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      Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

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          The natural course of abdominal aortic aneurysms ( AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture.

          Methods and Results

          Potential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty‐two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S‐elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta‐analysis was conducted because of clinical and methodological heterogeneity.


          We identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.

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          Most cited references 94

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          Measuring inconsistency in meta-analyses.

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            Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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              Evaluation of the quality of prognosis studies in systematic reviews.

              To provide valid assessments of answers to prognostic questions, systematic reviews must appraise the quality of the available evidence. However, no standard quality assessment method is currently available. To appraise how authors assess the quality of individual studies in systematic reviews about prognosis and to propose recommendations for these quality assessments. English-language publications listed in MEDLINE from 1966 to October 2005 and review of cited references. 163 systematic reviews about prognosis that included assessments of the quality of studies. A total of 882 distinct quality items were extracted from the assessments that were reported in the various reviews. Using an iterative process, 2 independent reviewers grouped the items into 25 domains. The authors then specifically identified domains necessary to assess potential biases of studies and evaluated how often those domains had been addressed in each review. Fourteen of the domains addressed 6 sources of bias related to study participation, study attrition, measurement of prognostic factors, measurement of and controlling for confounding variables, measurement of outcomes, and analysis approaches. Reviews assessed a median of 2 of the 6 potential biases; only 2 (1%) included criteria aimed at appraising all potential sources of bias. Few reviews adequately assessed the impact of confounding (12%), although more than half (59%) appraised the methods used to measure the prognostic factors of interest. Reviews may have been missed by the search or misclassified because of incomplete reporting. Validity and reliability testing of the authors' recommendations are required. Quality appraisal, a necessary step in systematic reviews, is incomplete in most reviews of prognosis studies. Adequate quality assessment should include judgments about 6 areas of potential study biases. Authors should incorporate these quality assessments into their synthesis of evidence about prognosis.

                Author and article information

                J Am Heart Assoc
                J Am Heart Assoc
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                30 June 2018
                03 July 2018
                : 7
                : 13 ( doiID: 10.1002/jah3.2018.7.issue-13 )
                [ 1 ] Department of Vascular Surgery Amsterdam Cardiovascular Sciences (ACS) VU University Medical Center (VUmc) Amsterdam The Netherlands
                [ 2 ] Department of Physiology Amsterdam Cardiovascular Sciences (ACS) VU University Medical Center (VUmc) Amsterdam The Netherlands
                [ 3 ] Department of Health Sciences and Amsterdam Public Health research institute VU University Amsterdam The Netherlands
                Author notes
                [* ] Correspondence to: Kak Khee Yeung, MD, PhD, Department of Vascular Surgery, VU University Medical Center Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. E‐mail: k.yeung@
                © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                Page count
                Figures: 1, Tables: 4, Pages: 16, Words: 12860
                Systematic Review and Meta‐analysis
                Systematic Review and Meta‐analysis
                Custom metadata
                03 July 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version= mode:remove_FC converted:03.07.2018


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