Objectives
Type A aortic dissection (ATAAD) is hypothesised as a progression of aneurysmal dilation,
but 60% of patients in the International Registry of Acute Aortic Dissection (iRAD)
registry had a maximum aortic diameter (MAD)<55 mm. We aim to demonstrate that size
ratios and aortic wall stress, assessed using a simplified markers, are unique to
aortic patients who have had adverse events (ATAAD) compared to those who have not
(thoracic aortic aneurysm [TAA]).
Methods
A retrospective cohort analysis of patients who underwent aortic intervention at Waikato
Hospital, New Zealand between 2015–2020, comparing dissection (ATAAD) to TAA patients.
MAD; ratio of MAD to standardised-points within the aorta; and MAD-to-height collected
from computed tomography (CT)-scans of all patients was undertaken. Receiver operating
characteristic (ROC)-analysis to determine cut-off point for each marker was undertaken
together with multivariable logistic regression comparing both cohorts, cross-validated
by propensity-score matched analysis.
Results
Cohort of 215 patients, 78 (36.3%) ATAAD and 137 (63.7%) TAA; median age at intervention
63.3 years, 52 (24.2%) females, both cohorts matched for size. Using the entire cohort,
the MAD: sinus of Valsalva (SoV) ratio>1.06 (cut-off value) had 4.5-times greater
association with ATAAD (95%CI 1.46–13.8) and a 0.1-unit increased conferred 1.45-times
greater association with ATAAD (95%CI 1.00–2.08). MAD>55 mm only seen in 33.3% of
ATAAD (n=26/78), and not associated with ATAAD (OR 1.88, 95%CI 0.64–5.51). Compared
to MAD, MAD:SoV ratio had greater sensitivity (33% vs 73%), lower number-needed-to-treat
(17.9 vs 2.7) and superior discrimination (area under the curve [AUC] 0.54 vs 0.71).
Findings were consistent with propensity score matched analysis.
Conclusions
MAD:SoV ratio significantly correlates with ATAAD (4.5 times), with superior sensitivity,
discrimination, and attributable-risk-percentage compared to MAD alone.
Keywords
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References
- What is the appropriate size criterion for resection of thoracic aortic aneurysms?.J Thorac Cardiovasc Surg. 1997; 113 (discussion 489-491): 476-491
- Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research.Circulation. 2018; 137: 1846-1860
- Thoracic aortic aneurysm clinically pertinent controversies and uncertainties.J Am Coll Cardiol. 2010; 55: 841-857
- Echocardiography in aortic diseases: EAE recommendations for clinical practice.Eur J Echocardiogr. 2010; 11: 645-658
- How does the ascending aorta geometry change when it dissects?.J Am Coll Cardiol. 2014; 63: 1311-1319
- 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: 944-948 e941
- Introduction to the single ventricle reconstruction trial.J Thorac Cardiovasc Surg. 2012; 144: 880-881
- Aortic size distribution in the general population: explaining the size paradox in aortic dissection.Cardiology. 2015; 131: 265-272
- Aortic dimensions as predictors of adverse events.J Thorac Cardiovasc Surg. 2021; 161: 1193-1197
- Who is at risk of dissection or rupture in moderately dilated ascending aorta?.J Thorac Dis. 2016; 8: E1655-E1656
- Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection.Heart. 2020; 106: 892-897
- Four-dimensional flow cardiovascular magnetic resonance in aortic dissection: assessment in an ex vivo model and preliminary clinical experience.J Thorac Cardiovasc Surg. 2019; 157: 467-476 e461
- Mechanisms of vascular disease: a textbook for vascular specialists.Springer Nature, 2020
- 2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases: Document Covering Acute and Chronic Aortic Diseases of the Thoracic and Abdominal Aorta of the Adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2873-2926
- Dimensions of blood vessels from distributing artery to collecting vein.Circ Res. 1963; 12: 375-378
- Index for rating diagnostic tests.Cancer. 1950; 3: 32-35
- 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: 1120-1127
- Predictive imaging for thoracic aortic dissection and rupture: moving beyond diameters.Eur Radiol. 2019; 29: 6396-6404
Article info
Publication history
Published online: May 18, 2022
Accepted:
March 24,
2022
Received in revised form:
March 22,
2022
Received:
February 10,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
