Meccanici F, Bom A W, Knol W G, Gökalp A L, Thijssen C G E, Bekkers J A, Geuzebroek G S C, Mokhles M M, van Kimmenade R R J, Budde R P J, Takkenberg J J M, Roos-Hesselink J W
Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands.
Int J Cardiol Heart Vasc. 2023 Oct 29;49:101290. doi: 10.1016/j.ijcha.2023.101290. eCollection 2023 Dec.
Acute type A aortic dissection (ATAAD) is a highly lethal event, associated with aortic dilatation. It is not well known if patient height, weight or sex impact the thoracic aortic diameter (TAA) at ATAAD. The study aim was to identify male-female differences in TAA at ATAAD presentation.
This retrospective cross-sectional study analysed all adult patients who presented with ATAAD between 2007 and 2017 in two tertiary care centres and underwent contrast enhanced computed tomography (CTA) before surgery. Absolute aortic diameters were measured at the sinus of Valsalva (SoV), ascending (AA) and descending thoracic aorta (DA) using double oblique reconstruction, and indexed for body surface area (ASI) and height (AHI). Z-scores were calculated using the Campens formula.
In total, 59 % (181/308) of ATAAD patients had CT-scans eligible for measurements, with 82 female and 99 male patients. Females were significantly older than males (65.5 ± 12.4 years versus 60.3 ± 2.3, p = 0.024). Female patients had larger absolute AA diameters than male patients (51.0 mm [47.0-57.0] versus 49.0 mm [45.0-53.0], p = 0.023), and larger ASI and AHI at all three levels. Z-scores for the SoV and AA were significantly higher for female patients (2.99 ± 1.66 versus 1.34 ± 1.77, p < 0.001 and 5.27 [4.38-6.26] versus 4.06 [3.14-5.02], p < 0.001). After adjustment for important clinical factors, female sex remained associated with greater maximal TAA (p = 0.019).
Female ATAAD patients had larger absolute ascending aortic diameters than males, implying a distinct timing in disease presentation or selection bias. Translational studies on the aortic wall and studies on growth patterns should further elucidate these sex differences.
急性A型主动脉夹层（ATAAD）是一种致死率很高的疾病，与主动脉扩张有关。目前尚不清楚患者的身高、体重或性别是否会影响ATAAD患者的胸主动脉直径（TAA）。本研究的目的是确定ATAAD患者中胸主动脉直径的性别差异。
这项回顾性横断面研究分析了2007年至2017年间在两个三级医疗中心就诊的所有成年ATAAD患者，并在手术前行增强CT扫描。使用双斜位重建技术测量主动脉瓣窦（SoV）、升主动脉（AA）和降主动脉（DA）的绝对直径，并根据体表面积（ASI）和身高（AHI）进行指数化。使用坎彭斯公式计算Z值。
共有59%（181/308）的ATAAD患者的CT扫描结果符合测量条件，其中女性患者82例，男性患者99例。女性患者比男性患者年龄更大（65.5±12.4岁对60.3±2.3岁，p=0.024）。女性患者的升主动脉绝对直径大于男性患者（51.0mm[47.0-57.0]对49.0mm[45.0-53.0]，p=0.023），并且在所有三个测量水平上的ASI和AHI均更大。女性患者的SoV和AA的Z值显著更高（2.99±1.66对1.34±1.77，p<0.001；5.27[4.38-6.26]对4.06[3.14-5.02]，p<0.001）。在对重要临床因素进行校正后，女性性别仍与更大的最大胸主动脉直径相关（p=0.019）。
女性ATAAD患者的升主动脉绝对直径大于男性，这意味着疾病表现存在明显的时间差异或选择偏倚。关于主动脉壁的转化研究和生长模式的研究应进一步阐明这些性别差异。
