Luan Jingyang, Mao Le, Zhu Ziqing, Fu Weiguo, Zhu Ting
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.
J Thorac Dis. 2021 Jan;13(1):372-383. doi: 10.21037/jtd-20-2728.
In order to prevent the occurrence of aortic adverse events in ascending thoracic aortic aneurysm patients, preventive surgery is the sole option in case of large aneurysm. Identifying high-risk patients timely and accurately requires effective predictive indicators of aortic adverse events and accurate risk stratification thresholds. Absolute diameter measured after a single imaging examination, which has been used as the predictive indicator for decades, has been proved to be ineffective for risk stratification in moderately dilated aorta. Previously, new indicators combining absolute diameters with personalized parameters have been reported to show better predictive power of aortic adverse events than absolute diameters by correcting the effect of these parameters on the diameters. Meanwhile, combining three-dimensional parameters to formulate risk stratification thresholds not only may characterize the aortic risk morphology more precisely, but also predict aortic adverse events more accurately. These new indicators may provide more systematic assessment methods of patients' risk, formulate more personalized intervention strategies for ascending thoracic aortic aneurysm patients, and also provide a basis for researchers to develop more accurate and effective risk thresholds. We also highlight that the algorithm obtained by combining multiple indicators may be a better choice compared with single indicator, but this still requires the support of more evidence. Due to the particularity of syndromic aortic disease, whether these new indicators can be used for its risk stratification is still uncertain. Therefore, the scope of this manuscript does not include this kind of disease.
为预防升主动脉瘤患者发生主动脉不良事件，对于大型动脉瘤，预防性手术是唯一选择。及时、准确地识别高危患者需要有效的主动脉不良事件预测指标和准确的风险分层阈值。单次成像检查后测量的绝对直径作为预测指标已使用数十年，但事实证明其在中度扩张主动脉的风险分层中无效。此前有报道称，将绝对直径与个性化参数相结合的新指标通过校正这些参数对直径的影响，显示出比绝对直径更好的主动脉不良事件预测能力。同时，结合三维参数制定风险分层阈值不仅可以更精确地表征主动脉风险形态，还能更准确地预测主动脉不良事件。这些新指标可能为患者风险提供更系统的评估方法，为升主动脉瘤患者制定更个性化的干预策略，也为研究人员制定更准确有效的风险阈值提供依据。我们还强调，与单一指标相比，结合多个指标获得的算法可能是更好的选择，但这仍需要更多证据的支持。由于综合征性主动脉疾病的特殊性，这些新指标是否可用于其风险分层仍不确定。因此，本手稿的范围不包括此类疾病。
