Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 1.150, Houston, TX 77030, USA.
Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.106, Houston, TX 77030, USA.
Int J Cardiol. 2019 Jun 1;284:84-89. doi: 10.1016/j.ijcard.2018.10.052. Epub 2018 Oct 17.
Arterial tortuosity has emerged as a predictor of adverse outcomes in congenital aortopathies using 3D reconstructed images. We validated a new method to estimate aortic arch tortuosity on 2D CT. We hypothesize that arch tortuosity may identify bicuspid aortic valve (BAV) patients at high risk to develop thoracic aortic aneurysms or aortic dissections (TAD).
BAV subjects with chest CT scans were retrospectively identified in our clinical records and matched to tricuspid aortic valve (TAV) controls by age, gender, and presentation with TAD. Subjects with prior ascending aortic intervention were excluded. Measurements included aortic arch tortuosity, length, angle, width and height. Total aortic tortuosity was estimated in subjects with available abdominal images.
120 BAV and 234 TAV subjects were included. Our 2D measurements were highly correlated with 3D midline arch measurements and had high inter- and intra-observer reliability. Compared to TAV, BAV subjects had increased arch tortuosity (median 1.76 [Q1-Q3: 1.62-1.95] vs. 1.63 [1.53-1.78], P < 0.01), length (149 [136-160] vs. 135 [122-152] mm, P < 0.01), height (46 [41-53] vs. 39 [34-47] mm, P < 0.01), and vertex acuity (70 [61-77] vs. 75 [68-81] degree, P < 0.01). In a multivariable analysis, arch tortuosity remained independently associated with BAV after adjusting for aortic diameter and other clinical characteristics.
We found that aortic arch tortuosity is significantly increased in BAV and may identify BAV patients who are at increased risk for TAD. Further studies to evaluate the association between tortuosity and clinical outcomes are in progress.
使用 3D 重建图像，动脉迂曲已成为先天性主动脉病变不良结局的预测因子。我们验证了一种新的方法来评估二维 CT 上的主动脉弓迂曲程度。我们假设，主动脉弓迂曲程度可以识别出二叶式主动脉瓣（BAV）患者，他们发生胸主动脉瘤或主动脉夹层（TAD）的风险较高。
我们在临床记录中回顾性地确定了有胸部 CT 扫描的 BAV 患者，并按年龄、性别和 TAD 表现与三叶式主动脉瓣（TAV）患者进行匹配。排除了有升主动脉介入治疗史的患者。测量指标包括主动脉弓迂曲度、长度、角度、宽度和高度。有腹部图像可供评估的患者则评估总主动脉迂曲度。
共纳入 120 例 BAV 和 234 例 TAV 患者。我们的二维测量值与 3D 中线弓测量值高度相关，并且具有较高的观察者内和观察者间可靠性。与 TAV 相比，BAV 患者的弓迂曲度更大（中位数 1.76 [Q1-Q3：1.62-1.95] vs. 1.63 [1.53-1.78]，P < 0.01）、长度更长（149 [136-160] vs. 135 [122-152] mm，P < 0.01）、高度更高（46 [41-53] vs. 39 [34-47] mm，P < 0.01）、顶点锐度更大（70 [61-77] vs. 75 [68-81] 度，P < 0.01）。在多变量分析中，在校正主动脉直径和其他临床特征后，弓迂曲度仍然与 BAV 独立相关。
我们发现 BAV 的主动脉弓迂曲度显著增加，可能识别出 TAD 风险增加的 BAV 患者。正在进行进一步的研究来评估迂曲度与临床结局之间的关联。
