Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, 4811, Australia.
The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia.
Eur Radiol. 2023 Aug;33(8):5698-5706. doi: 10.1007/s00330-023-09488-1. Epub 2023 Mar 10.
The aim of this study was to assess whether aortic peak wall stress (PWS) and peak wall rupture index (PWRI) were associated with the risk of abdominal aortic aneurysm (AAA) rupture or repair (defined as AAA events) among participants with small AAAs.
PWS and PWRI were estimated from computed tomography angiography (CTA) scans of 210 participants with small AAAs (≥ 30 and ≤ 50 mm) prospectively recruited between 2002 and 2016 from two existing databases. Participants were followed for a median of 2.0 (inter-quartile range 1.9, 2.8) years to record the incidence of AAA events. The associations between PWS and PWRI with AAA events were assessed using Cox proportional hazard analyses. The ability of PWS and PWRI to reclassify the risk of AAA events compared to the initial AAA diameter was examined using net reclassification index (NRI) and classification and regression tree (CART) analysis.
After adjusting for other risk factors, one standard deviation increase in PWS (hazard ratio, HR, 1.56, 95% confidence intervals, CI 1.19, 2.06; p = 0.001) and PWRI (HR 1.74, 95% CI 1.29, 2.34; p < 0.001) were associated with significantly higher risks of AAA events. In the CART analysis, PWRI was identified as the best single predictor of AAA events at a cut-off value of > 0.562. PWRI, but not PWS, significantly improved the classification of risk of AAA events compared to the initial AAA diameter alone.
PWS and PWRI predicted the risk of AAA events but only PWRI significantly improved the risk stratification compared to aortic diameter alone.
• Aortic diameter is an imperfect measure of abdominal aortic aneurysm (AAA) rupture risk. • This observational study of 210 participants found that peak wall stress (PWS) and peak wall rupture index (PWRI) predicted the risk of aortic rupture or AAA repair. • PWRI, but not PWS, significantly improved the risk stratification for AAA events compared to aortic diameter alone.
本研究旨在评估在接受小 AAA（≥30 且≤50mm）的患者中，主动脉峰值壁应力（PWS）和峰值壁破裂指数（PWRI）与 AAA 破裂或修复（定义为 AAA 事件）的风险是否相关。
使用前瞻性纳入的 210 名小 AAA 患者（2002 年至 2016 年期间从两个现有数据库中招募）的计算机断层血管造影（CTA）扫描来估计 PWS 和 PWRI。中位随访 2.0 年（四分位距 1.9，2.8）以记录 AAA 事件的发生率。使用 Cox 比例风险分析评估 PWS 和 PWRI 与 AAA 事件之间的相关性。使用净重新分类指数（NRI）和分类和回归树（CART）分析评估 PWS 和 PWRI 与初始 AAA 直径相比重新分类 AAA 事件风险的能力。
在校正其他危险因素后，PWS（危险比，HR，1.56，95%置信区间，CI 1.19，2.06；p=0.001）和 PWRI（HR 1.74，95%CI 1.29，2.34；p<0.001）的标准偏差增加一个单位与 AAA 事件的风险显著增加相关。在 CART 分析中，PWRI 在截断值为>0.562 时被确定为 AAA 事件的最佳单一预测因子。与单独的初始 AAA 直径相比，PWRI 但不是 PWS，显著改善了 AAA 事件风险的分类。
PWS 和 PWRI 预测了 AAA 事件的风险，但只有 PWRI 与单独的主动脉直径相比显著改善了风险分层。
• 主动脉直径是评估腹主动脉瘤（AAA）破裂风险的不完美指标。• 本研究纳入了 210 名参与者，结果发现 PWS 和 PWRI 预测了主动脉破裂或 AAA 修复的风险。• 与单独的主动脉直径相比，PWRI（而不是 PWS）显著改善了 AAA 事件的风险分层。
