Li Da, Wang Jiarong, Zhao Jichun, Wang Tiehao, Zeng Xiangguo, Zheng Tinghui, Yuan Ding
Department of Applied Mechanics, Sichuan University, Chengdu, China.
Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China.
Front Physiol. 2023 Feb 2;14:1065805. doi: 10.3389/fphys.2023.1065805. eCollection 2023.
Predicting the development of sporadic type B aortic dissection (TBAD) always remains a difficult issue. This study aimed to identify high-risk patients for development of TBAD based on morphological parameters. This propensity-score-matched case-control study collected and reconstructed the computed tomography angiography of acute TBAD patients and hospital-based control participants without aortic dissection from January 2013 to December 2016. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). Discriminant and reclassification abilities were compared between our model and a previously established model. Our study included 76 acute TBAD patients and 79 control patients (48 cases and 48 controls after propensity-score matching). The degree of question mark (aOR 1.07, 95% CI 1.04-1.11), brachiocephalic trunk diameter (aOR 1.49, 95% CI 1.20-1.85), brachiocephalic trunk angle (aOR 0.97, 95% CI 0.94-0.99), aortic root diameter (aOR 1.31, 95% CI 1.15-1.48), and aortic width (aOR 1.12, 95% CI 1.07-1.17) were associated with a significantly increased risk of TBAD formation. Similar findings were observed in the propensity-score matching and sensitivity analysis only including hyperacute TBAD patients. A novel prediction model was established based on the aforementioned parameters. The new model showed significantly improved discriminant ability compared with the previously established model (c-index 0.78 [95% CI 0.71-0.85] vs. 0.67 [95% CI 0.58-0.75], = .03), driven by increased reclassification ability in identifying TBAD patients (NRI for events 0.16, 95% CI 0.02-0.30, = .02). Morphological predictors, including the degree of question mark, aortic width, aortic root diameter, brachiocephalic trunk angle, and brachiocephalic trunk diameter, may be used to identify patients at high risk of TBAD.
预测散发性B型主动脉夹层（TBAD）的发展一直是个难题。本研究旨在基于形态学参数识别TBAD发展的高危患者。这项倾向评分匹配的病例对照研究收集并重建了2013年1月至2016年12月期间急性TBAD患者及无主动脉夹层的医院对照参与者的计算机断层扫描血管造影。采用多变量回归分析计算调整后的优势比（aOR）和95%置信区间（CI）。比较了我们的模型与先前建立的模型之间的判别能力和重新分类能力。我们的研究纳入了76例急性TBAD患者和79例对照患者（倾向评分匹配后48例病例和48例对照）。问号程度（aOR 1.07，95%CI 1.04 - 1.11）、头臂干直径（aOR 1.49，95%CI 1.20 - 1.85）、头臂干角度（aOR 0.97，95%CI 0.94 - 0.99）、主动脉根部直径（aOR 1.31，95%CI 1.15 - 1.48）和主动脉宽度（aOR 1.12，95%CI 1.07 - 1.17）与TBAD形成风险显著增加相关。在仅纳入超急性TBAD患者的倾向评分匹配和敏感性分析中也观察到了类似结果。基于上述参数建立了一种新的预测模型。与先前建立的模型相比，新模型显示出显著提高的判别能力（c指数0.78 [95%CI 0.71 - 0.85]对0.67 [95%CI 0.58 - 0.75]，P = 0.03），这是由识别TBAD患者时重新分类能力的提高所驱动的（事件净重新分类指数为0.16，95%CI 0.02 - 0.30，P = 0.02）。包括问号程度、主动脉宽度、主动脉根部直径、头臂干角度和头臂干直径在内的形态学预测指标可用于识别TBAD高危患者。
