Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Abstract

BackgroundThe natural course of abdominal aortic aneurysms (AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture.Methods and ResultsPotential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty‐two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S‐elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta‐analysis was conducted because of clinical and methodological heterogeneity.ConclusionsWe identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.

Blood biomarker panel recommended for personalized prediction, prognosis, and prevention of complications associated with abdominal aortic aneurysm

“…Recently, a large number of studies have been published that analyze various biomarkers in patients with AAA [2,8,13,14]. We summarized our data, which will be discussed in following text in Tables 2 and 3.…”

Management of Abdominal Aortic Aneurysm Disease: Similarities and Differences Among Cardiovascular Guidelines and NICE Guidance

“…[31][32][33] However, further studies are needed to support evidence as the contemporary results remain controversial. [34][35][36] More than anatomical characteristics, biochemical and hemodynamic factors may affect aneurysm growth and progression as part of a multifactorial inflammatory process. 34,36,37 Despite encouraging findings, this information may not be applicable at the moment in clinical practice.…”

“…31–33 However, further studies are needed to support evidence as the contemporary results remain controversial. 34–36…”

Smooth muscle-specific biomarker for abdominal aortic aneurysm: a beacon for the silent killer

“…The myosin-11 concentration was higher in AAA samples than in control samples. In addition, myosin-11 exhibited a higher specificity and equivalent sensitivity compared with high-sensitivity C-reactive protein, a candidate biomarker for AAA (5). Notably, myosin-11 and high-sensitivity C-reactive protein did not correlate significantly, and the combination of the two biomarkers had a superior value in the area under the curve of the receiver operating characteristics analysis than either of them alone.…”

“…For the progression of AAA, the gradual expansion of the vessel diameter and catastrophic rupture are fundamentally different with regard to the consequences. Therefore, biomarkers for aneurysmal growth (a growth predictor) and aortic rupture (a rupture predictor) are usually discussed separately (5). However, no biomarker is currently known to be specific for the growth or the rupture of AAA.…”