Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.
J Thorac Cardiovasc Surg. 2017 Oct;154(4):1192-1200. doi: 10.1016/j.jtcvs.2017.04.064. Epub 2017 May 16.
Patients with Stanford type B aortic dissections (ADs) are at risk of long-term disease progression and late complications. The aim of this study was to evaluate the natural course and evolution of acute type B AD and intramural hematomas (IMHs) in patients who presented without complications during their initial hospital admission and who were treated with optimal medical management (MM).
Databases from 2 aortic centers in Europe and the United States were used to identify 136 patients with acute type B AD (n = 92) and acute type B IMH (n = 44) who presented without complications during their index admission and were treated with MM. Computed tomography angiography scans were available at onset (≤14 days) and during follow-up for those patients. Relevant data, including evidence of adverse events during follow-up (AE; defined according to current guidelines), were retrieved from medical records and by reviewing computed tomography scan images. Aortic diameters were measured with dedicated 3-dimensional software.
The 1-, 2-, and 5-year event-free survival rates of patients with type B AD were 84.3% (95% confidence interval [CI], 74.4-90.6), 75.4% (95% CI, 64.0-83.7), and 62.6% (95% CI, 68.9-73.6), respectively. Corresponding estimates for IMH were 76.5% (95% CI, 57.8-87.8), 76.5% (95% CI, 57.8-87.8), and 68.9% (95% CI, 45.2-83.9), respectively. In patients with type B AD, risk of an AE increased with aortic growth within the first 6 months after onset. A diameter increase of 5 mm in the first half year was associated with a relative risk for AE of 2.29 (95% CI, 1.70-3.09) compared with the median 6 months' growth of 2.4 mm. In approximately 60% of patients with IMH, the abnormality resolved within 12 months and in the patients with nonresolving IMH, risk of an adverse event was greatest in the first year after onset and remained stable thereafter.
More than one third of patients with initially uncomplicated type B AD suffer an AE under MM within 5 years of initial diagnosis. In patients with nonresolving IMH, most adverse events are observed in the first year after onset. In patients with type B AD an early aortic growth is associated with a greater risk of AE.
Stanford 型 B 型主动脉夹层（AD）患者存在长期疾病进展和晚期并发症的风险。本研究旨在评估在初次住院期间无并发症的急性 B 型 AD 和壁内血肿（IMH）患者的自然病程和演变，并对其进行最佳药物治疗（MM）。
利用欧洲和美国的 2 个主动脉中心的数据库，共纳入 136 名急性 B 型 AD（n=92）和急性 B 型 IMH（n=44）患者，这些患者在初次入院时无并发症，并接受 MM 治疗。对于这些患者，在发病时（≤14 天）和随访期间进行 CT 血管造影扫描。从病历和 CT 扫描图像中检索相关数据，包括随访期间的不良事件（AE；根据现行指南定义）证据。使用专用的 3 维软件测量主动脉直径。
B 型 AD 患者的 1 年、2 年和 5 年无事件生存率分别为 84.3%（95%置信区间 [CI]，74.4-90.6）、75.4%（95% CI，64.0-83.7）和 62.6%（95% CI，68.9-73.6）。IMH 的相应估计值分别为 76.5%（95% CI，57.8-87.8）、76.5%（95% CI，57.8-87.8）和 68.9%（95% CI，45.2-83.9）。在 B 型 AD 患者中，AE 的风险随着发病后 6 个月内主动脉生长而增加。与中位 6 个月的生长 2.4 毫米相比，前半年直径增加 5 毫米与 AE 的相对风险为 2.29（95%CI，1.70-3.09）。大约 60%的 IMH 患者在 12 个月内病变得到缓解，在非缓解 IMH 患者中，发病后第 1 年的不良事件风险最大，此后保持稳定。
超过三分之一的最初无并发症的 B 型 AD 患者在初次诊断后的 5 年内会发生 MM 相关的 AE。在非缓解性 IMH 患者中，大多数不良事件发生在发病后第 1 年。在 B 型 AD 患者中，早期主动脉生长与 AE 风险增加相关。
