Thoracic aortic aneurysm: reading the enemy's playbook.
BACKGROUND
The purpose of the present study was to use the clinical database at the Yale University Center for Thoracic Aortic Disease to shed light on the pathophysiology of thoracic aortic aneurysm (TAA), the clinical behavior of thoracic aortic aneurysm, and the optimal clinical management.


METHODS
The Yale database contains information on 3,000 patients with thoracic aortic aneurysm, with 9,000 patient-years of follow-up and 9,000 imaging studies. Advanced statistical techniques were applied to this information.


RESULTS
Analysis provided the following observations: (1) TAA is a genetic disease with a predominantly autosomal dominant mode of inheritance, (2) matrix metalloproteinase (MMP) enzymes are activated in the pathogenesis of TAA, (3) wall tension in TAA approaches the tensile limits of aortic tissue at a diameter of 6 cm, (4) by the time a TAA reaches a clinical diameter of 6 cm, 34% of affected patients have suffered dissection or rupture, (5) extreme physical exertion or severe emotion often precipitate acute dissection, and (6) single nucleotide polymorphisms (SNPs) are being identified which predispose a patient to TAA.


CONCLUSIONS
The "playbook" of TAA is gradually being read, with the help of scientific investigations, positioning practitioners to combat this lethal disease more effectively than ever before.
Elefteriades
John A
JA
Division of Cardiothoracic Surgery, Yale University Medical Center, 333 Cedar Street, Room 121 FMB, New Haven, Connecticut 06510, USA. john.elefteriades@yale.edu
D000784:Aortic Dissection / Q000145:classification / Q000628:therapy; D001011:Aorta / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000235:genetics / Q000401:mortality; D001019:Aortic Rupture / Q000145:classification / Q000209:etiology; D001837:Body Weights and Measures; D002908:Chronic Disease; D003237:Connecticut; D016208:Databases, Factual; D006801:Humans; D049451:Nomograms; D017063:Outcome Assessment, Health Care; D010375:Pedigree; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis