Preliminary Study of A New Staging System of Aortic Dissection Based on Systemic Inflammatory Response_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAOZheng-hua , GUJun , HUJia , QIANHong , ZHANGEr-yong , SHIYing-kang ,  MENGWei

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

MENGWei, Email: meng_wei_1111@yahoo.com

Keywords：

Aortic dissection; Inflammatory response; Sub-acute phase; Endotoxin

DOI：

10.7507/1007-4848.20140208

Video：

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Objective To observe systemic inflammatory response (SIR)of patients in different stages after the onset of aortic dissection (AD), and preliminarily explore a new staging system of AD based on SIR. Methods From September 2011 to February 2012, 46 AD patients were admitted to the Department of Cardiovascular Surgery, West China Hospital of Sichuan University. There were 33 male and 13 female patients with their age ranging from 22 to 77 years (53.2±13.6 years). Blood samples were collected in 9 different periods after the onset of AD (0-12 hours (T1), 12-24 hours (T2), 24-48 hours (T3, 1-2 days), 48-96 hours (T4, 2-4 days), 96-168 hours (T5, 4-7 days), 168-336 hours (T6, 7-14 days), 336-720 hours (T7, 14-30 days), 720-1440 hours (T8, 30-60 days) and > 1 440 hours (T9, > days))to measure blood concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), endotoxin (ET), white blood cell (WBC)and neutrophils (Neut). SIR changes after the onset of AD were summarized. Results Blood concentrations of different inflammatory mediators were all significantly elevated within 14 days (T1-T6), significantly decreased in 14-60 days (T7-T8), and returned to normal range 60 days (T9)after the onset of AD. Peak levels of ET and TNF-α appeared in T1 with 263.42±29.98 pg/ml and 86.75±18.83 pg/ml respectively. Peak level of IL-6 appeared in T2 with 95.70±22.64 pg/ml. Peak level of CRP appeared in T5 with 123.74±54.78 mg/L. There was no obvious peak level of WBC or Neut. Conclusion Disease progression of AD can be divided into 3 stages including acute stage (within 14 days), subacute stage (14-60 days)and chronic stage ( > 60 days)based on the degree of SIR.

Citation： XIAOZheng-hua, GUJun, HUJia, QIANHong, ZHANGEr-yong, SHIYing-kang, MENGWei. Preliminary Study of A New Staging System of Aortic Dissection Based on Systemic Inflammatory Response. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 721-724. doi: 10.7507/1007-4848.20140208 Copy

1.	董逸飞, 卢安东, 闵凯, 等. Stanford A型主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2013, 20(6):647-651.
2.	Ranasinghe AM, Bonser RS. Biomarkers in acute aortic dissection and other aortic syndromes. J Am Coll Cardiol, 2010, 56(19):1535-1541.
3.	Ince H, Nienaber CA. Diagnosis and management of patients with aortic dissection. Heart, 2007, 93(2):266-270.
4.	Nienaber CA, Eagle KA. Aortic dissection:new frontiers in diagnosis and management:Part I:from etiology to diagnostic strategies. Circulation, 2003, 108(5):628-635.
5.	Debakey ME, Henly WS, Cooley DA, et al. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg, 1965, 49:130-149.
6.	Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3):237-247.
7.	Crawford ES. The diagnosis and management of aortic dissection. JAMA, 1990, 264(19):2537-2541.
8.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection(IRAD):new insights into an old disease. JAMA, 2000, 283(7):897-903.
9.	Steuer J, Björck M, Mayer D, et al. Distinction between acute and chronic type B aortic dissection:is there a sub-acute phase? Eur J Vasc Endovasc Surg, 2013, 45(6):627-631.
10.	Luo F, Zhou XL, Li JJ, et al. Inflammatory response is associated with aortic dissection. Ageing Res Rev, 2009, 8(1):31-35.
11.	del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8):622-629.
12.	Parthenakis F, Koutalas E, Patrianakos A, et al. Diagnosing acute aortic syndromes:the role of specific biochemical markers. Int J Cardiol, 2010, 145(1):3-8.
13.	Komukai K, Shibata T, Mochizuki S, et al. C-reactive protein is related to impaired oxygenation in patients with acute aortic dissection. Int Heart J, 2005, 46(5):795-799.
14.	Sugano Y, Anzai T, Yoshikawa T, et al. Serum C-reactive protein elevation predicts poor clinical outcome in patients with distal type acute aortic dissection:association with the occurrence of oxygenation impairment. Int J Cardiol, 2005, 102(1):39-45.
15.	Nagase H, Visse R, Murphy G. Structure and function of matrix metalloproteinases and TIMPs. Cardiovasc Res, 2006, 69(3):562-573.
16.	Maksimowicz-McKinnon K, Bhatt DL, Calabrese LH. Recent advances in vascularinflammation:C-reactive protein and other inflammatory biomarkers. Curr Opin Rheumatol, 2004, 16(1):18-24.
17.	Sakakura K, Kubo N, Ako J, et al. Peak C-reactive protein level predicts long-term outcomes in type B acute aortic dissection. Hypertension, 2010, 55(2):422-429.
18.	Wen D, Zhou XL, Li JJ, et al. Plasma concentrations of interleukin-6, C-reactive protein, tumor necrosis factor-alpha and matrix metallopro teinase-9 in aortic dissection. Clin Chim Acta, 2012, 413(1-2):198-202.
19.	Lombardi JV, Cambria RP, Nienaber CA, et al. Prospective multic-enter clinical trial(STABLE)on the endovascular treatment of complicated type B aortic dissection using a composite device design.J Vasc Surg, 2012, 55(3):629-640.
20.	White RA, Miller DC, Criado FJ, et al. Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subco-mmittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg, 2011, 53(4):1082-1090.

1. 董逸飞, 卢安东, 闵凯, 等. Stanford A型主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2013, 20(6):647-651.
2. Ranasinghe AM, Bonser RS. Biomarkers in acute aortic dissection and other aortic syndromes. J Am Coll Cardiol, 2010, 56(19):1535-1541.
3. Ince H, Nienaber CA. Diagnosis and management of patients with aortic dissection. Heart, 2007, 93(2):266-270.
4. Nienaber CA, Eagle KA. Aortic dissection:new frontiers in diagnosis and management:Part I:from etiology to diagnostic strategies. Circulation, 2003, 108(5):628-635.
5. Debakey ME, Henly WS, Cooley DA, et al. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg, 1965, 49:130-149.
6. Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3):237-247.
7. Crawford ES. The diagnosis and management of aortic dissection. JAMA, 1990, 264(19):2537-2541.
8. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection(IRAD):new insights into an old disease. JAMA, 2000, 283(7):897-903.
9. Steuer J, Björck M, Mayer D, et al. Distinction between acute and chronic type B aortic dissection:is there a sub-acute phase? Eur J Vasc Endovasc Surg, 2013, 45(6):627-631.
10. Luo F, Zhou XL, Li JJ, et al. Inflammatory response is associated with aortic dissection. Ageing Res Rev, 2009, 8(1):31-35.
11. del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8):622-629.
12. Parthenakis F, Koutalas E, Patrianakos A, et al. Diagnosing acute aortic syndromes:the role of specific biochemical markers. Int J Cardiol, 2010, 145(1):3-8.
13. Komukai K, Shibata T, Mochizuki S, et al. C-reactive protein is related to impaired oxygenation in patients with acute aortic dissection. Int Heart J, 2005, 46(5):795-799.
14. Sugano Y, Anzai T, Yoshikawa T, et al. Serum C-reactive protein elevation predicts poor clinical outcome in patients with distal type acute aortic dissection:association with the occurrence of oxygenation impairment. Int J Cardiol, 2005, 102(1):39-45.
15. Nagase H, Visse R, Murphy G. Structure and function of matrix metalloproteinases and TIMPs. Cardiovasc Res, 2006, 69(3):562-573.
16. Maksimowicz-McKinnon K, Bhatt DL, Calabrese LH. Recent advances in vascularinflammation:C-reactive protein and other inflammatory biomarkers. Curr Opin Rheumatol, 2004, 16(1):18-24.
17. Sakakura K, Kubo N, Ako J, et al. Peak C-reactive protein level predicts long-term outcomes in type B acute aortic dissection. Hypertension, 2010, 55(2):422-429.
18. Wen D, Zhou XL, Li JJ, et al. Plasma concentrations of interleukin-6, C-reactive protein, tumor necrosis factor-alpha and matrix metallopro teinase-9 in aortic dissection. Clin Chim Acta, 2012, 413(1-2):198-202.
19. Lombardi JV, Cambria RP, Nienaber CA, et al. Prospective multic-enter clinical trial(STABLE)on the endovascular treatment of complicated type B aortic dissection using a composite device design.J Vasc Surg, 2012, 55(3):629-640.
20. White RA, Miller DC, Criado FJ, et al. Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subco-mmittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg, 2011, 53(4):1082-1090.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Preliminary Study of A New Staging System of Aortic Dissection Based on Systemic Inflammatory Response

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