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1.
Nefrología (Madrid) ; 44(2): 256-267, Mar-Abr. 2024. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-231576

RESUMO

Fundamento y objetivos: El aumento de la rigidez arterial central (aórtica) tiene repercusiones hemodinámicas con efectos nocivos cardiovasculares y renales. En la enfermedad renal crónica (ERC) puede existir un aumento de la rigidez aórtica secundaria a múltiples alteraciones metabólicas, entre ellas la calcificación de la pared vascular (CV). El objetivo de este estudio fue analizar la asociación de la rigidez aórtica y de la hemodinámica central con la presencia de CV en dos territorios: aorta abdominal (CAA) y arterias coronarias (CC). Material y métodos: Se incluyeron 87 pacientes con ERC estadios 3 y 4. Usando tonometría de aplanamiento se estudiaron la hemodinámica central y la rigidez aórtica. Esta se determinó mediante la velocidad de pulso carótida-femoral (Vpc-f). A partir de la Vpc-f se calculó el índice de la VPc-f (iVpc-f) que considera otras variables que influyen en la Vpc-f, como edad, presión arterial, sexo y frecuencia cardiaca. La presencia de CAA se valoró mediante radiografía lateral de columna lumbar calculándose el índice de Kauppila (iKauppila) y las CC mediante tomografía computarizada multidetección por el método de Agatston, calculándose su índice (iAgatston). Para el estudio de la asociación entre iVpc-f, iKauppila, iAgatston, presión aórtica central, parámetros clínicos y datos de laboratorio se usaron la regresión múltiple y la regresión logística. La capacidad discriminativa del iVpc-f para evaluar la presencia de CAA y CC se determinó mediante el área bajo la curva (ABC) de ROC (receiver-operating characteristic). Resultados: La Vpc-f y el iVpc-f fueron 11,3±2,6m/s y 10,6m/s, respectivamente. El iVpc-f fue mayor cuando la ERC coexistía con diabetes mellitus (DM). Se detectaron CAA y CC en el 77% y el 87%, respectivamente. La albuminuria (β=0,13, p=0,005) y el iKauppila (β=0,36, p=0,001) se asociaron de forma independiente con la magnitud del iVpc-f... (AU)


Rationale and objectives: Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC). The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries (CAC). Materials and methods: We included 87 patients with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pvc-f) and Pvc-f adjusted for age, blood pressure, sex and heart rate (Pvc-f index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respectively. For the study of the association between iPvc-f index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pvc-f index for prediction of VC using receiver-operating characteristic (ROC). Results: Pvc-f and Pvc-f index were 11.3±2.6m/s and 10.6m/s, respectively. The Pvc-f index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively. Albuminuria (β=0.13, p=0.005) and Kauppila score (β=0.36, p=0.001) were independently associated with Pvc-f index. In turn, Pvc-f index (β=0.39, p=0.001), DM (β=0.46, p=0.01), and smoking (β=0.53; p=0.006) were associated with Kauppila score, but only Pvc-f index predicted AAC [OR: 3.33 (95% CI: 1.6–6.9; p=0.001)]. The Kauppila score was independently associated with the Agatston score (β=1.53, p=0.001)... (AU)


Assuntos
Humanos , Insuficiência Renal Crônica , Aorta/crescimento & desenvolvimento , Abdome , Erros Inatos do Metabolismo , Aorta Abdominal , Vasos Coronários , Pressão Arterial , Frequência Cardíaca
2.
Radiol Cardiothorac Imaging ; 6(2): e230105, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38483247

RESUMO

Immunoglobulin 4 (IgG4)-related disease is a chronic immune-mediated fibroinflammatory disorder. Involvement of the vascular system, including large- and medium-sized vessels, is increasingly recognized. The varied appearances of vascular involvement reflect the sequela of chronic inflammation and fibrosis and can include aortitis and periaortitis with resultant complications such as aneurysm formation and dissection. A diagnosis of IgG4-related large vessel involvement should be considered when there is known or suspected IgG4-related disease elsewhere. Other organs that are typically affected in IgG4-related disease include the lacrimal and salivary glands, thyroid, pancreas, biliary tree, lungs, kidneys, and meninges. Diagnosis typically requires careful correlation with clinical, imaging, serum, and pathologic findings. Patients may be managed with corticosteroid therapy or the anti-CD20 monoclonal antibody, rituximab, if needed. The varied clinical presentations and imaging features of large vessel involvement are discussed herein. Keywords: Vascular, Inflammation, Aorta, IgG4-related Vessel Involvement © RSNA, 2024.


Assuntos
Doença Relacionada a Imunoglobulina G4 , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Imunoglobulina G , Imagem Multimodal , Aorta , Inflamação
3.
Kyobu Geka ; 77(2): 101-105, 2024 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-38459858

RESUMO

A 75-year-old woman was diagnosed with type B acute aortic dissection 14 years ago and 3-channeled aortic dissection 7 years ago. She received total arch replacement 6 years ago and descending aortic replacement with double barrel anastomosis technique for distal anastomosis 5 years ago. Computed tomography( CT) revealed giant thyroid tumor and thoracoabdominal aortic aneurysm( 58 mm in diameter). She suffered from back pain during her follow-up period. CT revealed ruptured thoracoabdominal aortic aneurysm. First, the false lumen of descending aorta was closed by thoracic endovascular aortic repair, and then thoracoabdominal aortic replacement was performed uneventfully.


Assuntos
Aneurisma da Aorta Torácica , Aneurisma da Aorta Toracoabdominal , Dissecção Aórtica , Ruptura Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Feminino , Idoso , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Anastomose Cirúrgica , Resultado do Tratamento
4.
Surg Clin North Am ; 104(2): 311-323, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38453304

RESUMO

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been utilized by trauma surgeons at the bedside for over a decade in both civilian and military settings. Both translational and clinical research suggest it is superior to resuscitative thoracotomy for specific patient populations. Technological advancements in recent years have significantly enhanced the safety profile of REBOA. Resuscitative balloon occlusion of the aorta has also swiftly found implementation in patients in shock from non-traumatic hemorrhage.


Assuntos
Oclusão com Balão , Procedimentos Endovasculares , Choque Hemorrágico , Humanos , Aorta/lesões , Choque Hemorrágico/etiologia , Choque Hemorrágico/terapia , Ressuscitação
5.
Methodist Debakey Cardiovasc J ; 20(2): 51-58, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38495666

RESUMO

Thoracic aortic disease (TAD) poses substantial risks during pregnancy, particularly for women with genetic conditions such as Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome. This review examines the epidemiology, risk assessment, and management of TAD in pregnancy. Preconception counseling is vital considering the hereditary nature of TAD and potential pregnancy-related complications. Genetic testing and imaging surveillance aid in risk assessment. Medical management, including beta-blockade and strict blood pressure control, is essential throughout pregnancy. Surgical interventions may be necessary in certain cases. A multidisciplinary approach involving cardiologists, obstetricians, cardiac surgeons, anesthesiologists, and other specialists with expertise in cardio-obstetrics is essential for optimal outcomes. Patient education and shared decision-making play vital roles in navigating the complexities of TAD in pregnancy and improving maternal and neonatal outcomes.


Assuntos
Doenças da Aorta , Síndrome de Loeys-Dietz , Síndrome de Marfan , Gravidez , Recém-Nascido , Humanos , Feminino , Aorta , Síndrome de Loeys-Dietz/complicações , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/epidemiologia , Síndrome de Marfan/terapia , Medição de Risco
6.
Biochem Biophys Res Commun ; 705: 149734, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38430607

RESUMO

CD38 is a multifunctional enzyme implicated in chemotaxis of myeloid cells and lymphocyte activation, but also expressed by resident cells such as endothelial and smooth muscle cells. CD38 is important for host defense against microbes. However, CD38's role in the pathogenesis of atherosclerosis is controversial with seemingly conflicting results reported so far. To clarify the discrepancy of current literature on the effect of CD38 ablation on atherosclerosis development, we implanted a shear stress modifier around the right carotid artery in CD38-/- and WT mice. Hypercholesterolemia was induced by human gain-of-function PCSK9 (D374Y), introduced using AAV vector (serotype 9), combined with an atherogenic diet for a total of 9 weeks. Atherosclerosis was assessed at the aortic root, aortic arch and the right carotid artery. The findings can be summarized as follows: i) CD38-/- and WT mice had a similar atherosclerotic burden in all three locations, ii) No significant differences in monocyte infiltration or macrophage content could be seen in the plaques, and iii) The amount of collagen deposition in the plaques were also similar between CD38-/- and WT mice. In conclusion, our data suggest that CD38-/- mice are neither protected against nor prone to atherosclerosis compared to WT mice.


Assuntos
Aterosclerose , Pró-Proteína Convertase 9 , Animais , Humanos , Camundongos , Aorta , Aterosclerose/genética , Aterosclerose/prevenção & controle , Artéria Carótida Primitiva , Antígenos CD/genética , Antígenos CD/metabolismo
7.
Kyobu Geka ; 77(3): 213-216, 2024 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-38465494

RESUMO

Formation of a pseudoaneurysm due to blood leakage from the anastomotic site of the vascular graft in large-diameter vessels is often seen, but formation of a pseudoaneurysm from the non-anastomotic site is extremely rare. A 68-year-old woman presented with a history of double valve replacement for combined valvular disease at 37 years old and hemiarch replacement for thoracic aortic dilatation at 65 years old. She visited the emergency room with a 2-week history of chest pain. Contrast-enhanced computed tomography (CT) revealed a 5-cm-diameter pseudoaneurysm and extravasation from the ascending aorta, so emergency surgery was performed. Around the ascending aorta area, we confirmed bleeding from a 5-mm dehiscence in the non-anastomotic part of the graft prosthesis, so hemostasis was performed with a cross-stitch mattress suture over a felt strip. Initially, the cause of the pseudoaneurysm was unknown, but re-examination of CT images from after the previous hemiarch replacement confirmed contact between the sternal wire and graft prosthesis. The wire was thus considered to have caused damage and bleeding. The patient was discharged from the hospital with a good postoperative course and is being followed-up in the outpatient department.


Assuntos
Falso Aneurisma , Implante de Prótese Vascular , Idoso , Feminino , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aorta/cirurgia , Substitutos Sanguíneos , Implante de Prótese Vascular/efeitos adversos
8.
J Am Heart Assoc ; 13(6): e033233, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38497463

RESUMO

BACKGROUND: Nonobstructive general angioscopy (NOGA) can identify vulnerable plaques in the aortic lumen that serve as potential risk factors for cardiovascular events such as embolism. However, the association between computed tomography (CT) images and vulnerable plaques detected on NOGA remains unknown. METHODS AND RESULTS: We investigated 101 patients (67±11 years; women, 13.8%) who underwent NOGA and contrast-enhanced CT before or after 90 days in our hospital. On CT images, the aortic wall thickness, aortic wall area (AWA), and AWA in the vascular area were measured at the thickest point from the 6th to the 12th thoracic vertebral levels. Furthermore, the association between these measurements and the presence or absence of NOGA-derived aortic plaque ruptures (PRs) at the same vertebral level was assessed. NOGA detected aortic PRs in the aortic lumens at 145 (22.1%) of the 656 vertebral levels. The presence of PRs was significantly associated with greater aortic wall thickness (3.3±1.7 mm versus 2.1±1.2 mm), AWA (1.33±0.68 cm2 versus 0.89±0.49 cm2), and AWA in the vascular area (23.2%±9.3% versus 17.2%±7.6%) (P<0.001 for all) on the CT scans compared with the absence of PRs. The frequency of PRs significantly increased as the aortic wall thickness increased. Notably, a few NOGA-derived PRs were detected on CT in near-normal intima. CONCLUSIONS: The presence of NOGA-derived PRs was strongly associated with increased aortic wall thickness, AWA, and AWA in the vascular area, measured using CT. NOGA can detect PRs in the intima that appear almost normal on CT scans.


Assuntos
Tomografia Computadorizada Multidetectores , Placa Aterosclerótica , Humanos , Feminino , Angioscopia/métodos , Aorta Torácica , Aorta
9.
Comput Methods Programs Biomed ; 247: 108081, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38428251

RESUMO

BACKGROUND AND OBJECTIVES: Physics-informed neural networks (PINNs) can be used to inversely model complex physical systems by encoding the governing partial differential equations and training data into the neural network. However, neural networks are known to be biased towards learning less complex functions, called spectral bias. This has important implications in modeling cardiovascular flows, where spatial frequencies can vary substantially across anatomies and pathologies (e.g., aneurysms or stenoses). Recent evidence suggests that Fourier-based activation functions have desirable properties, and can potentially reduce spectral bias; however, the performance and adequacy of such Fourier activation functions have not yet been evaluated in patient-specific cardiovascular flow applications. METHODS: The performance of sine activation function was evaluated against tanh and swish activation functions in a 1D advection-diffusion problem, an eccentric 2D stenosis model (Re=5000), and a patient-specific 3D aortic model (Re=823) under pulsatile flow conditions. CFD simulations were performed at high spatio-temporal resolution and data points were extracted for training the neural network. The number of training data points were normalized by L/D. The performance of the PINNs framework was evaluated with increasing number of training data points and across all three activation functions. RESULTS: Our results demonstrate that sine activation function presents desirable characteristics, such as monotonic reduction in errors, relatively faster convergence, and accurate eigen spectra at higher modes, compared to tanh and swish activation functions. Interestingly, for all activation functions, the domain-averaged errors tended to asymptote at ≈15-20% despite substantial increase in training point density. For 2D eccentric stenosis, errors asymptoted at a sensor point density of 40L/D. For 3D patient-specific aorta, this asymptote was achieved at 180L/D for all three activation functions with an error of ≈15% although sine activation function demonstrated relatively faster convergence. CONCLUSIONS: We have demonstrated that Fourier-based activation functions have higher performance in terms of accuracy and convergence properties for cardiovascular flow applications; however, inherent challenges of neural networks (e.g., spectral bias) can limit the accuracy to ≈15% under physiological, 3D patient-specific blood flow conditions.


Assuntos
Aorta , Redes Neurais de Computação , Humanos , Constrição Patológica , Difusão , Física
10.
Medicine (Baltimore) ; 103(12): e37472, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38518053

RESUMO

BACKGROUND: Iatrogenic aortic dissection (IAD) is a rare but highly lethal complication that may occur following coronary artery bypass grafting (CABG) surgery. Aortic dissection (AD) is often asymptomatic, making early detection difficult. We aimed to optimize preoperative evaluation strategies of CABG surgery for minimizing the incidence of IAD and assess early recognition and management of IAD for improving outcomes. METHODS: Electronic databases were searched to identify all case reports of patients undergoing CABG surgery who developed IAD. Clinical characteristics, operative information, perioperative management, and patient outcomes were compiled and analyzed. RESULTS: Nineteen case reports involving 27 patients aged 50 to 81 were included. Patients were from Europe (n = 23) and Asia (n = 4), mostly men (n = 25). The aorta was described as normal, abnormal, and unmentioned (n = 8, 5, and 14, respectively). Sixteen patients had a bypass with more than 3 grafts. Most patients (n = 25) experienced type A dissection. There were intraoperative (n = 12) and postoperative (n = 15) cases. Surgery (n = 19) was the most common treatment, with 9 patients selecting deep hypothermic circulatory arrest. Eighteen patients were restored to health, while 9 patients died (3 died before treatment). CONCLUSIONS: Our study focused on patients with IAD and developed a recommended management protocol for patients undergoing CABG surgery.


Assuntos
Dissecção Aórtica , Ponte de Artéria Coronária , Masculino , Humanos , Feminino , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Doença Iatrogênica , Ásia , Resultado do Tratamento
12.
Sci Rep ; 14(1): 6959, 2024 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-38521811

RESUMO

Abdominal aortic aneurysm (AAA) is a deadly, permanent ballooning of the aortic artery. Pharmacological and genetic studies have pointed to multiple proteins, including microsomal prostaglandin E2 synthase-1 (mPGES-1), as potentially promising targets. However, it remains unknown whether administration of an mPGES-1 inhibitor can effectively attenuate AAA progression in animal models. There are still no FDA-approved pharmacological treatments for AAA. Current research stresses the importance of both anti-inflammatory drug targets and rigor of translatability. Notably, mPGES-1 is an inducible enzyme responsible for overproduction of prostaglandin E2 (PGE2)-a well-known principal pro-inflammatory prostanoid. Here we demonstrate for the first time that a highly selective mPGES-1 inhibitor (UK4b) can completely block further growth of AAA in the ApoE-/- angiotensin (Ang)II mouse model. Our findings show promise for the use of a mPGES-1 inhibitor like UK4b as interventional treatment of AAA and its potential translation into the clinical setting.


Assuntos
Aneurisma da Aorta Abdominal , Camundongos , Animais , Aneurisma da Aorta Abdominal/tratamento farmacológico , Aneurisma da Aorta Abdominal/metabolismo , Prostaglandina-E Sintases/genética , Aorta/metabolismo , Prostaglandinas , Dinoprostona/uso terapêutico , Angiotensina II/farmacologia , Modelos Animais de Doenças
13.
Sci Rep ; 14(1): 6762, 2024 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-38514703

RESUMO

The failure of the aortic heart valve is common, resulting in deterioration of the pumping function of the heart. For the end stage valve failure, bi-leaflet mechanical valve (most popular artificial valve) is implanted. However, due to its non-physiological behaviour, a significant alteration is observed in the normal haemodynamics of the aorta. While in-vivo experimentation of a human heart valve (native and artificial) is a formidable task, in-silico study using computational fluid dynamics (CFD) with fluid structure interaction (FSI) is an effective and economic tool for investigating the haemodynamics of natural and artificial heart valves. In the present work, a haemodynamic model of a natural and mechanical heart valve has been developed using meshless particle-based smoothed particle hydrodynamics (SPH). In order to further enhance its clinical relevance, this study employs a patient-specific vascular geometry and presents a successful validation against traditional finite volume method and 4D magnetic resonance imaging (MRI) data. The results have demonstrated that SPH is ideally suited to simulate the heart valve function due to its Lagrangian description of motion, which is a favourable feature for FSI. In addition, a novel methodology for the estimation of the wall shear stress (WSS) and other related haemodynamic parameters have been proposed from the SPH perspective. Finally, a detailed comparison of the haemodynamic parameters has been carried out for both native and mechanical aortic valve, with a particular emphasis on the clinical risks associated with the mechanical valve.


Assuntos
Hidrodinâmica , Modelos Cardiovasculares , Humanos , Simulação por Computador , Aorta/fisiologia , Valva Aórtica/fisiologia , Estresse Mecânico , Hemodinâmica/fisiologia
14.
Sci Rep ; 14(1): 5779, 2024 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-38461168

RESUMO

In individuals with Marfan Syndrome (MFS), fibrillin-1 gene (FBN1) mutations can lead to vascular wall weakening and dysfunction. The experimental mouse model of MFS (Fbn1C1041G/+) has been advantageous in investigating MFS-associated life-threatening aortic aneurysms. It is well established that the MFS mouse model exhibits an accelerated-aging phenotype in elastic organs like the aorta, lung, and skin. However, the impact of Fbn1 mutations on the in vivo function and structure of various artery types with the consideration of sex and age, has not been adequately explored in real-time and a clinically relevant context. In this study, we investigate if Fbn1 mutation contributes to sex-dependent alterations in central and cerebral vascular function similar to phenotypic changes associated with normal aging in healthy control mice. In vivo ultrasound imaging of central and cerebral vasculature was performed in 6-month-old male and female MFS and C57BL/6 mice and sex-matched 12-month-old (middle-aged) healthy control mice. Our findings confirm aortic enlargement (aneurysm) and wall stiffness in MFS mice, but with exacerbation in male diameters. Coronary artery blood flow velocity (BFV) in diastole was not different but left pulmonary artery BFV was decreased in MFS and 12-month-old control mice regardless of sex. At 6 months of age, MFS male mice show decreased posterior cerebral artery BFV as compared to age-matched control males, with no difference observed between female cohorts. Reduced mitral valve early-filling velocities were indicated in MFS mice regardless of sex. Male MFS mice also demonstrated left ventricular hypertrophy. Overall, these results underscore the significance of biological sex in vascular function and structure in MFS mice, while highlighting a trend of pre-mature vascular aging phenotype in MFS mice that is comparable to phenotypes observed in older healthy controls. Furthermore, this research is a vital step in understanding MFS's broader implications and sets the stage for more in-depth future analyses, while providing data-driven preclinical justification for re-evaluating diagnostic approaches and therapeutic efficacy.


Assuntos
Aorta , Síndrome de Marfan , Pessoa de Meia-Idade , Masculino , Humanos , Feminino , Camundongos , Animais , Idoso , Lactente , Fibrilina-1/genética , Camundongos Endogâmicos C57BL , Aorta/diagnóstico por imagem , Síndrome de Marfan/complicações , Fenótipo , Mutação
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