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BMC Cardiovascular Disorders May 2023Individual risk estimation is an essential part of cardiovascular (CV) disease prevention. Several imaging parameters have been studied for this purpose. Based on...
BACKGROUND
Individual risk estimation is an essential part of cardiovascular (CV) disease prevention. Several imaging parameters have been studied for this purpose. Based on mounting evidence, international guidelines recommend the ultrasound assessment of carotid artery plaques to refine individual risk estimation. Previous studies have not compared carotid artery and abdominal aorta plaques in CV risk estimation. Our aim was to explore this matter in a prospective study setting.
METHODS
Participants were part of the Oulu Project Elucidating Risk of Atherosclerosis (OPERA) project. All participants (n = 1007, 50% males, aged 51.3 ± 6.0 years) were clinically examined in the beginning of 1990's and followed until the end 2014 for fatal and non-fatal CV events.
RESULTS
During a median follow-up of 22.5 (17.5-23.2) years, 246 (24%) participants suffered a CV event and 79 (32%) of those CV events were fatal. When compared to those without plaques, both carotid (hazard ratio, HR 2.854 [95% confidence interval, CI, 2.188-3.721, p < 0.001) and abdominal aorta plaques (HR 2.534 [1.503-4.274], p < 0.001) were major risk factors for CV events as an aggregate endpoint. These associations remained even after adjusting the multivariable models with age, sex, systolic blood pressure, smoking, diabetes, LDL cholesterol, and with previous CV events (coronary artery disease and stroke/transient ischemic attack). However, only carotid plaques were significant risk factors for fatal CV events: multivariable adjusted HR 2.563 (1.452-4.524), p = 0.001. Furthermore, reclassification and discrimination parameters were improved only when carotid plaques were added to a baseline risk model. Adding abdominal aorta plaques to the baseline risk model improved C-statistic from 0.718 (0.684-0.751) to 0.721 (0.688-0.754) whereas carotid plaques improved it to 0.743 (0.710-0.776).
CONCLUSIONS
Both carotid and abdominal aorta plaques are significant risk factors for CV events, but only carotid plaques provide prognostic information beyond traditional CV risk factors on fatal CV events. If one ultrasound parameter for plaque detection and CV risk estimation had to be chosen, carotid plaques may be preferred over abdominal aorta.
Topics: Male; Humans; Female; Aorta, Abdominal; Cardiovascular Diseases; Prospective Studies; Atherosclerosis; Carotid Artery, Common
PubMed: 37161438
DOI: 10.1186/s12872-023-03264-1 -
Journal of Vascular Surgery Aug 2022Abdominal aortic coarctation and hypoplasia are uncommon diseases, recognized most often in pediatric-aged individuals. Comprehensive studies regarding the pathologic... (Review)
Review
OBJECTIVES
Abdominal aortic coarctation and hypoplasia are uncommon diseases, recognized most often in pediatric-aged individuals. Comprehensive studies regarding the pathologic spectrum of these aortopathies are nonexistent. This investigation was undertaken to better define the histologic and morphologic character of abdominal aortic narrowings affecting children and assess its potential relevance to contemporary clinical practice.
METHODS
Aortic specimens obtained during open operations in children being treated for symptomatic, noninflammatory abdominal aortic narrowings at the University of Michigan were subjected to histologic study after hematoxylin and eosin, Movat, Verhoeff Van Gieson, and Masson's trichrome preparations. Microscopic findings were correlated with the anatomic aortic images. In addition, a detailed review was completed of all prior reports in the English literature that included images depicting the histologic character of noninflammatory abdominal aortic narrowings in children.
RESULTS
Among a series of 67 pediatric-aged individuals undergoing open surgical interventions for abdominal aortic narrowings, eight children ranging in age from 9 months to 18 years, had adequate aortic tissue available for study. The loci of the specimens paralleled the anatomic sites of segmental coarctations observed in the entire series, with involvement of the suprarenal abdominal aorta (n = 3), intrarenal aorta (n = 2), and infrarenal aorta (n = 1). Diffusely hypoplastic abdominal aortas (n = 2) included one case of a de facto aortic duplication, represented by a channel that paralleled the narrow native aorta and gave origin to celiac artery branches, as well as the superior mesenteric and renal arteries. Concentric or eccentric intimal fibroplasia was observed in every aorta, often with internal elastic fragmentation and duplication (n = 4). Media abnormalities included elastic tissue disorganization (n = 3) and focal medial fibrosis (n = 1). Organizing luminal thrombus occurred in two infants. Coexistent ostial stenoses of the celiac, superior mesenteric, or renal arteries were observed in all but the only child who had an infrarenal aortic coarctation. Neurofibromatosis type 1 affected one child whose histologic findings were indistinguishable from those of the other children. A review of prior published histologic images of abdominal aortic coarctation and hypoplasia affecting children from other centers revealed a total of 14 separate reports, each limited to single case photomicrographs, of which 11 exhibited intimal fibroplasia.
CONCLUSIONS
Intimal fibroplasia is a common accompaniment of developmental abdominal aortic coarctation and hypoplasia. It is posited that intimal fibroplasia, which is likely progressive in instances of abnormal shear stresses in these diminutive vessels, may contribute to less salutary outcomes after endovascular and certain open reconstructions of pediatric abdominal aortic narrowings.
Topics: Adolescent; Aorta, Abdominal; Aortic Coarctation; Child; Child, Preschool; Humans; Infant; Plastic Surgery Procedures
PubMed: 35149163
DOI: 10.1016/j.jvs.2022.01.121 -
Journal of Biomechanics Mar 2012Biomechanical factors play fundamental roles in the natural history of abdominal aortic aneurysms (AAAs) and their responses to treatment. Advances during the past two... (Review)
Review
Biomechanical factors play fundamental roles in the natural history of abdominal aortic aneurysms (AAAs) and their responses to treatment. Advances during the past two decades have increased our understanding of the mechanics and biology of the human abdominal aorta and AAAs, yet there remains a pressing need for considerable new data and resulting patient-specific computational models that can better describe the current status of a lesion and better predict the evolution of lesion geometry, composition, and material properties and thereby improve interventional planning. In this paper, we briefly review data on the structure and function of the human abdominal aorta and aneurysmal wall, past models of the mechanics, and recent growth and remodeling models. We conclude by identifying open problems that we hope will motivate studies to improve our computational modeling and thus general understanding of AAAs.
Topics: Animals; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Biomechanical Phenomena; Computer Simulation; Humans; Models, Cardiovascular
PubMed: 22189249
DOI: 10.1016/j.jbiomech.2011.11.021 -
Arteriosclerosis, Thrombosis, and... Jun 2017
Review
Topics: Animals; Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Disease Models, Animal; Humans; Risk Factors; Signal Transduction; Vascular Remodeling
PubMed: 28539494
DOI: 10.1161/ATVBAHA.117.309578 -
Journal of Vascular Surgery Dec 2014
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Female; Humans; Male; Vascular Surgical Procedures
PubMed: 25454112
DOI: 10.1016/j.jvs.2014.07.023 -
Medicine Aug 2022To investigate the normal diameter of the abdominal aorta and common iliac arteries of the middle-aged and elderly people in China and the relationship of the diameters...
To investigate the normal diameter of the abdominal aorta and common iliac arteries of the middle-aged and elderly people in China and the relationship of the diameters with age, sex, height, weight, body mass index (BMI), and body surface area (BSA). This retrospective study enrolled 625 patients including 380 males and 245 females aged 60.00 years (interquartile range 13.00 years). All clinical data and the diameters of the abdominal aorta and common iliac arteries were analyzed. The diameter of the abdominal aorta was 21.49 ± 2.49 mm at the proximal, 16.94 (interquartile range 2.39) mm at the middle, and 15.65 (interquartile range 2.90) mm at the distal segment. The diameter of the common iliac artery was 10.76 (interquartile range 1.99) mm at the right proximal, 10.41 (interquartile range 2.05) mm at the left proximal, 10.74 (interquartile range 2.25) mm at the right distal, and 10.67 (interquartile range 2.22) mm at the left distal segment. The height, weight, BSA, BMI, diameters of the proximal, middle and distal abdominal aorta as well as the proximal and distal left and right common iliac arteries were significantly higher in males than those in females (P < .001). Height, weight, BSA, and BMI were significantly (P < .001) positively correlated with the diameter of the abdominal aorta and common iliac artery at the proximal, middle, and distal segments. The middle and distal diameters of the abdominal aorta were significantly higher in males than those in females (P < .05). The diameter of the abdominal aorta at the proximal, middle, and distal segment as well as the diameter of the left and right common iliac artery at the distal segment were significantly (P < .05) increased with age. The normal values of the diameter of the abdominal aorta and common iliac arteries are suggested for the middle-aged and elderly Chinese people for clinical reference. The diameters are gender related and significantly positively correlated with BSA, height, weight, and BMI, which is beneficial for the diagnosis and treatment planning of relevant vascular diseases.
Topics: Aged; Aorta, Abdominal; Body Surface Area; China; Female; Humans; Iliac Artery; Male; Middle Aged; Retrospective Studies
PubMed: 35945710
DOI: 10.1097/MD.0000000000030026 -
European Journal of Vascular and... Apr 2019
Topics: Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Humans; Treatment Outcome
PubMed: 30711382
DOI: 10.1016/j.ejvs.2019.01.004 -
Journal of the Royal Society, Interface Jun 2013Aortic disease is a significant cause of death in developed countries. The most common forms of aortic disease are aneurysm, dissection, atherosclerotic occlusion and... (Review)
Review
Aortic disease is a significant cause of death in developed countries. The most common forms of aortic disease are aneurysm, dissection, atherosclerotic occlusion and ageing-induced stiffening. The microstructure of the aortic tissue has been studied with great interest, because alteration of the quantity and/or architecture of the connective fibres (elastin and collagen) within the aortic wall, which directly imparts elasticity and strength, can lead to the mechanical and functional changes associated with these conditions. This review article summarizes the state of the art with respect to characterization of connective fibre microstructure in the wall of the human aorta in ageing and disease, with emphasis on the ascending thoracic aorta and abdominal aorta where the most common forms of aortic disease tend to occur.
Topics: Aging; Aorta; Aorta, Abdominal; Aorta, Thoracic; Aortic Diseases; Collagen; Elasticity; Elastin; Humans; Models, Anatomic
PubMed: 23536538
DOI: 10.1098/rsif.2012.1004 -
Journal of the Royal Society, Interface Feb 2019The paper provides a deepened insight into the role of anisotropy in the analysis of residual stresses in arteries. Residual deformations are modelled following...
The paper provides a deepened insight into the role of anisotropy in the analysis of residual stresses in arteries. Residual deformations are modelled following Holzapfel and Ogden (Holzapfel and Ogden 2010, J. R. Soc. Interface 7, 787-799. ( doi:10.1098/rsif.2009.0357 )), which is based on extensive experimental data on human abdominal aortas (Holzapfel et al. 2007, Ann. Biomed. Eng. 35, 530-545. ( doi:10.1007/s10439-006-9252-z )) and accounts for both circumferential and axial residual deformations of the individual layers of arteries-intima, media and adventitia. Each layer exhibits distinctive nonlinear and anisotropic mechanical behaviour originating from its unique microstructure; therefore, we use the most general form of strain-energy function (Holzapfel et al. 2015, J. R. Soc. Interface 12, 20150188. ( doi:10.1098/rsif.2015.0188 )) to derive residual stresses for each layer individually. Finally, the systematic experimental data (Niestrawska et al. 2016, J. R. Soc. Interface 13, 20160620. ( doi:10.1098/rsif.2016.0620 )) on both mechanical and structural properties of the different layers of the human abdominal aorta facilitate our discussion on (i) the importance of anisotropy in modelling residual stresses; (ii) the variability of residual stresses within the same class of tissue, the abdominal aorta; (iii) the limitations of conventional opening angle method to account for complex residual deformations; and (iv) the effect of residual stresses on the loaded configuration of the aorta mimicking in vivo conditions.
Topics: Anisotropy; Aorta, Abdominal; Humans; Models, Cardiovascular; Stress, Mechanical
PubMed: 30958201
DOI: 10.1098/rsif.2019.0029 -
Anesthesiology Sep 2015
Topics: Aorta, Abdominal; Female; Humans; Pregnancy; Vena Cava, Inferior
PubMed: 26284870
DOI: 10.1097/ALN.0000000000000792