Sun Lianjie, Li Xiao, Wang Guoqing, Sun Jianchao, Zhang Xiaoming, Chi Honghui, Cao Huihui, Ma Wanteng, Yan Zhisheng, Liu Gaoli
Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
Front Cardiovasc Med. 2022 Jun 20;9:927105. doi: 10.3389/fcvm.2022.927105. eCollection 2022.
Type A aortic dissection (TAAD) has a rapid onset and high mortality. Currently, aortic diameter is the major criterion for evaluating the risk of TAAD. We attempted to find other aortic morphological indicators to further analyze their relationships with the risk of type A dissection.
We included the imaging and clinical data of 112 patients. The patients were divided into three groups, of which Group 1 had 49 patients with normal aortic diameter, Group 2 had 22 patients with ascending aortic aneurysm, and Group 3 had 41 patients with TAAD. We used AW Server software, version 3.2, to measure aorta-related morphological indicators.
First, in Group 1, the univariate analysis results showed that ascending aortic diameter was correlated with patient age ( = 0.35) and ascending aortic length (AAL) ( = 0.43). AAL was correlated with age ( = 0.12) and height ( = 0.11). Further analysis of the aortic morphological indicators among the three groups found that the median aortic diameter was 36.20 mm in Group 1 (Q1-Q3: 33.40-37.70 mm), 42.5 mm in Group 2 (Q1-Q3: 41.52-44.17 mm) and 48.6 mm in Group 3 (Q1-Q3: 42.4-55.3 mm). There was no significant difference between Groups 2 and 3 ( > 0.05). Group 3 had the longest AAL (median: 109.4 mm, Q1-Q3: 118.3-105.3 mm), followed by Group 2 (median: 91.0 mm, Q1-Q3: 95.97-84.12 mm) and Group 1 (81.20 mm, Q1-Q3: 76.90-86.20 mm), and there were statistically significant differences among the three groups ( < 0.05). The Aortic Bending Index (ABI) was 14.95 mm/cm in Group 3 (Q1-Q3: 14.42-15.78 mm/cm), 13.80 mm/cm in Group 2 (Q1-Q3: 13.42-14.42 mm/cm), and 13.29 mm/cm in Group 1 (Q1-Q3: 12.71-13.78 mm/cm), and the difference was statistically significant in comparisons between any two groups ( < 0.05). Regression analysis showed that aortic diameter + AAL + ABI differentiated Group 2 and Group 3 with statistical significance (area under the curve (AUC) = 0.834), which was better than aortic diameter alone (AUC = 0.657; < 0.05).
We introduced the new concept of ABI, which has certain clinical significance in distinguishing patients with aortic dissection and aneurysm. Perhaps the ascending aortic diameter combined with AAL and ABI could be helpful in predicting the occurrence of TAAD.
A型主动脉夹层（TAAD）起病迅速，死亡率高。目前，主动脉直径是评估TAAD风险的主要标准。我们试图寻找其他主动脉形态学指标，以进一步分析它们与A型夹层风险的关系。
我们纳入了112例患者的影像学和临床资料。将患者分为三组，其中第1组有49例主动脉直径正常的患者，第2组有22例升主动脉瘤患者，第3组有41例TAAD患者。我们使用AW Server软件3.2版测量主动脉相关形态学指标。
首先，在第1组中，单因素分析结果显示升主动脉直径与患者年龄（r = 0.35）和升主动脉长度（AAL）（r = 0.43）相关。AAL与年龄（r = 0.12）和身高（r = 0.11）相关。对三组间主动脉形态学指标的进一步分析发现，第1组主动脉直径中位数为36.20 mm（四分位数间距：33.40 - 37.70 mm），第2组为42.5 mm（四分位数间距：41.52 - 44.17 mm），第3组为48.6 mm（四分位数间距：42.4 - 55.3 mm）。第2组和第3组之间无显著差异（P > 0.05）。第3组的AAL最长（中位数：109.4 mm，四分位数间距：118.3 - 105.3 mm），其次是第2组（中位数：91.0 mm，四分位数间距：95.97 - 84.12 mm）和第1组（81.20 mm，四分位数间距：76.90 - 86.20 mm），三组间差异有统计学意义（P < 0.05）。第3组的主动脉弯曲指数（ABI）为14.95 mm/cm（四分位数间距：14.42 - 15.78 mm/cm），第2组为13.80 mm/cm（四分位数间距：13.42 - 14.42 mm/cm），第1组为13.29 mm/cm（四分位数间距：12.71 - 13.78 mm/cm），任意两组比较差异均有统计学意义（P < 0.05）。回归分析显示，主动脉直径 + AAL + ABI对第2组和第3组的区分具有统计学意义（曲线下面积（AUC） = 0.834），优于单独使用主动脉直径（AUC = 0.657；P < 0.05）。
我们引入了ABI这一新概念，其在区分主动脉夹层和动脉瘤患者方面具有一定的临床意义。或许升主动脉直径联合AAL和ABI有助于预测TAAD的发生。
