Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Limburg, The Netherlands.
Heart. 2020 Jun;106(12):892-897. doi: 10.1136/heartjnl-2019-316251. Epub 2020 Mar 8.
Management of thoracic aortic aneurysms (TAAs) comprises regular diameter follow-up until the indication criterion for prophylactic surgery is reached. However, this approach is unable to predict the majority of acute type A aortic dissections (ATAADs). The current study aims to evaluate the diagnostic accuracy of ascending aortic diameter, length and volume for occurrence of ATAAD.
This two-centre observational cohort study retrospectively screened 477 consecutive patients who presented with ATAAD between 2009 and 2018. Of those, 25 (5.2%) underwent CT angiography (CTA) within 2 years before dissection onset. Aortic diameter, length and volume of these patients ('pre-ATAAD') were compared with those of TAA controls (n=75). Receiver operating curve analysis was performed to evaluate the predictive accuracy of the three different measurements.
96% of patients with pre-ATAAD did not meet the surgical diameter threshold of 55 mm before dissection onset. Maximal aortic diameters (45 (40-49) mm vs 46 (44-49) mm, p=0.075) and volume (126 (95-157) cm vs 124 (102-136) cm, p=0.909) were comparable between patients with pre-ATAAD and TAA controls. Conversely, ascending aortic length (84±9 mm vs 90±16 mm, p=0.031) was significantly larger in patients with pre-ATAAD. All three parameters had an area under the curve of >0.800. At the 55 mm cut-off point, the maximal diameter yielded a positive predictive value (PPV) of 20%. While maintaining same specificity levels, measurements of aortic volume and length showed superior diagnostic accuracy (PPV 55% and 70%, respectively).
Measurements of aortic volume and length have superior diagnostic accuracy compared with the maximal diameter and could improve the timely identification of patients at risk for ATAAD.
胸主动脉瘤（TAA）的管理包括定期进行直径随访，直到达到预防性手术的指征标准。然而，这种方法无法预测大多数急性A型主动脉夹层（ATAAD）。本研究旨在评估升主动脉直径、长度和体积对 ATAAD 发生的诊断准确性。
本研究为一项回顾性的、两中心的观察性队列研究，纳入了 2009 年至 2018 年间连续就诊的 477 例 ATAAD 患者。其中 25 例（5.2%）在夹层发病前 2 年内接受了 CT 血管造影（CTA）检查。比较这些患者（“ATAAD 前”）的主动脉直径、长度和体积与 TAA 对照组（n=75）的差异。通过接受者操作特征曲线分析评估三种不同测量方法的预测准确性。
96%的 ATAAD 前患者在夹层发病前未达到 55mm 的手术直径阈值。ATAAD 前患者的最大主动脉直径（45（40-49）mm 比 46（44-49）mm，p=0.075）和体积（126（95-157）cm 比 124（102-136）cm，p=0.909）与 TAA 对照组无差异。相反，ATAAD 前患者的升主动脉长度（84±9mm 比 90±16mm，p=0.031）显著更大。所有三个参数的曲线下面积均大于 0.800。在 55mm 截断点，最大直径的阳性预测值（PPV）为 20%。在保持相同特异性水平的情况下，主动脉体积和长度的测量具有更高的诊断准确性（PPV 分别为 55%和 70%）。
与最大直径相比，主动脉体积和长度的测量具有更高的诊断准确性，可提高对 ATAAD 风险患者的及时识别。
