Neovascularization with chronic inflammation characterizes ascending aortic dissectionEetu Niinimäki1, Ville Pynnönen2, Ivana Kholova2, Timo Paavonen2, Ari Mennander1
1Department of Pathology, Fimlab Laboratories, Cardiac Research, Tampere University Hospital and Tampere University Medical School; Tampere-Finland
2Departments of Pathology, Heart Center, Cardiac Research, Tampere University Hospital and Tampere University Medical School; Tampere-Finland
Objective: Neovascularization of the aortic wall may be associated with aortic dissection (AD). Aortic wall endothelial CD31 deposition together with chronic inflammation indicates angiogenesis that may lead to tissue disruption. We studied the presence of neovascularization of the ascending aortic wall by characterizing CD31 positive endothelial cells.Keywords: neovascularization, ascending aortic dissection, chronic inflammation, CD31
Methods: Aortic wall routine histology and immunohistochemistry for CD31, T- and B-lymphocytes, plasma cells, macrophages, endothelial cells, smooth muscle cells, and cell proliferation were performed on 35 selected patients who underwent surgery for the ascending aorta, and the samples were grouped according to the presence of AD.
Results: Three subjects with Marfan syndrome were excluded from the study. A total of 14 out of 32 patients had AD. A total of 18 patients were operated on due to dilatation only. Chronic inflammation of the adventitia (p=0.003), media (p=0.001), and intima (p=0.005) was increased in AD. Neovascularization was predominant in the outer third medial layer in AD (p=0.037), corresponding to the site of aortic wall disruption. A receiver operating characteristic curve analysis showed that neovascularization was associated with AD (AUC 0.750; SE 0.092; p=0.022; 95% CI 0.5700.930).
Conclusion: Endothelial immunohistochemistry confirms neovascularization of the outer third medial layer during AD. Aortic wall remodeling including neovascularization characterizes AD. Chronic inflammation and neovascularization of the dilated ascending aorta suggest susceptibility for AD.
Eetu Niinimäki, Ville Pynnönen, Ivana Kholova, Timo Paavonen, Ari Mennander. Neovascularization with chronic inflammation characterizes ascending aortic dissection. Anatol J Cardiol. 2018; 20(5): 289-295
Sorumlu Yazar: Ari Mennander, Finland