Kai Higashigaito1, Anna M Sailer2, Sander M J van Kuijk3, Martin J Willemink4, Lewis D Hahn5, Trevor J Hastie6, D Craig Miller7, Michael P Fischbein7, Dominik Fleischmann8. 1. Stanford 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif. 2. Stanford 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif. 3. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands. 4. Stanford 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. 5. Stanford 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Stanford, Calif. 6. Department of Statistics, Stanford University, Stanford, Calif. 7. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif. 8. Stanford 3D and Quantitative Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif. Electronic address: d.fleischmann@stanford.edu.
Abstract
BACKGROUND: Patients with medically treated type B aortic dissection (TBAD) remain at significant risk for late adverse events (LAEs). We hypothesize that not only initial morphological features, but also their change over time at follow-up are associated with LAEs. MATERIALS AND METHODS: Baseline and 188 follow-up computed tomography (CT) scans with a median follow-up time of 4 years (range, 10 days to 12.7 years) of 47 patients with acute uncomplicated TBAD were retrospectively reviewed. Morphological features (n = 8) were quantified at baseline and each follow-up. Medical records were reviewed for LAEs, which were defined according to current guidelines. To assess the effects of changes of morphological features over time, the linear mixed effects models were combined with Cox proportional hazards regression for the time-to-event outcome using a joint modeling approach. RESULTS: LAEs occurred in 21 of 47 patients at a median of 6.6 years (95% confidence interval [CI], 5.1-11.2 years). Among the 8 investigated morphological features, the following 3 features showed strong association with LAEs: increase in partial false lumen thrombosis area (hazard ratio [HR], 1.39; 95% CI, 1.18-1.66 per cm2 increase; P < .001), increase of major aortic diameter (HR, 1.24; 95% CI, 1.13-1.37 per mm increase; P < .001), and increase in the circumferential extent of false lumen (HR, 1.05; 95% CI, 1.01-1.10 per degree increase; P < .001). CONCLUSIONS: In medically treated TBAD, increases in aortic diameter, new or increased partial false lumen thrombosis area, and increases of circumferential extent of the false lumen are strongly associated with LAEs.
BACKGROUND:Patients with medically treated type B aortic dissection (TBAD) remain at significant risk for late adverse events (LAEs). We hypothesize that not only initial morphological features, but also their change over time at follow-up are associated with LAEs. MATERIALS AND METHODS: Baseline and 188 follow-up computed tomography (CT) scans with a median follow-up time of 4 years (range, 10 days to 12.7 years) of 47 patients with acute uncomplicated TBAD were retrospectively reviewed. Morphological features (n = 8) were quantified at baseline and each follow-up. Medical records were reviewed for LAEs, which were defined according to current guidelines. To assess the effects of changes of morphological features over time, the linear mixed effects models were combined with Cox proportional hazards regression for the time-to-event outcome using a joint modeling approach. RESULTS: LAEs occurred in 21 of 47 patients at a median of 6.6 years (95% confidence interval [CI], 5.1-11.2 years). Among the 8 investigated morphological features, the following 3 features showed strong association with LAEs: increase in partial false lumen thrombosis area (hazard ratio [HR], 1.39; 95% CI, 1.18-1.66 per cm2 increase; P < .001), increase of major aortic diameter (HR, 1.24; 95% CI, 1.13-1.37 per mm increase; P < .001), and increase in the circumferential extent of false lumen (HR, 1.05; 95% CI, 1.01-1.10 per degree increase; P < .001). CONCLUSIONS: In medically treated TBAD, increases in aortic diameter, new or increased partial false lumen thrombosis area, and increases of circumferential extent of the false lumen are strongly associated with LAEs.
Authors: Lewis D Hahn; Gabriel Mistelbauer; Kai Higashigaito; Martin Koci; Martin J Willemink; Anna M Sailer; Michael Fischbein; Dominik Fleischmann Journal: Radiol Cardiothorac Imaging Date: 2020-06-25
Authors: Molly E Roseland; Yunus Ahmed; Joost A van Herwaarden; Frans L Moll; Bo Yang; Himanshu J Patel; Nicholas S Burris Journal: Interact Cardiovasc Thorac Surg Date: 2021-08-18