Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
J Cardiovasc Magn Reson. 2022 Mar 28;24(1):20. doi: 10.1186/s12968-022-00852-6.
Patency of the false lumen in chronic aortic dissection (AD) is associated with aortic dilation and long-term aortic events. However, predictors of adverse outcomes in this population are limited. The aim of this study was to evaluate the relationship between aortic growth rate and false lumen flow dynamics and biomechanics in patients with chronic, patent AD.
Patients with a chronic AD with patent false lumen in the descending aorta and no genetic connective tissue disorder underwent an imaging follow-up including a contrast-enhanced 4D flow cardiovascular magnetic resonance (CMR) protocol and two consecutive computed tomography angiograms (CTA) acquired at least 1 year apart. A comprehensive analysis of anatomical features (including thrombus quantification), and false lumen flow dynamics and biomechanics (pulse wave velocity) was performed.
Fifty-four consecutive patients with a chronic, patent false lumen in the descending aorta were included (35 surgically-treated type A AD with residual tear and 19 medically-treated type B AD). Median follow-up was 40 months. The in-plane rotational flow, pulse wave velocity and the percentage of thrombus in the false lumen were positively related to aortic growth rate (p = 0.006, 0.017, and 0.037, respectively), whereas wall shear stress showed a trend for a positive association (p = 0.060). These results were found irrespectively of the type of AD.
In patients with chronic AD and patent false lumen of the descending aorta, rotational flow, pulse wave velocity and wall shear stress are positively related to aortic growth rate, and should be implemented in the follow-up algorithm of these patients. Further prospective studies are needed to confirm if the assessment of these parameters helps to identify patients at higher risk of adverse clinical events.
慢性主动脉夹层（AD）假腔的通畅与主动脉扩张和长期主动脉事件有关。然而，该人群不良结局的预测因素有限。本研究旨在评估慢性、通畅的 AD 患者主动脉生长率与假腔血流动力学和生物力学之间的关系。
对 54 例慢性 AD 患者进行影像学随访，这些患者的降主动脉存在假腔通畅且无遗传性结缔组织疾病，包括对比增强 4D 流心血管磁共振（CMR）方案和至少相隔 1 年采集的两次连续 CT 血管造影（CTA）。对解剖特征（包括血栓定量）以及假腔血流动力学和生物力学（脉搏波速度）进行全面分析。
连续纳入 54 例慢性、通畅的降主动脉假腔患者（35 例手术治疗的 A 型 AD 伴残余撕裂，19 例药物治疗的 B 型 AD）。中位随访时间为 40 个月。平面内旋转流、脉搏波速度和假腔中的血栓百分比与主动脉生长率呈正相关（p=0.006、0.017 和 0.037），而壁切应力呈正相关趋势（p=0.060）。这些结果与 AD 的类型无关。
在慢性 AD 患者和降主动脉假腔通畅的患者中，旋转流、脉搏波速度和壁切应力与主动脉生长率呈正相关，应纳入这些患者的随访算法中。需要进一步的前瞻性研究来证实评估这些参数是否有助于识别发生不良临床事件风险较高的患者。
