Kaji Shuichiro, Akasaka Takashi, Katayama Minako, Yamamuro Atsushi, Yamabe Kenji, Tamita Koichi, Akiyama Maki, Watanabe Nozomi, Tanemoto Kazuo, Morioka Shigefumi, Yoshida Kiyoshi
Division of Cardiovascular Medicine and Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan.
Circulation. 2003 Sep 9;108 Suppl 1:II307-11. doi: 10.1161/01.cir.0000087425.86049.74.
The long-term clinical course of patients with type B aortic intramural hematoma (IMH) and predictors for progression remains unknown. The difference of aortic pathology may have a different impact on clinical course compared with classic aortic dissection (AD). The purpose of this study was to investigate long-term clinical course and predictors of progression in patients with type B IMH.
Clinical data were compared retrospectively between 53 patients with acute type B IMH (IMH group) and 57 patients with acute type B AD (AD group). All patients were treated initially with medical therapy. Two patients in IMH group and 14 patients in AD group underwent surgical repair because of aortic enlargement. The in-hospital mortality rate in IMH group was significantly lower than that in AD group (0% and 14%, P=0.006). Mean follow-up periods were 53+/-43 months, which revealed 3 and 5 late deaths, respectively. Eleven patients with IMH showed progression (development of aortic dissection or aortic enlargement) in follow-up imaging study. The actuarial survival rates in IMH group were 100%, 97%, and 97% at 1, 2, and 5 years, which were significantly higher than those in AD group (83%, 79%, and 79%) (P=0.009). Multivariate analysis identified age >70 years and new appearance of an ulcerlike projection as the strongest predictors of progression in patients with IMH.
Patients with type B IMH have better long-term prognosis than patients with AD. Older age and appearance of an ulcerlike projection are predictive for progression in patients with type B IMH.
B型主动脉壁内血肿（IMH）患者的长期临床病程及病情进展的预测因素尚不清楚。与经典主动脉夹层（AD）相比，主动脉病理改变的差异可能对临床病程产生不同影响。本研究旨在探讨B型IMH患者的长期临床病程及病情进展的预测因素。
对53例急性B型IMH患者（IMH组）和57例急性B型AD患者（AD组）的临床资料进行回顾性比较。所有患者均首先接受药物治疗。IMH组有2例患者和AD组有14例患者因主动脉增宽而接受了手术修复。IMH组的院内死亡率显著低于AD组（0%和14%，P = 0.006）。平均随访时间为53±43个月，分别有3例和5例患者出现晚期死亡。11例IMH患者在随访影像学检查中出现病情进展（主动脉夹层形成或主动脉增宽）。IMH组1年、2年和5年的精算生存率分别为100%、97%和97%，显著高于AD组（83%、79%和79%）（P = 0.009）。多因素分析确定年龄>70岁和出现溃疡样突出为IMH患者病情进展的最强预测因素。
B型IMH患者的长期预后优于AD患者。年龄较大和出现溃疡样突出是B型IMH患者病情进展的预测因素。
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