TY - JOUR
T1 - Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture, and need for surgical repair
AU - The MA3RS Study Investigators
AU - Forsythe, Rachael
AU - McBride, Olivia
AU - Robson, Jennifer
AU - Vesey, Alex
AU - Chalmers, Roderick
AU - Burns, Paul
AU - Garden, O. James
AU - Newby, David
AU - Semple, Scott
AU - Dweck, Marc
AU - Gray, Calum
AU - MacGillivray, Tom
AU - Wang, Chengjia
AU - Koutraki, Yolanda Georgia
AU - Mitchard, Neil
AU - Cooper, Annette
AU - Van Beek, Edwin
AU - McKillop, Graham
AU - Ho, Weiyang
AU - Fraser, Liz
AU - Cuthbert, Hayley
AU - Hoskins, Peter
AU - Doyle, Barry
AU - Conlisk, Noel
AU - Stuart, Wesley
AU - Berry, Colin
AU - Roditi, Giles
AU - Murdoch, Laura
AU - Holdsworth, Richard
AU - Scott, Emma
AU - Milne, Lynsey
AU - Strachan, Fiona
AU - Wee, Fiona
AU - Oatey, Katherine
AU - Graham, Catriona
AU - Murray, Gordon
AU - Milne, Garry
AU - Bucukoglu, Marise
AU - Goodman, Kirsteen
AU - Kaczynski, Jakub
AU - Shah, Anoop
AU - Tambyraja, Andrew
AU - Brittenden, Julie
AU - Houston, Graeme
AU - Lambie, Robert
AU - Norrie, John
AU - Mc-Bride, Olivia
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% versus3.7%, 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 inpatients 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% versus3.7%, 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 inpatients 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
C2 - 28720724
AN - SCOPUS:85026221592
SN - 0009-7322
VL - 136
SP - 787
EP - 797
JO - Circulation
JF - Circulation
IS - 9
ER -