD, Wallace WA, Kaczynski J, Ho W, van Beek EJR, Gray CD, Fletcher A, Lucatelli C, Marin A, Burns P, Tambyraja A, Chalmers RTA, Weir G, Mitchard N, Tavares A, Robson JMJ, Newby DE. 18F-Sodium Fluoride Uptake in Abdominal Aortic Aneurysms: The SoFIA 3 Study. J Am Coll Cardiol 2019; 71:513-523. [PMID: 29406857 PMCID: PMC5800891 DOI: 10.1016/j.jacc.2017.11.053] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 12/03/2022]
Abstract
Background Fluorine-18–sodium fluoride (18F-NaF) uptake is a marker of active vascular calcification associated with high-risk atherosclerotic plaque. Objectives In patients with abdominal aortic aneurysm (AAA), the authors assessed whether 18F-NaF positron emission tomography (PET) and computed tomography (CT) predicts AAA growth and clinical outcomes. Methods In prospective case-control (n = 20 per group) and longitudinal cohort (n = 72) studies, patients with AAA (aortic diameter >40 mm) and control subjects (aortic diameter <30 mm) underwent abdominal ultrasound, 18F-NaF PET-CT, CT angiography, and calcium scoring. Clinical endpoints were aneurysm expansion and the composite of AAA repair or rupture. Results Fluorine-18-NaF uptake was increased in AAA compared with nonaneurysmal regions within the same aorta (p = 0.004) and aortas of control subjects (p = 0.023). Histology and micro-PET-CT demonstrated that 18F-NaF uptake localized to areas of aneurysm disease and active calcification. In 72 patients within the longitudinal cohort study (mean age 73 ± 7 years, 85% men, baseline aneurysm diameter 48.8 ± 7.7 mm), there were 19 aneurysm repairs (26.4%) and 3 ruptures (4.2%) after 510 ± 196 days. Aneurysms in the highest tertile of 18F-NaF uptake expanded 2.5× more rapidly than those in the lowest tertile (3.10 [interquartile range (IQR): 2.34 to 5.92 mm/year] vs. 1.24 [IQR: 0.52 to 2.92 mm/year]; p = 0.008) and were nearly 3× as likely to experience AAA repair or rupture (15.3% vs. 5.6%; log-rank p = 0.043). Conclusions Fluorine-18-NaF PET-CT is a novel and promising approach to the identification of disease activity in patients with AAA and is an additive predictor of aneurysm growth and future clinical events. (Sodium Fluoride Imaging of Abdominal Aortic Aneurysms [SoFIA3]; NCT02229006; Magnetic Resonance Imaging [MRI] for Abdominal Aortic Aneurysms to Predict Rupture or Surgery: The MA3RS Trial; ISRCTN76413758)
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Affiliation(s)
- Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Olivia M B McBride
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Alex T Vesey
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott I Semple
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - William A Wallace
- National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jakub Kaczynski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Weiyang Ho
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Calum D Gray
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Alison Fletcher
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Christophe Lucatelli
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Aleksander Marin
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Burns
- National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Tambyraja
- National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Roderick T A Chalmers
- National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Graeme Weir
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Neil Mitchard
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Adriana Tavares
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer M J Robson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; National Health Service Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Petsophonsakul P, Furmanik M, Forsythe R, Dweck M, Schurink GW, Natour E, Reutelingsperger C, Jacobs M, Mees B, Schurgers L. Role of Vascular Smooth Muscle Cell Phenotypic Switching and Calcification in Aortic Aneurysm Formation. Arterioscler Thromb Vasc Biol 2019; 39:1351-1368. [PMID: 31144989 DOI: 10.1161/atvbaha.119.312787] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aortic aneurysm is a vascular disease whereby the ECM (extracellular matrix) of a blood vessel degenerates, leading to dilation and eventually vessel wall rupture. Recently, it was shown that calcification of the vessel wall is involved in both the initiation and progression of aneurysms. Changes in aortic wall structure that lead to aneurysm formation and vascular calcification are actively mediated by vascular smooth muscle cells. Vascular smooth muscle cells in a healthy vessel wall are termed contractile as they maintain vascular tone and remain quiescent. However, in pathological conditions they can dedifferentiate into a synthetic phenotype, whereby they secrete extracellular vesicles, proliferate, and migrate to repair injury. This process is called phenotypic switching and is often the first step in vascular pathology. Additionally, healthy vascular smooth muscle cells synthesize VKDPs (vitamin K-dependent proteins), which are involved in inhibition of vascular calcification. The metabolism of these proteins is known to be disrupted in vascular pathologies. In this review, we summarize the current literature on vascular smooth muscle cell phenotypic switching and vascular calcification in relation to aneurysm. Moreover, we address the role of vitamin K and VKDPs that are involved in vascular calcification and aneurysm. Visual Overview- An online visual overview is available for this article.
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Affiliation(s)
- Ploingarm Petsophonsakul
- From the Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (P.P., M.F., C.R., L.S.)
| | - Malgorzata Furmanik
- From the Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (P.P., M.F., C.R., L.S.)
| | - Rachael Forsythe
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (R.F., M.D.)
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (R.F., M.D.)
| | - Geert Willem Schurink
- Department of Vascular Surgery (G.W.S., M.J., B.M.), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
| | - Ehsan Natour
- Department of Cardiovascular Surgery (E.N.), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands.,European Vascular Center Aachen-Maastricht, Maastricht, the Netherlands (E.N., M.J., B.M.)
| | - Chris Reutelingsperger
- From the Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (P.P., M.F., C.R., L.S.)
| | - Michael Jacobs
- Department of Vascular Surgery (G.W.S., M.J., B.M.), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands.,European Vascular Center Aachen-Maastricht, Maastricht, the Netherlands (E.N., M.J., B.M.)
| | - Barend Mees
- Department of Vascular Surgery (G.W.S., M.J., B.M.), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands.,European Vascular Center Aachen-Maastricht, Maastricht, the Netherlands (E.N., M.J., B.M.)
| | - Leon Schurgers
- From the Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (P.P., M.F., C.R., L.S.)
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19
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Yalta K. Aortic aneurysm in patients undergoing transcatheter aortic valve implantation: A prognostic determinant? or just an innocent bystander? Indian Heart J 2018; 70 Suppl 3:S501-S502. [PMID: 30595319 PMCID: PMC6309568 DOI: 10.1016/j.ihj.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kenan Yalta
- Trakya University, Cardiology Department, Edirne, Turkey.
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20
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Behr Andersen C, Lindholt JS, Urbonavicius S, Halekoh U, Jensen PS, Stubbe J, Rasmussen LM, Beck HC. Abdominal Aortic Aneurysms Growth Is Associated With High Concentrations of Plasma Proteins in the Intraluminal Thrombus and Diseased Arterial Tissue. Arterioscler Thromb Vasc Biol 2018; 38:2254-2267. [DOI: 10.1161/atvbaha.117.310126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Porosity of the intraluminal thrombus (ILT) is believed to convey biologically active components from the bloodstream toward the aneurismal wall. Accumulation of molecules in the abdominal aortic aneurysmatic tissue may influence vascular protein turnover and regulate abdominal aortic aneurysm growth. We sought to identify proteins with concentrations in the ILT and the abdominal aortic aneurysm wall which associate with aneurysmal expansion rate.
Approach and Results—
Proteomic analysis by liquid chromatography tandem-mass spectrometry of separated wall and ILT samples was correlated with preoperative aneurysmal growth rate in 24 individuals operated electively for infrarenal abdominal aortic aneurysm. The median preoperative growth rate was 3.8 mm/y (interquartile range, 3) and the mean observational time was 3.3±1.7 years. Plasma components dominated the group of proteins with tissue concentrations, which correlate positively with growth rates (
P
<0.001, Fisher exact test, both in the ILT and the wall). In contrast, in the wall and thrombus samples, ECM (extracellular matrix) proteins were significantly more prevalent in the group of proteins with negative correlations to growth rates (
P
<0.05, Fisher exact test). Similarly, a long series of proteins, related to cellular functions correlated negatively to growth rates.
Conclusions—
When the preoperative aneurysmatic growth rate has been high, the concentration of many plasma proteins residing in the ILT and the aneurysmatic tissue is also high, compatible with the hypothesis of increased tissue porosity and accumulation of plasma components as a driver of aneurysm expansion. Moreover, many matrix and cellular proteins which are found in high concentrations in slower-growing aneurysms provides new knowledge about potential treatment targets.
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Affiliation(s)
- Carsten Behr Andersen
- From the Cardiovascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark (C.B.A., J.S.L., S.U.)
| | - Jes S. Lindholt
- From the Cardiovascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark (C.B.A., J.S.L., S.U.)
- Department of Heart, Lung and Vascular Surgery T (J.S.L.)
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
| | - Sigitas Urbonavicius
- From the Cardiovascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark (C.B.A., J.S.L., S.U.)
| | | | - Pia Søndergaard Jensen
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
- Department of Clinical Biochemistry and Pharmacology, Centre for Clinical Proteomics (P.S.J., L.M.R., H.C.B.), Odense University Hospital, Denmark
| | - Jane Stubbe
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
- Cardiovascular and Renal Research (J.S.), University of Southern Denmark, Odense
| | - Lars Melholt Rasmussen
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
- Department of Clinical Biochemistry and Pharmacology, Centre for Clinical Proteomics (P.S.J., L.M.R., H.C.B.), Odense University Hospital, Denmark
| | - Hans Christian Beck
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
- Department of Clinical Biochemistry and Pharmacology, Centre for Clinical Proteomics (P.S.J., L.M.R., H.C.B.), Odense University Hospital, Denmark
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21
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Forsythe RO, Syed M, Newby DE. Response to Letter Regarding Article, "Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair". Circulation 2018; 137:1295-1296. [PMID: 29555714 DOI: 10.1161/circulationaha.117.032344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
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22
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Loughborough WW, Minhas KS, Rodrigues JCL, Lyen SM, Burt HE, Manghat NE, Brooks MJ, Stuart G, Hamilton MCK. Cardiovascular Manifestations and Complications of Loeys-Dietz Syndrome: CT and MR Imaging Findings. Radiographics 2018; 38:275-286. [DOI: 10.1148/rg.2018170120] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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23
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Jansen CHP, Brangsch J, Reimann C, Adams L, Hamm B, Botnar RM, Makowski MR. In Vivo High-Frequency Ultrasound for the Characterization of Thrombi Associated with Aortic Aneurysms in an Experimental Mouse Model. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2882-2890. [PMID: 28965722 DOI: 10.1016/j.ultrasmedbio.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
The development of abdominal aortic aneurysm (AAA) associated thrombi plays an important role during the onset and progression of AAAs. The aim of this study was to evaluate the potential of high-frequency ultrasound for characterization of AAA associated thrombi in an apolipoprotein-E-deficient mouse-model. Ultrasound measurements were performed using a high-resolution ultrasound system (Vevo770, FUJIFILM VisualSonics, Inc., Toronto, ON, Canada) with a 30 MHz linear-array transducer (RMV707 B). Magnetic resonance imaging with a 3 Tesla scanner (Achieva MR system, Philips Healthcare, Best, The Netherlands) and a single-loop microscopy coil was performed as a reference standard. All stages of aneurysm development were evaluated by histologic analyses. The "signal-thrombus-matrix" to "signal-blood" ratio on high-frequency ultrasound measurements showed a strong correlation (R2 = 0.81, p <0.05) with the state of extracellular matrix remodeling. Furthermore, size measurements derived from the high-frequency ultrasound correlated well with magnetic resonance imaging and histology. This study demonstrated that high-frequency ultrasound enables the reliable in vivo quantification of extracellular matrix remodeling at various stages of thrombus development, based on the thrombus echogenicity.
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Affiliation(s)
| | | | | | - Lisa Adams
- Department of Radiology, Charité, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Berlin, Germany
| | - Rene M Botnar
- Division of Imaging Sciences, King's College London, London, United Kingdom; BHF Centre of Excellence, King's College London, London, United Kingdom; Cardioascular Division, 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
| | - Marcus R Makowski
- Division of Imaging Sciences, King's College London, London, United Kingdom; Department of Radiology, Charité, Berlin, Germany
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24
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Conlisk N, Forsythe RO, Hollis L, Doyle BJ, McBride OMB, Robson JMJ, Wang C, Gray CD, Semple SIK, MacGillivray T, van Beek EJR, Newby DE, Hoskins PR. Exploring the Biological and Mechanical Properties of Abdominal Aortic Aneurysms Using USPIO MRI and Peak Tissue Stress: A Combined Clinical and Finite Element Study. J Cardiovasc Transl Res 2017; 10:489-498. [PMID: 28808955 PMCID: PMC5722953 DOI: 10.1007/s12265-017-9766-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/04/2017] [Indexed: 01/15/2023]
Abstract
Inflammation detected through the uptake of ultrasmall superparamagnetic particles of iron oxide (USPIO) on magnetic resonance imaging (MRI) and finite element (FE) modelling of tissue stress both hold potential in the assessment of abdominal aortic aneurysm (AAA) rupture risk. This study aimed to examine the spatial relationship between these two biomarkers. Patients (n = 50) > 40 years with AAA maximum diameters > = 40 mm underwent USPIO-enhanced MRI and computed tomography angiogram (CTA). USPIO uptake was compared with wall stress predictions from CTA-based patient-specific FE models of each aneurysm. Elevated stress was commonly observed in areas vulnerable to rupture (e.g. posterior wall and shoulder). Only 16% of aneurysms exhibited co-localisation of elevated stress and mural USPIO enhancement. Globally, no correlation was observed between stress and other measures of USPIO uptake (i.e. mean or peak). It is suggested that cellular inflammation and stress may represent different but complimentary aspects of AAA disease progression.
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Affiliation(s)
- Noel Conlisk
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK. .,School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK. .,Institute for Bioengineering, The University of Edinburgh, Faraday Building, The King's Buildings, Mayfield Road, Edinburgh, EH9 3JL, UK.
| | - Rachael O Forsythe
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK.,Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - Lyam Hollis
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Barry J Doyle
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Perth, Australia.,School of Mechanical and Chemical Engineering, The University of Western Australia, Perth, Australia
| | - Olivia M B McBride
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK.,Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - Jennifer M J Robson
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK
| | - Chengjia Wang
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - Calum D Gray
- Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - Scott I K Semple
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - Tom MacGillivray
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,Clinical Research Imaging Centre, The University of Edinburgh, Edinburgh, UK
| | - Peter R Hoskins
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,Institute for Bioengineering, The University of Edinburgh, Faraday Building, The King's Buildings, Mayfield Road, Edinburgh, EH9 3JL, UK
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25
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Li X, Fang Q, Tian X, Wang X, Ao Q, Hou W, Tong H, Fan J, Bai S. Curcumin attenuates the development of thoracic aortic aneurysm by inhibiting VEGF expression and inflammation. Mol Med Rep 2017; 16:4455-4462. [PMID: 28791384 PMCID: PMC5647005 DOI: 10.3892/mmr.2017.7169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 05/09/2017] [Indexed: 11/05/2022] Open
Abstract
Angiogenesis is an important process in the pathogenesis of aortic aneurysm. The aim of the present study was to investigate the angiogenic balance and the expression of vascular endothelial growth factor (VEGF) in thoracic aortic aneurysm (TAA). A previous study demonstrated that curcumin exerts a marked effect on aortic aneurysm development. Therefore, the present study determined whether curcumin is able to modulate angiogenesis and inflammatory signaling in TAA by collecting human TAA samples and establishing a rat TAA model using periaortic application of CaCl2. TAA rats were treated with curcumin or 1% carboxymethyl cellulose and were sacrificed 4 weeks after the operation. All tissue specimens were analyzed by histological staining, immunohistochemistry and western blotting. Human TAA samples exhibited increased neovascularization and VEGF expression when compared with normal aortic walls. In rat tissues, treatment with curcumin resulted in reduced aneurysm size and restored the wavy structure of the elastic lamellae. In addition, curcumin decreased neovascularization and the expression of VEGF. Immunohistochemical analysis indicated that curcumin significantly inhibited infiltration of cluster of differentiation (CD)3+ and CD68+ cells in TAA. Furthermore, curcumin treatment decreased the expression of vascular cell adhesion molecule‑1, intracellular adhesion molecule‑1, monocyte chemoattractant protein‑1 and tumor necrosis factor‑α. Collectively, the results demonstrated that angiogenesis and VEGF expression were increased in the aortic wall in TAA. Treatment with curcumin inhibited TAA development in rats, which was associated with suppression of VEGF expression. In addition, curcumin attenuated inflammatory cell infiltration and suppressed inflammatory factor expression in the periaortic tissue of TAA.
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Affiliation(s)
- Xiang Li
- Department of Cell Biology, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Qin Fang
- Department of Cardiac Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Xiaohong Tian
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Xiaohong Wang
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Qiang Ao
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Weijian Hou
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Hao Tong
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Jun Fan
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Shuling Bai
- Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning 110122, P.R. China
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26
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Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair. Circulation 2017; 136:787-797. [PMID: 28720724 PMCID: PMC5571881 DOI: 10.1161/circulationaha.117.028433] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/17/2017] [Indexed: 12/31/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation on magnetic resonance imaging (MRI). In patients with abdominal aortic aneurysm, we assessed whether USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes. Methods In a prospective multicenter open-label cohort study, 342 patients with abdominal aortic aneurysm (diameter ≥40 mm) were classified by the presence of USPIO enhancement and were monitored with serial ultrasound and clinical follow-up for ≥2 years. The primary end point was the composite of aneurysm rupture or repair. Results Participants (85% male, 73.1±7.2 years) had a baseline aneurysm diameter of 49.6±7.7 mm, and USPIO enhancement was identified in 146 (42.7%) participants, absent in 191 (55.8%), and indeterminant in 5 (1.5%). During follow-up (1005±280 days), 17 (5.0%) abdominal aortic aneurysm ruptures, 126 (36.8%) abdominal aortic aneurysm repairs, and 48 (14.0%) deaths occurred. Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1±2.5 versus 2.5±2.4 mm/year, P=0.0424), although this was not independent of current smoking habit (P=0.1993). Patients with USPIO enhancement had higher rates of aneurysm rupture or repair (47.3% versus 35.6%; 95% confidence intervals, 1.1–22.2; P=0.0308). This finding was similar for each component of rupture (6.8% versus 3.7%, P=0.1857) or repair (41.8% versus 32.5%, P=0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair (P=0.0275), all-cause mortality (P=0.0635), and aneurysm-related mortality (P=0.0590). Baseline abdominal aortic aneurysm diameter (P<0.0001) and current smoking habit (P=0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic, 0.7935–0.7936). Conclusions USPIO-enhanced MRI is a novel approach to the identification of aortic wall cellular inflammation in patients with abdominal aortic aneurysms and predicts the rate of aneurysm growth and clinical outcome. However, it does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors. Clinical Trial Registration: URL: http://www.isrctn.com. Unique identifier: ISRCTN76413758.
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27
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Jansen CHP, Reimann C, Brangsch J, Botnar RM, Makowski MR. In vivo MR-angiography for the assessment of aortic aneurysms in an experimental mouse model on a clinical MRI scanner: Comparison with high-frequency ultrasound and histology. PLoS One 2017; 12:e0178682. [PMID: 28582441 PMCID: PMC5459432 DOI: 10.1371/journal.pone.0178682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND MR-angiography currently represents one of the clinical reference-standards for the assessment of aortic-dimensions. For experimental research in mice, dedicated preclinical high-field MRI scanners are used in most studies. This type of MRI scanner is not available in most institutions. The aim of this study was to evaluate the potential of MR-angiography performed on a clinical MR scanner for the assessment of aortic aneurysms in an experimental mouse model, compared to a preclinical high-resolution ultrasound imaging system and histopathology. METHODS All in vivo MR imaging was performed with a clinical 3T MRI system (Philips Achieva) equipped with a clinical gradient system in combination with a single-loop surface-coil (47 mm). All MR sequences were based on clinically used sequences. For ultrasound, a dedicated preclinical high-resolution system (30 MHz linear transducer, Vevo770, VisualSonics) was used. All imaging was performed with an ApoE knockout mouse-model for aortic aneurysms. Histopathology was performed as reference-standard at all stages of aneurysm development. RESULTS MR-angiography on a clinical 3T system enabled the clear visualization of the aortic lumen and aneurysmal dilation at different stages of aneurysm development. A close correlation (R2 = 0.98; p < 0.001) with histological area measurements was found. Additionally, a good agreement between MR and ultrasound area measurements in systole (R2 = 0.91; p < 0.001) and diastole (R2 = 0.94; p < 0.001) were measured. Regarding interobserver reproducibility, MRI measurements yielded a smaller 95% confidence interval and a closer interreader correlation compared to ultrasound measurements (-0.37-0.46; R2 = 0.97 vs. -0.78-0.88; R2 = 0.87). CONCLUSION This study demonstrates that MR-angiography, performed on a clinical 3T MR scanner, enables the reliable detection and quantification of the aortic dilatation at different stages of aneurysm development in an experimental mouse model.
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Affiliation(s)
- Christian H. P. Jansen
- King’s College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | | | | | - René M. Botnar
- King’s College London, Division of Imaging Sciences and Biomedical Engineering, 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
- School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Marcus R. Makowski
- King’s College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
- Department of Radiology, Charite, Berlin, Germany
- BHF Centre of Excellence, King’s College London, London, United Kingdom
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