Aortic stiffness in thoracic aortic aneurysm patients
Research type
Research Study
Full title
Observation on aortic stiffness in patients with thoracic aortic aneurysm: prognostic implications and changes after surgery.
IRAS ID
334824
Contact name
Riccardo Proietti
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
2 years, 8 months, 31 days
Research summary
The NHS faces a significant challenge in controlling end-organ damage associated with high blood pressure due to the increasing number of older persons and the growing incidence of chronic hypertension in Western nations. Although there has been significant study conducted on the correlation between high blood pressure and diseases such as coronary artery disease and renal failure, aortic pathologies such thoracic aortic aneurysms (TAA) are sometimes overlooked. TAAs are particularly dangerous due to their silent progression, leading to potentially fatal outcomes if not detected early.
High blood pressure is the main contributing factor for TAA, underscoring the importance of careful blood pressure control in individuals with the condition. Recent research indicates that central aortic blood pressure (CAP) offers a more precise representation of hemodynamic stress compared to conventional brachial blood pressure measurements. The association between CAP and aneurysm growth underscores its significance in the assessment of thoracic aortic aneurysms (TAA). Furthermore, there is a correlation between aortic stiffness, which is assessed by pulse wave velocity (PWV), and alterations in cardiac workload and heart function, particularly following procedures such as stent grafts.
Recent studies on biomarkers, such as markers of inflammation and indicators of endothelial function, provide a new understanding of the processes that contribute to the enlargement of aneurysms and the development of aortic diseases. These findings propose specific routes for focused therapies. The expanding comprehension emphasizes the significance of enhanced diagnostic tools and awareness in order to efficiently handle and reduce the hazards linked to TAAs in older individuals.
This project will focus on thoracic aortic aneurysm (TAA), which are aneurysms that occur close to the heart and are very difficult to detect, and a leading cause of death in the Western World. The most worrisome aspect of TAAs is related to its silent clinical progression with one in two cases occurring without any symptoms and often detected by chance. Worldwide, TAAs cause up to 175,000 deaths per year, accounting for 1 % of deaths in men over 65 years of age. In England, 6000 people die of TAAs each year. Hypertension is the most important risk factor for the onset and progression of TAA; therefore, controlling blood pressure is essential in its clinical management. Recent studies have suggested that the assessment of central aortic pressure (CAP) and arterial stiffness (AS) can be a more reliable marker than brachial blood pressure(bBP) in monitoring TAA progression.
The overarching aim of this project is to investigate the applicability of AS and CAP in the clinical monitoring of patients with TAA. This will be achieved through the following specific objectives:
1) We assess the difference in AS, CAP, and ratio CAP:bBP between three groups of patients: TAA with no indication for surgery, TAA with an indication for surgery, and the hypertensive group without TAA.
2) We correlate AS, CAP, and ratio CAP:bBP with the progression of aneurysm. The measurements will be gathered from participant file records, and the changes in aortic diameter over the preceding 5-10 years will be considered.
3) We investigate the changes in AS, CAP and ratio CAP:bBP in patients undergoing aortic endovascular repair or open chest surgery. We correlate these changes with echocardiographic markers of left ventricle workload.In addition, we are collecting blood samples from the participants to assess the correlation between inflammatory biomarkers (CRP, Interleukin-6, E-selectin, Von Willebrand factor, D-dimer, T, and high-sensitivity troponin) and AS in patients with TAA. Our study aims to define new pathways in the management of a wide population of patients with TAA by integrating into clinical practice the assessment of AS, CAP, and blood biomarkers.
REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
24/EM/0112
Date of REC Opinion
21 Aug 2024
REC opinion
Further Information Favourable Opinion