In 1963 – 1965, a large-scale health screening survey was undertaken in Sweden and this data set was linked to data from the national cause of death register. The data set involved more than 60,000 participants whose age at death less than 80 years. During the follow-up period until 2007, a total of 437 (338 males and 99 females) participants died from aortic aneurysm. The survival analysis, continuation ratio model, and logistic regression were applied in order to identify significant risk factors. The Cox regression after stratification for AGE revealed that SEX, Blood Diastolic Pressure (BDP), and Beta-lipoprotein (BLP) were the most significant risk factors, followed by Cholesterol (KOL), Sialic Acid (SIA), height, Glutamic Oxalactic Transaminase, Urinary glucose (URIN_SOC), and Blood Systolic Pressure (BSP). Moreover, SEX and BDP were found as risk factors in almost every age group. Furthermore, BDP was strongly significant in both male and female subgroup.   The data set was divided into two sets: 70 percent for the training set and 30 percent for the test set in order to find the best technique for predicting aortic aneurysm. Five techniques were implemented: the Cox regression, the continuation ratio model, the logistic regression, the back-propagated artificial neural network, and the decision tree. The performance of each technique was evaluated by using area under the receiver operating characteristic curve. In our study, the continuation ratio and the logistic regression outperformed among the other techniques.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thèse--Faculté de médecine de Paris.

Acute aortic syndrome (AAS) is a life threatening clinical syndrome resulting from three distinct diagnoses; acute aortic dissection, penetrating atherosclerotic ulcer and intramural hematoma. There are no widely accepted guidelines that are both safe and efficient to guide the clinician on when to suspect AAS. Our aim was to assess the need for a clinical decision rule to help improve diagnosis of AAS. We conducted a diagnostic accuracy systematic review and meta-analysis, a historical case control study and historical cohort study. We found wide variation in practice with a perceived need by physicians for a clinical decision rule. In addition we found it feasible to risk stratify patients at risk for AAS by historical, clinical and laboratory features. Therefore we conclude there is a need for the development of a clinical decision rule for the risk stratification of patients with a clinical suspicion of AAS.

The aortic valve (AV) functions in arguably the most demanding mechanical environment in the body. The AV experiences fluid shear stress, cyclic pressure and mechanical strain in vivo. Recent evidence has shown the progression of degenerative aortic valve disease (AVD) to be an active cellular mediated process, altering the conception of the AV as a passive tissue. AVD has shown a strong correlation with altered hemodynamics and tissue mechanics. Aortic valve endothelial cells (AVECs) line the fibrosa (aortic facing) and ventricularis (left ventricle facing) surfaces of the valve. AVECs sense and respond to circulating stimuli in the blood stream while maintaining a non-thrombogenic layer. AVEC activation has been implicated in the initiation and progression of AVD, but the role of cyclic strain has yet to be elucidated. The hypothesis of this dissertation is that altered mechanical forces have a causal relationship with aortic valvular endothelial cell activation. To test this hypothesis 1) the role of in vitro cyclic strain in regulating expression of pro-inflammatory adhesion molecule was elucidated 2) cyclic strain-dependent activation of side-specific aortic valve endothelial cells was investigated 3) a novel stretch bioreactor was developed to dramatically increase the ability to correlate valvular endothelium response to physiologically relevant applied planar biaxial loads. The results from this study further the field of heart valve mechanobiology by correlating AVEC physiological and pathophysiological function to cellular and tissue level strain. Elucidating the AVEC response to an altered mechanical environment may result in novel clinical diagnostic and therapeutic approaches to the initiation and progression of degenerative AVD. Furthermore, a cardiovascular health outreach program, Bulldogs for Heart Health, has been designed and implemented to combat the startling rise in childhood obesity in the state of Mississippi. It is the hope that these results, novel methods, and outreach initiatives developed will significantly impact the study of the mechanobiology of the aortic valve endothelial cell and potential treatment and prevention of cardiovascular disease.

UA Open Access Publishing Fund / Background: The use of intra-aortic balloon pump (IABP) via the trans-femoral approach has been established for hemodynamic support in patients undergoing high-risk percutaneous coronary intervention (PCI). However, there are various challenges associated with its use, especially in patients with aortoiliac occlusive arterial disease. Case presentation: We describe a case of high-risk PCI with IABP support complicated by intra-procedural detection of severe abdominal aortic stenosis that was successfully overcome with angioplasty of the stenotic lesion. Conclusions: Our report highlights distal abdominal aortic stenosis as a potential barrier to successful PCI with IABP support, and angioplasty as an effective means to overcome it.

Transcatheter aortic valve implantation (TAVI) is an effective alternative treatment option for patients with severe aortic stenosis, who are at a high risk for conventional surgical aortic valve replacement or considered inoperable. Despite the short- and mid-term survival benefits of TAVI, adverse clinical events, such as paravalvular leak, aortic rupture, and coronary occlusion, have been reported extensively. Many of these adverse events can be explained from the biomechanics perspective. Therefore, an in-depth understanding of biomechanical interaction between the device and native tissue is critical to the success of TAVI. The objective of this thesis was to investigate the biomechanics involved in the TAVI procedure using patient-specific finite element (FE) simulations. Patient-specific FE models of the aortic roots were reconstructed using pre-procedural multi-slice computed tomography images. The models incorporated aged human aortic material properties with material failure criteria obtained from mechanical tests, and realistic stent expansion methods. TAV deployment and tissue-device interaction were simulated; and the simulation results were compared to the clinical observations. Additionally, parametric studies were conducted to examine the influence of the model input on TAVI simulation results and subsequently the potential clinical complications such as paravalvular leak, annular rupture, and coronary artery occlusion. The methodology presented in this thesis could be potentially utilized to develop valuable pre-procedural planning tools to evaluate device performance for TAVI and eventually improve clinical outcomes.

The gold standard treatment for patients with AVD is surgical replacement of the aortic valve with either mechanical or fixed tissue prostheses. These implants have a limited lifespan and are associated with serious adverse events. Patient autologous tissue engineered heart valves (TEHVs) offer a solution. Vital to the development of a TEHV is determining a source of donor tissue(s) that most closely mimics the native valve tissue. In pursuit of determining an alternative cell source for patient autologous TEHVs we compared a number of phenotypic and genotypic characteristics of atrial fibroblasts, dermal fibroblasts and differentiated bone marrow-derived progenitor cells (BMCs) and made a comparison to valvular interstitial cells (VICS). We demonstrate that while VICs share some phenotypic similarities with fibroblasts and BMCs, they also possess unique characteristics and demonstrate differential mRNA expression of key regulatory pathways that may influence their phenotype. / October 2016

BACKGROUND: It is well established that thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA) have different risk factors, clinical features, and genetic influences. Differences between and amongst subtypes of TAAs have received less attention. Despite observations of divergent clinical outcomes between ascending thoracic aortic aneurysms (ATAAs) and descending thoracic aortic aneurysms (DTAAs), etiologic factors determining the anatomic distribution of these aneurysms are not well understood. METHODS: From 3,247 patients registered in an institutional Thoracic Aortic Center Database from July 1992 through August 2013, we identified 921 patients with full aortic dimensional imaging by CT or MRI scan with TAA > 3.5 cm and without evidence of aortic dissection (AoD). Patients were analyzed in three groups: isolated ATAA (n=677), isolated DTAA (n=97), and combined ATAA and DTAA (n=146). RESULTS: Patients with a DTAA, alone or with coexistent ATAA, had significantly more hypertension (80.6% vs. 61.8%, p<.001) and a higher burden of atherosclerotic disease ( 86.7% vs. 7.5%, p<.001) ) and were more likely to be female (59.3% vs. 29.5%, P<.001). Conversely, patients with isolated ATAA were significantly younger (average age 59.5 vs. 71, p<.001), and contained almost every case of overt genetically-triggered TAA. Patients with isolated DTAA were demographically indistinguishable from patients with combined ATAA and DTAA. In follow up, patients with isolated DTAA, or with ATAA and DTAA, experienced significantly more aortic events (aortic dissection/rupture) and had higher mortality than patients with isolated ATAA. CONCLUSIONS: Based on patient characteristics and outcomes, subtypes of TAA emerge. DTAA with or without associated ATAA or AAA appears to be a disease more highly associated with atherosclerosis, hypertension, and advanced age. In contrast, isolated ATAA appears to be a clinically distinct entity with a higher burden of genetically triggered disease. These data have important implications for familial screening recommendations for TAA.