Comparing American, European and Asian practice guidelines for aortic diseases

Abstract

Abstract:The aortic disease comprises a group of different pathologies of high prevalence, seriousness and ever changing by the medical and surgical investigations. Therefore cardiovascular scientific societies in USA, Europe and Asia have created Task Force on practice guidelines (PG) to develop, update and revise PG for aortic diseases. These documents issue recommendations on the diagnosis and management of different aortic diseases. The three societies agree on the recommendations about diagnostic tests and on the value of computed tomography and magnetic resonance as the main tools for the diagnosis and follow-up of aortic disease. Concerning to acute aortic syndromes (AAS), American and European GPs recognize intramural hematoma (IMH) as a type of AAS with surgery indication; however Asian guidelines consider IMH a pathological process different from AAS and indicate medical treatment. In thoracic aortic aneurysms (TAA), all express the need for an adequate control of cardiovascular risk factors, emphasizing strict control of blood pressure, smoking cessation and recommend the use of beta-blockers and statins.The threshold for asymptomatic repair is 5.5 cm in European and American and 6 cm for Asian PG, with lower thresholds in Marfan and bicuspid aortic valve (BAV). As regards the abdominal aortic aneurysms (AAA), the PGs recognize the adequate control of cardiovascular risk factors, but there are differences in class of recommendation on statins, angiotensin-converting enzyme inhibitors or beta-blockers to prevent progression of AAA. For intervention, the threshold diameter in asymptomatic is 5.5 cm but can be reduced to 5 cm in women as recommended by Asian PG. Moreover the specific diseases such as Marfan, BAV, pregnancy or atherosclerosis aortic present specific recommendations with small differences between PGs. In conclusion, PGs are interesting and appropriate documents at present. They issue recommendations based on evidence that help the clinician and surgeon in their daily approach to aortic pathology.

Parenting a child with Marfan syndrome: Distress and everyday problems

“…This was an unexpected finding given the well-known risk of (acute) medical MFS related complications (Dietz, 1993;Faivre et al, 2012;Loeys et al, 2010;Sheikhzadeh et al, 2012;Stheneur et al, 2014;Velvin et al, 2015aVelvin et al, , 2016b, the need for regular medical follow up (Hilhorst-Hofstee, 2013; Rozado et al, 2017;Tinkle & Saal, 2013) for both children and also for the parent with MFS, and the perceived significant impact of MFS on daily (physical) functioning of children, parents and the family (Nielsen et al, 2019;Peters et al, 2002;Speed et al, 2017; Velvin et al, 2015a, 2015b, 2016a, 2016b; Warnink-Kavelaars, T A B L E 2 DT-P overall and clinical distress score, problem domain scores and additional question scores of mothers and fathers of a child with MFS compared to control-group mothers and fathers of healthy children Note: Significant differences at p < .05 are presented in bold; distress and domain scores: numerical data > not normal distributed > Mann-Whitney U tests with Z score (z) and effect size (r); binary data > Chisquare tests with odds ratio (OR) and confidence interval (CI). Abbreviations: IQR, interquartile range; MFS, Marfan syndrome; p value, probability value; OR, odds ratio; r, effect size; n, number.…”

“…The estimated prevalence is 1:5,000-1:10,000 (Dietz, 1993) and the diagnosis is based on the revised Ghent criteria (Loeys et al, 2010). Children and adults/parents with MFS need regular medical follow-up (Hilhorst-Hofstee, 2013;Rozado, Martin, Pascual, Hernandez-Vaquero, & Moris, 2017;Tinkle & Saal, 2013) because of the risk of developing medical complications of the cardiovascular-(aortic aneurysm, mitral valve prolapse), musculoskeletal-and ophthalmic-(ectopia lentis, severe myopia) systems (Dietz, 1993;Faivre et al, 2012;Loeys et al, 2010;Sheikhzadeh et al, 2012;Stheneur et al, 2014;Velvin, Bathen, Rand-Hendriksen, & Geirdal, 2015a, 2016b. Therefore, parents may have extended caregiving responsibilities, both for their child/children with MFS and for themselves or their partner with MFS, which may further increase distress and everyday problems.…”

Soluble EMMPRIN levels discriminate aortic ectasia in Marfan syndrome patients

“…Importantly, the high sensitivity reached with this test along with the 81.0% accuracy indicate that sEMMPRIN levels may have implications in the management of MFS patients, since the identification of patients at higher risk of AE onset is of primary importance to prevent TAA development and dissection, the leading cause of death in MFS 4. To date, the most widespread tools for measuring patient aortic diameter are imaging techniques such as transthoracic echocardiography, computed tomography and magnetic resonance imaging which allow an effective monitoring of aortic diameter progression 58. The added value, on top of current clinical practice, of new biochemical information in this context may help to further discriminate subset of patients at higher risk 59.…”

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma

“…Therefore, patients with type B PAU-IMH may benefit from surgery. Although ACCF-TAD Guidelines 2010 and JCS-AD Guidelines 2011 did not give recommendation on patients with type B PAU-IMH, ESC-AD Guidelines 2014 recommended open surgery or endovascular repair [23]. According to our data, patients with type B PAU-IMH should be referred to surgery more aggressively.…”