Lipid profiles help to explain protection from systemic atherosclerosis in patients with ascending aortic aneurysm

Weininger, Gabe; Ostberg, Nicolai P; Shang, Michael; Zafar, Mohammad A.; Ziganshin, Bulat A.; Liu, Shirley; Erben, Young; Elefteriades, John A.

doi:10.1016/j.jtcvs.2021.09.031

Cited by 11 publications

(6 citation statements)

References 13 publications

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“…We suspect that the valve may be “washed” very well by flowing blood, as it is the same exact diameter as the graft. Also, our patients with aortic root disease are usually free of atherosclerosis 34 and have good left ventricular ejection fraction.…”

Section: Discussionmentioning

confidence: 88%

Midterm follow-up of composite graft replacement of the aortic root (30-year experience)—remarkably safe, effective, and durable

Haider Jeoffrey,

Zafar,

Velasco

et al. 2024

JTCVS Open

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Section: Discussionmentioning

confidence: 88%

Midterm follow-up of composite graft replacement of the aortic root (30-year experience)—remarkably safe, effective, and durable

Haider Jeoffrey,

Zafar,

Velasco

et al. 2024

JTCVS Open

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“…This dissociation between CAD and ascending aortic disease is in keeping with multiple studies from our team [17][18][19] showing that ascending aortic aneurysm patients are remarkably free of atherosclerotic disease; in fact, ascending aortic aneurysm patients have less total body vascular calcification, a lower intimal medial thickness (IMT) in the carotid artery, and almost complete protection from myocardial infarction. Additionally, ascending aortic aneurysm patients have much lower LDL than non-aneurysmal patients [24] These findings seem paradoxical compared to general dogma regarding atherosclerosis until one recognizes that ascending aneurysms are non-calcified, smooth contoured, and non-thrombus containing. This stands in contradistinction to descending and abdominal aortic aneurysms, which are frankly atherosclerotic, with heavily calcified walls, irregular contour, and heavy thrombus burden.…”

Section: Discussionmentioning

confidence: 90%

KIF6 Trp719Arg Genetic Variant Increases Risk for Thoracic Aortic Dissection

Velasco

Ziganshin

et al. 2023

Genes

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Background: KIF6 (kinesin family member 6), a protein coded by the KIF6 gene, serves an important intracellular function to transport organelles along microtubules. In a pilot study, we found that a common KIF6 Trp719Arg variant increased the propensity of thoracic aortic aneurysms (TAA) to suffer dissection (AD). The present study aims for a definite investigation of the predictive ability of KIF6 719Arg vis à vis AD. Confirmatory findings would enhance natural history prediction in TAA. Methods: 1108 subjects (899 aneurysm and 209 dissection patients) had KIF6 719Arg variant status determined. Results: The 719Arg variant in the KIF6 gene correlated strongly with occurrence of AD. Specifically, KIF6 719Arg positivity (homozygous or heterozygous) was substantially more common in dissectors (69.8%) than non-dissectors (58.5%) (p = 0.003). Odds ratios (OR) for suffering aortic dissection ranged from 1.77 to 1.94 for Arg carriers in various dissection categories. These high OR associations were noted for both ascending and descending aneurysms and for homozygous and heterozygous Arg variant patients. The rate of aortic dissection over time was significantly higher for carriers of the Arg allele (p = 0.004). Additionally, Arg allele carriers were more likely to reach the combined endpoint of dissection or death (p = 0.03). Conclusions: We demonstrate the marked adverse impact of the 719Arg variant of the KIF6 gene on the likelihood that a TAA patient will suffer aortic dissection. Clinical assessment of the variant status of this molecularly important gene may provide a valuable “non-size” criterion to enhance surgical decision making above and beyond the currently used metric of aortic size (diameter).

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“…The degree of inflammatory activity and location of infiltrated leukocytes, i.e., subintimal or mid-media, varies without known associations to patient characteristics [11]. Noteworthy is also the reported experience of surgeons treating aortic diseases, where degenerative AscAA differ significantly from descending aortic aneurysm or abdominal aortic aneurysms (AAA), in particular with respect to the absence of mural thrombi or macroscopic signs of atherosclerosis [73]. Taken together, this indicates, in our minds, that the degenerative changes described in the pathological consensus apply to most AscAA patients despite some reports of heterogeneity as pronounced inflammation or microscopic atherosclerotic lesions.…”

Section: Degenerative Ascending Aortic Aneurysmmentioning

confidence: 99%

Ascending Aortic Aneurysm in Relation to Aortic Valve Phenotype

Freiholtz,

Eriksson,

M. Björck

2024

Cardiology and Cardiovascular Medicine

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Being born with a bicuspid aortic valve (BAV) is a significant risk factor for developing an ascending aortic aneurysm (AscAA). Research has uncovered different mechanisms influencing AscAA development in BAV-patients compared to those with normal tricuspid aortic valves (TAV). BAV-associated AscAA may result from intrinsic hemodynamic or genetic alterations, possibly even embryonic origins. During embryonic development, neural crest cells and the second heart field contribute to the ascending aorta’s formation, with defective signaling potentially increasing susceptibility to aneurysm development. BAV can manifest with different phenotypes, impacting clinical outcomes. The degenerative AscAA in TAV-patients differs from BAV-associated AscAA, marked by fibrosis, smooth muscle cell loss, and inflammation. AscAA in TAV-patients rarely appears in those with aortic stenosis, suggesting a link between aortic valve disease and degenerative AscAA. This chapter aims to describe suggested molecular mechanisms driving aneurysm formation in BAV- and TAV-patients.

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Lipid profiles help to explain protection from systemic atherosclerosis in patients with ascending aortic aneurysm

Cited by 11 publications

References 13 publications

Midterm follow-up of composite graft replacement of the aortic root (30-year experience)—remarkably safe, effective, and durable

Midterm follow-up of composite graft replacement of the aortic root (30-year experience)—remarkably safe, effective, and durable

KIF6 Trp719Arg Genetic Variant Increases Risk for Thoracic Aortic Dissection

Ascending Aortic Aneurysm in Relation to Aortic Valve Phenotype

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