Risk Factors for Thoracic Aortic Dissection

Zhou, Zhen; Cecchi, Alana C.; Prakash, Siddharth K.; Milewicz, Dianna M.

doi:10.3390/genes13101814

Cited by 56 publications

(36 citation statements)

References 260 publications

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“…Importantly, our results also indicated that regorafenib could also induce aortic dissection with a much higher incidence, which was not reported nor listed in FDA instruction. It was reported that the risk factor for aortic dissection include hypertension, atherosclerosis, age and dyslipidemia [32]. According to our results, one of the most common side effects followed the use of TKIs was hypertension, which also played vital role in the occurrence of TKI-induced aortic dissection.…”

Section: Discussionsupporting

confidence: 56%

Cardiovascular toxicities following the use of tyrosine kinase inhibitors in Hepatocellular Cancer Patients: A Retrospective, Pharmacovigilance Study

Lai

Wan

Jiao

et al. 2023

Preprint

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Aims: With the extensive use of tyrosine kinases inhibitors(TKIs) in hepatocellular cancer, cardiac adverse events(AEs) emerged in recent years. This study explored the cardiac AEs of TKIs through the Food and Drug Administration’s Adverse Event Reporting System (FAERS). Methods: Disproportionality analysis and Bayesian analysis were utilized for data mining of the suspected cardiac AEs of TKIs, based on FAERS data from January 2004 to December 2021. Results: A total of 4708 cardiac AEs reports of sorafenib, regorafenib, lenvatinib and cabozantinib were identifed. Among them, 17 cardiac AEs signals were detected in regorafenib, 15 cardiac AEs signals were detected in lenvatinib, 57 cardiac AEs signals were detected in sorafenib while 27 cardiac AEs signals were detected in cabozantinib. Hypertension accounts for the most reported cardiac AE. Lenvatinib appears to induce cardiac failure with the highest signals strength [ROR=7.7(3.46,17.17)]. Acute myocardial infarction were detected in lenvatinib [ROR=7.91(5.64,11.09)] and sorafenib[ROR=2.22(1.74, 2.84)]. Acute coronary syndrome were detected in lenvatinib[ROR=11.57(6.84, 19.58)] and sorafenib [ROR=2.81(1.87,4.24)]. Atrial fibrillation were detected in sorafenib [ROR=1.82(1.55,2.14)] and regorafenib [ROR=1.36(1.03,1.81)]. Meanwhile, aortic dissection were detected in sorafenib [ROR=5.08(3.31,7.8)] and regorafenib [ROR=3.39(1.52,7.56)]. Most patients developed hypertension and cardiac failure within 30 days after TKIs treatment. Patients taking lenvatinib developed acute coronary syndrome increased in the periods of 180 days(64.29%) . Conclusion: Analysis of FAERS provides more precise profile on the characteristics of cardiac AEs after different TKI regimens. Distinct monitoring and appropriate management are needed in the care of the TKIs recipients.

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Section: Discussionsupporting

confidence: 56%

Cardiovascular toxicities following the use of tyrosine kinase inhibitors in Hepatocellular Cancer Patients: A Retrospective, Pharmacovigilance Study

Lai

Wan

Jiao

et al. 2023

Preprint

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“…Além disso, a incidência dessa patologia é difícil de ser definida, devido à mortalidade pré-hospitalar e falta de diagnóstico Brazilian Journal of Development, Curitiba, v.9, n.3, p. 12379-12391, mar., 2023 adequado, o que associa-se a sinais e sintomas pouco específicos. No entanto, estima-se cerca de 2,6 a 3,5 casos por 100.000 pessoas ao ano, sendo que 67% dos casos são dissecções do tipo A -Classificação de Stanford -e 33%, do tipo B. Outrossim, a DAA acomete, principalmente, pessoas idosas acima de 75 anos de idade e estima-se que seja a causa de cerca de 7% das mortes súbitas extra-hospitalares (SAYED; MUNIR; BAHBAH, 2020;BOSSONE;CARBONE;EAGLE, 2022;YUAN;MITSIS;NIENABER, 2022;ZHOU et al, 2022).…”

Section: Epidemiologiaunclassified

“…A principal alteração patológica que contribui para o desenvolvimento da DAA é a degeneração da camada média por um aumento de pressão, criando um lúmen falso na parede do vaso. Esse processo é estimulado especialmente por fragmentação das fibras elásticas levando à fraqueza estrutural da parede do vaso, além de acúmulo de proteoglicanos na matriz extracelular (SAYED; MUNIR; BAHBAH, 2020;VILACOSTA et al, 2021;ZHOU et al, 2022).…”

Section: Fisiopatologiaunclassified

Dissecção aguda de aorta - aspectos epidemiológicos, fisiopatológicos e manejo terapêutico

Souza¹,

Araujo²,

Costa³

et al. 2023

Braz. J. Develop.

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A dissecção aguda de aorta (DAA) é uma emergência cardíaca de risco de morte elevado, pois tem taxa de mortalidade de 90% anual se não identificada e tratada precocemente. Estima-se que 2,6 a 3,5 casos por 100.000 pessoas sejam diagnosticados ao ano, principalmente em pessoas acima de 75 anos, sendo responsável por 7% das mortes súbitas extra-hospitalares. A identificação e tratamento adequado da doença são importantes para a redução da mortalidade, por isso é essencial discutir esse assunto. A DAA é causada pela degeneração da camada média vascular, resultante de pressão elevada, que leva à fraqueza da parede. Nesse sentido, a hipertensão arterial sistêmica (HAS) não tratada contribui para o acúmulo de metaloproteinases e citocinas pró-inflamatórias no endotélio, aumentando a probabilidade do quadro; dessa forma, a melhor maneira de prevenir a dissecção é controlar a pressão arterial. Ademais, a dissecção aórtica é uma emergência clínica caracterizada por dor torácica intensa, lacrimejante, migratória e de início agudo; os sintomas podem variar dependendo da idade, comorbidades e tipo de dissecção. Para detectar e prever o risco da dissecção aórtica, biomarcadores, como proteínas do músculo liso e metaloproteínas da matriz extracelular, são utilizados. Além disso, exames de imagem, como a tomografia computadorizada (TC), a ressonância nuclear magnética (RNM) e o ecocardiograma transesofágico (ETE), são fundamentais para confirmar o diagnóstico e determinar a parte da aorta afetada, a extensão da dilatação e o tratamento adequado para cada paciente. O tratamento é sempre direcionado ao alívio da dor e controle da hipertensão; a DAA do tipo A de Stanford é uma urgência médica com risco de vida que precisa de cirurgia para prevenir morte, ruptura e regurgitação aórtica. Para o tipo B, a terapia medicamentosa é a opção usual, mas as diretrizes europeias sugerem tratamento endovascular da aorta torácica em casos complicados.

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“…Despite the progressive improvements in terms of outcome and quality of life post-intervention for type A aortic dissection (TAAD), the results are still not satisfactory [1][2][3] and, as described by David, TAAD is still often lethal unless emergency surgery is performed. 4 In the context of technical and procedural advances that increasingly require the use of endovascular prostheses, 5,6 preoperative risk assessment is a topic of fundamental importance in planning the optimal surgical approach.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the progressive improvements in terms of outcome and quality of life post-intervention for type A aortic dissection (TAAD), the results are still not satisfactory 1–3 and, as described by David, TAAD is still often lethal unless emergency surgery is performed. 4…”

Section: Introductionmentioning

confidence: 99%

Analysis of current mortality risk scores for acute type A aortic dissection: The Siena experience

Lorenz,

Muzzi,

Neri

2024

Asian Cardiovasc Thorac Ann

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Objective In literature, various risk scores have been described to predict in-hospital mortality of patients undergoing surgery for acute type A dissection. We want to evaluate which factors are most correlated with a negative outcome and testing the validity of the current scores in literature analyzing our experience of over 20 years in the surgery of type A aortic dissections. Materials and methods A total of 324 patients were included in the study. Patients were divided into two groups according to 30-day survival or mortality. The preoperative variables analyzed are the parameters necessary for the calculation of scores: Penn Classification, Leipzig Halifax and adjusted Leipzig Halifax score, GERAADA score and EuroSCORE II. Intra- and post-operative mortality were 10.2% and 17.5%, respectively. In multivariate analysis, the preoperative predictors of 30-day mortality were age greater than 70 years, low eject fraction levels, visceral and coronary malperfusion. Both GERAADA and EuroSCORE II were statistically significant predictors of 30-day mortality. However, EuroSCORE II underestimates the mortality compared to GERAADA score probably due to the lack of evaluation of fundamental preoperative factors in the course of type A aortic dissection. Results The study has demonstrated the efficacy of the GERAADA score in predicting the outcome of patients undergoing surgery and the underestimation of the mortality of EuroSCORE II in our population.

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Risk Factors for Thoracic Aortic Dissection

Cited by 56 publications

References 260 publications

Cardiovascular toxicities following the use of tyrosine kinase inhibitors in Hepatocellular Cancer Patients: A Retrospective, Pharmacovigilance Study

Cardiovascular toxicities following the use of tyrosine kinase inhibitors in Hepatocellular Cancer Patients: A Retrospective, Pharmacovigilance Study

Dissecção aguda de aorta - aspectos epidemiológicos, fisiopatológicos e manejo terapêutico

Analysis of current mortality risk scores for acute type A aortic dissection: The Siena experience

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