Anfinogenova Nina D, Sinitsyn Valentin E, Kozlov Boris N, Panfilov Dmitry S, Popov Sergey V, Vrublevsky Alexander V, Chernyavsky Alexander, Bergen Tatyana, Khovrin Valery V, Ussov Wladimir Yu
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia.
University Hospital, Lomonosov Moscow State University, Moscow 119991, Russia.
J Imaging. 2022 Oct 14;8(10):280. doi: 10.3390/jimaging8100280.
Ascending thoracic aortic aneurysm is a life-threatening disease, which is difficult to detect prior to the occurrence of a catastrophe. Epidemiology patterns of ascending thoracic aortic dilations/aneurysms remain understudied, whereas the risk assessment of it may be improved. The electronic databases PubMed/Medline 1966-2022, Web of Science 1975-2022, Scopus 1975-2022, and RSCI 1994-2022 were searched. The current guidelines recommend a purely aortic diameter-based assessment of the thoracic aortic aneurysm risk, but over 80% of the ascending aorta dissections occur at a size that is lower than the recommended threshold of 55 mm. Moreover, a 55 mm diameter criterion could exclude a vast majority (up to 99%) of the patients from preventive surgery. The authors review several visualization-based and alternative approaches which are proposed to better predict the risk of dissection in patients with borderline dilated thoracic aorta. The imaging-based assessments of the biomechanical aortic properties, the Young's elastic modulus, the Windkessel function, compliance, distensibility, wall shear stress, pulse wave velocity, and some other parameters have been proposed to improve the risk assessment in patients with ascending thoracic aortic aneurysm. While the authors do not argue for shifting the diameter threshold to the left, they emphasize the need for more personalized solutions that integrate the imaging data with the patient's genotypes and phenotypes in this heterogeneous pathology.
升主动脉瘤是一种危及生命的疾病，在灾难发生之前很难被检测到。升主动脉扩张/动脉瘤的流行病学模式仍未得到充分研究，而其风险评估可能会得到改善。我们检索了电子数据库PubMed/Medline（1966 - 2022年）、Web of Science（1975 - 2022年）、Scopus（1975 - 2022年）和RSCI（1994 - 2022年）。当前指南建议基于单纯的主动脉直径来评估胸主动脉瘤风险，但超过80%的升主动脉夹层发生时的尺寸低于推荐阈值55毫米。此外，55毫米的直径标准可能会将绝大多数（高达99%）患者排除在预防性手术之外。作者回顾了几种基于可视化和替代方法，这些方法旨在更好地预测胸主动脉轻度扩张患者的夹层风险。有人提出基于成像的主动脉生物力学特性评估，如杨氏弹性模量、风箱功能、顺应性、扩张性、壁面剪应力、脉搏波速度及其他一些参数，以改善升主动脉瘤患者的风险评估。虽然作者并不主张将直径阈值向左移动，但他们强调在这种异质性病理中需要更个性化的解决方案，即将成像数据与患者的基因型和表型相结合。
