期刊
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
卷 161, 期 4, 页码 1184-+出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2019.10.074
关键词
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资金
- Swiss National Research Foundation [P2ZHP3_168559]
- American Heart Association [18POST34030192]
- National Institutes of Health Clinical and Translational Science Award [UL1 RR025744]
- Swiss National Science Foundation (SNF) [P2ZHP3_168559] Funding Source: Swiss National Science Foundation (SNF)
The study found that in patients with medically treated type B aortic dissection, increases in aortic diameter, new or increased partial false lumen thrombosis area, and increases in the circumferential extent of the false lumen are strongly associated with late adverse events.
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 investigatedmorphological 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 cm(2) 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.
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