Predictive value of glycemia and serum calcium in aortic root dilation disease: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Ziyao ¹ , SONG Zhengkun ² ,  Edris·Awut ¹ ,  HUO Qiang ³

1. Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, P. R. China;
2. Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P. R. China;
3. Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, P. R. China;

Corresponding author：

Edris·Awut, Email: 15999180777@qq.com; HUO Qiang, Email: Huoqiangxinjiang@126.com

Keywords：

Aortic root dilation; aortic dissection; glycemia; serum calcium

DOI：

10.7507/1007-4848.202207017

Video：

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Objective To explore the effects of glycemia and serum calcium on occurrence and development of aortic root dilation disease. Methods The clinical data of patients with aortic root dilation who underwent surgical treatment in the Department of Cardiac Surgery of the First Affiliated Hospital of Xinjiang Medical University from January 2011 to October 2021 were retrospectively collected. They were divided into two groups according to whether they were accompanied by acute aortic dissection (Stanford type A), and were matched with the propensity scoring method. Logistic univariate and multivariate regression analyses were used to analyze the glycemia and the serum calcium of the patients in 24 hours at admission, and their receiver operating characteristic (ROC) curves were plotted. Results Finally 184 pairs of patients were matched, including 297 males with an average age of 48.76±9.62 years and 71 females with an average age of 49.97±10.97 years. There were statistical differences in ethnicity, history of hypertension, aortic root diameter, serum calcium and glycemia between the two groups (P<0.05). Logistic multivariate regression analyses results showed that age＜40 years (OR=4.106, P=0.010), Han nationality (OR=2.863, P<0.001), aortic root diameter＜45 mm (OR=5.063, P<0.001), hypertension (OR=2.736, P=0.001), hyperglycemia (OR=4.426, P<0.001) and hypocalcemia (OR=5.375, P<0.001) were independent risk factors for aortic root dilation disease with dissection. ROC curve analysis suggested that the area under the curve (AUC) of glycemia was 0.742 and the AUC of serum calcium was 0.737, all of which had some predictive value. Conclusion Hyperglycemia and hypocalcemia are risk factors for the development of aortic root dilation disease, and to some extent, they can be used as indicators for screening high-risk patients with aortic root dilation disease.

Citation： LI Ziyao, SONG Zhengkun, Edris·Awut, HUO Qiang. Predictive value of glycemia and serum calcium in aortic root dilation disease: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(9): 1327-1332. doi: 10.7507/1007-4848.202207017 Copy

1.	Saeyeldin AA, Velasquez CA, Mahmood SUB, et al. Thoracic aortic aneurysm: Unlocking the "silent killer" secrets. Gen Thorac Cardiovasc Surg, 2019, 67(1): 1-11.
2.	Sharples L, Sastry P, Freeman C, et al. Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: The effective treatments for thoracic aortic aneurysms study. Eur Heart J, 2022, 43(25): 2356-2369.
3.	Milewicz DM, Ramirez F. Therapies for thoracic aortic aneurysms and acute aortic dissections. Arterioscler Thromb Vasc Biol, 2019, 39(2): 126-136.
4.	Shen M, Quertermous T, Fischbein MP, et al. Generation of vascular smooth muscle cells from induced pluripotent stem cells: Methods, applications, and considerations. Circ Res, 2021, 128(5): 670-686.
5.	Stratman AN, Burns MC, Farrelly OM, et al. Chemokine mediated signalling within arteries promotes vascular smooth muscle cell recruitment. Commun Biol, 2020, 3(1): 734.
6.	Chen Y, Zhang T, Yao F, et al. Dysregulation of interaction between LOXhigh fibroblast and smooth muscle cells contributes to the pathogenesis of aortic dissection. Theranostics, 2022, 12(2): 910-928.
7.	Kobylecki CJ, Nordestgaard BG, Afzal S. Plasma ionized calcium and risk of cardiovascular disease: 106 774 individuals from the Copenhagen general population study. Clin Chem, 2021, 67(1): 265-275.
8.	Choudhury RP, Akbar N. Beyond diabetes: A relationship between cardiovascular outcomes and glycaemic index. Cardiovasc Res, 2021, 117(8): e97-e98.
9.	Zhu Y, Qu J, He L, et al. Calcium in vascular smooth muscle cell elasticity and adhesion: Novel insights into the mechanism of action. Front Physiol, 2019, 10: 852.
10.	Patel K, Zafar MA, Ziganshin BA, et al. Diabetes mellitus: Is it protective against aneurysm? A narrative review. Cardiology, 2018, 141(2): 107-122.
11.	Arun D, Munir W, Schmitt LV, et al. Exploring the correlation and protective role of diabetes mellitus in aortic aneurysm disease. Front Cardiovasc Med, 2021, 8: 769343.
12.	Vignac M, Ntika S, Olsson C, et al. Metformin therapy is not associated with the lower prevalence of ascending aortic aneurysm in diabetic patients. Eur J Cardiothorac Surg, 2022, 61(2): 388-392.
13.	高明妃, 胡如英. 中国糖尿病死亡流行特征研究进展. 预防医学, 2022, 34(7): 692-695.Gao MF, Hu RY. Research progress on epidemiological characteristics of death of diabetes in China. Prev Med, 2022, 34(7): 692-695.
14.	Daly A, Hovorka R. Technology in the management of type 2 diabetes: Present status and future prospects. Diabetes Obes Metab, 2021, 23(8): 1722-1732.
15.	Dall TM, Yang W, Gillespie K, et al. The economic burden of elevated blood glucose levels in 2017: Diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care, 2019, 42(9): 1661-1668.
16.	Can A, Rudy RF, Castro VM, et al. Low serum calcium and magnesium levels and rupture of intracranial aneurysms. Stroke, 2018, 49(7): 1747-1750.
17.	Roman MJ, Devereux RB, Kramer-Fox R, et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol, 1989, 64(8): 507-512.
18.	王洪岩. 急性主动脉夹层患者的入院血钠和血糖对其短期预后的影响. 华北理工大学, 2021.Wang HY. Influence of admission serum sodium and serum glucose on short-term prognosis of patients with acute aortic dissection. North China University of Science and Technology, 2021.
19.	Kim JB, Spotnitz M, Lindsay ME, et al. Risk of aortic dissection in the moderately dilated ascending aorta. J Am Coll Cardiol, 2016, 68(11): 1209-1219.
20.	Akin I, Nienaber CA. Prediction of aortic dissection. Heart, 2020, 106(12): 870-871.
21.	Ganapathi AM, Ranney DN, Peterson MD, et al. Location of aortic enlargement and risk of type A dissection at smaller diameters. J Am Coll Cardiol, 2022, 79(19): 1890-1897.
22.	Galan A, Barcelona PF, Nedev H, et al. Subconjunctival delivery of p75NTR antagonists reduces the inflammatory, vascular, and neurodegenerative pathologies of diabetic retinopathy. Invest Ophthalmol Vis Sci, 2017, 58(7): 2852-2862.
23.	Watson EC, Grant ZL, Coultas L. Endothelial cell apoptosis in angiogenesis and vessel regression. Cell Mol Life Sci, 2017, 74(24): 4387-4403.
24.	Zhou S, Huang G, Huang H. Extraction, derivatization and antioxidant activities of onion polysaccharide. Food Chem, 2022, 388: 133000.
25.	Qi K, Xia G, Huang G, et al. Extraction, chemical modification, and antioxidant activities of Daucus carota polysaccharide. Chem Biol Drug Des, 2021, 98(6): 1098-1103.
26.	阿依加马丽·加怕尔, 巴哈依定·吾甫尔. 胡萝卜的功能特性及食品应用研究进展. 现代园艺, 2013, 5(3): 11-12.Ayigamali Gabor, Bahayiding Wufuer. Research progress on functional characteristics and food applications of carrots. Mod Horticul, 2013, 5(3): 11-12.
27.	Tosello F, Guala A, D'ascenzo F, et al. Central pulse pressure is inversely associated with proximal aortic remodelling. J Hypertens, 2021, 39(5): 919-925.
28.	Lam CS, Xanthakis V, Sullivan LM, et al. Aortic root remodeling over the adult life course: Longitudinal data from the Framingham Heart Study. Circulation, 2010, 122(9): 884-890.
29.	Yin ZQ, Han H, Yan X, et al. Research progress on the pathogenesis of aortic dissection. Curr Probl Cardiol, 2022: 101249.
30.	李根, 刘达兴. 急性主动脉夹层发生机制的病理生理学研究进展. 海南医学, 2022, 9: 69-71.Li G, Liu DX. Progress in pathophysiology of acute aortic dissection. Hainan Med, 2022, 9: 69-71.
31.	Tankeu AT, Ndip Agbor V, Noubiap JJ. Calcium supplementation and cardiovascular risk: A rising concern. J Clin Hypertens (Greenwich), 2017, 19(6): 640-646.
32.	Yang Y, Chen W, Wen N, et al. Benidipine, an anti-hypertensive drug, relaxes mouse airway smooth muscle. Life Sci, 2019, 227: 74-81.
33.	Cheng J, Wen J, Wang N, et al. Ion channels and vascular diseases. Arterioscler Thromb Vasc Biol, 2019, 39(5): e146-e156.
34.	Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet, 2009, 373(9677): 1798-1807.

1. Saeyeldin AA, Velasquez CA, Mahmood SUB, et al. Thoracic aortic aneurysm: Unlocking the "silent killer" secrets. Gen Thorac Cardiovasc Surg, 2019, 67(1): 1-11.
2. Sharples L, Sastry P, Freeman C, et al. Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: The effective treatments for thoracic aortic aneurysms study. Eur Heart J, 2022, 43(25): 2356-2369.
3. Milewicz DM, Ramirez F. Therapies for thoracic aortic aneurysms and acute aortic dissections. Arterioscler Thromb Vasc Biol, 2019, 39(2): 126-136.
4. Shen M, Quertermous T, Fischbein MP, et al. Generation of vascular smooth muscle cells from induced pluripotent stem cells: Methods, applications, and considerations. Circ Res, 2021, 128(5): 670-686.
5. Stratman AN, Burns MC, Farrelly OM, et al. Chemokine mediated signalling within arteries promotes vascular smooth muscle cell recruitment. Commun Biol, 2020, 3(1): 734.
6. Chen Y, Zhang T, Yao F, et al. Dysregulation of interaction between LOXhigh fibroblast and smooth muscle cells contributes to the pathogenesis of aortic dissection. Theranostics, 2022, 12(2): 910-928.
7. Kobylecki CJ, Nordestgaard BG, Afzal S. Plasma ionized calcium and risk of cardiovascular disease: 106 774 individuals from the Copenhagen general population study. Clin Chem, 2021, 67(1): 265-275.
8. Choudhury RP, Akbar N. Beyond diabetes: A relationship between cardiovascular outcomes and glycaemic index. Cardiovasc Res, 2021, 117(8): e97-e98.
9. Zhu Y, Qu J, He L, et al. Calcium in vascular smooth muscle cell elasticity and adhesion: Novel insights into the mechanism of action. Front Physiol, 2019, 10: 852.
10. Patel K, Zafar MA, Ziganshin BA, et al. Diabetes mellitus: Is it protective against aneurysm? A narrative review. Cardiology, 2018, 141(2): 107-122.
11. Arun D, Munir W, Schmitt LV, et al. Exploring the correlation and protective role of diabetes mellitus in aortic aneurysm disease. Front Cardiovasc Med, 2021, 8: 769343.
12. Vignac M, Ntika S, Olsson C, et al. Metformin therapy is not associated with the lower prevalence of ascending aortic aneurysm in diabetic patients. Eur J Cardiothorac Surg, 2022, 61(2): 388-392.
13. 高明妃, 胡如英. 中国糖尿病死亡流行特征研究进展. 预防医学, 2022, 34(7): 692-695.Gao MF, Hu RY. Research progress on epidemiological characteristics of death of diabetes in China. Prev Med, 2022, 34(7): 692-695.
14. Daly A, Hovorka R. Technology in the management of type 2 diabetes: Present status and future prospects. Diabetes Obes Metab, 2021, 23(8): 1722-1732.
15. Dall TM, Yang W, Gillespie K, et al. The economic burden of elevated blood glucose levels in 2017: Diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care, 2019, 42(9): 1661-1668.
16. Can A, Rudy RF, Castro VM, et al. Low serum calcium and magnesium levels and rupture of intracranial aneurysms. Stroke, 2018, 49(7): 1747-1750.
17. Roman MJ, Devereux RB, Kramer-Fox R, et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol, 1989, 64(8): 507-512.
18. 王洪岩. 急性主动脉夹层患者的入院血钠和血糖对其短期预后的影响. 华北理工大学, 2021.Wang HY. Influence of admission serum sodium and serum glucose on short-term prognosis of patients with acute aortic dissection. North China University of Science and Technology, 2021.
19. Kim JB, Spotnitz M, Lindsay ME, et al. Risk of aortic dissection in the moderately dilated ascending aorta. J Am Coll Cardiol, 2016, 68(11): 1209-1219.
20. Akin I, Nienaber CA. Prediction of aortic dissection. Heart, 2020, 106(12): 870-871.
21. Ganapathi AM, Ranney DN, Peterson MD, et al. Location of aortic enlargement and risk of type A dissection at smaller diameters. J Am Coll Cardiol, 2022, 79(19): 1890-1897.
22. Galan A, Barcelona PF, Nedev H, et al. Subconjunctival delivery of p75NTR antagonists reduces the inflammatory, vascular, and neurodegenerative pathologies of diabetic retinopathy. Invest Ophthalmol Vis Sci, 2017, 58(7): 2852-2862.
23. Watson EC, Grant ZL, Coultas L. Endothelial cell apoptosis in angiogenesis and vessel regression. Cell Mol Life Sci, 2017, 74(24): 4387-4403.
24. Zhou S, Huang G, Huang H. Extraction, derivatization and antioxidant activities of onion polysaccharide. Food Chem, 2022, 388: 133000.
25. Qi K, Xia G, Huang G, et al. Extraction, chemical modification, and antioxidant activities of Daucus carota polysaccharide. Chem Biol Drug Des, 2021, 98(6): 1098-1103.
26. 阿依加马丽·加怕尔, 巴哈依定·吾甫尔. 胡萝卜的功能特性及食品应用研究进展. 现代园艺, 2013, 5(3): 11-12.Ayigamali Gabor, Bahayiding Wufuer. Research progress on functional characteristics and food applications of carrots. Mod Horticul, 2013, 5(3): 11-12.
27. Tosello F, Guala A, D'ascenzo F, et al. Central pulse pressure is inversely associated with proximal aortic remodelling. J Hypertens, 2021, 39(5): 919-925.
28. Lam CS, Xanthakis V, Sullivan LM, et al. Aortic root remodeling over the adult life course: Longitudinal data from the Framingham Heart Study. Circulation, 2010, 122(9): 884-890.
29. Yin ZQ, Han H, Yan X, et al. Research progress on the pathogenesis of aortic dissection. Curr Probl Cardiol, 2022: 101249.
30. 李根, 刘达兴. 急性主动脉夹层发生机制的病理生理学研究进展. 海南医学, 2022, 9: 69-71.Li G, Liu DX. Progress in pathophysiology of acute aortic dissection. Hainan Med, 2022, 9: 69-71.
31. Tankeu AT, Ndip Agbor V, Noubiap JJ. Calcium supplementation and cardiovascular risk: A rising concern. J Clin Hypertens (Greenwich), 2017, 19(6): 640-646.
32. Yang Y, Chen W, Wen N, et al. Benidipine, an anti-hypertensive drug, relaxes mouse airway smooth muscle. Life Sci, 2019, 227: 74-81.
33. Cheng J, Wen J, Wang N, et al. Ion channels and vascular diseases. Arterioscler Thromb Vasc Biol, 2019, 39(5): e146-e156.
34. Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet, 2009, 373(9677): 1798-1807.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of glycemia and serum calcium in aortic root dilation disease: A propensity score matching study

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