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

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• 作者：Paul T. Albini ; Ana Maria Segura ; Guanghui Liu ; Charles G. Minard ; Joseph S. Coselli ; Dianna M. Milewicz ; Ying H. Shen ; Scott A. LeMaire
• 关键词：Aorta ; Thoracic aneurysm ; Atherosclerosis ; Muscle ; Smooth ; Elastin
• 刊名：Atherosclerosis
• 出版年：February, 2014
• 年：2014
• 卷：232
• 期：2
• 页码：361-368
• 全文大小：2996 K

文摘

class="h4">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.

class="h4">Methods and results

Atherosclerosis was characterized in ascending aortic tissues collected from 68 SAAA patients (mean age, 62.9聽卤聽12.0 years) and 15 controls (mean age, 56.6聽卤聽11.4 years [P聽=聽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聽鈮ヂ?; 40%), whereas most control samples showed minimal atherosclerosis (none or type 1, 80%; P聽<聽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聽<聽0.001), elastic fiber depletion (P聽=聽0.02), elastic fiber fragmentation (P聽<聽0.001), and mucopolysaccharide accumulation (P聽=聽0.04). Aortic diameter was larger in SAAA patients with advanced atherosclerosis than in patients with minimal (P聽=聽0.04) or intermediate atherosclerosis (P聽=聽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.

class="h4">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.