Diagnosis and Management of Aortic Diseases: Drafting from Theoretical Aspects to Clinical Practice

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (13 December 2023) | Viewed by 3547

Special Issue Editor

Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
Interests: vascular surgery; vascular biology

Special Issue Information

Dear Colleagues,

Aortic disease may be diagnosed after a long period of subclinical development or they may have an acute presentation. Aortic diseases contribute to the wide spectrum of arterial diseases: aortic aneurysms (AA), aortic dissection (AD), carotid atherosclerotic and inflammatory affections. Thoracic- and abdominal aortic aneurysms (TAA and AAA, respectively) are often incidental findings, genetic variants predispose individuals to these aortic diseases. About biomarkers, ranging from plasma to serum markers, that could lead to a better understanding of the development and progression of AAA, TAA, and AD associated with other detection of vascular injury. Damage of intima and weakness of the media were the key pathological changes, and smooth muscle cells (SMCs) death is an important inducer of thoracic aorta disease, abdominal aorta disease, and carotid diseases. Simultaneously, media regression is also responsible for aortic aneurysm and aortic dissection progression, including loss of SMCs and degradation of the ECM. Many regulated cell deaths (RCD, also called programmed cell death), such as apoptosis, ferroptosis, autophagic cell death, pyroptosis, and necroptosis, involved in the progression of AAA, TAA, and AD, and the targeting of RCD pathways shows promise as an approach for attenuating and interrupting the occurrence of aortic disease. Meanwhile, vascular aging is another process characterized by the progressive loss of physiological functions, leading to an increased challenges in aortic diseases. Recently, single-cell RNA sequencing (scRNA-seq) has been developed and widely used in vascular biological fields to reveal biological mechanisms at the cellular level and solve the problems of cellular heterogeneity. With more researchers focusing on single-cell atlas of aortic disease reveals immune-SMCs crosstalk and communication between them during AAA, TAA, and AD. For clinical practice, artificial intelligence (AI) applications for the diagnosis and risk evaluation of aortic disease have been an active research area in recent years. The machine learning or deep learning, as a product of this era, has achieved promising success in many fields including genetic systems biology and aortic disease diagnosis.

We would like to investigate novel biomolecular mechanism (e.g. RCD, and vascular aging) in the progression of aortic disease, which would provide a new perspective for drug research and development. We also would like to shed some light on the diagnosis of AAA, TAA, and AD where existing diagnostic consistently fails to impact its progression. We would recommend the discovery of pathogenic mechanism form the standpoint of aortic disease spectrum which ranges from bulk RNA-seq to scRNA-seq. Every step of your research will advance treatment of aortic disease. This Special Issue will also cover recent developments in machine learning methods for detecting aortic diseases disease using imaging and clinical data.

We welcome Original Research, Review, and Mini-review covering, but not limited to, the following topics:

  1. Machine learning or deep learning for the diagnosis and risk management of aortic diseases;
  2. New models for handling complex genetic/genomic data sets integrating bulk and single-cell RNA-seq data in AAA, TAA, and AD;
  3. New biomolecular mechanism which regulates RCD and aging of aortic disease;
  4. Discovery of circulating biomarkers indicating the progression of AAA and AD;
  5. The interaction of different types of endothelial cells (ECs), smooth muscle cells (SMCs), and immune cells, and communication between them in the process of AAA and AD;
  6. 6. Discovery of candidate biomarkers, such as metabolomics and proteomics, to gain a lot of attention in AAA, TAA, and AD.

Dr. Jian Zhang
Guest Editor

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Published Papers (3 papers)

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10 pages, 1112 KiB  
Article
Prognostic Impact of Modified H2FPEF Score in Patients Receiving Trans-Catheter Aortic Valve Replacement
by Kousuke Akao, Teruhiko Imamura, Shuhei Tanaka, Hiroshi Onoda, Ryuichi Ushijima, Mitsuo Sobajima, Nobuyuki Fukuda, Hiroshi Ueno and Koichiro Kinugawa
J. Clin. Med. 2023, 12(16), 5396; https://doi.org/10.3390/jcm12165396 - 19 Aug 2023
Cited by 2 | Viewed by 563
Abstract
Background: H2FPEF is a recently introduced score for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Many patients with severe aortic stenosis have clinical/subclinical HFpEF and have worsening heart failure even after trans-catheter aortic valve replacement (TAVR). We investigated the prognostic [...] Read more.
Background: H2FPEF is a recently introduced score for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Many patients with severe aortic stenosis have clinical/subclinical HFpEF and have worsening heart failure even after trans-catheter aortic valve replacement (TAVR). We investigated the prognostic impact of the H2FPEF score in TAVR candidates. Methods: Patients undergoing TAVR procedures at a single academic center between 2015 and 2022 were included. The H2FPEF score was calculated using baseline characteristics before TAVR. The prognostic impact of the score on the post-TAVR composite endpoint, consisting of all-cause death and heart failure readmissions during the 2-year observation period, was evaluated. Results: A total of 244 patients (median age 86 years, 70 males) were included. The median value of H2FPEF score was 3 (2, 4). The score was significantly associated with the primary outcome with a hazard ratio of 1.33 (95% confidence interval 1.02–1.74, p = 0.036). We constructed a modified H2FPEF score by adjusting cutoffs of several items for better prognostic stratification (i.e., age and body mass index). A modified score had a higher area under the curve than the original one (0.65 vs. 0.59, p = 0.028) and was independently associated with the primary outcome with an adjusted hazard ratio of 1.22 (95% confidence interval 1.01–1.49, p = 0.047). Conclusions: A modified H2FPEF score, which was originally developed to diagnose the presence of HFpEF, could be used to risk-stratify elderly patients receiving TAVR. The clinical utility of this score should be validated in future studies. Full article
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12 pages, 911 KiB  
Article
High Serum VE-Cadherin and Vinculin Concentrations Are Markers of the Disruption of Vascular Integrity during Type B Acute Aortic Dissection
by Shiyue Wang, Xin Li, Han Jiang and Jian Zhang
J. Clin. Med. 2023, 12(14), 4730; https://doi.org/10.3390/jcm12144730 - 17 Jul 2023
Cited by 1 | Viewed by 701
Abstract
Background: In the present study, we measured the serum vascular endothelial cadherin (VEC) and vinculin (Vcn) concentrations in patients with type B acute aortic dissection (TBAD) to evaluate their diagnostic value for this condition. Methods: A total of 100 patients with TBAD and [...] Read more.
Background: In the present study, we measured the serum vascular endothelial cadherin (VEC) and vinculin (Vcn) concentrations in patients with type B acute aortic dissection (TBAD) to evaluate their diagnostic value for this condition. Methods: A total of 100 patients with TBAD and 90 matched controls were included in the study. The serum concentrations of VEC and Vcn were measured using enzyme-linked immunosorbent assays. Results: The serum VEC and Vcn concentrations were significantly higher in participants with TBAD than in healthy controls. Compared with patients with acute myocardial infarction (AMI), the serum concentrations of VEC and Vcn in patients with TBAD were higher, and the Vcn showed significant difference, with statistical significance. Receiver operating characteristic analysis generated areas under the curves for VEC and Vcn that were diagnostic for TBAD (0.599 and 0.655, respectively). The optimal cut-off values were 3.975 ng/μL and 128.1 pg/mL, the sensitivities were 43.0% and 35.0%, and the specificities were 73.3% and 90.0%, respectively. In addition, the use of a combination of serum VEC and Vcn increased the AUC to 0.661, with a sensitivity of 33.0% and a specificity of 93.33%. A high serum Vcn concentration was associated with a higher risk of visceral malperfusion in participants with TBAD (odds ratio (OR) = 1.007, 95% confidence interval [CI]: 1.001–1.013, p = 0.014). In participants with refractory pain, the adjusted OR for the serum VEC concentration increased to 1.172 (95% CI: 1.010–1.361; p = 0.036), compared with participants without refractory pain. Conclusion: This study is the first to show the diagnostic value of serum VEC and Vcn for AAD and their relationships with the clinical characteristics of patients with TBAD. Thus, VEC and Vcn are potential serum markers of TBAD. Full article
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Systematic Review
DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives
by Tom Langenaeken, Arnaud Vanoppen, Fien Janssens, Loes Tanghe, Peter Verbrugghe, Filip Rega and Bart Meuris
J. Clin. Med. 2023, 12(15), 4984; https://doi.org/10.3390/jcm12154984 - 28 Jul 2023
Cited by 4 | Viewed by 1863
Abstract
Valvular heart disease is a common disease often necessitating valve replacement. Mechanical heart valves (MHVs) are often used in younger patients because of their longer durability. Their main disadvantage is the need for lifelong anticoagulation. Warfarin is considered a standard treatment, but it [...] Read more.
Valvular heart disease is a common disease often necessitating valve replacement. Mechanical heart valves (MHVs) are often used in younger patients because of their longer durability. Their main disadvantage is the need for lifelong anticoagulation. Warfarin is considered a standard treatment, but it is far from perfect. Direct oral anticoagulants (DOACs) are a new and more patient-friendly alternative to warfarin when anticoagulation is required, but have not yet been approved for the indication of mechanical valves. Evidence acquisition: A literature search of Pubmed, Embase, Web of Science (Core Collection), and Cochrane Library (from inception to May 2023) was performed using a search string that was well defined and not modified during the study. An extensive overview of the search terms used in each database can be found in the Appendix. Only prospective clinical trials were included in this review. A total of 10 publications were included in this review. Relevance to clinical practice: This systematic review summarizes the different types of DOACs and their possible use in the anticoagulation of mechanical valves. We aim to propose future directions in anticoagulation research for mechanical valves. Conclusions: DOAC use in MHVs has been halted due to the failure of both dabigatran and apixaban in two major clinical trials. However, rivaroxaban was successful in two small clinical trials. Ample research is still needed to explore new valve designs as well as new anticoagulation targets. Full article
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