-
Current Cardiology Reports Mar 2022Acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer, are a group of highly morbid, related pathologies that are... (Review)
Review
PURPOSE OF REVIEW
Acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer, are a group of highly morbid, related pathologies that are defined by compromised aortic wall integrity. The purpose of this review is to summarize current management strategies for acute aortic syndromes.
RECENT FINDINGS
All acute aortic syndromes have potential for high morbidity and mortality and must be quickly identified and managed with the appropriate algorithm to prevent suboptimal outcomes. Recent trials suggest that TEVAR is increasingly useful in stabilizing pathology of the descending thoracic aorta but when possible should be applied in a delayed fashion and with limited coverage to minimize neurologic complications. Treatment for acute aortic syndrome is frequently dictated by the anatomic location and extent of the wall compromise as well as patient comorbidities. Therapy is often individualized and often includes some combination of medical, procedural, and surgical intervention.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Diseases; Hematoma; Humans; Syndrome; Ulcer
PubMed: 35029783
DOI: 10.1007/s11886-022-01642-3 -
Nature Genetics Jan 2022Enlargement or aneurysm of the aorta predisposes to dissection, an important cause of sudden death. We trained a deep learning model to evaluate the dimensions of the...
Enlargement or aneurysm of the aorta predisposes to dissection, an important cause of sudden death. We trained a deep learning model to evaluate the dimensions of the ascending and descending thoracic aorta in 4.6 million cardiac magnetic resonance images from the UK Biobank. We then conducted genome-wide association studies in 39,688 individuals, identifying 82 loci associated with ascending and 47 with descending thoracic aortic diameter, of which 14 loci overlapped. Transcriptome-wide analyses, rare-variant burden tests and human aortic single nucleus RNA sequencing prioritized genes including SVIL, which was strongly associated with descending aortic diameter. A polygenic score for ascending aortic diameter was associated with thoracic aortic aneurysm in 385,621 UK Biobank participants (hazard ratio = 1.43 per s.d., confidence interval 1.32-1.54, P = 3.3 × 10). Our results illustrate the potential for rapidly defining quantitative traits with deep learning, an approach that can be broadly applied to biomedical images.
Topics: Adult; Aged; Aorta, Thoracic; Aortic Aneurysm; Biological Variation, Population; Deep Learning; Female; Genome-Wide Association Study; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Quantitative Trait Loci; Transcriptome
PubMed: 34837083
DOI: 10.1038/s41588-021-00962-4 -
Cleveland Clinic Journal of Medicine Aug 2020Aneurysm of the thoracic aorta is less common than in the abdominal aorta, but it is clinically important because of the risk of rupture and death. Cases are often found... (Review)
Review
Aneurysm of the thoracic aorta is less common than in the abdominal aorta, but it is clinically important because of the risk of rupture and death. Cases are often found incidentally. Indications for surgical or endovascular repair are based on aneurysm location and risk factors for rupture such as aneurysm size, rate of growth, and associated conditions, while medical management is also important. Surveillance with various imaging tests is critical before and after intervention to guide treatment.
Topics: Adrenergic beta-Antagonists; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Computed Tomography Angiography; Heart Disease Risk Factors; Humans; Magnetic Resonance Angiography; Patient Care Team; Sentinel Surveillance
PubMed: 32868306
DOI: 10.3949/ccjm.87a.19140-1 -
The Journal of Thoracic and... Jun 2020
Topics: Aorta, Thoracic; Stents; Vertebral Artery
PubMed: 31668544
DOI: 10.1016/j.jtcvs.2019.08.066 -
Circulation May 2020Inherited thoracic aortopathies denote a group of congenital conditions that predispose to disease of the thoracic aorta. Aortic wall weakness and abnormal aortic... (Review)
Review
Inherited thoracic aortopathies denote a group of congenital conditions that predispose to disease of the thoracic aorta. Aortic wall weakness and abnormal aortic hemodynamic profiles predispose these patients to dilatation of the thoracic aorta, which is generally silent but can precipitate aortic dissection or rupture with devastating and often fatal consequences. Current strategies to assess the future risk of aortic dissection or rupture are based primarily on monitoring aortic diameter. However, diameter alone is a poor predictor of risk, with many patients experiencing dissection or rupture below current intervention thresholds. Developing tools that improve the risk assessment of those with aortopathy is internationally regarded as a research priority. A robust understanding of the molecular pathways that lead to aortic wall weakness is required to identify biomarkers and therapeutic targets that could improve patient management. Here, we summarize the current understanding of the genetically determined mechanisms underlying inherited aortopathies and critically appraise the available blood biomarkers, imaging techniques, and therapeutic targets that have shown promise for improving the management of patients with these important and potentially fatal conditions.
Topics: Aortic Dissection; Animals; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Aortic Rupture; Biomarkers; Genetic Predisposition to Disease; Humans; Molecular Targeted Therapy; Phenotype; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Signal Transduction; Translational Research, Biomedical; Vascular Surgical Procedures
PubMed: 32392100
DOI: 10.1161/CIRCULATIONAHA.119.043756 -
The Journal of Thoracic and... Jul 2020
Topics: Aorta, Thoracic; Cerebrovascular Circulation; Spinal Cord
PubMed: 31590950
DOI: 10.1016/j.jtcvs.2019.07.119 -
Interactive Cardiovascular and Thoracic... Nov 2022
Topics: Humans; Aorta, Thoracic; Thorax
PubMed: 36394267
DOI: 10.1093/icvts/ivac270 -
Journal of Cardiothoracic Surgery Apr 2020Blunt thoracic aortic injury, a life-threatening concern, remains the second most common cause of mortality among all non-penetrating traumatic injuries, second only to... (Review)
Review
BACKGROUND
Blunt thoracic aortic injury, a life-threatening concern, remains the second most common cause of mortality among all non-penetrating traumatic injuries, second only to intracranial hemorrhage. Kinetic forces from the rapid deceleration are the impetus for the injury mechanism and are graded accordingly. Given the prevalence of trauma as a public health problem, contemporary management considerations are important.
MAIN BODY
Blunt thoracic aortic injury may be fatal if not diagnosed and treated expeditiously. Endovascular options allow safe and effective management of these dangerous injuries. This paper describes the overview of blunt thoracic aortic trauma, the epidemiology, presentation, diagnosis, and treatment options with a focus on endovascular management.
CONCLUSION
Blunt thoracic aortic injury requires a high index of suspicion based on mechanism of injury in the trauma population. Endovascular options have become the mainstay of blunt thoracic aortic injury treatment whenever feasible with satisfactory results and long-term outcomes.
Topics: Aorta, Thoracic; Diagnostic Imaging; Endovascular Procedures; Humans; Postoperative Complications; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 32307000
DOI: 10.1186/s13019-020-01101-6 -
International Journal of Cardiology May 2023Biomarkers might help to improve diagnosis, surveillance and risk stratification of thoracic aortic disease (TAD). We explored the association between a broad spectrum...
BACKGROUND
Biomarkers might help to improve diagnosis, surveillance and risk stratification of thoracic aortic disease (TAD). We explored the association between a broad spectrum of cardiovascular biomarkers with clinical characteristics and thoracic aortic diameter in TAD patients.
METHODS
Venous blood-samples were obtained in 158 clinically stable TAD patients visiting our outpatient clinic (2017-2020). TAD was defined as a thoracic aortic diameter ≥ 40 mm, or genetic confirmation (hereditary TAD). The cardiovascular panel III of the Olink multiplex platform was used for batch analysis of 92 proteins. A comparison was made between biomarker levels in patients with and without previous aortic dissection and/or surgery, and with and without hereditary TAD. Linear regression analyses were applied to identify (relative, normalized) biomarker concentrations associated with the absolute thoracic aortic diameter (AD), and thoracic aortic diameter indexed for body surface area (ID).
RESULTS
Median age of study patients was 61.0 (IQR 50.3-68.8) years, 37.3% females. Mean AD and ID were 43.3 ± 5.4 mm and 21.3 ± 3.3 mm/m. After multivariable adjustment, Matrix Metalloproteinase-3 (MMP-3) and Insulin-like growth factor binding protein 2 (IGFBP-2) showed a significant positive association with AD and ID, respectively. Patients with previous aortic surgery/dissection had higher N-terminal-pro hormone BNP (NTproBNP) (median 3.67 [IQR 3.01-3.99] vs 2.84 [2.32-3.26], p ≤0.001). Patients with hereditary TAD had higher Trem-like transcript protein 2 (TLT-2) (median 4.64 [IQR 4.45-4.84]) than those with non-heriditary TAD (4.40 [4.17-4.64]; p = 0.00042).
CONCLUSIONS
Among a broad range of biomarkers, MMP-3 and IGFBP-2 were associated with disease severity in TAD patients. The pathophysiological pathways uncovered by these biomarkers, and their potential clinical use warrants further research.
Topics: Female; Humans; Middle Aged; Aged; Male; Matrix Metalloproteinase 3; Insulin-Like Growth Factor Binding Protein 2; Aortic Aneurysm, Thoracic; Aortic Diseases; Aorta, Thoracic; Aortic Dissection; Biomarkers
PubMed: 36796491
DOI: 10.1016/j.ijcard.2023.02.006 -
Arteriosclerosis, Thrombosis, and... Jul 2023
Topics: Humans; Aorta; Aorta, Thoracic; Signal Transduction; Integrins; Aortic Aneurysm, Thoracic
PubMed: 37165879
DOI: 10.1161/ATVBAHA.123.319404