Association of Mortality and Acute Aortic Events With Ascending Aortic Aneurysm

Guo, Ming; Appoo, Jehangir J.; Saczkowski, Richard; Smith, H. W.; Ouzounian, Maral; Gregory, Alexander J.; Herget, Eric J.; Boodhwani, Munir

doi:10.1001/jamanetworkopen.2018.1281

Cited by 82 publications

(54 citation statements)

References 37 publications

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“…Thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) are major vascular diseases induced by systemic atherosclerosis. TAA and AAA are related to increased morbidity and mortality rates, especially due to the rupture of TAA/AAA (1,2). Since the mortality of TAA/ AAA rupture is still very high, open surgery or endovascular aortic repair should be performed before rupture occurs (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…TAA and AAA are related to increased morbidity and mortality rates, especially due to the rupture of TAA/AAA (1,2). Since the mortality of TAA/ AAA rupture is still very high, open surgery or endovascular aortic repair should be performed before rupture occurs (2)(3)(4). Furthermore, patients with TAA/AAA often have coronary artery disease (CAD), which results in an even greater mortality rate (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm

et al. 2021

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Objective Since patients with thoracic aortic aneurysm (TAA)/abdominal aortic aneurysm (AAA) are often complicated with coronary artery disease, it is common for those patients to undergo percutaneous coronary intervention (PCI). The ankle brachial index (ABI) is usually measured in patients with TAA/AAA to screen the presence of peripheral arterial disease. The present study investigated the association between the ABI and clinical outcomes following PCI in patients with TAA/AAA. Methods and Material We divided 200 TAA/AAA patients who underwent PCI into a normal ABI group (n=137) and an abnormal ABI group (n=63) according to the ABI cutoff level of 1.00. The primary endpoint was one-year major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fetal myocardial infarction, stroke, target vessel revascularization, and hospitalization for heart failure. Results Mean ABIs in the normal and abnormal ABI groups were 1.12±0.09 and 0.86±0.11, respectively (p <0.01). Kaplan-Meier curves showed MACE were more frequent in the abnormal ABI group than in the normal ABI group (p=0.01). A multivariate Cox hazard analysis revealed that an abnormal ABI was significantly associated with 1-year MACE (vs. ABI ! 1.0: HR 3.02, 95% confidence interval 1.00-9.08, p=0.049). Conclusion Among patients with TAA/AAA who underwent PCI, abnormal ABI was significantly associated with 1-year MACE, suggesting the utility of the ABI measurement in this high-risk population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm

et al. 2021

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“…However, recent studies have found that many patients with acute ascending aortic dissection have aortic diameters of <5.5 cm at hospital presentation [ 14 , 15 ]. Moreover, Ming et al conducted a systematic review and meta-analysis about the natural history of ascending aortic aneurysm and found the conclusions about the conventional risk factors, such as aortic diameters, not only varied significantly but were often contradictory among studies [ 16 ]. For example, 4 studies [ 17 – 20 ] identified that aortic dilation had no association with baseline aortic diameter, while 2 studies [ 21 , 22 ] reported higher annual aortic growth rate with lower baseline aortic diameter.…”

Section: Introductionmentioning

confidence: 99%

Patient-Specific CT-Based Fluid-Structure-Interaction Aorta Model to Quantify Mechanical Conditions for the Investigation of Ascending Aortic Dilation in TOF Patients

Zuo

et al. 2020

Computational and Mathematical Methods in Medicine

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Background. Some adult patients with Tetralogy of Fallot (TOF) were found to simultaneously develop ascending aortic dilation. Severe aortic dilation would lead to several aortic diseases, including aortic aneurysm and dissection, which seriously affect patients’ living quality and even cause patients’ death. Current practice guidelines of aortic-dilation-related diseases mainly focus on aortic diameter, which has been found not always a good indicator. Therefore, it may be clinically useful to identify some other factors that can potentially better predict aortic response to dilation. Methods. 20 TOF patients scheduled for TOF repair surgery were recruited in this study and were divided into dilated and nondilated groups according to the Z scores of ascending aorta diameters. Patient-specific aortic CT images, pressure, and flow rates were used in the construction of computational biomechanical models. Results. Simulation results demonstrated a good coincidence between numerical mean flow rate at inlet and the one obtained from color Doppler ultrasonography, which implied that computational models were able to simulate the movement of the aorta and blood inside accurately. Our results indicated that aortic stress can effectively differentiate patients of the dilated group from the ones of the nondilated group. Mean ascending aortic stress-P1 (maximal principal stress) from the dilated group was 54% higher than that from the nondilated group (97.97 kPa vs. 63.47 kPa, p value = 0.044) under systolic pressure. Velocity magnitude in the aorta and aortic wall displacement of the dilated group were also greater than those of the nondilated group with p value < 0.1. Conclusion. Computational modeling and ascending aortic biomechanical factors may be used as a potential tool to identify and analyze aortic response to dilation. Large-scale clinical studies are needed to validate these preliminary findings.

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“…Subsequently, however, long-term independent studies [12][13][14] produced evidences supporting new guidelines providing separate threshold for aortic surgery in MF and BAV patients [12][13][14]. Indeed, a recent meta-analysis [15] indicates a low risk of rupture or dissection of moderately dilated aortas without evidence that those related to BAV perform more poorly than others. These data further support the recommended threshold of 55 mm for intervention in BAVs without risk factors [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

When should a rare inherited connective tissue disorder be suspected in bicuspid aortic valve by primary-care internists and cardiologists? Proposal of a score

Pepe

Giusti

Colonna³

et al. 2020

Intern Emerg Med

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Size threshold for aortic surgery in bicuspid aortic valve (BAV) is debated. Connective tissue disorders (CTDs) are claimed as a clinical turning point, suggesting early surgery in BAV patients with CTD. Thus, we aimed at developing a score to detect high risk of carrying CTDs in consecutive BAVs from primary care. Ninety-eight BAVs without ectopia lentis or personal/family history of aortic dissection were studied at the Marfan syndrome Tuscany Referral Center. Findings were compared with those detected in 84 Marfan patients matched for sex and age. We selected traits with high statistical difference between MFS and BAV easily obtainable by cardiologists and primary-care internists: mitral valve prolapse, myopia ≥ 3DO, pectus carenatum, pes planus, wrist and thumb signs, and difference between aortic size at root and ascending aorta ≥ 4 mm. Clustering of ≥ 3 of these manifestations were more frequent in Marfan patients than in BAVs (71.4% vs 6.1%, p < 0.0001) resulting into an Odds Ratio to be affected by MFS of 38.3 (95% confidence intervals 14.8–99.3, p < 0.0001). We propose a score assembling simple clinical and echocardiographic variables resulting in an appropriate referral pattern of BAVs from a primary-care setting to a tertiary center to evaluate the presence of a potential, major CTD.

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Association of Mortality and Acute Aortic Events With Ascending Aortic Aneurysm

Cited by 82 publications

References 37 publications

Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm

Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm

Patient-Specific CT-Based Fluid-Structure-Interaction Aorta Model to Quantify Mechanical Conditions for the Investigation of Ascending Aortic Dilation in TOF Patients

When should a rare inherited connective tissue disorder be suspected in bicuspid aortic valve by primary-care internists and cardiologists? Proposal of a score

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