Aggrecan: a new biomarker for acute type A aortic dissection

AbstractAcute type A aortic dissection (ATAAD) constitutes a life-threatening aortic pathology with significant morbidity and mortality. Without surgical intervention the usual mortality rate averages between 1 and 2% per hour. Thus, an early diagnosis of ATAAD is of pivotal importance to direct the affected patients to the appropriate treatment. Preceding tests to find an appropriate biomarker showed among others an increased aggrecan (ACAN) mRNA expression in aortic tissue of ATAAD patients. As a consequence, we investigated whether ACAN is a potential biomarker for diagnosing ATAAD. Mean ACAN protein concentration showed a significantly higher plasma concentration in ATAAD patients (38.59 ng/mL, n = 33) compared to plasma of patients with thoracic aortic aneurysms (4.45 ng/mL, n = 13), patients with myocardial infarction (11.77 ng/mL, n = 18) and healthy volunteers (8.05 ng/mL, n = 12). Cardiac enzymes like creatine kinase MB and cardiac troponin T showed no correlation with ACAN levels in ATAAD patients. Receiver-operator characteristics (ROC) curve analysis for ATAAD patients versus control subjects an optimum discrimination limit of ACAN plasma levels at 14.3 ng/mL with a corresponding sensitivity of 97% and specificity of 81%. According to our findings ACAN is a reliable potential biomarker in plasma samples to detect ATAAD with high sensitivity and specificity.

Download Full-text

Aggrecan - a new biomarker for acute type A aortic dissection

10.21203/rs.3.rs-139989/v1 ◽

2021 ◽

Author(s):

Karl König ◽

Harald Lahm ◽

Martina Dreßen ◽

Stefanie Doppler ◽

Stefan Eichhorn ◽

...

Keyword(s):

Aortic Dissection ◽

Troponin T ◽

Type A ◽

Aortic Aneurysms ◽

Aortic Tissue ◽

Acute Type ◽

Type A Aortic Dissection ◽

Potential Biomarker ◽

Aortic Pathology ◽

Creatine Kinase Mb

Abstract Acute type A aortic dissection (ATAAD) constitutes a life-threatening aortic pathology with significant morbidity and mortality. Without surgical intervention the usual mortality rate averages between 1-2 % per hour. Thus, an early diagnosis of ATAAD is of pivotal importance to direct the affected patients to the appropriate treatment. As a consequence, we investigated whether aggrecan (ACAN) is a potential biomarker for diagnosing ATAAD. Our investigation showed that ACAN mRNA expression is highest in aortic tissue from ATAAD patients. Mean ACAN protein concentration showed a significantly higher plasma concentration in ATAAD patients (38.59 ng/mL) compared to plasma of patients with thoracic aortic aneurysms (4.45 ng/mL), patients with ST-elevation myocardial infarction (11.77 ng/mL) and healthy volunteers (8.05 ng/mL). Cardiac enzymes like creatine kinase MB and cardiac troponin T showed no correlation with ACAN levels in ATAAD patients. Receiver-operator characteristics (ROC) curve analysis for ATAAD patients versus control subjects revealed an area under the curve of 0.947 and an optimum discrimination limit of ACAN plasma levels at 14.3 ng/mL with a corresponding sensitivity of 97 % and specificity of 81 %. According to our findings ACAN is a reliable potential biomarker in plasma samples to detect ATAAD with high sensitivity and specificity.

Download Full-text

Veno-Arterial Extracorporeal Membrane Oxygenation for Patients Undergoing Acute Type A Aortic Dissection Surgery: A Six-Year Experience

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.652527 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jun-yi Hou ◽

Chun-sheng Wang ◽

Hao Lai ◽

Yong-xin Sun ◽

Xin Li ◽

...

Keyword(s):

Aortic Dissection ◽

Extracorporeal Membrane Oxygenation ◽

Troponin T ◽

Type A ◽

Ecmo Support ◽

Acute Type ◽

Type A Aortic Dissection ◽

Membrane Oxygenation ◽

Creatine Kinase Mb ◽

Va Ecmo

Objectives: Acute type A aortic dissection (aTAAD) is usually lethal without emergency surgery. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in patients with cardiogenic shock following cardiac surgery, VA-ECMO support following aTAAD surgery has not been well-described. Based on our 6-year experience, we aimed to retrospectively analyze risk factors, application and timing of VA-ECMO, and outcomes in aTAAD patients.Methods: In this retrospective, single-center study, we enrolled adult patients who underwent aTAAD surgery from January 2014 to December 2019 and were supported with VA-ECMO. Patients were divided into two groups according to whether or not they were successfully weaned from VA-ECMO. Preoperative, intraoperative and postoperative variables were assessed and analyzed. Outcomes of the patients were followed up until discharge.Results: Twenty-seven patients who received aTAAD surgery with VA-ECMO support were included in the study. Nine patients (33.3%) were successfully weaned from VA-ECMO. The median VA-ECMO support time and length of hospital stay in the successfully weaned group were significantly longer than in the group could not be successfully weaned (192 [111–327] vs. 55 [23–95] h, p < 0.01; 29 [18–40] vs. 4 [3–8] days, p < 0.01). Overall in-hospital mortality was 81.5%. The main causes of death were bleeding (37%), neurological complications (15%), and multiple organ dysfunction syndrome (15%). Preoperative levels of creatine kinase-MB (CK-MB) were lower in patients who were successfully weaned from VA-ECMO than in the failed group (14 [6–30] vs. 55 [28–138] U/L, p < 0.01). Postoperative peak levels of CK-MB, cardiac troponin T, lactate dehydrogenase, and lactate were significantly lower in the successful group than in the failed group.Conclusion: Postoperative VA-ECMO support was rarely used in aTAAD patients. Our study showed that VA-ECMO can be considered as a salvage treatment in aTAAD patients, despite the high rate of complications and mortality.

Download Full-text

Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01529-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiao-Chai Lv ◽

Yong Lin ◽

Qing-song Wu ◽

Lei Wang ◽

Yan-ting Hou ◽

...

Keyword(s):

Aortic Dissection ◽

Interleukin 6 ◽

Postoperative Delirium ◽

Surgical Repair ◽

Inflammatory Responses ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Cerebral Dysfunction ◽

Potential Biomarker

Abstract Objectives The relationship between inflammatory cytokines and postoperative delirium (POD) remains to be further investigated, especially in patients undergoing acute type A aortic dissection (AAD). Interleukin-6 (IL-6) is involved in the inflammatory process and has recently been identified as a biomarker of cerebral dysfunction. We explored the hypothesis that IL-6 was one of the critical causes of POD after surgical repair of AAD. Methods Plasma IL-6 was measured using electrochemiluminescence technology in patients preoperatively and 24 h, 48 h, and 72 h after surgical repair of acute type A aortic dissection. After the first three postoperative days, delirium was evaluated twice daily using the Confusion Assessment Method. ROC curves were used to evaluate the ability of IL-6 measurements to distinguish POD. Results The incidence of POD was 14.03% (31 of 221 patients). The patients in the POD group were significantly older than the patients in the non-POD group (56.48 ± 11.68 years vs 52.22 ± 10.50 years, P = 0.040). Plasma IL-6 concentrations were significantly higher in the POD group than in the non-POD group at three time points: preoperatively, after 24 h, and after 48 h. The AUC values corresponding to IL-6 preoperatively and 24 h after surgery were 0.73 and 0.72, respectively. Conclusions Cerebral dysfunction after the surgical repair of AAD shows elevated stress levels and inflammatory responses. Plasma IL-6 is a potential biomarker to predict the onset of POD in acute type A aortic dissection patients following surgical repair.

Download Full-text

Plasma Interleukin-6 is a Potential Predictive Biomarker for Postoperative Delirium among Acute Type A Aortic Dissection Patients Treated with Open Surgical Repair

10.21203/rs.3.rs-145157/v1 ◽

2021 ◽

Author(s):

Xiao-Chai Lv ◽

Yong Lin ◽

Qing-song Wu ◽

Lei Wang ◽

Yan-ting Hou ◽

...

Keyword(s):

Aortic Dissection ◽

Interleukin 6 ◽

Postoperative Delirium ◽

Surgical Repair ◽

Inflammatory Responses ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Cerebral Dysfunction ◽

Potential Biomarker

Abstract Objectives. The relationship between inflammatory cytokines and postoperative delirium (POD) remains to be further investigated, especially in patients undergoing acute type A aortic dissection (AAD). Interleukin-6 (IL-6) is involved in the inflammatory process and has recently been identified as a biomarker of cerebral dysfunction. We explored the hypothesis that IL-6 was one of the critical causes of POD after surgical repair of AAD.Methods. Plasma IL-6 was measured using electrochemiluminescence technology in patients preoperatively and 24 h, 48 h, and 72 h after surgical repair of acute type A aortic dissection. After the first three postoperative days, delirium was evaluated twice daily using the Confusion Assessment Method. ROC curves were used to evaluate the ability of IL-6 measurements to distinguish POD.Results. The incidence of POD was 14.03% (31 of 221 patients). The patients in the POD group were significantly older than the patients in the non-POD group (56.48±11.68 years vs 52.22±10.50 years, P=0.040). Plasma IL-6 concentrations were significantly higher in the POD group than in the non-POD group at three time points: preoperatively, after 24 h, and after 48 h. The AUC values corresponding to IL-6 preoperatively and 24 h after surgery were 0.73 and 0.72, respectively.Conclusions. Cerebral dysfunction after the surgical repair of AAD shows elevated stress levels and inflammatory responses. Plasma IL-6 is a potential biomarker to predict the onset of POD in acute type A aortic dissection patients following surgical repair.

Download Full-text

Ascending Aortic Length and Its Association With Type A Aortic Dissection

Journal of the American Heart Association ◽

10.1161/jaha.120.020140 ◽

2021 ◽

Author(s):

Daniella Eliathamby ◽

Mariana Gutierrez ◽

Aileen Liu ◽

Maral Ouzounian ◽

Thomas L. Forbes ◽

...

Keyword(s):

Aortic Dissection ◽

Innominate Artery ◽

Type A ◽

Ascending Aorta ◽

Aortic Aneurysms ◽

Control Group ◽

Acute Type ◽

Type A Aortic Dissection ◽

Acute Dissection ◽

Thoracic Aneurysms

Background The aim of this study was to determine the role of ascending aortic length and diameter in type A aortic dissection. Methods and Results Computed tomography scans from patients with acute type A dissections (n=51), patients with proximal thoracic aortic aneurysms (n=121), and controls with normal aortas (n=200) were analyzed from aortic annulus to the innominate artery using multiplanar reconstruction. In the control group, ascending aortic length correlated with diameter ( r 2 =0.35, P <0.001), age ( r 2 =0.17, P <0.001), and sex ( P <0.001). As a result of immediate changes in aortic morphology at the time of acute dissection, predissection lengths and diameters were estimated based on models from published literature. Ascending aortic length was longer in patients immediately following acute dissection (median, 109.7 mm; interquartile range [IQR], 101.0–115.1 mm), patients in the estimated predissection group (median, 104.2 mm; IQR, 96.0–109.3 mm), and patients in the aneurysm group (median, 107.0 mm; IQR, 99.6–118.7 mm) in comparison to controls (median, 83.2 mm; IQR, 74.5–90.7 mm) ( P <0.001 all comparisons). The diameter of the ascending aorta was largest in the aneurysm group (median, 52.0 mm; IQR, 45.9–58.0 mm), followed by the dissection group (median, 50.3 mm; IQR, 46.6–57.5 mm), and not significantly different between controls and the estimated predissection group (median, 33.4 mm [IQR, 30.7–36.7 mm] versus 35.2 mm [IQR, 32.6–40.3 mm], P =0.09). After adjustment for diameter, age, and sex, the estimated predissection aortic lengths were 16 mm longer than those in the controls and 12 mm longer than in patients with nondissected thoracic aneurysms. Conclusions The length of the ascending aorta, after adjustment for age, sex, and aortic diameter, may be useful in discriminating patients with type A dissection from normal controls and patients with nondissected thoracic aneurysms.

Download Full-text