Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review

Uimonen, Mikko

doi:10.21037/jtd-21-829

Cited by 2 publications

(3 citation statements)

References 71 publications

(150 reference statements)

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“…To some extent, thickening of the intimal collagen fibers improves the aortic stiffness, but the internal structural integrity is damaged, and some of the elastic and collagen fibers are structurally and functionally impaired ( Tsamis et al, 2013 ). A balance between damage and repair is achieved ( Uimonen, 2021 ) to keep the original mechanical properties.…”

Section: Discussionmentioning

confidence: 99%

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A study on the ultimate mechanical properties of middle-aged and elderly human aorta based on uniaxial tensile test

Chen,

Zhao,

et al. 2024

Front. Bioeng. Biotechnol.

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Background:The mechanical properties of the aorta are particularly important in clinical medicine and forensic science, serving as basic data for further exploration of aortic disease or injury mechanisms.Objective:To study the influence of various factors (age, gender, test direction, anatomical location, and pathological characteristics) on the mechanical properties and thickness of the aorta.Methods:In this study, a total of 24 aortas (age range: 54–88 years old) were collected, one hundred and seventy-four dog-bone-shaped samples were made, and then the uniaxial tensile test was run, finally, pathological grouping was performed through histological staining.Results:Atherosclerotic plaques were mainly distributed near the openings of blood vessel branches. The distribution was most severe in the abdominal aorta, followed by the aortic arch. Aortic atherosclerosis was a more severe trend in the male group. In the comparison of thickness, there were no significant differences in age (over 50 years) and test direction, the average thickness of the aorta was greater in the male group than the female group and decreased progressively from the ascending aorta to the abdominal aorta. Comparing the mechanical parameters, various parameters are mainly negatively correlated with age, especially in the circumferential ascending aorta (εp “Y = −0.01402*X + 1.762, R2 = 0.6882”, εt “Y = −0.01062*X + 1.250, R2 = 0.6772”); the parameters of males in the healthy group were larger, while the parameters of females were larger in atherosclerosis group; the aorta has anisotropy, the parameters in the circumferential direction were greater than those in the axial direction; the parameters of the ascending aorta were the largest in the circumferential direction, the ultimate stress [σp “1.69 (1.08,2.32)”] and ultimate elastic modulus [E2“8.28 (6.67,10.25)”] of the abdominal aorta were significantly larger in the axial direction; In the circumferential direction, the stress [σp “2.2 (1.31,3.98)”, σt “0.13 (0.09,0.31)”] and ultimate elastic modulus (E2 “14.10 ± 7.21”) of adaptive intimal thickening were greater than those of other groups, the strain (εp “0.82 ± 0.17”, εt “0.53 ± 0.14”) of pathological intimal thickening was the largest in the pathological group.Conclusion:The present study systematically analyzed the influence of age, sex, test direction, anatomical site, and pathological characteristics on the biomechanical properties of the aorta, described the distribution of aortic atherosclerosis, and illustrated the characteristics of aortic thickness changes. At the same time, new insights into the grouping of pathological features were presented.

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Section: Discussionmentioning

confidence: 99%

“…Frontiers in Bioengineering and Biotechnology frontiersin.org some of the elastic and collagen fibers are structurally and functionally impaired (Tsamis al., 2013). A balance between damage and repair is achieved (Uimonen, 2021) to keep the original mechanical properties.…”

Section: The Effect Of Different Pathological Features On Parametersmentioning

confidence: 99%

A study on the ultimate mechanical properties of middle-aged and elderly human aorta based on uniaxial tensile test

Chen,

Zhao,

et al. 2024

Front. Bioeng. Biotechnol.

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“…Degeneration of the media layer of the aortic wall is the main predisposing factor for aortic dissection (23). Induction of inflammatory cascade by vascular smooth muscle cells in the media layer as a result of mechanical or oxidative stress initiates the development of degeneration (24). Considering this pathophysiology caused by inflammation, the relation between inflammatory markers such as albumin, CRP, CRP/albumin ratio (CAR), Neutrophil/lymphocyte ratio (NLR) and mortality was investigated in the study.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Blood Lactate Level and Mortality in Patients Diagnosed with Acute Aortic Dissection in the Emergency Department

Acehan¹,

Satar²,

Gülen³

et al. 2022

JEURMEDS

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Objective: Acute aortic dissection is a time-sensitive and difficult-to-diagnose cardiovascular emergency. The aim of this study was to investigate the relation between blood lactate level and mortality in patients diagnosed with acute aortic dissection (AAD) in the emergency department. Material and Methods:The study was conducted by retrospectively examining the electronic files of 32 patients who had been diagnosed with acute aortic dissection by computed tomography angiography in the emergency department and hospitalized between 01 January 2020 and 31 December 2020. Results:Of the patients included in the study, 78.1% were males. Mean age of the patients was 60.9 ± 10.4 years. The most frequent complaints of the patients were chest pain (50%) and back pain (43.8%). When comorbidities were examined, hypertension was the most common (59.4%). Of the patients, 71.9% were treated surgically and 28.1% medically. According to the Stanford classification, 65.6% of the patients had Stanford type A and 34.4% had Stanford type B aortic dissection. Mortality was seen in 50% of the patients. When the relation between laboratory parameters and mortality was examined, mean serum lactate level was 1.6 ± 0.6 mmol/l in surviving patients and 3.5 ± 2.3 mmol/l in mortal patients (p= 0.004). When Reciever Operating Characteristic (ROC) analysis, which determines mortality predictive properties of laboratory parameters, was examined, the Area Under Curve (AUC) value of serum lactate level was determined as 0.875 (95% CI 0.738-1.0, p= 0.004). When the threshold value of serum lactate level determined to predict mortality was 2.1 mmol/l, its sensitivity was determined as 86.7% and specificity as 81.2%. Conclusion:According to the study data, the threshold value of serum lactate level above 2.1 mmol/l in patients with acute aortic dissection may guide the clinician as a new and valuable marker in the evaluation of in-hospital mortality.

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Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review

Cited by 2 publications

References 71 publications

A study on the ultimate mechanical properties of middle-aged and elderly human aorta based on uniaxial tensile test

A study on the ultimate mechanical properties of middle-aged and elderly human aorta based on uniaxial tensile test

The Relationship Between Blood Lactate Level and Mortality in Patients Diagnosed with Acute Aortic Dissection in the Emergency Department

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