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Pham MHC, Kühl JT, Fuchs A, Sigvardsen PE, Sillesen H, Afzal S, Nordestgaard BG, Køber LV, Kofoed KF. Determinants of thoracic aortic size in normotensive and hypertensive individuals. J Hypertens 2024; 42:1736-1742. [PMID: 39132699 DOI: 10.1097/hjh.0000000000003792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
AIMS Thoracic aortic diameter is modulated by various factors including both physiological and pathological mechanisms. The aim of this study was to explore the determinants of thoracic aortic size focusing on arterial blood pressure and physical activity in normotensive and hypertensive individuals. METHODS Ascending and descending aortic diameters were measured in participants of the Copenhagen General Population Study using thoracic CT angiography. To assess the relation between arterial blood pressure and thoracic aortic diameters, individuals with diabetes, hypercholesterolemia, smoking, and prescribed antihypertensive medication were excluded. Intensity of physical activity was recorded based on self-reported questionnaire data. RESULTS A total of 1214 normotensive and 284 hypertensive individuals were examined. In all individuals, male sex, older age, and body surface area were associated with higher diameters of the ascending and descending aorta ( P < 0.01). In normotensive individuals, hard physical activity > 4 h/week was independently associated with higher thoracic aortic diameters (ascending β:1.09[0.52;1.66] and descending β : 0.47[0.14;0.80], both P < 0.01), whereas higher systolic blood pressure was not associated with thoracic aortic diameters (ascending P = 0.12 and descending p = 0.33). In hypertensive individuals, higher systolic blood pressure (per 10 mmHg) was independently associated with higher thoracic aortic diameters (ascending β : 0.55[0.17;0.94] and descending β : 0.23[0.10;0.37] mm/10 mmHg, both P < 0.01), whereas hard physical activity was not associated with higher aortic diameters (ascending P = 0.11 and descending P = 0.51). CONCLUSION In normotensive individuals hard physical activity, and in hypertensive individuals increasing systolic blood pressure are factors each independently associated with larger thoracic aortic size. These findings suggest a context sensitive mode of aortic vascular response to size modulating adaptation.
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Affiliation(s)
- Michael H C Pham
- Department of Cardiology, The Heart Center
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen
| | - Jørgen T Kühl
- Department of Cardiology, Zealand University Hospital, Roskilde
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Center
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen
| | - Henrik Sillesen
- Department of Vascular Surgery, The Heart Center, Copenhagen University Hospital - Rigshospitalet
| | - Shoaib Afzal
- Department of Clinical Biochemistry
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Center
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Center
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Pucci A, Rossetti M, Lenzi C, Buja ML. The cardiovascular pathologist in the aortic team. Cardiovasc Pathol 2024; 72:107649. [PMID: 38703970 DOI: 10.1016/j.carpath.2024.107649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
Aortic diseases require a multidisciplinary management for diagnosis, treatment and follow-up with better outcomes in referral centers using a team-based approach. The setting up of a multi-disciplinary aortic team for the discussion of complex cases has been already proposed; it is also supported by the ACC/AHA. Surgeons and radiologists, more or less other physicians such as cardiologists, geneticists, rheumatologists/internal medicine specialists and pathologists are involved into such a team. The role of the cardiovascular pathologist is to examine the aortic specimens, to diagnose and classify the aortic lesions. Herein, the role of the pathologist in the aortic team is discussed and the pathobiology of aortic diseases is reviewed for reference by pathologists. The aortic specimens are mainly obtained from emergency or elective surgical procedures on the thoracic aorta, less frequently from organ/tissue (including cardiac or heart valve) donors, post-mortem procedures or abdominal aortic surgery. In the last decade, together with the progress of medical sciences, the histological definitions and classifications of the aortic pathology are undergoing thorough revisions that are addressed to an etiopathogenetic approach because of possible clinico-pathological correlations, therapeutic and prognostic impact. Pathologists may also have an important role in research and teaching. Therefore, histological analyses of the aortic specimens require adequate sample processing and pathologist expertise because histology contributes to definite diagnosis, correct management of patients and even (in genetic diseases) families, but also to research in the challenging field of aortopathies.
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Affiliation(s)
- Angela Pucci
- Department of Histopathology, Pisa University Hospital, Pisa, Italy.
| | - Martina Rossetti
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Chiara Lenzi
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Maximilian L Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Zamirpour S, Boskovski MT, Pirruccello JP, Pace WA, Hubbard AE, Leach JR, Ge L, Tseng EE. Sex differences in ascending aortic size reporting and growth on chest computed tomography and magnetic resonance imaging. Clin Imaging 2024; 105:110021. [PMID: 37992628 DOI: 10.1016/j.clinimag.2023.110021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Diameter-based guidelines for prophylactic repair of ascending aortic aneurysms have led to routine aortic evaluation in chest imaging. Despite sex differences in aneurysm outcomes, there is little understanding of sex-specific aortic growth rates. Our objective was to evaluate sex-specific temporal changes in radiologist-reported aortic size as well as sex differences in aortic reporting. METHOD In this cohort study, we queried radiology reports of chest computed tomography or magnetic resonance imaging at an academic medical center from 1994 to 2022, excluding type A dissection. Aortic diameter was extracted using a custom text-processing algorithm. Growth rates were estimated using mixed-effects modeling with fixed terms for sex, age, and imaging modality, and patient-level random intercepts. Sex, age, and modality were evaluated as predictors of aortic reporting by logistic regression. RESULTS This study included 89,863 scans among 46,622 patients (median [interquartile range] age, 64 [52-73]; 22,437 women [48%]). Aortic diameter was recorded in 14% (12,722/89,863 reports). Temporal trends were analyzed in 7194 scans among 1998 patients (age, 68 [60-75]; 677 women [34%]) with ≥2 scans. Aortic growth rate was significantly higher in women (0.22 mm/year [95% confidence interval 0.17-0.28] vs. 0.09 mm/year [0.06-0.13], respectively). Aortic reporting was significantly less common in women (odds ratio, 0.54; 95% CI, 0.52-0.56; p < 0.001). CONCLUSIONS While aortic growth rates were small overall, women had over twice the growth rate of men. Aortic dimensions were much less frequently reported in women than men. Sex-specific standardized assessment of aortic measurements may be needed to address sex differences in aneurysm outcomes.
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Affiliation(s)
- Siavash Zamirpour
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; School of Medicine, University of California San Francisco, CA, USA
| | - Marko T Boskovski
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - James P Pirruccello
- Division of Cardiology, Department of Medicine, University of California San Francisco, USA; Institute for Human Genetics, University of California San Francisco, USA
| | - William A Pace
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; School of Medicine, University of California San Francisco, CA, USA
| | - Alan E Hubbard
- Division of Biostatistics, School of Public Health, University of California Berkeley, USA
| | - Joseph R Leach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Liang Ge
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Elaine E Tseng
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
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Lum RTW, Wang X, Zhang M, Zhang X, Ho JYK, Chow SCY, Fujikawa T, Wong RHL. Emerging role of radiogenomics in genetically triggered thoracic aortic aneurysm and dissection: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:356. [PMID: 37675315 PMCID: PMC10477616 DOI: 10.21037/atm-22-6149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/17/2023] [Indexed: 09/08/2023]
Abstract
Background and Objective Thoracic aortic aneurysm and dissection (TAAD) and its complications are life-threatening conditions. Hypertension and atherosclerosis had all along been recognized as the predominant risk factors for the development of TAAD. However, it was increasingly reported that genetic factors, such as single nucleotide polymorphisms (SNPs), are playing an important role in the disease development. The development of next-generation sequencing (NGS) and the rapid growth in radiomics provide a promising new platform to evaluate genetically triggered thoracic aortic aneurysm and dissection (GTAAD) from a new angle. This review is to present an overview of currently available knowledge regarding the use of radiomics and radiogenomics in GTAAD. Methods We performed literature searches in PubMed, EMBASE and Cochrane database from 2012 to 2022 regarding the use of radiomics and radiogenomics in GTAAD. Key Content and Findings There were only 13 studies on radiomics and 4 studies on radiogenomics integration retrieved from the search and it signifies there is still a significant knowledge gap in this field of translational medicine. An overview of the current knowledge of GTAAD, the workflow and role of radiomics, the radiogenomics integration for GTAAD including its potential role in the development of polygenic scores, as well as the implications, challenges, and limitations of radiogenomics research were discussed. Conclusions In the contemporary era, radiogenomics has been emerging as a state-of-the art approach to establish statistical correlation with radiomics features with genomic information in diagnosis, risk modeling and prediction and treatment decision in TAAD.
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Affiliation(s)
- Ray Tak Wai Lum
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Xin Wang
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Miaoru Zhang
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Xianrui Zhang
- Department of Biomedical Science, The City University of Hong Kong, Hong Kong, China
| | - Jacky Yan Kit Ho
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon Chi Ying Chow
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Takuya Fujikawa
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Randolph Hung Leung Wong
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Álvarez Gómez JL, López de Victoria O, Chévere Rivera JL. Avant-Garde Endovascular Stent Graft Insertion in Dissected Ascending Thoracic Aortic Aneurysm. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023:15569845231171128. [PMID: 37144728 DOI: 10.1177/15569845231171128] [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: 05/06/2023]
Abstract
Current guidelines and regulatory parameters for cardiothoracic surgery in the United States establish that open surgery is the first front line for treating ascending thoracic aortic aneurysms (ATAA). Despite advances in performing endovascular procedures in thoracic aortic aneurysms, there are no approved state-of-the-art techniques that allow endovascular procedures to be performed in ATAA. Thus, thoracic endovascular aortic repair (TEVAR) of the ascending aorta, as we will demonstrate, is a useful and effective technical opportunity for treating high-risk patients with type A dissections, intramural hematomas, and pseudoaneurysms. In this case, an 88-year-old female patient was consulted due to a preliminary diagnosed descending thoracic aortic aneurysm. As a result of uncertainty regarding the initial diagnosis, abdominal-pelvic and chest computed tomography scan tests contradicted the original conclusion and surprisingly yielded a different scenario; in fact, the patient had a dissected ATAA. Using the TEVAR procedure, the patient's ATAA was treated with a thoracic GORE TAG endograft stent (W. L. Gore & Associates, Inc., Newark, DE, USA). Four weeks later, the aneurysm was completely thrombosed, and the stent-graft was properly in place.
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Zamirpour S, Xuan Y, Wang Z, Gomez A, Hope MD, Leach J, Mitsouras D, Saloner DA, Guccione JM, Ge L, Tseng EE. Association of 3-Year All-Cause Mortality and Peak Wall Stresses of Ascending Thoracic Aortic Aneurysms in Veterans. Semin Thorac Cardiovasc Surg 2022; 35:447-456. [PMID: 35690227 DOI: 10.1053/j.semtcvs.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
Risk of aortic dissection in ascending thoracic aortic aneurysms is not sufficiently captured by size-based metrics. From a biomechanical perspective, dissection may be initiated when wall stress exceeds wall strength. Our objective was to assess the association between aneurysm peak wall stresses and 3-year all-cause mortality. Finite element analysis was performed in 273 veterans with chest computed tomography for surveillance of ascending thoracic aortic aneurysms. Three-dimensional geometries were reconstructed and models developed accounting for prestress geometries. A fiber-embedded hyperelastic material model was applied to obtain circumferential and longitudinal wall stresses under systolic pressure. Patients were followed up to 3 years following the scan to assess aneurysm repair and all-cause mortality. Fine-Gray subdistribution hazards were estimated for all-cause mortality based on age, aortic diameter, and peak wall stresses, treating aneurysm repair as a competing risk. When accounting for age, subdistribution hazard of mortality was not significantly increased by peak circumferential stresses (p = 0.30) but was significantly increased by peak longitudinal stresses (p = 0.008). Aortic diameter did not significantly increase subdistribution hazard of mortality in either model (circumferential model: p = 0.38; longitudinal model: p = 0.30). The effect of peak longitudinal stresses on subdistribution hazard of mortality was maximized at a binary threshold of 355kPa, which captured 34 of 212(16%) patients with diameter <5 cm, 11 of 36(31%) at 5.0-5.4 cm, and 11 of 25(44%) at ≥5.5 cm. Aneurysm peak longitudinal stresses stratified by age and diameter were associated with increased hazard of 3-year all-cause mortality in a veteran cohort. Risk prediction may be enhanced by considering peak longitudinal stresses.
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Affiliation(s)
- Siavash Zamirpour
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA; Joint Medical Program, School of Public Health, University of California, Berkeley, and School of Medicine, University of California, San Francisco, CA, USA
| | - Yue Xuan
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Zhongjie Wang
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Axel Gomez
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Joseph Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Dimitrios Mitsouras
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - David A Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Julius M Guccione
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Liang Ge
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Elaine E Tseng
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA.
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