Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture, and need for surgical repair

Newby, D. et al. (2017) Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture, and need for surgical repair. Circulation, 136(9), pp. 787-797. (doi: 10.1161/CIRCULATIONAHA.117.028433) (PMID:28720724) (PMCID:PMC5571881)

209022.pdf - Published Version
Available under License Creative Commons Attribution.



Background: Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation on magnetic resonance imaging (MRI). In patients with abdominal aortic aneurysm, we assessed whether USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes. Methods: In a prospective multicenter open-label cohort study, 342 patients with abdominal aortic aneurysm (diameter ≥40 mm) were classified by the presence of USPIO enhancement and were monitored with serial ultrasound and clinical follow-up for ≥2 years. The primary end point was the composite of aneurysm rupture or repair. Results: Participants (85% male, 73.1±7.2 years) had a baseline aneurysm diameter of 49.6±7.7 mm, and USPIO enhancement was identified in 146 (42.7%) participants, absent in 191 (55.8%), and indeterminant in 5 (1.5%). During follow-up (1005±280 days), 17 (5.0%) abdominal aortic aneurysm ruptures, 126 (36.8%) abdominal aortic aneurysm repairs, and 48 (14.0%) deaths occurred. Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1±2.5 versus 2.5±2.4 mm/year, P=0.0424), although this was not independent of current smoking habit (P=0.1993). Patients with USPIO enhancement had higher rates of aneurysm rupture or repair (47.3% versus 35.6%; 95% confidence intervals, 1.1–22.2; P=0.0308). This finding was similar for each component of rupture (6.8% versus 3.7%, P=0.1857) or repair (41.8% versus 32.5%, P=0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair (P=0.0275), all-cause mortality (P=0.0635), and aneurysm-related mortality (P=0.0590). Baseline abdominal aortic aneurysm diameter (P<0.0001) and current smoking habit (P=0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic, 0.7935–0.7936). Conclusions USPIO-enhanced MRI is a novel approach to the identification of aortic wall cellular inflammation in patients with abdominal aortic aneurysms and predicts the rate of aneurysm growth and clinical outcome. However, it does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Stuart, Mr Wesley and Roditi, Dr Giles and Berry, Professor Colin
Authors: Newby, D., Forsythe, R., McBride, O., Robson, J., Vesey, A., Chalmers, R., Burns, P., Garden, O. J., Semple, S., Dweck, M., Gray, C., MacGillivray, T., Wang, C., Koutraki, Y. G., Mitchard, N., Cooper, A., van Beek, E., McKillop, G., Ho, W., Fraser, L., Cuthbert, H., Hoskins, P., Doyle, B., Conlisk, N., Stuart, W., Berry, C., Roditi, G., Murdoch, L., Holdsworth, R., Scott, E., Milne, L., Strachan, F., Wee, F., Oatey, K., Graham, C., Murray, G., Milne, G., Bucukoglu, M., Goodman, K., Kaczynski, J., Shah, A., Tambyraja, A., Brittenden, J., Houston, G., Lambie, R., and Norrie, J.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Circulation
Publisher:American Heart Association
ISSN (Online):1524-4539
Published Online:18 July 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Circulation 136(9):787-797
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
169122BHF Centre for regenerative medicineAndrew BakerBritish Heart Foundation (BHF)RM/13/2/30158Institute of Cardiovascular & Medical Sciences