Sex differences and temporal trends in aortic dissection: a population-based study of incidence, treatment strategies, and outcome in Swedish patients during 15 years

Smedberg, Christian; Steuer, Johnny; Leander, Karin; Hultgren, Rebecka

doi:10.1093/eurheartj/ehaa446

Cited by 104 publications

(100 citation statements)

References 29 publications

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“…3 Moreover, female patients were older, had smaller aortic diameters less likely to smoke or have hypertension, and more likely to have diabetes mellitus and anemia. 1,8 In the present cohort, we found that the proximal landing zone for stent graft in 0 and 1 tended to be higher in males. Therefore, males were more likely to require aortic arch bypass.…”

Section: Discussionsupporting

confidence: 46%

“…28 Indeed, female patients who were surgically treated for TAAD had a higher mortality rate than male patients (31.9% vs 21.9%, P ¼ .013). 8 Meanwhile, 2 studies from Japan and Germany found that female sex was not an independent predictor of mortality after surgery for TAAD. 29,30 Several studies have reported no sex differences in shortterm outcomes for TBAD.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is generally accepted that females have a worse outcome following AD, 1,8 the clinical outcomes differ widely between subtypes and treatment groups. 9 For instance, type A AD (TAAD) is often critical and usually requires emergency surgical management.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

et al. 2021

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We aimed to investigate whether sex differences influence the clinical outcomes of patients who undergo thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We retrospectively analyzed a prospectively maintained single-center cohort of patients with TBAD who underwent TEVAR between January 2010 and June 2017. We evaluated the in-hospital and long-term mortality and composite end point. Of the 913 patients, 793 (86.8%) were male and 120 (13.1%) were female. Compared to male patients, the female patients were older, more likely to have diabetes mellitus, but less likely to smoke or have hypertension. The proximal landing zone in 0 and 1 was higher in male patients ( P = .023), who were more likely to require an aortic arch bypass. Endoleak, delirium, and ICU stay after stent-graft implantation were also more frequent in men. Sex factor was not associated with in-hospital or long-term mortality or the composite end point in the multivariable regression analyses and Cox regression model. The mean estimated survival time was similar between males and females (2462.9 ± 141.2 vs 2804.1 ± 117.4 days, P = .167) in the propensity score–matched cohort. Despite distinct characteristics between sex, there was no sex-related difference in long-term clinical outcomes after TEVAR for TBAD.

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

et al. 2021

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“…For untreated Standford type A of AAD, the mortality rate increased by 1-2% every 1 hour [3][4] . 30-day mortality in hospitalized patients with any acute aortic dissection was 37% [5] . Due to the rapid development of AAD and the high mortality rate, early diagnosis and progress evaluation are clinically important issues.…”

Section: Introductionmentioning

confidence: 97%

Identification Novel Biomarker for Acute Aortic Dissection Using 4D-Label-Free Proteomics

wang

Wang

Maitusun

et al. 2021

Preprint

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Purpose: we aimed to identify potential candidate biomarkers in aorta tissue from AAD patients. Methods: We used 4D label-free quantification (4D-LFQ) mass spectrometry to screen differentially expressed proteins in aorta tissues of AAD patients. Then we performed protein annotation, unsupervised hierarchical clustering, functional classification, functional enrichment and cluster, and protein-protein interaction analyses. Parallel Reaction Monitoring (PRM) technology was used to accurately and quantitatively confirm the selected target proteins. Results: A total of 3350 proteins were identified. Taking 1.5 times as the differential expression threshold, 139 were upregulated and 108 were downregulated as compared to the control groups. Bioinformatics analysis showed that the differential proteins were mainly distributed in extracellular matrix and cytoplasm. And their functions mainly involve cell migration and proliferation, inflammatory cell activation, cell contraction, muscle organ development and other processes. PRM technology accurately quantified the selected 20 target proteins, and found SAA1, LBP, MPO, and ENG were confirmed to be enriched in the aorta tissue of AAD patients. Conclusions: This is the first application of a 4D-LFQ-PRM workflow to identify and validate biomarkers in AAD patients. SAA1, LBP, MPO, and ENG represent novel biomarkers for the pathogenesis of AAD and might be a therapeutic target in the future.

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“…An acute aortic dissection is a medical catastrophe [ 1 ] with an estimated mortality of 26% in patients undergoing acute surgery and up to 58% in patients not receiving surgical treatment [ 2 ]. Reported incidences of an aortic dissection vary between 3 and 9 per 100,000 person-years [ 1 , 2 , 3 , 4 ], but with an aging population further increases are anticipated for the future.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation

Grewal

Velders

Groot

et al. 2021

JCDD

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(1) Background: The pathophysiologic basis of an acute type A aortic dissection (TAAD) is largely unknown. In an effort to evaluate vessel wall defects, we systematically studied aortic specimens in TAAD patients. (2) Methods: Ascending aortic wall specimens (n = 58, mean age 63 years) with TAAD were collected. Autopsy tissues (n = 17, mean age 63 years) served as controls. All sections were studied histopathologically. (3) Results: Pathomorphology in TAAD showed predominantly moderate elastic fiber fragmentation/loss, elastic fiber thinning, elastic fiber degeneration, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration. The control group showed significantly fewer signs of those histopathological features (none-mild, p = 0.00). It was concluded that the dissection plane consistently coincides with the vasa vasorum network, and that TAAD associates with a significantly thinner intimal layer p = 0.005). (4) Conclusions: On the basis of the systematic evaluation and the consistent presence of diffuse, pre-existing medial defects, we hypothesize that TAAD relates to a developmental defect of the ascending aorta and is caused by a triple-hit mechanism that involves (I) an intimal tear; and (II) a diseased media, which allows (III) propagation of the tear towards the plane of the vasa vasorum where the dissection further progresses.

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Sex differences and temporal trends in aortic dissection: a population-based study of incidence, treatment strategies, and outcome in Swedish patients during 15 years

Cited by 104 publications

References 29 publications

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Identification Novel Biomarker for Acute Aortic Dissection Using 4D-Label-Free Proteomics

A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation

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