bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanosensitive Ion Channel Piezo1 regulates tight junctions between endothelium and mediates the occurrence of aortic dissection
Authors: Teng P , Chen Z H , Ma L 
Published: October 2024

Abstract

Aims
Exploring whether changes in endothelial Piezo1 mechanically sensitive ion channels can lead to thoracic aortic dissection（TAD） and its specific mechanisms of action.

Methods and results
IF showed aberrant Piezo1 expressions in the CD31+ endothelial cells in thoracic aortas of patients with TAD. In a β-aminopropionitrile (BAPN)-induced TAD mouse model, knockout of Piezo1 in endothelial cells shows a protective effect on aortic dissection, while the crucial tight junction (TJ) components ZO-1 was significantly increased by En Face staining. For identified how the Piezo1 ion channel influences the ZO-1 between endothelium, we used mass spectrometry analysis and RNA sequencing to identify a key factor Trib1 mediating the ubiquitination degradation of ZO-1. Also, we found the low expression of Trib1 in endothelial cell of Piezo1 ECKO mouse with BAPN feeding. Finally, we rescued the expression of TRIB1 by targeting endothelial cells with AAV9-TIE2-TRIB1, demonstrating that Piezo1 indeed promotes the occurrence of aortic dissection through degrading the TRIB1-COP1-ZO-1 complex.

Conclusion
The activation of Piezo1 promotes the occurrence of （TAD） through Trib1 mediated degradation of endothelial tight junctions. Inhibiting endothelial Piezo has the potential to become a specific therapeutic and preventive target for（TAD）.
The aortic paradox: a nationwide analysis of 523,994 individual echocardiograms exploring aortic dissection
Authors: Paratz E , Nadel J , Humphries J , Rowe S , Fahy L , La Gerche A , Prior D , Celermajer D , Strange G , Playford D 
Published: October 2024

Abstract

Background
Increasing aortic dilation increases risk of aortic dissection. Nevertheless, dissection occurs below guideline-directed cut-offs for prophylactic surgery. There is no current large-scale population imaging data assessing aortic dimensions before dissection.

Purpose
To examine the proportion of aortic dissections occurring in people with aortic diameters below guidelines for prophylactic intervention.

Methods
Patients within the National Echo Database of Australia (NEDA) were stratified according to absolute, height-indexed and body surface area (BSA)-indexed aortic dimensions. Fatal thoracic aortic dissections (ICD-10-AM code I79) were identified via linkage with the National Death Index.

Results
524,994 individuals were assessed, comprising patients with normal aortic dimensions (n=460,992), mild dilation (n=53,402), moderate dilation (n=10,029) and severe dilation (n=572). 274,992 (52.4%) were male, with median age 64 years and median follow-up time 6.9 years. 899 fatal aortic dissections occurred (normal diameter=610, mildly-dilated aorta=215, moderately-dilated =53 and severely-dilated=21). Using normal aortas as the reference population, odds of fatal dissection increased with aortic diameter (mild=OR 3.05, 95% confidence interval (CI) 2.61-3.56; moderate=OR 4.0, 95% CI 3.02-5.30; severe=OR 28.72, 95% CI 18.44-44.72). Due to the much larger number of patients without severe aortic dilation, 97.7% of fatal aortic dissections occurred in non-severely dilated aortas. Following sensitivity analysis, severe aortic dilation was responsible for at most 24.4% of fatal aortic dissections. Results were robust for absolute, height-indexed or BSA-indexed aortic measurements.

Conclusion
Although severe aortic dilatation is associated with a thirty-fold increase in fatal dissection, severely dilated aortas are implicated in only 2.3-24.4% of fatal dissections. This highlights the ‘aortic paradox’ and limitations of current guidelines. Future studies should seek to refine risk predictors in patients without severe aortic dilation.
Twenty-year trends in peripheral artery disease, lower extremity revascularization, and lower extremity amputation in newly diagnosed type 2 diabetes
Authors: Gyldenkerne C , Olesen K K W , Kahlert J , Thrane P G , Hansen M K , Stoedkilde-Joergensen N , Soerensen H T , Thomsen R W , Maeng M 
Published: October 2024

Abstract

Background
Trends in risk of lower extremity complications in patients with newly diagnosed type 2 diabetes (T2DM) are largely unexplored.

Purpose
To examine the 5-year risk trends of peripheral artery disease (PAD), lower extremity revascularization (LER), and lower extremity amputation (LEA) in patients with newly diagnosed T2DM over a 25-year study period.

Methods
We conducted a cohort study that included all patients in Denmark diagnosed with T2DM from 1996 to 2015, who had no prior hospital diagnosis of atherosclerotic cardiovascular disease. These patients were age- and sex-matched with up to three comparisons from the general population. Individuals were assigned to 5-year calendar periods based on their year of inclusion and were followed for 5 years. The primary outcomes were the 5-year risks of PAD, LER, and LEA. Age- and sex-adjusted hazard ratios (aHR) were computed using Cox regression analysis.

Results
The study cohort consisted of 288,825 newly diagnosed T2DM patients (52% males; median age 61 years) and 782,232 comparisons from the general population. From 1996-2000 to 2015-2020, the 5-year risk of PAD decreased from 2.2% to 1.2% (aHR 0.56 [95% CI 0.52-0.61]), LER from 0.7% to 0.5% (aHR 0.73 [95% CI 0.63-0.84]), and LEA from 1.0% to 0.4% (aHR 0.44 [95% CI 0.38-0.50]) in T2DM patients (Figure). Compared with the general population, the 5-year risk differences decreased from 1.4% to 0.5% for PAD, from 0.4% to 0.2% for LER, and from 0.8% to 0.3% for LEA. The distribution of LEA types (hip/thigh, knee/lower leg, or ankle/foot/toe amputation) remained largely stable over time in T2DM patients. Use of prophylactic cardiovascular medications in T2DM patients increased notably during the study period, especially use of statins (5% to 50%) and multiple antihypertensive drugs (18% to 33%).

Conclusions
Over recent decades, the risks of PAD, LER, and LEA have decreased in patients with newly diagnosed T2DM, approaching the risk levels observed in the general population. This coincided with a great increase in use of prophylactic cardiovascular medications among T2DM patients.Trends in lower extremity complications.
Variation in care in individuals hospitalised with abdominal aortic aneurysm in nine high-income countries: a cross-sectional cohort study
Authors: Pasea L , Cram P , Bakx P , Huang N , Ko D T , Burrack N , Lix L , Kim S J , Al-Azazi S , Cordier J , Hatfield L , Hirani J C , Uyl-De Groot C , Landon B , Banerjee A 
Published: October 2024

Abstract

Background
Abdominal aortic aneurysms (AAA) can be safely repaired using either endovascular aneurysm repair (EVAR) or open repair when intact, but after rupture morbidity and mortality are extremely high. Treatment patterns and outcomes for intact AAA are likely to differ between countries due to differences in AAA screening policies, health system capacity and payment approaches, and other factors, such as demographics and lifestyle, but are poorly studied.

Methods
We conducted a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalised for with an intact AAA and repair procedure in the same admission between 2011 and 2019 in nine countries (US, Canada, England, Denmark, Netherlands, Switzerland, Taiwan, South Korea and Israel) using population-representative administrative data. We investigated age-sex standardised (to the 2019 US population) repair rates (open repair or EVAR) and health system performance measures, including hospital length of stay (LOS), 30-day readmission, and all-cause mortality (30 days and 1 year).

Results
The number of intact AAA hospital admissions between 2011 and 2019 ranged from 1,290 in Israel to 199,764 in the US. The rates of intact AAA repair per 1000 population varied between countries and over time, from 0.11 per 1000 (South Korea) to 0.69 per 1000 (US) in 2011 and from 0.14 per 1000 (Taiwan) to 0.57 per 1000 (the Netherlands) in 2019. Most countries saw a decline in the rate of AAA repair over the study period. The proportion repaired using open repair vs EVAR also varied widely across the countries. In the US, Israel and Taiwan open repair was used in 11% or fewer cases whereas in the remaining countries we observed open repair in 25.1 % (South Korea) to 56.7% (Denmark) of cases. (Figure 1)
Mortality was generally higher following open repairs compared to EVAR in all countries. In 2019, following EVAR, 30-day mortality varied from 0.6% (8.1% at 1 year) in South Korea to 2.3% (11.7% at 1 year) in Israel and following open repair varied from 2.9 (4.4% at 1 year) in England to 7.6% (15.1% at 1 year) in the US. (Figure 2)
Mean hospital LOS in 2019 ranged from 2.5 days (US) to 12.2 days (South Korea), following EVAR and from 9.1 days (Taiwan) to 21.5 days (South Korea) following open repair. The 30-day readmission rate in 2019 ranged from 8.1% (US) to 31.8% in Israel following EVAR and from 11.4% (US) to 22.2% (South Korea) following open repair.

Conclusions
We observed substantial between-country variation in surgical approaches, mortality, and health system performance measures for AAA. Further research is needed to understand and plan optimal, evidence-based AAA screening and treatment strategies.Rates of EVAR and open repairAdjusted 30-day all-cause mortality
Study on screening and diagnosis of aortic dissection based on non-enhanced CT and deep learning
Authors: Cheng Z , Yan J , Yin L , Lin S M , Lin J Y 
Published: October 2024

Abstract

Objective
To develop a machine learning algorithm to detect aortic dissection on non-contrast-enhanced CT and evaluate the diagnostic ability of the algorithm compared with those of radiologists.

Methods
This study developed a machine learning algorithm using single-center data collected between May 1st, 2022, and April 30th, 2023. Included in the study were 220 patients (110 with AD and 110 without AD). An AD detection algorithm was developed using a 3D full-resolution U-net architecture. We have continuously trained and developed an algorithm based on machine learning to segment the true and false lumens of the aorta and then determine whether there is aortic dissection. The diagnostic capabilities of our algorithm and three radiologists were also compared.

Results
The developed algorithm achieved an accuracy of 95.8%, a sensitivity of 93.2%, and a specificity of 92.6%. For radiologists, accuracy, sensitivity, and specificity were 88.6%, 90.6%, and 94.2%, respectively. The algorithm's performance was not significantly different from the mean performance of radiologists in terms of accuracy, sensitivity, or specificity.

Conclusion
The proposed algorithm showed comparable diagnostic performance to radiologists for detecting AD on non-contrast-enhanced CT, which suggests that the proposed algorithm has the potential to reduce misdiagnosis of AD to improve clinical outcomes.Aortic SegmentationAlgorithm development
Marfan syndrome in children: large, single centre experience on management and outcome
Authors: Freixa-Benavente A , Tang L , Field E , Cervi E 
Published: October 2024

Abstract

Introduction
Beta-blockers (BBs) and angiotensin receptor blockers (ARBs) have been proved to decrease the growth rate of the aortic root in Marfan patients, we describe our single centre experience at a large tertiary paediatric institution.

Methods
This is a retrospective longitudinal study of a large, paediatric only, Marfan cohort through review of medical notes for clinical data and treatment and assessment of serial echocardiograms.

Results
167 patients were included, mean age at first assessment was 4.05 ± 3.12 years, 86 (51.50%) were males. 41 pts (24.55%) had a de novo FBN1 mutation. A 35.32% had a cysteine loss mutation. Median follow up was 9.54±4.37 years. 2 patients had a clinical and molecular diagnosis of early-onset Marfan, they both underwent mitral valve surgery in infancy and one of them died at 7 years old. No other deaths or acute aortic events in our cohort until transition to adult services at 18 years old. Of the entire study population 12 pts (7.2%) underwent aortic surgery at a median age of 13±7.02 years, 1 patient had a mitral valve repair. Chemoprophylaxis (currently only evaluated in a subgroup of our youngest 65 patients) was offered to all patients, 27.69% declined medicines. The remining 47 subjects are on treatment which was started at a mean age of 4.88 ±2.96 years, surveillance data available for a mean follow up of 2.75±2.41 years. 50 received BB (58.50% atenolol [average dose 0.79 mg/kg/day] and 19.15% bisoprolol [average dose 0.087 mg/kg/day]), 5 (8.51%) losartan [average dose 0.763 mg/kg/day], and 10 (15.38%) double therapy with BB and ARBs. The Sinus of Valsalva (SOV) z-scores, as assessed on echocardiograms and normalised according to Lopez dataset, showed a reduction over time in children treated with chemoprophylaxis (see figure 1). SOV mean z-score at starting treatment was 3.38 ± 2.06 which reduced to 2.79± 1.81, however, differences were not statistically significant (paired T-student p-value 0.078). In non-treated patients, initial SOV z-score was 1.89 ± 1.05. When comparing evolution there was a trend towards decreased average SOV z-score over the years in the treated group, not seen in the non-treated patients (see figure 2). No statistical differences in the SOV z-score reduction change were found when comparing different treatment groups (ANOVA p-value 0.851), but a tendency to more profound decrease in the losartan groups was observed. Reduction in blood pressure or heart rate did not differ amongst the treatment groups.

Conclusions
We present one of the largest single centre reviews on management of paediatric Marfan patients. Our data confirm a decrease in SOV z-score with chemoprophylaxis in a real-world cohort. This is in line with current evidence and corroborates clinical practice.SOV Z-SCORE EVOLUTION AFTER TREATMENTSOV Z-SCORE GROUP AVERAGE CHANGE
Comparative effectiveness of Castor single-branch stent and hybrid surgery for the left subclavian artery in managing acute Type B aortic dissection with an inadequate proximal landing zone
Authors: Cheng Z , Ma L Y 
Published: October 2024

Abstract

Background
Our study aims to compare the clinical outcomes and risk factors for adverse events between TEVAR with branch stent-graft and Hybrid surgery for the reconstruction of the left subclavian artery.

Methods
We retrospectively analyzed data from patients with insufficient proximal landing zones of acute Type B aortic dissection treated at our hospital from January 2017 to December 2022. According to the surgical method, patients were divided into TEVAR group (n=58) and Hybrid group (n=69). The primary endpoint was all-cause mortality.

Results
The diameter of the proximal landing zone in the TEVAR group was larger than that in the Hybrid group (31.5mm vs 30.3mm, P=0.037). Early Results: There was no significant difference in major adverse events and 30-day mortality between the TEVAR and Hybrid groups. The Hybrid group had significantly longer surgery time (110min vs 238min), hospital stay (8d vs 12d), and ICU stay (0d vs 1d) compared to the TEVAR group (P&lt;0.001). Mid-Term Results: There was no statistical difference in mid-term mortality rates (3.4% vs 8.7%; P=0.398) between the TEVAR and Hybrid groups. The rate of mid-term adverse events was significantly higher in the Hybrid group compared to the TEVAR group (23.2% vs 6.9%; P=0.023). The rate of re-intervention was significantly higher in the Hybrid group compared to the TEVAR group (17.4% vs 3.4%; P=0.027). The 18-month freedom from mid-term adverse event rate was 93.1% (95% CI, 86.4% - 99.8%) for the TEVAR group and 76.8% (95% CI, 66.6% - 87.0%) for the Hybrid group. There was a significant difference in the rate of mid-term adverse events between the TEVAR and Hybrid groups, with the Hybrid group being higher (6.9% vs 23.2%, P=0.013). COX regression results showed: Diameter of the proximal landing zone (HR=0.6, 95%CI=0.4–0.9, P=0.009) was an independent risk factor for postoperative aortic-related adverse events.

Conclusions
TEVAR reconstruction of LSA and hybrid surgery are both safe and effective treatments for acute Type B aortic dissection with insufficient proximal landing zones. There is no difference in early adverse events and 30-day mortality rates between TEVAR reconstruction of LSA and hybrid surgery. Compared to hybrid surgery, TEVAR reconstruction of LSA has the advantages of shorter operation time, hospital stay, and ICU duration. There is no difference in aortic-related mortality and all-cause mortality between TEVAR reconstruction of LSA and hybrid surgery. However, TEVAR has significantly lower rates of mid-term adverse events and re-intervention compared to the hybrid group. The diameter of the proximal landing zone are risk factors for all-cause mortality.
Three-dimensional transthoracic vs transesophageal echocardiography vs computed tomography angiography aorta for aortic annular diameter measurement for TAVI in our hospital
Authors: Kieattisaksopon S , Wongpraparut N , Jakrapanichakul D , Maneesai A 
Published: October 2024

Abstract

Background
Tans femoral transcatheter aortic valve implantation (TF-TAVI) was recently the standard treatment option in patient with severe aortic stenosis. All patients undergoing TF-TAVI needed computed tomography angiography (CTA) aorta not only to evaluate entry site but to measure the annulus size to determine the prosthesis valve size. In Siriraj hospital we have protocol to perform Three-dimensional transthoracic echocardiography (3D-TTE) and three-dimensional esophageal echocardiography (3D-TEE) prior to TF-TAVI. We aimed to evaluate the correlation between conventional CTA aorta vs 3D-TEE vs 3D-TTE aortic annulus size.

Method and result
We performed a cross sectional study in all patients undergone TF-TAVI in our hospital who had all 3 aortic annulus sizes measured by 3 methods: CTA aorta, 3D-TEE vs 3D-TTE during 2015-2023.
For 244 patients underwent TAVI, 52 patients were excluded (22 Transapical approach, 10 valve in valve TAVI, 6 not complete annulus measurement, 6 transcarotid, 3 severe AR, etc.)
One hundred sixteen patients were female (60.4%) with average age of 83.2 years old. 98% of patients had comorbid disease; hypertension 84%, dyslipidemia 79%, diabetes 47%, coronary artery disease 55% (9% CABG), 2.6% of patients were bicuspid aortic valve. 27% of patients had LVEF less than 55%, average AVA was 0.71 centimeter-square, average mean pressure gradient was 52.5 mmHg.
We analyzed the co-relation between these 3 methods by Bland–Altman plot which revealed the Pearson's correlation coefficient (r) between CTA Aorta and 3D-TEE was 0.814 with average difference of 0.68 mm (95% limit of agreement –1.68 - 3.04) and r between CTA Aorta and 3D-TTE was 0.442 with average difference of 0.41 mm (95% limit of agreement –3.82 - 4.63)

Conclusion
3D-TTE annulus sizing had a reasonable correlation with CTA annulus sizing (Pearson’s correlation of 0.442) while 3D-TEE annulus sizing had a very high correlation with CTA annulus sizing (Pearson’s correlation of 0.814). In patient which CTA was not available to measure annulus size 3D-TEE annulus sizing might be reasonable method to measure the annulus size for TF-TAVI.

Keyword
trans femoral transcatheter aortic valve implantation (TF-TAVI), annulus size, three-dimensional transthoracic echocardiography (3D-TTE), three-dimensional esophageal echocardiography (3D-TEE), computed tomography angiography (CTA) aorta
Increased risk for thoracic and abdominal aortic aneurysm in the relatives of abdominal aorta aneurysm patients
Authors: Van Beusekom H M M , Liu H , Ijpma A S , De Bruin J L , Verhagen H J M , Majoor-Krakauer D F 
Published: October 2024

Abstract

Introduction
Genetic susceptibilities in aneurysm genes are risk factors for developing aneurysms of the aorta. This translates to a high aneurysm prevalence in relatives of aortic aneurysm patients. For relatives of abdominal aorta aneurysm (AAA) patients, guidelines recommend abdominal ultrasound screening for early detection and management, while for relatives of thoracic aorta aneurysm patients (TAA), transthoracic ultrasound of the ascending aorta and aortic root is recommended. Neither of these guidelines are designed to detect aneurysms in the whole aorta.
The incidence of TAA in relatives of AAA index-patients is unknown and may determine whether abdominal ultrasound screening is sufficient for relatives of AAA patients or whether whole aorta screening should be recommended. Furthermore, focused screening of high risk relatives of aneurysm patients may improve the yield of aneurysm detection now that population frequencies are declining.

Methods
Whole aorta non-contrast CTs of relatives of AAA index-patients were collected retrospectively in a tertiary referral (2016 to 2021). Family history and DNA testing of AAA index-patients were used to classify relatives into high genetic risk (familial disease and/or pathogenic/likely pathogenic variant (P/LP) in an aneurysm gene) or unknown genetic risk (no familial disease or no P/LP detected).
TAA were defined as ascending diameters ≥ 45mm or descending diameters ≥ 40mm. Thoracic aortic dilatations (TAD) were defined as ascending diameters of 40-45 mm or descending diameters of 35-40 mm. Abdominal diameters ≥30mm were classified as AAA and diameters between 25-29 mm as abdominal dilatations (AAD). References 1-3.

Results
CT scans (n=301 relatives, 47% male, age 58(50-65)) showed 34% aortic aneurysms and/or dilatations versus 14% in the general population (age adjusted, p&lt;0.001). TAA was 28-times more frequent (2%, p&lt;0001) and AAA 3 times more frequent (8%, p&lt;0.001) than in the general population. Thoracic and abdominal dilatations occurred in 18% and 17% of relatives. Overall, males were 4 times more likely to have an aneurysm than females (p&lt;0.05).
Aneurysms and dilatations occurred at the same rate in relatives with or without a family history or a P/LP in an aneurysm gene. These results endorse total aorta screening for relatives of all AAA patients rather than restricting screening to the abdominal aorta.

Conclusions
Relatives of AAA patients had a high risk for thoracic and abdominal aneurysms as well as dilatations. This indicates that imaging of the whole aorta will improve early detection of aortic aneurysms in relatives both with and without a family history of aneurysms.