Department of Cardiovascular Surgery, Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan.
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
PLoS One. 2022 Feb 11;17(2):e0263881. doi: 10.1371/journal.pone.0263881. eCollection 2022.
Aortic calcification in the tunica media is correlated with aortic stiffness, elastin degradation, and wall shear stress. The study aim was to determine if aortic calcifications influence disease progression in patients with acute type A aortic dissection (ATAAD). We retrospectively reviewed a total of 103 consecutive patients who had undergone surgery for ATAAD at our institution between January 2009 and December 2019. Of these, 85 patients who had preoperatively undergone plain computed tomography angiography (CTA) for evaluation of their aortic calcification were included. Moreover, we assessed the progression of aortic dissection after surgery via postoperative CTA. Using a classification and regression tree to identify aortic Agatston score thresholds predictive of disease progression, the patients were classified into high-score (Agatston score ≥ 3344; n = 36) and low-score (<3344; n = 49) groups. Correlations between aortic Agatston scores and CTA variables were assessed. Higher aortic Agatston scores were significantly correlated with the smaller distal extent of aortic dissection (p < 0.001), larger true lumen areas of the ascending (p = 0.009) and descending aorta (p = 0.002), and smaller false lumen areas of the descending aorta (p = 0.028). Patients in the high-score group were more likely to have DeBakey type II dissection (p = 0.001) and false lumen thrombosis (p = 0.027) than those in the low-score group, thereby confirming the correlations. Aortic dissection in the high-score group was significantly less distally extended (p < 0.001). A higher aortic Agatston score correlates with the larger true lumen area of the ascending and descending aorta and the less distal progression of aortic dissection in patients with ATAAD. Interestingly, the findings before and after surgery were consistent. Hence, aortic Agatston scores are associated with aortic dissection progression and may help predict postoperative residual dissected aorta remodeling.
主动脉中层的钙化与主动脉僵硬度、弹性蛋白降解和壁切应力有关。本研究旨在确定主动脉钙化是否会影响急性 A 型主动脉夹层（ATAAD）患者的疾病进展。我们回顾性分析了 2009 年 1 月至 2019 年 12 月在我院接受手术治疗的 103 例连续 ATAAD 患者。其中，85 例患者术前接受了plain computed tomography angiography（CTA）评估主动脉钙化情况，包括在内。此外，我们通过术后 CTA 评估了手术后主动脉夹层的进展情况。使用分类回归树来确定预测疾病进展的主动脉 Agatston 评分阈值，将患者分为高分（Agatston 评分≥3344；n=36）和低分（<3344；n=49）组。评估主动脉 Agatston 评分与 CTA 变量之间的相关性。较高的主动脉 Agatston 评分与主动脉夹层的远端范围较小（p<0.001）、升主动脉（p=0.009）和降主动脉（p=0.002）的真腔面积较大以及降主动脉的假腔面积较小（p=0.028）显著相关。高分组患者发生 DeBakey Ⅱ型夹层（p=0.001）和假腔血栓形成（p=0.027）的可能性高于低分组，从而证实了这些相关性。高分组的主动脉夹层在远端的延伸程度明显较低（p<0.001）。较高的主动脉 Agatston 评分与 ATAAD 患者升主动脉和降主动脉的真腔面积较大以及主动脉夹层的远端进展程度较小相关。有趣的是，术前和术后的发现是一致的。因此，主动脉 Agatston 评分与主动脉夹层进展相关，可能有助于预测术后残留的主动脉夹层重塑。
