Download PDF
CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2024; 72(02): 126-133
DOI: 10.1055/s-0043-57026
Original Cardiovascular

Computed Tomography Scan of the Aorta to Predict Type B Aortic Dissection

Han Lee
1   Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
2   Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, Jiangsu, China
,
Qing Zhou
1   Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
2   Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, Jiangsu, China
,
Haitao Zhang
1   Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
,
Min Jin
3   Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
,
XinLong Tang
1   Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
,
Kai Li
3   Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
,
Tayierjiang Tuoerxun
4   Department of Cardiothoracic Surgery, Nanjing University, Nanjing, Jiangsu, China
› Author Affiliations Funding Funding for Clinical Trials from the Affiliated Hospital, Medical School of University 2022-LCYJ-PY-50.
› Further Information
   Permissions and Reprints All articles of this category

Abstract

Background The purpose of this study is to find the high-risk morphological features in type B aortic dissection (TBAD) population and to establish an early detection model.

Methods From June 2018 to February 2022, 234 patients came to our hospital because of chest pain. After examination and definite diagnosis, we excluded people with previous cardiovascular surgery history, connective tissue disease, aortic arch variation, valve malformation, and traumatic dissection. Finally, we included 49 patients in the TBAD group and 57 in the control group. The imaging data were retrospectively analyzed by Endosize (Therevna 3.1.40) software. The aortic morphological parameters mainly include diameter, length, direct distance, and tortuosity index. Multivariable logistic regression models were performed and systolic blood pressure (SBP), aortic diameter at the left common carotid artery (D3), and length of ascending aorta (L1) were chosen to build a model. The predictive capacity of the models was evaluated through the receiver operating characteristic (ROC) curve analysis.

Results The diameters in the ascending aorta and aortic arch are larger in the TBAD group (33.9 ± 5.9 vs. 37.8 ± 4.9 mm, p < 0.001; 28.2 ± 3.9 vs. 31.7 ± 3.0 mm, p < 0.001). The ascending aorta was significantly longer in the TBAD group (80.3 ± 11.7 vs. 92.3 ± 10.6 mm, p < 0.001). Besides, the direct distance and tortuosity index of the ascending aorta in the TBAD group increased significantly (69.8 ± 9.0 vs. 78.7 ± 8.8 mm, p < 0.001; 1.15 ± 0.05 vs. 1.17 ± 0.06, p < 0.05). Multivariable models demonstrated that SBP, aortic diameter at the left common carotid artery (D3), and length of ascending aorta (L1) were independent predictors of TBAD occurrence. Based on the ROC analysis, area under the ROC curve of the risk prediction models was 0.831.

Conclusion Morphological characteristic including diameter of total aorta, length of ascending aorta, direct distance of ascending aorta, and tortuosity index of ascending aorta are valuable geometric risk factors. Our model shows a good performance in predicting the incidence of TBAD.

Keywords

aorta/aortic - anatomy - computed tomography - CAT scan

Authors' Contribution

Conception and design of the work, corresponding author: Z.Q.; data collection: L.K., T.T., J.M.; statistical analysis: Z.H.; analysis and interpretation of the data: T.X.; drafting the manuscript: L.H.; critical revision of the manuscript: L.H.




Publication History

Received: 20 November 2022

Accepted: 13 March 2023

Article published online:
03 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Vilacosta I, San Román JA, di Bartolomeo R. et al. Acute aortic syndrome revisited: JACC state-of-the-art review. J Am Coll Cardiol 2021; 78 (21) 2106-2125
    Google Scholar
  • 2 Lombardi JV, Hughes GC, Appoo JJ. et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg 2020; 71 (03) 723-747
    Google Scholar
  • 3 Alberta HB, Takayama T, Smits TC. et al. Aortic arch morphology and aortic length in patients with dissection, traumatic, and aneurysmal disease. Eur J Vasc Endovasc Surg 2015; 50 (06) 754-760
    Google Scholar
  • 4 Poullis M. Aortic length and curvature and risk of aortic dissection. J Cardiovasc Surg (Torino) 2021; 62 (04) 410
    Google Scholar
  • 5 Krüger T, Sandoval Boburg R, Lescan M. et al. Aortic elongation in aortic aneurysm and dissection: the Tübingen Aortic Pathoanatomy (TAIPAN) project. Eur J Cardiothorac Surg 2018; 54 (01) 26-33
    Google Scholar
  • 6 Gode S, Akinci O, Ustunısık CT. et al. The role of the angle of the ascending aortic curvature on the development of type A aortic dissection: ascending aortic angulation and dissection. Interact Cardiovasc Thorac Surg 2019; 29 (04) 615-620
    Google Scholar
  • 7 Heuts S, Adriaans BP, Gerretsen S. et al. Aortic elongation part II: the risk of acute type A aortic dissection. Heart 2018; 104 (21) 1778-1782
    Google Scholar
  • 8 MacGillivray TE, Gleason TG, Patel HJ. et al. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. Ann Thorac Surg 2022; 113 (04) 1073-1092
    Google Scholar
  • 9 Wang W, Duan W, Xue Y. et al; Registry of Aortic Dissection in China Sino-RAD Investigators. Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China. J Thorac Cardiovasc Surg 2014; 148 (06) 2995-3000
    Google Scholar
  • 10 Robicsek F, Thubrikar MJ. Hemodynamic considerations regarding the mechanism and prevention of aortic dissection. Ann Thorac Surg 1994; 58 (04) 1247-1253
    Google Scholar
  • 11 Davies RR, Gallo A, Coady MA. et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg 2006; 81 (01) 169-177
    Google Scholar
  • 12 Coady MA, Rizzo JA, Hammond GL. et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms?. J Thorac Cardiovasc Surg 1997; 113 (03) 476-491 , discussion 489–491
    Google Scholar
  • 13 Davies RR, Goldstein LJ, Coady MA. et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg 2002; 73 (01) 17-27 , discussion 27–28
    Google Scholar
  • 14 Pape LA, Tsai TT, Isselbacher EM. et al; International Registry of Acute Aortic Dissection (IRAD) Investigators. Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation 2007; 116 (10) 1120-1127
    Google Scholar
  • 15 O'Rourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol 2007; 50 (01) 1-13
    Google Scholar
  • 16 Koullias GJ, Ravichandran P, Korkolis DP, Rimm DL, Elefteriades JA. Increased tissue microarray matrix metalloproteinase expression favors proteolysis in thoracic aortic aneurysms and dissections. Ann Thorac Surg 2004; 78 (06) 2106-2110 , discussion 2110–2111
    Google Scholar
  • 17 Coady MA, Rizzo JA, Hammond GL, Kopf GS, Elefteriades JA. Surgical intervention criteria for thoracic aortic aneurysms: a study of growth rates and complications. Ann Thorac Surg 1999; 67 (06) 1922-1926 , discussion 1953–1958
    Google Scholar
  • 18 Trimarchi S, Jonker FH, Hutchison S. et al. Descending aortic diameter of 5.5 cm or greater is not an accurate predictor of acute type B aortic dissection. J Thorac Cardiovasc Surg 2011; 142 (03) e101-e107
    Google Scholar
  • 19 Rylski B, Branchetti E, Bavaria JE. et al. Modeling of predissection aortic size in acute type A dissection: more than 90% fail to meet the guidelines for elective ascending replacement. J Thorac Cardiovasc Surg 2014; 148 (03) 944-8.e1
    Google Scholar
  • 20 Krüger T, Forkavets O, Veseli K. et al. Ascending aortic elongation and the risk of dissection. Eur J Cardiothorac Surg 2016; 50 (02) 241-247
    Google Scholar
  • 21 Shirali AS, Bischoff MS, Lin HM. et al. Predicting the risk for acute type B aortic dissection in hypertensive patients using anatomic variables. JACC Cardiovasc Imaging 2013; 6 (03) 349-357
    Google Scholar
  • 22 Lescan M, Veseli K, Oikonomou A. et al. Aortic elongation and Stanford B dissection: the Tubingen Aortic Pathoanatomy (TAIPAN) project. Eur J Vasc Endovasc Surg 2017; 54 (02) 164-169
    Google Scholar
  • 23 Sun L, Li X, Li Q. et al. Morphological features of aortic arch predicting the risk for acute type B aortic dissection. World J Surg 2021; 45 (11) 3458-3466
    Google Scholar
  • 24 Adriaans BP, Heuts S, Gerretsen S. et al. Aortic elongation part I: the normal aortic ageing process. Heart 2018; 104 (21) 1772-1777
    Google Scholar
  • 25 Morrison TM, Choi G, Zarins CK, Taylor CA. Circumferential and longitudinal cyclic strain of the human thoracic aorta: age-related changes. J Vasc Surg 2009; 49 (04) 1029-1036
    Google Scholar
  • 26 Sokolis DP. Passive mechanical properties and structure of the aorta: segmental analysis. Acta Physiol (Oxf) 2007; 190 (04) 277-289
    Google Scholar
  • 27 Sokolis DP, Boudoulas H, Karayannacos PE. Segmental differences of aortic function and composition: clinical implications. Hellenic J Cardiol 2008; 49 (03) 145-154
    Google Scholar