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Advanced atherosclerosis is associated with increased medial degeneration in sporadic ascending aortic aneurysms

  • Paul T. Albini
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA

    Department of Adult Cardiothoracic Surgery, Texas Heart Institute, PO Box 20345, Houston, TX 77225, USA
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  • Ana Maria Segura
    Affiliations
    Department of Cardiovascular Pathology, Texas Heart Institute, PO Box 20345, Houston, TX 77225, USA
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  • Guanghui Liu
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA

    Department of Adult Cardiothoracic Surgery, Texas Heart Institute, PO Box 20345, Houston, TX 77225, USA
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  • Charles G. Minard
    Affiliations
    Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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  • Joseph S. Coselli
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA

    Department of Adult Cardiothoracic Surgery, Texas Heart Institute, PO Box 20345, Houston, TX 77225, USA
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  • Dianna M. Milewicz
    Affiliations
    Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 1200, Houston, TX 77030, USA
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  • Ying H. Shen
    Correspondence
    Corresponding author. One Baylor Plaza, BCM 390, Houston, TX 77030, USA. Tel.: +1 832 355 9952; fax: +1 832 355 9951.
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA

    Department of Adult Cardiothoracic Surgery, Texas Heart Institute, PO Box 20345, Houston, TX 77225, USA
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  • Scott A. LeMaire
    Correspondence
    Corresponding author. Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX 77030, USA. Tel.: +1 832 355 9942; fax: +1 832 355 9948.
    Affiliations
    Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA

    Department of Adult Cardiothoracic Surgery, Texas Heart Institute, PO Box 20345, Houston, TX 77225, USA
    Search for articles by this author

      Highlights

      • In human SAAA tissues, the prevalence of intermediate and advanced atherosclerosis is high.
      • Patients with SAAA were more likely to have advanced atherosclerosis than controls.
      • Advanced atherosclerosis was associated with severe grades of aortic medial degeneration.
      • Atherosclerosis and SAAA may influence the progression of each respective disease.

      Abstract

      Objective

      The pathogenesis of non-familial, sporadic ascending aortic aneurysms (SAAA) is poorly understood, and the relationship between ascending aortic atherosclerosis and medial degeneration is unclear. We evaluated the prevalence and severity of aortic atherosclerosis and its association with medial degeneration in SAAA.

      Methods and results

      Atherosclerosis was characterized in ascending aortic tissues collected from 68 SAAA patients (mean age, 62.9 ± 12.0 years) and 15 controls (mean age, 56.6 ± 11.4 years [P = 0.07]) by using a modified American Heart Association classification system. Upon histologic examination, 97% of SAAA patients and 73% of controls showed atherosclerotic changes. Most SAAA samples had intermediate (types 2 and 3, 35%) or advanced atherosclerosis (types ≥ 4; 40%), whereas most control samples showed minimal atherosclerosis (none or type 1, 80%; P < 0.001 after adjusting for age). In a separate analysis, we examined the total incidence and grade distribution of medial degenerative changes among SAAA samples according to atherosclerosis grade. Advanced atherosclerosis was associated with higher grades of smooth muscle cell depletion (P < 0.001), elastic fiber depletion (P = 0.02), elastic fiber fragmentation (P < 0.001), and mucopolysaccharide accumulation (P = 0.04). Aortic diameter was larger in SAAA patients with advanced atherosclerosis than in patients with minimal (P = 0.04) or intermediate atherosclerosis (P = 0.04). Immunostaining showed marked CD3+ T-cell and CD68+ macrophage infiltration, MMP-2 and MMP-9 production, and cryopyrin expression in the medial layer adjacent to atherosclerotic plaque.

      Conclusions

      SAAA tissues exhibited advanced atherosclerosis that was associated with severe medial degeneration and increased aortic diameter. Our findings suggest a role for atherosclerosis in the progression of sporadic ascending aortic aneurysms.

      Keywords

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