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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.
Int J Mol Sci ; 20(16)2019 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-31409059

RESUMO

Thoracic aortic aneurysm (TAA) can lead to fatal complications such as aortic dissection. Since aneurysm dimension poorly predicts dissection risk, microRNAs (miRNAs) may be useful to diagnose or risk stratify TAA patients. We aim to identify miRNAs associated with TAA pathogenesis and that are possibly able to improve TAA diagnosis. MiRNA microarray experiments of aortic media tissue samples from 19 TAA patients and 19 controls allowed identifying 232 differentially expressed miRNAs. Using interaction networks between these miRNAs and 690 genes associated with TAA, we identified miR-574-5p as a potential contributor of TAA pathogenesis. Interestingly, miR-574-5p was significantly down-regulated in the TAA tissue compared to the controls, but was up-regulated in serum samples from a separate group of 28 TAA patients compared to 20 controls (p < 0.001). MiR-574-5p serum levels discriminated TAA patients from controls with an area under the receiver operating characteristic curve of 0.87. In the Fbn1C1041G/+ mouse model, miR-574-5p was down-regulated in aortic tissue compared to wild-type (p < 0.05), and up-regulated in plasma extracellular vesicles from Fbn1C1041G/+ mice compared to wild-type mice (p < 0.05). Furthermore, in vascular smooth muscle cells, angiotensin II appears to induce miR-574-5p secretion in extracellular vesicles. In conclusion, miR-574-5p is associated with TAA pathogenesis and may help in diagnosing this disease.


Assuntos
Aneurisma da Aorta Torácica/sangue , MicroRNAs/sangue , Animais , Aneurisma da Aorta Torácica/genética , Área Sob a Curva , Biomarcadores/sangue , Células Cultivadas , Estudos de Coortes , Feminino , Redes Reguladoras de Genes , Humanos , Masculino , Camundongos , MicroRNAs/genética , Curva ROC , Transcriptoma
3.
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
4.
Braz J Cardiovasc Surg ; 34(1): 8-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810667

RESUMO

INTRODUCTION: Non-familial ascending thoracic aorta dilation and aneurysms (TAAs) are silent diseases in elderly patients. Histopathology revealed that functionally polarized infiltrating CD4+ T-cells play a key role in aortic wall weakening. OBJECTIVE: To evaluate the possible associations between phenotype and cytokine production of circulating CD4+ T-lymphocytes and the presence of TAA in patients with aortic valve disease (AVD). METHODS: We studied blood samples from 10 patients with TAA and 10 patients with AVD. Flow cytometry was used to quantify: a) CD4+ T-lymphocytes surface expression of CD25, CD28, and chemokine receptors (CCR5, CXCR3, CX3CR1); b) fractions of in vitro stimulated CD4+ T-cells producing cytokines (interferon gamma [IFN-γ], interleukin [IL]-17A, IL-21, IL-10); c) CD4+CD25highFoxP3+ regulatory T-cells (Treg) fraction. Enzyme-linked immunosorbent assays (ELISA) were performed for cytokines (IFN-γ, IL-6, IL-10, IL-17A, IL-23, transforming growth factor beta [TGF-ß]) and chemokines (RANTES, CX3CL1). RESULTS: The total CD4+CD28±CD4+/CX3CR1+ T-cells fraction was higher (P=0.0323) in AVD (20.452±4.673) than in TAA patients (8.633±2.030). The frequency ratio of CD4+ T-lymphocytes producing IFN-γ vs. IL-17A+IL-21 cytokine-producing CD4+ T-cells was higher (P=0.0239) in AVD (2.102±0.272) than in TAA (1.365±0.123) patients. The sum of CD4+CD28±CD4+/CX3CR1+ T-cells correlated positively with values of the previous cytokine ratio (P=0.0002, R=0.732). The ratio of CD4+CD28±CD4+/CX3CR1+ T-cells vs. Treg was higher (P=0.0008) in AVD (20.859±3.393) than in TAA (6.367±1.277) patients. CONCLUSION: Our results show that the presence of TAA in subjects with AVD is associated with imbalance between phenotypic and cytokine-producing subsets of circulating CD4+ T-lymphocytes, prevalently oriented towards a pro-fibrotic and IFN-γ counteracting effect to functional polarization.


Assuntos
Aneurisma da Aorta Torácica/sangue , Valva Aórtica , Linfócitos T CD4-Positivos/fisiologia , Citocinas/sangue , Doenças das Valvas Cardíacas/sangue , Fenótipo , Idoso , Análise de Variância , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo/métodos , Humanos , Masculino , Valores de Referência
5.
Congenit Heart Dis ; 14(2): 256-263, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30485657

RESUMO

OBJECTIVE: The bicuspid aortic valve (BAV) is the most common congenital heart disease. The process of aortic dilatation is not completely clear in patients with the BAV. Apelin is a peptide found at high levels in vascular endothelial cells which has a role in vascular regulation and cardiovascular function. The aim of this study was to determine the relationship between serum apelin levels and ascending aortic dilatation in adult patients with BAV. DESIGN: This cross-sectional study included 62 patients with isolated BAV and to an age, gender, and body mass index-matched control group of 58 healthy volunteers with tricuspid aortic valve. Transesophageal echocardiography was performed on all patients to determine the type of BAV. Aortic diameters of the aortic root, sinus valsalva, sinotubular junction, and ascending aorta were evaluated with echocardiography. Patients with BAV were divided into two subgroups according to the aortic diameters, as the nondilated BAV group and the dilated BAV group. Serum apelin level was analyzed with ELISA method. RESULTS: The serum apelin levels of the BAV patients were significantly lower than those of the control group (833.5, 25th-75th percentile (713.5-1745) pg/dL vs 1669 (936-2543) pg/dL; P = 0.006). In the subgroup analysis, serum apelin level was significantly different between the nondilated BAV group and the dilated BAV group [977 (790-2433) pg/dL vs 737 (693-870) pg/dL, P < 0.05] and between the dilated BAV group and the control group [737 (693-870) pg/dL vs 1669 (936-2543) pg/dL, P < 0.001]. In multivariate logistic regression analysis apelin [7.27 (95% CI: 1.73-30.42), P = 0.007] and age [1.05 (95% CI: 0.99-1.20), P = 0.049] were determined as independent predictors for ascending aortic dilatation. CONCLUSION: Low serum apelin level was associated with dilatation of ascending aortic in BAV patients. However, apelin was not relevant to BAV without aortic dilatation.


Assuntos
Aorta/diagnóstico por imagem , Aneurisma da Aorta Torácica/sangue , Valva Aórtica/anormalidades , Apelina/sangue , Doenças das Valvas Cardíacas/sangue , Adulto , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/etiologia , Biomarcadores/sangue , Estudos Transversais , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Masculino , Estudos Retrospectivos
6.
Gen Thorac Cardiovasc Surg ; 67(1): 12-19, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29080094

RESUMO

Thoracic aortic aneurysm (TAA) represents a major cause of mortality and morbidity in Western countries. The natural history of TAA is indolent, with patients usually being asymptomatic until a catastrophic event such as rupture or dissection ensues. As such, early diagnosis is crucial and the search is ongoing for a biomarker that can indicate the presence of TAA with sufficient accuracy to act as a screening tool. To date, no such marker has been developed for the diagnosis of non-familial or 'sporadic' TAA. However, our increased understanding of the pathogenesis of both familial and sporadic TAA has suggested potential candidates for diagnostic biomarkers. Many markers/pathways have been shown to have differential activity levels or expression in the aortic tissue of TAA. However, priority is given to markers that have shown differential levels in blood plasma, as blood tests represent the easiest route for mass screening for TAA. This review aims to evaluate the efficacy of clinical tests already in use in diagnosing TAA, explore novel proposed biomarkers and identify key areas of future interest.


Assuntos
Aneurisma da Aorta Torácica/sangue , Biomarcadores/sangue , Aneurisma da Aorta Torácica/diagnóstico , Diagnóstico Diferencial , Humanos
7.
J Cardiothorac Vasc Anesth ; 33(2): 321-327, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30057251

RESUMO

OBJECTIVES: To investigate whether administering fibrinogen concentrate or cryoprecipitate is associated with increased postoperative thromboembolic events and improved mortality in patients undergoing thoracic aortic surgery. DESIGN: Multicenter retrospective cohort study using propensity-score analyses and multivariate logistic regression analysis to control for confounders. SETTING: Four hospitals (1 national cardiovascular center and 3 university hospitals). PARTICIPANTS: Patients undergoing thoracic aortic surgery with cardiopulmonary bypass between January 2010 and October 2012 (n = 1,047). INTERVENTIONS: Outcomes in patients treated with fibrinogen concentrate or cryoprecipitate (fibrinogen group) were compared with those who did not receive these products (no fibrinogen group) based on propensity-score matching. Multivariate logistic regression analysis then was performed to confirm the results. MEASUREMENTS AND MAIN RESULTS: Among 1,047 patients enrolled in this study, 247 patients received fibrinogen concentrate or cryoprecipitate. The median amount of administered fibrinogen was 3 g (interquartile range 2-4 g). Eighty-seven patients were excluded from the propensity-score matching because of missing data. Propensity-score-matched analysis showed no significant difference in the incidence of thromboembolic events or 30-day mortality rate between the groups. Multivariate analysis revealed that the fibrinogen group showed no significant difference in thromboembolic events (odds ratio 1.22; 95% confidence interval 0.76-1.95; p = 0.408) or mortality rate (odds ratio 0.44; 95% confidence interval 0.18-1.12; p = 0.081) compared with those in the no fibrinogen group. CONCLUSIONS: Administering fibrinogen concentrate or cryoprecipitate was associated with neither thromboembolic events nor 30-day mortality in patients undergoing thoracic aortic surgery. Administering fibrinogen concentrate or cryoprecipitate is safe and does not appear to increase thromboembolic events and mortality in thoracic aortic surgery patients.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Fibrinogênio/administração & dosagem , Hemorragia Pós-Operatória/prevenção & controle , Tromboembolia/epidemiologia , Idoso , Aneurisma da Aorta Torácica/sangue , Fatores de Coagulação Sanguínea/administração & dosagem , Bases de Dados Factuais , Feminino , Hemostáticos/administração & dosagem , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/mortalidade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Tromboembolia/sangue , Tromboembolia/etiologia
8.
Vasc Endovascular Surg ; 53(3): 230-241, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30572790

RESUMO

INTRODUCTION:: Despite advances in perioperative critical care and surgical technique, spinal cord ischemia remains a devastating complication of thoracic and thoracoabdominal aortic aneurysm repair. Biochemical markers present in peripheral blood and cerebrospinal fluid (CSF) may be useful in assessing spinal cord injury. We systematically analyze and report the role of all reported biochemical markers that have been used in assessing and diagnosing spinal cord ischemia in thoracic and thoracoabdominal aortic aneurysm repair. METHODS:: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for this review. Published literature was searched to identify all studies reporting on the use of biochemical markers in thoracoabdominal aortic aneurysm repair in the assessment of spinal cord ischemia. Marker-specific and patient-specific data were extracted from all studies and where possible, subgroup analysis was performed on marker-specific data sets. RESULTS:: Fourteen studies of 321 patients undergoing thoracic and thoracoabdominal aortic aneurysm repair were eligible for further analysis. Seven distinct biochemical markers were used in both CSF and blood samples: S100B proteins (S100B), neurone-specific enolase, lactate dehydrogenase, glial fibrillary acidic protein (GFAp), neurofilament triplet protein (NFL) and Tau protein, and glucose. There was substantial evidence demonstrating the heightened levels of S100, NFL, and GFAp in CSF in patients with spinal cord ischemia. There is however, wide variability in the correlation of the same 6 biochemical markers in peripheral blood and spinal cord ischemia. CONCLUSIONS:: In patients with spinal cord injury, dramatic rises occur with S100B, NFL, and GFAp in CSF. However, further work is needed if biochemical markers are to impact on the future of thoracoabdominal aortic aneurysm repair.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Isquemia do Cordão Espinal/sangue , Isquemia do Cordão Espinal/líquido cefalorraquidiano , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Fatores de Risco , Isquemia do Cordão Espinal/diagnóstico , Isquemia do Cordão Espinal/fisiopatologia , Resultado do Tratamento , Adulto Jovem
9.
BMC Cardiovasc Disord ; 18(1): 202, 2018 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373522

RESUMO

BACKGROUND: Matrix metalloproteinase-9 (MMP9) has been reported to play a key role in the pathogenesis of aortic aneurysm. However, few studies have assessed serum MMP9 levels in both abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA). In this study, we investigated the serum levels of MMP9 in aortic aneurysm to evaluate its predictive and diagnostic efficacy for AAA and TAA, and explored the association of MMP9 with circulating laboratory markers. METHODS: A total of 296 subjects were enrolled, including 105 AAA patients, 79 TAA patients and 112 healthy controls. The levels of serum MMP9 were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared to control group, both AAA and TAA patients had higher serum MMP9 levels in the overall comparison and subgroup analysis based on subjects aged<65 years, either male or female, hypertension, non-diabetes and non-hyperlipidemia (all P<0.05). Moreover, MMP9 levels were significantly higher in TAA group than those in AAA group in the total comparison, and this discrepancy was also found in the non-diabetes, non-hyperlipidemia and aortic diameter ≥ 5.5 cm subgroup analysis. Serum MMP9 levels were influenced by age and hypertension. There was a positive association of serum MMP9 with CRP (r = 0.33, P < 0.001) and Hcy (r = 0.199, P = 0.033). Multiple logistic analyses showed that serum MMP9 was an independent risk factor for AAA and TAA. Based on receiver operating characteristic (ROC) analysis, the area under the curve (AUC) of MMP9 for predicting TAA was 0.83 with 70% sensitivity and 91% specificity, while the AUC of MMP9 to detect AAA was 0.69 and the sensitivity and specificity were 50% and 88%. CONCLUSIONS: Serum MMP9 was closely related to the existence of aortic aneurysms and could be a valuable marker for the discrimination of aortic aneurysm, especially for TAA.


Assuntos
Aneurisma da Aorta Abdominal/sangue , Aneurisma da Aorta Torácica/sangue , Metaloproteinase 9 da Matriz/sangue , Idoso , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/enzimologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/enzimologia , Biomarcadores/sangue , Estudos de Casos e Controles , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
10.
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
11.
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
12.
Cardiovasc Res ; 114(13): 1702-1713, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30052821

RESUMO

Aortic aneurysm is a life-threatening disease due to the risk of aortic rupture. The only curative treatment available relies on surgical approaches; drug-based therapies are lacking, highlighting an unmet need for clinical practice. Abdominal aortic aneurysm (AAA) is frequently associated with atherosclerosis and cardiovascular risk factors including male sex, age, smoking, hypertension, and dyslipidaemia. Thoracic aortic aneurysm (TAA) is more often linked to genetic disorders of the extracellular matrix and the contractile apparatus but also share similar cardiovascular risk factors. Intriguingly, a large body of evidence points to an inverse association between diabetes and both AAA and TAA. A better understanding of the mechanisms underlying the negative association between diabetes and aortic aneurysm could help the development of innovative diagnostic and therapeutic approaches to tackle the disease. Here, we summarize current knowledge on the relationship between glycaemic parameters, diabetes, and the development of aortic aneurysm. Cellular and molecular pathways that underlie the protective effect of diabetes itself and its treatment are reviewed and discussed, along with their potential implications for clinical translation.


Assuntos
Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Torácica/epidemiologia , Glicemia/metabolismo , Diabetes Mellitus/epidemiologia , Remodelação Vascular , Animais , Aneurisma da Aorta Abdominal/sangue , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/prevenção & controle , Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/prevenção & controle , Biomarcadores/sangue , Diabetes Mellitus/sangue , Diabetes Mellitus/tratamento farmacológico , Dilatação Patológica , Modelos Animais de Doenças , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemiantes/uso terapêutico , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco
13.
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
14.
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
15.
J Cardiothorac Vasc Anesth ; 32(6): 2479-2484, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29699847

RESUMO

OBJECTIVE: In patients presenting with acute type-A aortic dissection (aTAAD), lactic acid measurement is a frequently used analysis for diagnosis of acute ischemia, which may have a dismal prognosis. The aim of the current study was to determine the performance of perioperative arterial lactic acid measurements in predicting outcome in aTAAD patients. DESIGN: Retrospective, observational study. SETTING: Cardiothoracic surgery unit at a tertiary-level hospital. PARTICIPANTS: The study involved 285 consecutive patients undergoing surgery for aTAAD. INTERVENTIONS: Preoperative and postoperative lactic acid levels were measured and evaluated together with clinical data related to outcome, including in-hospital and 1-year mortality. MEASUREMENTS AND MAIN RESULTS: Altogether, 37 patients (13%) died during the index hospital admission, and survival was 84.4 ± 2.2 at 1 year. Preoperative cardiac malperfusion (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.3-7.3) and cerebral malperfusion (OR 2.6; 95% CI 1.2-5.6) were associated significantly with poorer 1-year survival. The area under the curve (AUC) for in-hospital and 1-year mortality in relation to preoperative lactic acid levels was 0.684 and 0.673, respectively, corresponding to a lactic acid cut-off for in-hospital mortality of 2.75 mmol/L (sensitivity 56%; specificity 72%) and a cut-off for 1-year mortality of 2.85 mmol/L (sensitivity 48%; specificity 74%). The AUC for in-hospital and 1-year mortality in relation to lactic acid levels measured postoperatively on arrival at the intensive care unit was 0.582 and 0.498, respectively. CONCLUSION: Although hyperlactemia in aTAAD indicates an increased risk of postoperative mortality, the sole use of lactic acid levels as a tool for accurate assessment of postoperative mortality is inadvisable due to its poor discriminatory performance.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma da Aorta Torácica/sangue , Hiperlactatemia/sangue , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Hiperlactatemia/epidemiologia , Hiperlactatemia/etiologia , Incidência , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Suécia/epidemiologia , Fatores de Tempo
16.
J Vasc Surg ; 68(6S): 3S-13S, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29685513

RESUMO

OBJECTIVE: Thoracic aortic dissection (TAD) is a serious condition requiring urgent treatment to avoid catastrophic consequences. The inflammatory response is involved in the occurrence and development of TAD, possibly potentiated by platelet-derived growth factors (PDGFs). This study aimed to determine whether expression of PDGF-B (a subunit of PDGF-BB) was increased in TAD patients and to explore the factors responsible for its upregulation and subsequent effects on TAD. METHODS: Full-thickness ascending aorta wall specimens from TAD patients (n = 15) and control patients (n = 10) were examined for expression of PDGF-B and its receptor (PDGFRB) and in terms of morphology, inflammation, and fibrosis. Blood samples from TAD and control patients were collected to detect plasma levels of PDGF-BB and soluble elastins. RESULTS: Expression levels of PDGF-B, PDGFRB, and collagen I were significantly enhanced in ascending aorta wall specimens from TAD patients compared with controls. Furthermore, soluble elastic fragments and PDGF-BB were significantly increased in plasma from TAD patients compared with controls, and numerous irregular elastic fibers and macrophages were seen in the ascending aorta wall in TAD patients. CONCLUSIONS: An increase in elastic fragments in the aorta wall might be responsible for inducing the activation and migration of macrophages to injured sites, leading to elevated expression of PDGF-B, which in turn induces deposition of collagen, disrupts extracellular matrix homeostasis, and increases the stiffness of the aorta wall, resulting in compromised aorta compliance.


Assuntos
Aneurisma Dissecante/sangue , Aorta Torácica/química , Aneurisma da Aorta Torácica/sangue , Proteínas Proto-Oncogênicas c-sis/sangue , Adulto , Aneurisma Dissecante/patologia , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/cirurgia , Aorta Torácica/patologia , Aorta Torácica/fisiopatologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Biomarcadores/sangue , Estudos de Casos e Controles , Colágeno Tipo I/análise , Tecido Elástico/química , Tecido Elástico/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-sis/genética , Receptor beta de Fator de Crescimento Derivado de Plaquetas/análise , Receptor beta de Fator de Crescimento Derivado de Plaquetas/genética , Regulação para Cima , Remodelação Vascular , Rigidez Vascular
17.
Clin Chim Acta ; 481: 193-199, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29555322

RESUMO

BACKGROUND: Interleukin (IL) 11 is closely related to tumor and hematological system diseases. Recent studies have demonstrated that IL-11 also participates in cardiovascular diseases, including ischemia-reperfusion mediated heart injury and acute myocardial infarction. This study aimed to investigate whether IL-11 is involved in acute thoracic aortic dissection (TAD). METHODS: Aortic tissue samples from normal donors and acute TAD patients were collected, and the expression of IL-11 in all aortic tissue was analyzed. In addition, blood samples from patients with chest pain were collected and divided into a non-AD (NAD) group and a TAD group according to the results of computed tomography angiography of the thoracic aorta. The plasma IL-11, IL-17 and interferon (IFN) γ in all blood samples were measured. RESULTS: Compared with aortic tissue of normal controls, IL-11 was significantly increased in aortic tissue of acute TAD patients, especially in the torn section. The IL-11 was derived from aorta macrophages in TAD. In addition, the plasma IL-11, IL-17 and IFN-γ were significantly higher in acute TAD patients than in NAD patients, and the correlation analysis showed that IL-11 levels were positively correlated with levels of IFN-γ, IL-17, glucose, systolic blood pressure, diastolic blood pressure, white blood cells, C-reactive proteins and D-dimers. Binary logistic regression analyses showed that elevated IL11 in patients who may have diagnostic value of TAD, but less that D-dimer. CONCLUSION: IL-11 was increased in thoracic aorta and plasma of TAD patients and may be a promising biomarker for diagnosis in patients with TAD.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/diagnóstico , Aorta Torácica/química , Aneurisma da Aorta Torácica/sangue , Interleucina-11/sangue , Adulto , Idoso , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Humanos , Interleucina-11/biossíntese , Masculino , Pessoa de Meia-Idade , Análise de Regressão
18.
Angiology ; 69(8): 686-691, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29334754

RESUMO

The predictive value of the neutrophil to lymphocyte ratio (NLR) has been demonstrated in several cardiovascular diseases. The aim of our study was to investigate the association between the preoperative NLR and aneurysm characteristics as well as 30-day postoperative morbidity and mortality in patients with thoracic aortic aneurysm (TAA) undergoing aortic surgical repair. Consecutive patients (n = 75) with TAA were retrospectively included over a 10-year period. Clinical characteristics, aneurysm characteristics, and 30-day postoperative outcome were recorded. The median age of patients was 71 (67-80) years. The median preoperative NLR was 3.5 (2.3-5.8). The proportion of asymptomatic TAA was significantly lower in patients with an NLR > 3.5 compared with those with an NLR < 3.5 (52.6% vs 75.7%; P = .054). The proportion of patients with pain or with ruptured TAA was significantly higher in patients with an NLR > 3.5 compared with those with NLR < 3.5 (42.1% vs 16.2%; P = .022 and 26.3% vs 2.7%; P = .007, respectively). No significant difference was observed regarding the 30-day overall postoperative mortality and morbidity. The preoperative NLR did not correlate with TAA diameter. A high preoperative NLR is significantly associated with symptomatic and ruptured TAA, suggesting a potential interest as a marker and/or player in the disease.


Assuntos
Aneurisma da Aorta Torácica/sangue , Ruptura Aórtica/sangue , Linfócitos , Neutrófilos , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/mortalidade , Ruptura Aórtica/cirurgia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
Anatol J Cardiol ; 19(1): 11-16, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29339694

RESUMO

OBJECTIVE: The is to report immunohistochemical observations of aortic α-smooth muscle actin (SMA) expressions in patients with aortic aneurysm, acute aortic dissection, and coronary artery disease and to discuss phenotypic switching of smooth muscle cells (SMCs) of these lesions. METHODS: Forty-nine consecutive patients scheduled for surgical treatment for acute type A aortic dissection (20 patients), aortic aneurysm (9 patients), and coronary artery disease (20 patients) were included. Surgical specimens of the aorta were obtained and prepared for hematoxylin and eosin and immunohistochemical stainings. RESULTS: A comparison of aortic structural changes between the three groups showed that patients with coronary artery disease had the least severe aorta degeneration with the most intense α-SMA positivity. Aortic structural impairment was the most severe in patients with aortic dissection, whereas α-SMA positivity was more intense in patients with aortic dissection than in those with aortic aneurysm. CONCLUSION: Disparities in α-SMA expressions in the aortic tissues of the three groups represent the extent of SMC degenerations or a phenotypic switching between contractile and synthetic SMCs. The results imply severe SMC degenerations in patients with aortic aneurysm, which may be beneficial because of the production of extracellular matrix necessary for healing of the vascular wall, but severe disruptions in elastic fibers in patients with aortic dissection. Patients with coronary artery disease show slight SMC degeneration and phenotypic switching among the three groups. The possible apoptotic and genetic mechanisms of aortic structural impairments warrant further elaborations.


Assuntos
Actinas/metabolismo , Aneurisma Dissecante/metabolismo , Aneurisma da Aorta Torácica/metabolismo , Doença da Artéria Coronariana/metabolismo , Actinas/sangue , Aneurisma Dissecante/sangue , Aneurisma da Aorta Torácica/sangue , Doença da Artéria Coronariana/sangue , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade
20.
Ann Vasc Surg ; 48: 204-213, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29197606

RESUMO

BACKGROUND: Plasma low-density lipoprotein (LDL) cholesterol is implicated in abdominal aorta (AA) and aortic dissection (AD); however, its role in the pathogenesis of AA and AD, a disease with a high mortality rate, is unknown. The existing animal models such as apolipoprotein E-deficient (Apoe-/-) mice cannot reproduce all the conditions of AA/AD, including elevated LDL-cholesterol levels and spontaneous atheroma formation; therefore, a more reliable in vivo model is required. Here, we analyzed angiotensin II (Ang II)-induced mice with combined deficiency of the LDL receptor and the catalytic component of the apolipoprotein B-edisome complex (Ldlr-/-/Apobec1-/- [WKO]) to understand AA formation and AD occurrence in relation to plasma lipid composition. METHODS: AAs and ADs were created in 18- to 22- week-old male Apoe-/- and Ldlr-/-/Apobec1-/- mice by Ang II infusion. Immunostaining allowed assessment of smooth muscle cells and mural monocytes/macrophages. RESULTS: Ldlr-/-/Apobec1-/- mice had elevated LDL-cholesterol levels characteristic for human type IIa hyperlipidemia, resulting in atherogenesis, which promoted mortality, AA formation, and AD development. Interestingly, variations in the distribution of atheromas and inflammatory sites between Apoe-/- and Ldlr-/-/Apobec1-/- mice depending on lipid profiles resulted in differences in AA formation and AD occurrence in the thoracic aorta. CONCLUSIONS: Our results indicate the presence of a pathogenic pathway involving serum lipid composition that plays a key role in AA formation and AD occurrence in Ang II-induced mice.


Assuntos
Angiotensina II , Aorta Torácica/metabolismo , Aneurisma da Aorta Torácica/induzido quimicamente , LDL-Colesterol/sangue , Hipercolesterolemia/sangue , Desaminase APOBEC-1/deficiência , Desaminase APOBEC-1/genética , Animais , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/patologia , Biomarcadores/sangue , Modelos Animais de Doenças , Predisposição Genética para Doença , Hipercolesterolemia/complicações , Hipercolesterolemia/genética , Masculino , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Knockout para ApoE , Fenótipo , Placa Aterosclerótica , Receptores de LDL/deficiência , Receptores de LDL/genética , Fatores de Tempo , Regulação para Cima
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