在患有胸腔大动脉动脉瘤的患者中基因检测指南的临床有效性
Ely Erez1, Adrian R Acuna Higaki1, Michela Cupo1
1Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
The Journal of thoracic and cardiovascular surgery
|September 25, 2024
概括
分析了当前对胸前动脉动脉瘤 (TAD) 的遗传测试指南. 改进标准并专注于主要基因可以改善风险分层并减少不确定的遗传发现.
科学领域:
- 心血管遗传学 心血管遗传学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 胸前动脉动脉瘤 (TAD) 是一种严重的疾病,通常与遗传因素有关.
- 目前的基因测试指南旨在确定患有遗传性胸前大动脉疾病风险的个体.
研究的目的:
- 评估现有的胸前大动脉动脉瘤遗传检测指南的有效性.
- 根据既定的临床标准来确定基因突变检测率.
主要方法:
- 从2012年到2023年对1034名患者 (≥18岁,大动脉>4厘米) 的遗传测试进行分析.
- 基于年龄 (<60岁),综合征特征,家族病史或没有满足标准的突变率的比较.
- 将基因分类为与遗传性疾病的主要 (强烈相关) 或次要 (较少相关) 的基因.
主要成果:
- 总体病原性突变率为3.97%,其中不确定的意义 (VUS) 的变异为27.27%.
- 在具有综合征特征 (13.2%) 的患者中观察到的最高突变率,其次是年龄<60 (5.48%),家族病史 (4.63%) 和没有标准 (2.21%).
- 与二次基因相比,主要基因的病原性率较高 (3.29%),但VUS较低 (12.19%).
结论:
- 通过多个患者标准来完善基因测试指南,可以改善TAD的风险分层.
- 将基因测试集中在与TAD相关的初级基因上,可能会减少VUS的发生率.
- 改进的基因检测策略可以支持胸前动脉疾病患者的明智临床决策.
相关概念视频
Aneurysm II: Clinical Manifestations and Diagnostic Studies
3
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
3
Aneurysm III: Interprofessional Care
3
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
3
Atherosclerosis II: Clinical manifestations and prevention
2
Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
2
Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
3
Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
3
Atherosclerosis III: Management
2
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
2
Aneurysm IV: Nursing Management
3
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
3


