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1.
Medicine (Baltimore) ; 98(50): e18241, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852089

RESUMO

T helper 17 (Th17) cells are related to the progression of aortic dissection. This study aimed to determine whether circulating Th17 levels are associated with the prognosis of acute Stanford type B aortic dissection (STBAD) after thoracic endovascular aortic repair (TEVAR).A cohort study was performed and STBAD patients (n = 140) received TEVAR were enrolled, the circulating Th17 levels were measured and the patients were divided into low and high Th17 groups, and 36 months of follow-up was performed. The data for mortality, survival outcomes, heart structure and function changes, aortic regurgitation prevalence, and aortic remodeling outcomes were recorded.Lower mortality and fewer complications were observed in the low Th17 group than in the high Th17 group in the third year of follow-up. In addition, the low Th17 group exhibited better cardiac remodeling and cardiac function when compared with that in the high Th17 group in the second to third year after TEVAR. Aortic reflux was improved in both groups but was more pronounced in the low Th17 group. During follow-up, the true lumen of the proximal thoracic aorta at the level of the celiac trunk in both the low and high Th17 groups continuously enlarged and was more pronounced in the low Th17 group.Circulating Th17 cells were related to cardiac and aortic remodeling and prognosis during STBAD after TEVAR. Anti-inflammatory therapy may be useful for STBAD patients who have undergone TEVAR.


Assuntos
Aneurisma Dissecante/sangue , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/sangue , Procedimentos Endovasculares/métodos , Células Th17/patologia , Remodelação Vascular , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
2.
Medicine (Baltimore) ; 98(43): e17023, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651834

RESUMO

Stanford type A aortic dissection (AD) is a lethal disease requiring surgery. Evidence regarding the prognostic ability of perioperative myocardiac markers on long-term outcome is limited.In this cohort study, we measured perioperative myocardiac markers level in 583 surgical patients with type A AD in our hospital between 2015 and 2017. All patients were followed up after surgery for a median period of 864 days to determine short- and long-term mortality.About one-fifth of patients has a positive preoperative myocardial markers, which was increased significantly after operation. Increase log10 post-creatine kinase MB isoenzyme (CK-MB) (hazard ratio [HR], 4.64; 95% confidence interval [CI] 1.89-11.43; P = .0008), log10 post-TnI (HR, 3.11; 95% CI 1.56-6.21; P = .0013), log10 post-Mb (HR, 3.00; 95% CI 1.40-6.43; P = .0048), log10 pre-CK-MB (HR,1.82; 95% CI 1.03-3.21; P = .0377), and upper tertile of post-CK-MB (HR,1.52; 95% CI 1.05-2.20; P = .0261) were the independent risk factor for 30 days mortality adjusted for potential confounders. None of cardiac markers was significantly associated with long-term outcome independent of other factors.Perioperative myocardiac predicts early outcome in type A AD patients undergoing surgery. Increasing perioperative myocardial markers do not appear to be a predictor for long-term all-cause mortality.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Creatina Quinase Forma MB/sangue , Troponina I/sangue , Adulto , Aneurisma Dissecante/cirurgia , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
Croat Med J ; 60(4): 309-315, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31483116

RESUMO

AIM: To assess the prognostic role of admission C-reactive protein (CRP) in patients with acute aortic dissection (AAD). METHODS: We searched Medline and Scopus for studies published before January 2019 that evaluated the prognostic impact of CRP on all-cause mortality during short- and mid-term follow-up period in patients with AAD. Additional studies were identified by manual search of the references from the original studies. Receiver-operating characteristic curves were used to determine the optimal cut-off values of admission CRP for the prediction of mortality, and patients were categorized into two groups based on the CRP cut-off levels. RESULTS: Medline, Scopus, and manual literature search yielded 138 citations. Based on the title and abstract analysis and review of potentially relevant studies, five studies, involving 711 patients, were included in the final analysis. Multivariate statistical analysis was performed in all the studies. The median admission CRP value across the studies was 13 mg/L (range 4-21 mg/L). Two out of three studies that evaluated in-hospital outcome and all of the studies that evaluated medium-term outcome reported a significant association between elevated CRP values and mortality. The studies that included treatment strategy (surgery vs conservative treatment) as a confounding variable confirmed a significant effect of elevated CRP values on both in-hospital and mid-term unfavorable outcomes. CONCLUSION: This systematic review demonstrated a clear association between elevated admission serum CRP levels and increased in-hospital and mid-term mortality risk in AAD.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/sangue , Aneurisma Aórtico/mortalidade , Proteína C-Reativa/análise , Adulto , Biomarcadores , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Curva ROC , Fatores de Tempo
4.
J Immunol Res ; 2019: 9782594, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467936

RESUMO

Monocytes are a heterogeneous cell population distinguished into three subsets with distinctive phenotypic and functional properties: "classical" (CD14++CD16-), "intermediate" (CD14++CD16+), and "nonclassical" (CD14+CD16++). Monocyte subsets play a pivotal role in many inflammatory systemic diseases including atherosclerosis (ATS). Only a low number of studies evaluated monocyte behavior in patients affected by cardiovascular diseases, and data about their role in acute aortic dissection (AAD) are lacking. Thus, the aim of this study was to investigate CD14++CD16-, CD14++CD16+, and CD14+CD16++ cells in patients with Stanford-A AAD and in patients with carotid artery stenosis (CAS). Methods. 20 patients with carotid artery stenosis (CAS group), 17 patients with Stanford-A AAD (AAD group), and 17 subjects with traditional cardiovascular risk factors (RF group) were enrolled. Monocyte subset frequency was determined by flow cytometry. Results. Classical monocytes were significantly increased in the AAD group versus CAS and RF groups, whereas intermediate monocytes were significantly decreased in the AAD group versus CAS and RF groups. Conclusions. Results of this study identify in AAD patients a peculiar monocyte array that can partly explain depletion of T CD4+ lymphocyte subpopulations observed in patients affected by AAD.


Assuntos
Aneurisma Dissecante/imunologia , Estenose das Carótidas/imunologia , Monócitos/imunologia , Doença Aguda , Idoso , Aneurisma Dissecante/sangue , Estenose das Carótidas/sangue , Feminino , Citometria de Fluxo , Proteínas Ligadas por GPI/análise , Humanos , Receptores de Lipopolissacarídeos/análise , Masculino , Pessoa de Meia-Idade , Monócitos/classificação , Receptores de IgG/análise , Estudos Retrospectivos
5.
Int Heart J ; 60(4): 919-923, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257330

RESUMO

Tenascin-C (TNC) is involved in aortic disease pathophysiology. This study aims to evaluate TNC's value for predicting in-hospital death in acute aortic dissection (AD).We prospectively enrolled consecutive patients with suspected acute AD within 48 hours from symptom onset. Serum TNC and C-reactive protein (CRP) levels were examined on admission. Their baseline clinical characteristics and serum D-Dimer (DD) were collected. The endpoint was in-hospital death from AD.In the study cohort,78 survivors and 31 non-survivors with acute AD were enrolled. Compared to survivors, elevated median levels of serum TNC (141.10 pg/mL versus 75.30 pg/mL, P < 0.001), DD (8.74 µg/mL versus 4.58 µg/mL, P < 0.001), and CRP (19.20 mg/L versus 13.40 mg/L, P < 0.001) were found in non-survivors. Multiple logistic regressions revealed TNC, DD, and CRP were independent predictors of in-hospital death from acute AD. The OR and 95% CI were 1.038, 1.017-1.055; 1.084, 1.009-1.165 and 1.386, 1.107-1.643, respectively. Furthermore, TNC's sensitivity and specificity in predicting in-hospital death in acute AD were 83.87% and 83.33%. The combination of TNC and DD can improve the sensitivity and specificity to 90.30% and 88.46%.TNC is a valuable biomarker for predicting in-hospital death from acute AD. The combination of TNC and DD can improve predictions of in-hospital death from acute AD.


Assuntos
Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/mortalidade , Tenascina/sangue , Doença Aguda , Aneurisma Dissecante/sangue , Aneurisma da Aorta Torácica/sangue , Biomarcadores/sangue , China/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Taxa de Sobrevida/tendências
6.
Vasc Endovascular Surg ; 53(7): 547-557, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31248351

RESUMO

BACKGROUND: Acute aortic dissection (AD) is a lethal vascular disease, accounting for over 90% cases of acute aortic syndrome. Despite advances in understanding associated risk factors, the long-term prognosis for AD patients is still poor. Several prognostic biomarkers have been used for AD as per the IRAD, such as older age (>70 years), onset of chest pain and hypotension, but they are not effective in all patients. Instead, C-reactive protein (CRP) is a consistent inflammatory marker. CRP levels are abnormally increased in AD. However, the prognostic value of serum CRP level in AD remains unclear. OBJECTIVE: To perform a systematic review and meta-analysis (registration no CRD42017056205) to evaluate whether CRP is a biomarker associated with in-hospital mortality in type-A AD. METHODS: PubMed, Web of Science, CNKI, SciELO, and EMBASE were searched for papers published from January 2000 to October 2017 for studies on the prognostic role of CRP at admission in type-A AD patients. Outcome data were extracted and pooled hazard ratios (HRs) were calculated. RESULTS: 18 (N = 2875 patients) studies met the inclusion criteria. Elevated CRP level was associated with a significantly increased risk of in-hospital mortality in patients with type-A AD (HR = 1.15, 95% CI: 1.06-1.25, p = 0.001). The pooled sensitivity of CRP in type-A AD patients was 77% (95% CI 69%-84%, p < 0.001), and the specificity was 72% (95% CI 66%-78%, p < 0.001). CONCLUSION: Elevated CRP level is significantly associated with increased risks of in-hospital mortality in patients with type-A AD. CRP is a convenient prognostic factor in type-A AD patients.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/sangue , Aneurisma Aórtico/mortalidade , Proteína C-Reativa/análise , Mortalidade Hospitalar , Mediadores da Inflamação/sangue , Admissão do Paciente , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores de Tempo , Regulação para Cima
7.
Med Biol Eng Comput ; 57(9): 1861-1874, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31209712

RESUMO

Aortic dissections are challenging for it remains perplexing to determine when surgical, endovascular, or medical therapies are optimal. We studied the effect of the multilayer flow modulator (MFM) device in patients with different forms of type-B aortic dissections. CT scans were performed pre-, immediately post-MFM implantation, and multiple times within a 24-month follow-up. Three-dimensional reconstructions were created from these scans and the multilayer or single-layer mesh device placed virtually into the true lumen. We observed that MFM device can sufficiently restore flow perfusion, reduce the false lumen, eliminate local flow recirculation, and reduce wall shear stress distribution globally. Single-layer devices can reduce false lumen dimensions; however, they generate local disturbance and recirculation zones in selected areas at specific time points. Moreover, in polar extremes of dissection, the MFM device restored flow to vital organs perfusing vessels independent of effects on luminal patency. Management of aortic dissections should focus on modulation of blood flow, suppression of local recirculation, and restoration of vital organ perfusion rather than primarily restoring vascular lumen morphology. While the latter restores the geometry of the true lumen, only the former restores homeostasis. Graphical abstract.


Assuntos
Aneurisma Dissecante , Prótese Vascular , Modelos Cardiovasculares , Adulto , Aneurisma Dissecante/sangue , Aneurisma Dissecante/cirurgia , Velocidade do Fluxo Sanguíneo , Procedimentos Endovasculares/instrumentação , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
8.
Comput Methods Biomech Biomed Engin ; 22(6): 620-630, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30822150

RESUMO

The behavior of blood cells and vessel compliance significantly influence hemodynamic parameters, which are closely related to the development of aortic dissection. Here the two-phase non-Newtonian model and the fluid-structure interaction (FSI) method are coupled to simulate blood flow in a patient-specific dissected aorta. Moreover, three-element Windkessel model is applied to reproduce physiological pressure waves. Important hemodynamic indicators, such as the spatial distribution of red blood cells (RBCs) and vessel wall displacement, which greatly influence the hemodynamic characteristics are analyzed. Results show that the proximal false lumen near the entry tear appears to be a vortex zone with a relatively lower volume fraction of RBCs, a low time-averaged wall shear stress (TAWSS) and a high oscillatory shear index (OSI), providing a suitable physical environment for the formation of atherosclerosis. The highest TAWSS is located in the narrow area of the distal true lumen which might cause further dilation. TAWSS distributions in the FSI model and the rigid wall model show similar trend, while there is a significant difference for the OSI distributions. We suggest that an integrated model is essential to simulate blood flow in a more realistic physiological environment with the ultimate aim of guiding clinical treatment.


Assuntos
Aneurisma Dissecante/fisiopatologia , Simulação por Computador , Hemodinâmica/fisiologia , Análise Numérica Assistida por Computador , Aneurisma Dissecante/sangue , Velocidade do Fluxo Sanguíneo , Eritrócitos/metabolismo , Humanos , Modelos Cardiovasculares , Pressão , Reprodutibilidade dos Testes , Estresse Mecânico , Fatores de Tempo , Resistência Vascular
9.
Medicine (Baltimore) ; 98(6): e14486, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732220

RESUMO

Serum albumin (SA) is associated with inflammation and thrombosis, which are involved in acute aortic dissection (AAD). Our aim was to investigate the effect of SA level on survival in patients with AAD.We analyzed 777 patients with AAD. The patients were divided into hypoalbuminemia and non-hypoalbuminemia groups according to their AAD Stanford classification. Multivariable Cox regression was used to investigate the association between SA levels and in-hospital mortality in type A and B AAD.A total of 103 (13.3%) patients died in-hospital. The in-hospital mortality in type A and B patients with hypoalbuminemia was higher compared to those without (type A: 34.2% vs 13.9%, P <.001; type B: 7.9% vs 1.6%, P = .001). Kaplan-Meier analysis showed that survival was significantly lower in patients with hypoalbuminemia compared to those without, regardless of AAD type (type A: log-rank χ = 14.71; P <.001; Type B: log-rank χ = 10.42; P = .001). After adjusting for confounding factors, hypoalbuminemia was an independent predictor of in-hospital mortality in patients with either type A (HR, 2.492; 95% confidence interval [CI], 1.247-4.979; P = .010) or type B (HR, 8.729; 95% CI, 1.825-41.736; P = .007).SA is independently associated with increased in-hospital mortality in both type A and B AAD.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Albumina Sérica/análise , Adulto , Idoso , Aneurisma Dissecante/epidemiologia , Biomarcadores , Feminino , Mortalidade Hospitalar , Humanos , Hipoalbuminemia/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
10.
Ann Thorac Cardiovasc Surg ; 25(3): 142-148, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-30568075

RESUMO

PURPOSE: Platelets are crucial components of the coagulation processes, and low admission platelet count (PLC) is associated with adverse clinical outcomes in patients with Stanford type A acute aortic dissection (AAD). METHODS: A total of 130 consecutive patients undergoing Stanford type A AAD surgery in Beijing Anzhen Hospital were enrolled between January 2013 and July 2014. Preoperative clinical and laboratory data from patients were collected. Multiple regression analyses were used to determine the independent factors of low admission platelets. RESULTS: Adjusted multiple regression analysis showed that age (ß: -1.069, 95% confidence interval [CI]: -2.109, -0.029), sex (ß: -29.973, 95% CI: -56.512, -3.433), tissue factor pathway inhibitor (TFPI; ß: 0.197, 95% CI: 0.039, 0.354), fibrinogen degradation product (FDP) (ß: -0.476, 95% CI: -0.879, -0.074), and attack time (ß: 11.125, 95% CI: 7.963, 14.287) were significantly associated with admission PLC. Admission PLC increased with attack time up to the 3 days (ß: 16.2, 95% CI: 12.1, 20.2). CONCLUSIONS: We found that increasing age, male patients, patients with lower serum levels of TFPI and higher serum levels of FDP, and patients with a shorter attack time were significantly associated with lower PLC at admission. Moreover, the turning point of attack time is 3 days after the onset of dissection.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Aórtico/sangue , Plaquetas , Admissão do Paciente , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Pequim , Biomarcadores/sangue , Plaquetas/metabolismo , Ensaios Clínicos como Assunto , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
11.
Eur J Vasc Endovasc Surg ; 57(3): 434-441, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30087010

RESUMO

OBJECTIVES: Acute aortic dissection (AAD) is a severe clinical emergency with a high mortality, and is easily misdiagnosed in its early stage. This study aimed at discovering serum metabolomic markers with the potential to diagnose AAD and distinguish between two subtypes of AAD. METHODS: Thirty-five patients with AAD, including 20 with Stanford type A and 15 with Stanford type B were enrolled in this study, together with 20 healthy controls. All patients with AAD were admitted within 72 h of onset. Serum metabolomics profiles were determined by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry and the data were analysed by principal component analysis and partial least squares discriminant analysis. RESULTS: A total of 17 metabolites differing between the control and AAD groups were finally screened and identified as lysophosphatidylcholines (LPC) and sphingolipids including sphinganine, phytosphingosine, sphingomyelin, and ceramide. Compared with those in the healthy control group, LPC levels were significantly lower in both the Stanford type A and type B AAD groups. Interestingly, sphingolipids, including sphinganine, phytosphingosine, and ceramide, were remarkably reduced in the Stanford type A AAD group, but not in the Stanford type B AAD group. Subgroup analysis showed that the changes in LPC and sphingolipid levels were unrelated to hypertension or gender. CONCLUSIONS: The present results indicate that LPCs and sphingolipids are significantly altered in patients with AAD, and several sphingolipids, such as sphinganine, phytosphingosine, and ceramide, were dramatically decreased in patients with Stanford type A AAD. A combination of these two families of metabolites could serve as a potential biomarker for the diagnosis of AAD and distinguishing between Stanford type A and Stanford type B.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/diagnóstico , Aneurisma Aórtico/sangue , Aneurisma Aórtico/diagnóstico , Lisofosfatidilcolinas/sangue , Metabolômica/métodos , Esfingolipídeos/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Cromatografia Líquida , Diagnóstico Diferencial , Análise Discriminante , Feminino , Humanos , Análise dos Mínimos Quadrados , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Componente Principal
12.
BMC Cardiovasc Disord ; 18(1): 219, 2018 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-30497388

RESUMO

BACKGROUND: Matrix metalloproteinase 9 (MMP9) and Toll-like receptor 4 (TLR4) play important roles in aortic pathophysiology. However, there is lacking research on serum TLR4 levels in acute aortic dissection (AAD) patients, and the performance of serum MMP9 and TLR4 for the diagnosis of AAD is still unknown. This study aimed to evaluate the serum levels of MMP9 and TLR4 in AAD patients, identify their associations with circulating C-reactive protein (CRP) and D-dimer, which are well-known classical biomarkers of AAD, and further explore the potential diagnostic role of MMP9 and TLR4 in AAD. METHODS: Serum levels of MMP9 and TLR4 were measured by enzyme-linked immunosorbent assay (ELISA) in 88 AAD patients and 88 controls. The clinical test related information was collected from patients' electronic medical records. RESULTS: Serum MMP9 and TLR4 levels were significantly higher in AAD patients than those in healthy controls in the general and stratified comparisons. Either serum MMP9 or TLR4 was independently associated with the risk of AAD (all p < 0.001). There was a positive significant association between serum MMP9 and TLR4 (r = 0.518, p < 0.001). Both MMP9 and TLR4 levels were statistically correlated with circulating CRP, but not D-dimer. Based on receiver-operating characteristic (ROC) analysis, the area under the curves (AUCs) of MMP9 and TLR4 alone for the diagnosis of AAD were 0.810 and 0.799 with optimal cut-off points of 379.47 ng/ml and 7.83 ng/ml, respectively. Moreover, a combination of serum MMP9 and TLR4 increased the AUC to 0.89 with a sensitivity of 60.2% and specificity of 94.3%. CONCLUSIONS: Serum MMP9 and TLR4 could be potential biomarkers for identifying AAD, while the combined diagnostic value was higher in safely ruling out AAD.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Aórtico/sangue , Metaloproteinase 9 da Matriz/sangue , Receptor 4 Toll-Like/sangue , Doença Aguda , Adulto , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/enzimologia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/enzimologia , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Regulação para Cima
13.
Med Sci Monit ; 24: 6431-6437, 2018 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-30212440

RESUMO

BACKGROUND The aim of this observational case-control study was to compare the levels of plasma resistin between patients with acute aortic dissection and matched controls, and to use propensity score matching (PSM) to reduce case selection bias and clinical confounders. MATERIAL AND METHODS With the use of PSM, this study included 43 pairs of patients with acute aortic dissection (type-A and type-B dissection) and matched controls. Plasma resistin levels and other laboratory parameters were compared between the two groups, including white blood cell (WBC) count, glucose, high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and D-dimer. The correlations between resistin and other laboratory parameters were evaluated in patients with acute aortic dissection. RESULTS Following PSM adjustment for clinical variables, including age, sex, body mass index, smoking, alcohol drinking, hypertension, diabetes mellitus, coronary heart disease and stroke, plasma resistin levels were significantly increased in patients with acute aortic dissection when compared with controls (35.2±13.8 vs. 18.4±9.1 ng/ml) (p<0.001). WBC counts, and levels of glucose, hs-CRP, IL-6, TNF-α and D-dimer were also significantly increased in the patients with aortic dissection compared with the control group. After adjustment for these variables, the association between plasma resistin levels and acute aortic dissection remained significant (OR, 1.114; 95% CI, 1.036-1.224) (p<0.001). Plasma resistin levels was positively correlated with WBC count (r=0.368, p=0.015), hs-CRP (r=0.359, p=0.022), IL-6 (r=0.306, p=0.046) and TNF-α levels (r=0.315, p=0.040) in patients with acute aortic dissection. CONCLUSIONS Acute aortic dissection is associated with elevated levels of plasma resistin and other pro-inflammatory cytokines. Plasma resistin levels is positively associated with other pro-inflammatory cytokines in acute aortic dissection.


Assuntos
Aneurisma Aórtico/sangue , Resistina/sangue , Adulto , Idoso , Aneurisma Dissecante/sangue , Aneurisma Dissecante/patologia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/patologia , Biomarcadores/sangue , Glicemia , Proteína C-Reativa , Estudos de Casos e Controles , China , Estudos Transversais , Feminino , Humanos , Interleucina-6/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Fator de Necrose Tumoral alfa/sangue
14.
Am J Cardiol ; 122(7): 1244-1248, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30072126

RESUMO

Complement-C1q/tumor necrosis factor-related protein-3 (CTRP3) is one kind of adipocytokines and has been reported to play key roles in many cardiovascular diseases by regulating inflammation. Inflammation was reported to be involved in the development of acute aortic dissection (AAD). The purpose of this study was to investigate whether serum levels of CTRP3 were associated with AAD. The serum was collected from 108 participants, including 60 patients with AAD and 32 patients with hypertension, as well as 16 healthy subjects. Serum levels of CTRP3, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured using enzyme-linked immunosorbent assay kits. Decreased serum levels of CTRP3 were found in AAD patients compared with hypertension and healthy subjects (35.89 ± 11.26 vs 52.60 ± 13.90 and 51.71 ± 18.64 ng/mL, p < 0.001, respectively). IL-6 and TNF-α levels were significantly higher in AAD patients than those in hypertension and healthy subjects (IL-6: 31.33 ± 15.18 vs 13.13 ± 8.63 and 9.40 ± 6.27 pg/mL, p < 0.001; TNF-α: 36.87 ± 11.16 vs 29.66 ± 5.12 and 22.93 ± 7.18 pg/mL, p < 0.001, respectively). In AAD, CTRP3 levels showed a negative correlation with IL-6 and TNF-α levels respectively (r = -0.508, p < 0.001; r = -0.393, p = 0.002, respectively). In conclusion, decreased levels of CTRP3 may be associated with the development of AAD.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Aórtico/sangue , Complemento C1q/metabolismo , Fator de Necrose Tumoral alfa/sangue , Fatores de Necrose Tumoral/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade
15.
Anatol J Cardiol ; 20(2): 85-92, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30088482

RESUMO

OBJECTIVE: Type A aortic dissection (AD) and ascending thoracic aortic aneurysm (AA) are thoracic vascular diseases with similar initial pathology but inequable clinical features and outcomes, where local and systemic inflammation play an important part. We aimed to observe and analyze the differences and correlation between inflammation and pathological changes in the aorta and biomechanical strength between AD and AA. METHODS: From August 2011 to February 2013, 20 patients with AD (AD group) and 13 patients with AA (AA group) who underwent aorta surgery were included. Serum concentrations of total cholesterol (TC), triglycerides (TG), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels were measured just before surgical anesthesia. The longitudinal vessel samples of the affected ascending aorta were harvested during surgery and prepared for subsequent pathological observation and uniaxial tension test to measure the longitudinal tensile strength (TS). Samples were also prepared for further measurement of tissue homogenized TNF-α and IL-6 concentrations. RESULTS: No significant difference was seen between the two groups with respect to baseline data, and the serum concentrations of TC and TG of both the groups were within the normal range (p>0.05). Blood and tissue homogenized levels of IL-6 and TNF-α were significantly higher in the AD group than in the AA group (p<0.001). Pathological observation of the aortic tissue showed more inflammatory cells infiltration and elastic fiber destruction in the AD group than in the AA group, indicating significant aortic medial degeneration. Uniaxial tensile tests showed that the longitudinal TS was significant lower in the AD group than in the AA group (p<0.001). The longitudinal TS showed negative correlations with serum and tissue homogenized concentrations of IL-6 and TNF-α in the AD group (p<0.05), whereas no such significant correlation was seen in the AA group. CONCLUSION: Patients with AD had acute systemic inflammation, along with acute inflammation and declined biomechanical strength of the affected aorta. The serum and tissue homogenized concentrations of IL-6 and TNF-α showed a significant correlation with the biomechanical strength of affected aorta in AD.


Assuntos
Aneurisma Dissecante/fisiopatologia , Aorta/patologia , Inflamação/fisiopatologia , Adulto , Aneurisma Dissecante/sangue , Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/fisiopatologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Colesterol/sangue , Feminino , Humanos , Inflamação/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/sangue
16.
J Am Heart Assoc ; 7(14)2018 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-29987123

RESUMO

BACKGROUND: Clinical characteristics and treatment outcomes of acute type A aortic dissection with D-dimer elevation have not been clarified. METHODS AND RESULTS: D-dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D-dimer concentration in our total patient group was 26.7 (8.3-85.9) µg/mL. Median (interquartile range) D-dimer concentrations were 5.0 (2.6-18.0) µg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4-160.4) µg/mL for partial thrombosis (n=81), 26.5 (10.0-70.6) µg/mL for a patent false lumen (n=131), and 8.7 (3.2-26.9) µg/mL for ulcerlike projection (n=17) (P<0.01). With a D-dimer concentration of ≤8.3 µg/mL representing the lower quartile, we then investigated predictors of a low D-dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D-dimer concentration. Compared with patients with a low D-dimer concentration (≤8.3 µg/mL, n=66), patients with a D-dimer concentration >8.3 µg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In-hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7-year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21). CONCLUSIONS: D-dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D-dimer concentration.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda , Idoso , Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/mortalidade , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
17.
Int J Artif Organs ; 41(8): 452-459, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29976123

RESUMO

PURPOSE: During extracorporeal circulation in heart surgery, blood is exposed to non-physiological conditions, such as high shear stress, foreign surfaces, turbulence, and hypothermia. These factors cause damage to the red blood cells, which is manifested by immediate and delayed hemolysis or some changes in the mechanical properties of red blood cells, defined as sublethal trauma. Unfortunately, sublethal trauma is hard to detect, and there is not enough morphological evidence regarding red blood cell sublethal trauma. In this study, red blood cell sublethal trauma was observed after extracorporeal circulation by describing ultrastructural changes in red blood cell membranes using atomic force microscopy and scanning electron microscopy. METHODS: Venous blood (2 mL) was collected into heparin tubes from preoperative, intraoperative and postoperative aortic dissection patients for comparison with blood from healthy patients. The red blood cell morphological study (malformations percentage, diameter, height, concavity, and roughness) was performed with scanning electron microscopy and atomic force microscopy. RESULTS: Scanning electron microscopy and atomic force microscopy imaging analysis revealed that the red blood cell shape changed during extracorporeal circulation and that the red blood cell malformation percentage in the postoperative group was higher than those in the preoperative and intraoperative groups. Most morphological parameters had no obvious changes, except roughness (Ra and Rq) in aortic dissection patients. Atomic force microscopy quantitative analysis indicated that the roughness of red blood cell membranes increased during extracorporeal circulation. CONCLUSIONS: This study demonstrates that ultrastructural morphological damage occurs to red blood cells membranes due to extracorporeal circulation in aortic dissection patients. In addition, we provided a new parameter (Ra and Rq) to evaluate red blood cell sublethal trauma.


Assuntos
Aneurisma Dissecante/terapia , Eritrócitos/ultraestrutura , Circulação Extracorpórea , Hemólise/fisiologia , Adulto , Aneurisma Dissecante/sangue , Morte Celular/fisiologia , Feminino , Humanos , Masculino , Microscopia de Força Atômica , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Estresse Mecânico
18.
Anesth Analg ; 127(4): 920-927, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29863610

RESUMO

BACKGROUND: Thoracic aorta dissection is an acute critical condition associated with shock-induced endotheliopathy, coagulopathy, massive bleeding, and significant morbidity and mortality. Our aim was to compare the effect of coagulation support with solvent/detergent-treated pooled plasma (OctaplasLG) versus standard fresh frozen plasma (FFP) on glycocalyx and endothelial injury, bleeding, and transfusion requirements. METHODS: Investigator-initiated, single-center, blinded, randomized clinical pilot trial of adult patients undergoing emergency surgery for thoracic aorta dissection. Patients were randomized to receive OctaplasLG or standard FFP as coagulation factor replacement related to bleeding. The primary outcome was glycocalyx and endothelial injury. Other outcomes included bleeding, transfusions and prohemostatics at 24 hours, organ failure, length of stay in the intensive care unit and in the hospital, safety, and mortality at 30 and 90 days. RESULTS: Fifty-seven patients were included to obtain 44 evaluable on the primary outcome. The OctaplasLG group displayed significantly reduced damage to the endothelial glycocalyx (syndecan-1) and reduced endothelial tight junction injury (sVE-cadherin) compared to standard FFP. In the OctaplasLG group compared to the standard FFP, days on ventilator (1 day [interquartile range, 0-1] vs 2 days [1-3]; P = .013), bleeding during surgery (2150 [1600-3087] vs 2750 [2130-6875]; P = .046), 24-hour total transfusion and platelet transfusion volume (3975 mL [2640-6828 mL] vs 6220 mL [4210-10,245 mL]; P = .040, and 1400 mL [1050-2625 mL] vs 2450 mL [1400-3500 mL]; P = .027), and goal-directed use of prohemostatics (7/23 [30.4%] vs 13/21 [61.9%]; P = .036) were all significantly lower. Among the 57 patients randomized, 30-day mortality was 20.7% (6/29) in the OctaplasLG group and 25% (7/28) in the standard FFP group (P = .760). No safety concern was raised. CONCLUSIONS: In this randomized, clinical pilot trial of patients undergoing emergency surgery for thoracic aorta dissections, we found that OctaplasLG reduced glycocalyx and endothelial injury, reduced bleeding, transfusions, use of prohemostatics, and time on ventilator after surgery compared to standard FFP. An adequately powered multicenter trial is warranted to confirm the clinical importance of the findings.


Assuntos
Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/terapia , Ruptura Aórtica/terapia , Coagulação Sanguínea , Transfusão de Componentes Sanguíneos/métodos , Células Endoteliais/patologia , Glicocálix/patologia , Hemorragia/terapia , Plasma , Ressuscitação/métodos , Procedimentos Cirúrgicos Vasculares , Idoso , Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/patologia , Antígenos CD/sangue , Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/patologia , Ruptura Aórtica/sangue , Ruptura Aórtica/mortalidade , Ruptura Aórtica/patologia , Transfusão de Componentes Sanguíneos/efeitos adversos , Transfusão de Componentes Sanguíneos/mortalidade , Caderinas/sangue , Dinamarca , Células Endoteliais/metabolismo , Feminino , Glicocálix/metabolismo , Hemorragia/sangue , Hemorragia/mortalidade , Hemorragia/patologia , Hemostáticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Respiração Artificial , Ressuscitação/efeitos adversos , Sindecana-1/sangue , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
19.
Heart Vessels ; 33(12): 1463-1470, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29868945

RESUMO

Lung oxygenation impairment often occurs in patients with type B acute aortic dissection (AAD), necessitating mechanical ventilation. Patients receiving mechanical ventilation are at risk of complications, so a low-oxygen condition requiring mechanical ventilation should be avoided. We explored the predictors of oxygenation impairment. We enrolled 46 patients with type B AAD who had been medically treated and underwent computed tomography. Blood was sampled to measure markers of inflammation, such as the C-reactive protein (CRP) levels and white blood cell count. The arterial partial pressure of oxygen/fraction of inspired oxygen ratio (PaO2/FiO2) was calculated to quantify the severity of respiratory failure. Spearman's rank correlation analysis revealed that the minimum PaO2/FiO2 ratio was significantly correlated with gender, age, and current smoker, and the peak CRP, body temperature, and D-dimer values. A multivariate regression analysis revealed that younger age, male sex, and the peak CRP level were significant predictors of the minimum PaO2/FiO2 ratio (P = 0.01, 0.035 and 0.005, respectively). A covariance structure analysis showed that a younger age and the peak CRP level were significant predictors of oxygenation impairment in type B AAD. Oxygenation impairment in type B AAD is correlated with younger age and a higher peak CRP level. This will enable the identification of patients whose respiratory condition is susceptible to worsening and help prevent mechanical ventilation, leading to the provision of appropriate therapy.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma da Aorta Torácica/sangue , Proteína C-Reativa/metabolismo , Consumo de Oxigênio , Oxigênio/sangue , Respiração Artificial/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/terapia , Biomarcadores/sangue , Permeabilidade Capilar/fisiologia , Feminino , Humanos , Masculino , Prognóstico , Tomografia Computadorizada por Raios X
20.
Clin Chim Acta ; 484: 253-257, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29879418

RESUMO

BACKGROUND: Studies on the serum uric acid levels in patients with aortic dissection have yielded conflicting results. OBJECTIVE: To compare the difference in serum uric acid (SUA) levels between aortic dissection patients and controls by meta-analysis. METHODS: Electronic literature search was conducted in PubMed, Embase, CKNI, CBM, Wanfang, and VIP databases until January 31, 2018. All observational studies that investigated SUA levels in aortic dissection patients and controls were included. Weighted mean difference (WMD) with 95% confidence intervals (CI) was used to summarize the difference in SUA levels between aortic dissection and control group. RESULTS: A total of seven case-control studies involving 1197 patients and 1193 controls were included. Pooled analysis showed that SUA levels were significantly higher in aortic dissection patients compared with those in the controls (WMD 58.22 µmol/L; 95% CI 26.71-89.73) in a random effect model. No significant difference (WMD 9.94 µmol/L; 95% CI -17.89-37.76) was observed in SUA levels between Stanford type A and Stanford type B aortic dissection. CONCLUSIONS: This meta-analysis provides evidence that SUA levels are significantly higher among patients with aortic dissection than those in controls. Elevated SUA levels may contribute to the pathogenesis of aortic dissection. Further large clinical studies to investigate whether SUA levels are an independently risk factor for aortic dissection are warranted.


Assuntos
Aneurisma Dissecante/sangue , Ácido Úrico/sangue , Biomarcadores/sangue , Humanos
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