Acute Aortic Disease.. - Index of

348 Elefteriades
Figure 1 (See color insert) Future prospects in care of aneurysm disease.
disease. She has enumerated various categories of mutations, which comprise
considerable portions of the population with thoracic aortic aneurysm. Our own
laboratory, in conjunction with colleagues at Celera Diagnostics and Applied
Biosystems, has been performing genome-wide scanning of large libraries of
specific single nucleotide polymorphisms in hundreds of patients affected by thoracic
aortic aneurysm. We are hopeful that DNA patterns will be uncovered that can
diagnose a genetic aneurysm diathesis. At the RNA level, we have already achieved
some success, with identification of upregulated and downregulated RNAs that distinguish
patients with thoracic aortic aneurysm from controls (1–3). We are in the
process of reducing this testing to a clinically applicable 41-RNA gene chip that can
be used at the bedside (Fig. 2). If this “RNA Signature” profile is borne out in more
extensive clinical testing, it may be possible to test a chest pain patient on presentation
to the emergency department for the aneurysm diathesis. The diagnosis of aneurysm
disease on a molecular, genetic basis is becoming a reality. This means of
diagnosis is virtually assured of advancing dramatically in the near-term future.
FURTHER ADVANCEMENTS IN DIAGNOSTIC IMAGING
OF THE AORTA
Diagnostic imaging has undergone tremendous advancement in the last decade.
Three-dimensional imaging techniques [computed tomography (CT), magnetic
resonance imaging (MRI), transesophageal echocardiography (TEE)] have virtually
supplanted angiography in imaging of aortic aneurysms and dissections and,