Impact of histopathological changes in ascending aortic diseases

• Published in: International journal of cardiology 2020-07, Vol.311, p.91-96
• Main Authors: Amemiya, Kisaki, Mousseaux, Elie, Ishibashi-Ueda, Hatsue, Achouh, Paul, Ochiai, Masahiko, Bruneval, Patrick
• Format: Article
• Language: English
• Subjects: Aneurysm, Dissecting - diagnostic imaging; Aorta imaging; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - epidemiology; Aortic Diseases; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Bicuspid aortic valve; Cohort Studies; Histopathology; Humans; Media degenerative changes; Middle Aged; Thoracic aortic aneurysms; Thoracic aortic dissections
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2020.04.011

To better understand relationship between histological medial degenerative changes (MDC), pathological status [thoracic aorta aneurysm (TAA), thoracic aorta dissection (TAD), bicuspid aortic valve (BAV), and non-BAV] and aortic size at imaging. We collected 496 ascending aorta surgical specimens from patients with degenerative aortic diseases (mean age, 61 years) whose imaging data were available, including BAV in 191 (TAD 4%, TAA 96%) and with non-BAV in 305 (TAD 45%, TAA 55%). We analyzed them according to the pathology consensus statement and scored MDC [elastic fiber fragmentation and/or loss (EFFL); smooth muscle nuclei loss (SMNL); mucoid extracellular matrix accumulation (MEMA), intralamellar (I) or translamellar (T)] and measured medial wall thickness on correlation with imaging data and the status (TAA, TAD, BAV, or non-BAV). In TAA subset, EFFL, SMNL and MEMA-T scores were lower in BAV than in non-BAV. In relation to the aortic diameter, EFFL, SMNL and MEMA-T scores were more important in TAD subset than in TAA at the small aortic diameters. Independent predictors of aortic dissection included thicker medial wall (odds ratio [OR], 6.3; 95% confidence interval [CI], 2.4 to 17.6; p