Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Limburg, The Netherlands.
Heart. 2018 Nov;104(21):1778-1782. doi: 10.1136/heartjnl-2017-312867. Epub 2018 Mar 28.
Prophylactic surgery for prevention of acute type A aortic dissection (ATAAD) is reserved for patients with an ascending aortic aneurysm ≥55 mm. Identification of additional risk predictors is warranted since over 70% of patients presenting with ATAAD have a non-dilated aorta or an aneurysm that would not have met the diameter criterion for preventative surgery. Aim of the study was to evaluate ascending aortic elongation as a risk factor for ATAAD and to compare aortic lengths between ATAAD patients and healthy controls.
Aortic lengths and diameters of ATAAD patients were measured on three-dimensional modelled computed tomography and adjusted to predissection dimensions in this cross-sectional single-centre study. Logistic regression was used to evaluate the relation between ATAAD and aortic dimensions. Lengths of different aortic segments were compared with a healthy control group using propensity score matching.
Two-hundred and fifty patients were included in the study (ATAAD, n=40; controls, n=210). Ascending aortic length and diameter proved to be independent predictors for ATAAD (OR=5.3, CI 2.5 to 11.4, p<0.001 and OR=8.6, CI 2.4 to 31.0, p=0.001). Eighty patients were matched based on propensity scores (ATAAD n=40, controls n=40). The ascending aorta was longer and more dilated in ATAAD patients compared with healthy controls (78.6±8.8 mm vs 68.9±7.2 mm, p<0.001, 34.4 mm ±3.2. vs 39.4 mm ±5.7, p<0.001, respectively). No differences were found in lengths of the aortic arch and descending aorta.
Ascending aortic length could serve as an independent predictor for ATAAD. Future studies addressing indications for prophylactic surgery should also investigate aortic length.
预防急性 A 型主动脉夹层（ATAAD）的预防性手术仅适用于升主动脉瘤≥55mm 的患者。需要识别其他风险预测因子，因为超过 70%的 ATAAD 患者的主动脉没有扩张或动脉瘤直径不符合预防性手术的标准。本研究旨在评估升主动脉伸长作为 ATAAD 的危险因素，并比较 ATAAD 患者和健康对照组的主动脉长度。
在这项横断面单中心研究中，通过三维建模 CT 测量 ATAAD 患者的主动脉长度和直径，并将其调整为夹层前的尺寸。使用逻辑回归评估 ATAAD 与主动脉尺寸之间的关系。使用倾向评分匹配比较不同主动脉节段的长度与健康对照组。
本研究共纳入 250 例患者（ATAAD 患者 40 例，对照组 210 例）。升主动脉长度和直径被证明是 ATAAD 的独立预测因子（OR=5.3，95%CI 2.5 至 11.4，p<0.001 和 OR=8.6，95%CI 2.4 至 31.0，p=0.001）。根据倾向评分匹配了 80 例患者（ATAAD 患者 40 例，对照组 40 例）。与健康对照组相比，ATAAD 患者的升主动脉更长且更扩张（78.6±8.8mm 比 68.9±7.2mm，p<0.001，34.4mm±3.2mm 比 39.4mm±5.7mm，p<0.001）。主动脉弓和降主动脉的长度没有差异。
升主动脉长度可作为 ATAAD 的独立预测因子。未来研究预防性手术的适应证时也应研究主动脉长度。
