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1.
Clinical relevance of aortic stiffness in end-stage renal disease and diabetes: implication for hypertension management.
Yannoutsos, A, Bahous, SA, Safar, ME, Blacher, J
Journal of hypertension. 2018;(6):1237-1246
Abstract
: Evidence suggests that aortic stiffness may antedate and contribute initially to the development of hypertension and cardiovascular risk (CVR). In treated hypertensive patients, both diabetes and end-stage renal disease (ESRD) are comorbid conditions associated with increased aortic stiffness and high CVR. Thus, the pathophysiological relationship between aortic stiffness, blood pressure (BP) and CVR may have clinical implication in the management of hypertension. In patients with diabetes or ESRD, aortic stiffness is a significant predictor of CVR, independently of BP control. The hallmark of accelerated aortic stiffening in these patients associates the presence of vascular calcification, which is considered as a time-dependent process. Aortic stiffness represents a marker of structural but also functional arterial damage associated with increased pressure pulsatility. Carotid-femoral pulse wave velocity (cf-PWV), as a marker of aortic stiffness, may provide a readily available information for the effectiveness of risk reduction strategies. SBP, hyperglycemia and progressive alteration of renal function are considered as determinants of accelerated aortic stiffening. These findings suggest that earlier and intensive treatment of glycemia and BP could be important to limit or even reverse stiffening process. In patients with ESRD, more specific and potentially modifiable kidney disease-related parameters such as phosphocalcic disorders and vitamin K deficiency, appear correlated with aortic calcification and cf-PWV. An important and recent finding is that the magnitude of longitudinal increase in cf-PWV may represent a clinically pertinent surrogate for cardiovascular events. Aortic stiffness may be, thus, considered as an intermediate marker to monitor effectiveness of preventive strategies in these high-risk patients.
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2.
Sudden death due to aortic pathology.
Papagiannis, J
Cardiology in the young. 2017;(S1):S36-S42
Abstract
Sudden death from aortic dissection of an ascending aortic aneurysm is an uncommon but important finding in all series of sudden death in young, apparently healthy athletes. Individuals at risk include those having any of a variety of conditions in which structural weakness of the ascending aorta predisposes to pathological dilation under prolonged periods of increased wall stress. These conditions include Marfan syndrome, Loeys-Dietz syndrome, bicuspid aortic valve, and the vascular form of Ehlers-Danlos syndrome. Diagnostic criteria, surveillance strategies, medical management, and surgical indications are discussed. Finally, the current recommendations for sports participation are provided.
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3.
The two faces of hypertension: role of aortic stiffness.
Smulyan, H, Mookherjee, S, Safar, ME
Journal of the American Society of Hypertension : JASH. 2016;(2):175-83
Abstract
Adult hypertension can be divided into two relatively distinct forms-systolic/diastolic hypertension in midlife and systolic hypertension of the aged. The two types differ in prevalence, pathophysiology, and therapy. The prevalence of systolic hypertension in the elderly is twice that of midlife hypertension. The systolic pressure is elevated in both forms, but the high diastolic pressure in midlife is due to a raised total peripheral resistance, whereas the normal or low diastolic pressure in the elderly is due to aortic stiffening. Aortic stiffness, as measured by the carotid/femoral pulse wave velocity, has been found to be a cardiovascular risk marker independent of traditional risk factors for atherosclerosis. Instead, it is related to microcirculatory disease of the brain and kidney and to disorders of inflammation. Loss of aortic distensibility is an inevitable consequence of aging, but a review of its causes suggests that it may be amenable to future pharmacologic therapy.
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4.
Vascular manifestations of syndromic aortopathies: role of current and emerging imaging techniques.
Westerland, O, Frigiola, A, Robert, L, Shaw, A, Blakeway, L, Katsanos, K, Kiesewetter, C, Chung, N, Karunanithy, N
Clinical radiology. 2015;(12):1344-54
Abstract
Patients with connective tissue diseases such as Marfan's syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome comprise a small but important group of patients who present early with acute aortic syndrome comprising aneurysmal dilation, rupture, or aortic dissection. Cardiovascular pathologies are an important yet treatable cause of morbidity and mortality in these patients. Imaging plays an important role in initial diagnosis, surveillance, and identification of complications. Furthermore, these patients are prone to developing complications in other vascular territories. Effective screening and surveillance will allow early diagnosis and elective treatment thus reducing the morbidity and mortality associated with presentation with acute complications. In this article, we will provide an overview of the role of magnetic resonance and computed tomography angiography in the management of syndromic aortopathies.
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5.
Early detection of vulnerable atherosclerotic plaque for risk reduction of acute aortic rupture and thromboemboli and atheroemboli using non-obstructive angioscopy.
Komatsu, S, Ohara, T, Takahashi, S, Takewa, M, Minamiguchi, H, Imai, A, Kobayashi, Y, Iwa, N, Yutani, C, Hirayama, A, et al
Circulation journal : official journal of the Japanese Circulation Society. 2015;(4):742-50
Abstract
The mortality rate due to rupture of aortic dissection and aortic aneurysm is approximately 90%. Acute aortic rupture can be fatal prior to hospitalization and has proven difficult to diagnose correctly or predict. The in-hospital mortality rate of ruptured aortic aneurysm ranges from 53 to 66%. Emergency surgical and endovascular treatments are the only options for ruptured aortic dissection and aortic aneurysm. No method of systematic early detection or inspection of vessel injury is available at the prevention stage. Regardless of the improvement in many imaging modalities, aortic diameter has remained a major criterion for recommending surgery in diagnosed patients. Previous reports have suggested a relationship between vulnerable plaque and atherosclerotic aortic aneurysm. Non-obstructive angioscopy is a new method for evaluating intimal injury over the whole aorta. It has been used to identify many advanced atherosclerotic plaques that were missed on traditional imaging modalities before aneurysm formation. Non-obstructive angioscopy has shown that atherosclerosis of the aorta begins before that of the coronary artery, which had been noted on autopsy "in vivo". Strong or repetitive aortic injuries might cause sudden aortic disruption. Aortic atheroma is also a risk factor of stroke and perivascular embolism. Detecting aortic vulnerable atherosclerotic plaque on non-obstructive angioscopy may not only clarify the pathogenesis of acute aortic rupture and "aortogenic" thromboemboli and atheroemboli but also play a role in the pre-emptive medicine.
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6.
Lipid Interventions in Aortic Valvular Disease.
Choi, KJ, Tsomidou, C, Lerakis, S, Madanieh, R, Vittorio, TJ, Kosmas, CE
The American journal of the medical sciences. 2015;(4):313-9
Abstract
Aortic valve stenosis is the most common valvular disease in the elderly population. Presently, there is increasing evidence that aortic stenosis (AS) is an active process of lipid deposition, inflammation, fibrosis and calcium deposition. The pathogenesis of AS shares many similarities to that of atherosclerosis; therefore, it was hypothesized that certain lipid interventions could prevent or slow the progression of aortic valve stenosis. Despite the early enthusiasm that statins may slow the progression of AS, recent large clinical trials did not consistently demonstrate a decrease in the progression of AS. However, some researchers believe that statins may have a benefit early on in the disease process, where inflammation (and not calcification) is the predominant process, in contrast to severe or advanced AS, where calcification (and not inflammation) predominates. Positron emission tomography using 18F-fluorodeoxyglucose and 18F-sodium fluoride can demonstrate the relative contributions of valvular calcification and inflammation in AS, and thus this method might potentially be useful in providing the answer as to whether lipid interventions at the earlier stages of AS would be more effective in slowing the progression of the disease. Currently, there is a strong interest in recombinant apolipoprotein A-1 Milano and in the development of new pharmacological agents, targeting reduction of lipoprotein (a) levels and possibly reduction of the expression of lipoprotein-associated phospholipase A2, as potential means to slow the progression of aortic valvular stenosis.
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7.
Predictors of aortic growth in uncomplicated type B aortic dissection.
van Bogerijen, GH, Tolenaar, JL, Rampoldi, V, Moll, FL, van Herwaarden, JA, Jonker, FH, Eagle, KA, Trimarchi, S
Journal of vascular surgery. 2014;(4):1134-43
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Abstract
BACKGROUND Patients with uncomplicated acute type B aortic dissection (ABAD) generally can be treated with conservative medical management. However, these patients may develop aortic enlargement during follow-up, with the risk for rupture, which necessitates intervention. Several predictors have been studied in recent years to identify ABAD patients at high risk for aortic enlargement who may benefit from early surgical or endovascular intervention. This study systematically reviewed and summarized the current available literature on prognostic variables related to aortic enlargement during follow-up in uncomplicated ABAD patients. METHODS Studies were included if they reported predictors of aortic growth in uncomplicated ABAD patients. Studies about type A aortic dissection, aortic aneurysm, intramural hematoma, or ABAD that required acute intervention were excluded. RESULTS A total of 18 full-text articles were selected. The following predictors of aortic growth in ABAD patients were identified: age <60 years, white race, Marfan syndrome, high fibrinogen-fibrin degradation product level (≥20 μg/mL) at admission, aortic diameter ≥40 mm on initial imaging, proximal descending thoracic aorta false lumen (FL) diameter ≥22 mm, elliptic formation of the true lumen, patent FL, partially thrombosed FL, saccular formation of the FL, presence of one entry tear, large entry tear (≥10 mm) located in the proximal part of the dissection, FL located at the inner aortic curvature, fusiform dilated proximal descending aorta, and areas with ulcer-like projections. Tight heart rate control (<60 beats/min), use of calcium-channel blockers, thrombosed FL, two or more entry tears, FL located at the outer aortic curvature, and circular configuration of the true lumen were associated with negative or limited aortic growth. CONCLUSIONS Several predictors might be used to identify those ABAD patients at high risk for aortic growth. Although conservative management remains indicated in uncomplicated ABAD, these patients might benefit from closer follow-up or early endovascular intervention.
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8.
Single gene disorders of the aortic wall.
Halushka, MK
Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology. 2012;(4):240-4
Abstract
Genetic diseases that affect the vasculature primarily affect the aortic root and ascending aorta. These conditions lead to aortic root dilatation, which, if not treated, will result in dissection and death. Often, aortic disease is just one manifestation of a syndrome with diverse findings. Some of these diseases were described over 100 years ago based on physical manifestations, and their causative genes are among the first described Mendelian causes of cardiovascular disease. Within the pediatric and young adult population, there are over 15 causes of ascending aortic disease. Previously, these diverse diseases, along with their histopathology, have been extensively characterized. Most genetic causes of root aneurysm are extremely rare. Amongst these, five diseases are relatively common with known genetic mutations for which pathologists should be familiar. These are Marfan syndrome, vascular Ehlers-Danlos syndrome, Loeys-Dietz syndrome, Turner syndrome, and familial thoracic aneurysm and dissection. This review will focus on these important causes of genetic aortic disease. The aim is to briefly describe the historical record and physical manifestations and then focus on cardiovascular complications, the causative genes, and current research into these entities.
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9.
[Sonography today: reference values in abdominal ultrasound: aorta, inferior vena cava, kidneys].
Sienz, M, Ignee, A, Dietrich, CF
Zeitschrift fur Gastroenterologie. 2012;(3):293-315
Abstract
OBJECTIVE Reference values for B-mode abdominal ultrasound are controversially discussed due to the limited data in the literature. A systematic survey of data published so far is presented for the big retroperitoneal vessels and the kidneys. METHODS A literature review of reference values in the abdomen from 1970 to 2011 in healthy subjects 18 years of age and older was undertaken. According to the determination of reference intervals for laboratory values, reference values are generally determined using 95 % reference intervals and their associated 90 % confidence intervals. The diameters of the abdominal aorta and the inferior vena cava were evaluated as well as the length, width, thickness, parenchymal thickness and volume of the kidneys. RESULTS 61 studies were analysed. Reference values determined for the aorta vary considerably according to age and gender of the probands, measuring position and measuring technique. The upper interval limits of the 95 % reference intervals lie between 17 and 40 mm. The diameter of the inferior vena cava depends on the position of the patient, the measuring site, respiration and the resting heart rate. Normal results up to 27 mm can be encountered. Influencing factors on the size and volume of the kidneys are the side (right/left), age, gender, anthropometric parameters and the ethnic membership of the probands. For central European women, 9 cm - 12.8 cm can be regarded as the normal range of the length of the kidney and for men 9.2 cm - 13.3 cm. For the width of the kidney, interval limits were determined between 3 cm and 7.1 cm, for the thickness between 2.9 cm and 6 cm, for the parenchymal thickness between 1.1 cm and 2.3 cm and for the volume between 59 and 230 mL. DISCUSSION Normal values are helpful in delimiting numerous pathological changes in the respective organs.
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10.
Is there a role for measuring central aortic pressure?
Huan, Y, Townsend, R
Current cardiology reports. 2011;(6):502-6
Abstract
Peripheral brachial blood pressure measurements by sphygmomanometry remains the standard for measuring and managing blood pressure. Elevated brachial blood pressure is a major risk for cardiovascular disease, and reduction of bracial blood pressure decreases target organ damage and cardiovascular events. However, many patients still succumb to heart disease, stroke, kidney failure, and death even when the brachial blood pressures appear adequately controlled. Central aortic pressure may be more relevant to the pathogenesis of cardiovascular disease, which is not always accurately represented by brachial blood pressure. Noninvasive applanation tonometry can now assess central aortic pressure easily and reliably. Emerging data suggest that central arotic pressure and related parameters are often better and more robust predictors of cardiovascular outcome than peripheral brachial blood pressures.