High Levels of Endothelin (ET)-1 and Aneurysm Diameter Independently Predict Growth of Stable Abdominal Aortic Aneurysms

Abstract

The etiology of abdominal aortic aneurysm (AAA) includes inflammation and endothelial dysfunction. To evaluate relations between these mechanisms and AAA growth, endothelin (ET)-1, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and CD40 ligand were related to yearly AAA growth for 2.9 +/- 1.6 years (mean +/- SD) in 178 patients with conservatively followed AAA. Total number of follow-up years was 491. Abdominal aortic aneurysm diameter increased by 3.3 +/- 4.0 mm during the first year and by 4.9 +/- 4.4 mm during the first 2 years. Median (range) growth was 2.5 (-1.0 to 30.6) mm/year. When patients with AAA growth above or below median were compared, initial AAA diameter (46.1 +/- 5.8 vs 42.0 +/- 8.3 mm; P < .0001), age (75 +/- 7 vs 72 +/- 8 years; P < .029), and initial ET-1 levels (1.31 +/- 0.50 vs 1.13 +/- 0.49 pg/mL; P < .0177) were higher in patients with growth above median. Endothelin 1 (P = .0230) and initial AAA diameter (P = .0019) predicted AAA growth above median in logistic regression. In conclusion, higher initial levels of ET-1 and initial AAA diameter independently predict AAA growth.

Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

“…Halazun et al29 were the only group to describe a significant correlation ( r =0.28; n=108). The other 2 studies observed no association between homocysteine and AAA expansion (total n=248) 13, 21…”

“…Complement reactive protein was examined as marker for expansion in 5 studies17, 18, 19, 20, 21 and in 2 as marker for rupture 22, 23. De Haro et al and Wiernicki et al were the only groups to demonstrate significant correlations with expansion.…”

“…Interleukin‐6 and AAA expansion were examined in 3 studies, but none observed a significant association 21, 30, 31. Jones et al found no correlation in 466 follow‐up patients (low bias risk).…”

“…In 9 studies, AAA diameter was described as a marker for expansion8, 17, 19, 21, 40, 56, 57, 58, 59 and in 9 as a marker for rupture 34, 37, 60, 61, 62, 63, 64, 65, 66. Overall, the data are reliable because 2570 patients in total were included and 8 studies were appraised with low bias risk, 7 with medium risk, and only 3 with high risk.…”

“…Overall, the data are reliable because 2570 patients in total were included and 8 studies were appraised with low bias risk, 7 with medium risk, and only 3 with high risk. In 7 studies, significant correlations with expansion were demonstrated in 958 patients in total ( r =0.30–0.83),8, 21, 40, 56, 57, 58 and Norman et al measured faster growth in patients with a large (≥4 cm; n=112) versus small AAA (3–4 cm; n=433) 19. In 6 studies, with a total of 552 patients, significant outcomes were demonstrated for AAA diameter as a marker for rupture.…”