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

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Abstract

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.
Original languageEnglish
Pages (from-to)787 - 797
Number of pages10
JournalCirculation
Volume136
Issue number9
DOIs
Publication statusPublished - 29 Aug 2017

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Abdominal Aortic Aneurysm
Aneurysm
Rupture
Inflammation
Magnetic Resonance Imaging
Habits
Smoking
ferumoxtran-10
Aortic Rupture
Mortality
Growth
Disease-Free Survival
Cohort Studies
Confidence Intervals

Keywords

  • abdominal aortic aneurysm
  • MRI
  • repair
  • rupture

Cite this

@article{eb0455259f284bbcbc75207cb4c2d898,
title = "Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture and need for surgical repair",
abstract = "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.",
keywords = "abdominal aortic aneurysm , MRI, repair, rupture",
author = "John Houston",
note = "This study was funded by the Medical Research Council and managed by the National Institute of Healthcare Research on behalf of the Medical Research Council‒National Institute of Healthcare Research partnership (National Institute of Healthcare Research Efficacy and Mechanism Evaluation Program: funding reference 11/20/03). Dr Newby is supported by the British Heart Foundation (CH/09/002, RE/13/3/30183, RM/13/2/30158) and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Olivia B.M. McBride is supported by the Academic Department of Military Surgery and Trauma.",
year = "2017",
month = "8",
day = "29",
doi = "10.1161/CIRCULATIONAHA.117.028433",
language = "English",
volume = "136",
pages = "787 -- 797",
journal = "Circulation",
issn = "0009-7322",
publisher = "American Heart Association",
number = "9",

}

Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture and need for surgical repair. / Houston, John.

In: Circulation, Vol. 136, No. 9, 29.08.2017, p. 787 - 797.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture and need for surgical repair

AU - Houston, John

N1 - This study was funded by the Medical Research Council and managed by the National Institute of Healthcare Research on behalf of the Medical Research Council‒National Institute of Healthcare Research partnership (National Institute of Healthcare Research Efficacy and Mechanism Evaluation Program: funding reference 11/20/03). Dr Newby is supported by the British Heart Foundation (CH/09/002, RE/13/3/30183, RM/13/2/30158) and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Olivia B.M. McBride is supported by the Academic Department of Military Surgery and Trauma.

PY - 2017/8/29

Y1 - 2017/8/29

N2 - 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.

AB - 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.

KW - abdominal aortic aneurysm

KW - MRI

KW - repair

KW - rupture

U2 - 10.1161/CIRCULATIONAHA.117.028433

DO - 10.1161/CIRCULATIONAHA.117.028433

M3 - Article

VL - 136

SP - 787

EP - 797

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 9

ER -