Zhao Qin, Shi Ke, Yang Zhi-Gang, Diao Kai-Yue, Xu Hua-Yan, Liu Xi, Guo Ying-Kun
Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan, China.
BMC Cardiovasc Disord. 2018 Jun 22;18(1):124. doi: 10.1186/s12872-018-0863-8.
Coarctation of aorta (CoA) may progressively develop aortic dilation at other site of the aorta and can lead to fatal aortic diseases. We aimed to evaluate the occurrence of aortic dilation and related predictors in patients with CoA using dual-source computed tomography (DSCT).
Fifty-three patients with CoA identified by DSCT were retrospectively reviewed. Aortic diameters were measured at six different levels and standardized as z-scores based on the square root of body surface area. Coarctation site-diaphragm ratio (CDR) was used to describe the degree of narrowing. A total of 26 patients were included in mild group (CDR > 50%) and 27 in severe group (CDR < 50%) according to the severity of coarctation. Student's t-test and Spearman correlation coefficients, univariate and multivariable logistic regression analyses were used to assess the risk factors including age, degree of narrowing and other malformations for aortic dilation.
Severe group had significantly larger z-scores of ascending aorta (2.41 ± 0.39 vs. 2.10 ± 0.57, p < 0.05) and post-coarctation aorta (2.17 ± 0.48 vs. 1.68 ± 0.43, p < 0.001) compared with mild group. Degree of coarctation was associated with the z-scores of the ascending aorta (r = - 0.356, p < 0.05) and post-coarctation aorta (r = - 0.414, p < 0.05). Collateral circulation was related to the z-scores of ascending aorta (r = 0.375, p < 0.05). Increased severity of coarctation was independent predictor of ascending (odds ratio 7.46; 95% CI 1.19-46.76; p < 0.05) and post-coarctation aortic dilation(odds ratio 8.42; 95% CI 1.84-38.56; p < 0.05).
Ascending and post-coarctation aortic diameters or dilations were both associated with the degree of coarctation. By comprehensively evaluating the aortic diameters and associated malformations including collateral circulation, DSCT can aid in stratification of risk for aortic dilation in patients with CoA.
主动脉缩窄（CoA）可能会在主动脉的其他部位逐渐发展为主动脉扩张，并可能导致致命的主动脉疾病。我们旨在使用双源计算机断层扫描（DSCT）评估CoA患者主动脉扩张的发生率及相关预测因素。
回顾性分析53例经DSCT确诊的CoA患者。在六个不同水平测量主动脉直径，并根据体表面积的平方根将其标准化为z值。采用缩窄部位与膈肌距离比（CDR）来描述狭窄程度。根据缩窄严重程度，将26例患者纳入轻度组（CDR＞50%），27例患者纳入重度组（CDR＜50%）。采用学生t检验、Spearman相关系数、单因素和多因素logistic回归分析评估年龄、狭窄程度和其他畸形等主动脉扩张的危险因素。
与轻度组相比，重度组升主动脉（2.41±0.39 vs. 2.10±0.57，p＜0.05）和缩窄后主动脉（2.17±0.48 vs. 1.68±0.43，p＜0.001）的z值显著更大。缩窄程度与升主动脉（r = -0.356，p＜0.05）和缩窄后主动脉（r = -0.414，p＜0.05）的z值相关。侧支循环与升主动脉的z值相关（r = 0.375，p＜0.05）。缩窄严重程度增加是升主动脉扩张（比值比7.46；95%可信区间1.19 - 46.76；p＜0.05）和缩窄后主动脉扩张（比值比8.42；95%可信区间1.84 - 38.56；p＜0.05）的独立预测因素。
升主动脉和缩窄后主动脉的直径或扩张均与缩窄程度相关。通过综合评估主动脉直径及包括侧支循环在内的相关畸形，DSCT有助于对CoA患者主动脉扩张的风险进行分层。
