“…Observations from the International Registry of Aortic Dissection suggest that most aortic dissections are associated with at least moderate aortic enlargement (90% ≥4 cm) with many having aneurysmal enlargement (75% ≥4.5 cm) . In the absence of dissection, aneurysms of the ascending aorta are asymptomatic and are usually discovered during thoracic imaging for other indications . Medical therapy has been used to slow growth and reduce risk of ascending aortic aneurysm, although evidence for effectiveness in nonsyndromic aneurysm remains understudied .…”
Section: Introductionmentioning
confidence: 99%
“…5 In the absence of dissection, aneurysms of the ascending aorta are asymptomatic and are usually discovered during thoracic imaging for other indications. 6,7 Medical therapy has been used to slow growth and reduce risk of ascending aortic aneurysm, [8][9][10] although evidence for effectiveness in nonsyndromic aneurysm remains understudied. 11 For severe enlargement, prophylactic aortic surgery has been used to prevent aortic dissection.…”
ImportanceAscending thoracic aortic disease is an important cause of sudden death in the US, yet most aortic aneurysms are identified incidentally.ObjectiveTo develop and validate a clinical score to estimate ascending aortic diameter.Design, Setting, and ParticipantsUsing an ongoing magnetic resonance imaging substudy of the UK Biobank cohort study, which had enrolled participants from 2006 through 2010, score derivation was performed in 30 018 participants and internal validation in an additional 6681. External validation was performed in 1367 participants from the Framingham Heart Study (FHS) offspring cohort who had undergone computed tomography from 2002 through 2005, and in 50 768 individuals who had undergone transthoracic echocardiography in the Community Care Cohort Project, a retrospective hospital-based cohort of longitudinal primary care patients in the Mass General Brigham (MGB) network between 2001-2018.ExposuresDemographic and clinical variables (11 covariates that would not independently prompt thoracic imaging).Main Outcomes and MeasuresAscending aortic diameter was modeled with hierarchical group least absolute shrinkage and selection operator (LASSO) regression. Correlation between estimated and measured diameter and performance for identifying diameter 4.0 cm or greater were assessed.ResultsThe 30 018-participant training cohort (52% women), were a median age of 65.1 years (IQR, 58.6-70.6 years). The mean (SD) ascending aortic diameter was 3.04 (0.31) cm for women and 3.32 (0.34) cm for men. A score to estimate ascending aortic diameter explained 28.2% of the variance in aortic diameter in the UK Biobank validation cohort (95% CI, 26.4%-30.0%), 30.8% in the FHS cohort (95% CI, 26.8%-34.9%), and 32.6% in the MGB cohort (95% CI, 31.9%-33.2%). For detecting individuals with an ascending aortic diameter of 4 cm or greater, the score had an area under the receiver operator characteristic curve of 0.770 (95% CI, 0.737-0.803) in the UK Biobank, 0.813 (95% CI, 0.772-0.854) in the FHS, and 0.766 (95% CI, 0.757-0.774) in the MGB cohorts, although the model significantly overestimated or underestimated aortic diameter in external validation. Using a fixed-score threshold of 3.537, 9.7 people in UK Biobank, 1.8 in the FHS, and 4.6 in the MGB cohorts would need imaging to confirm 1 individual with an ascending aortic diameter of 4 cm or greater. The sensitivity at that threshold was 8.9% in the UK Biobank, 11.3% in the FHS, and 18.8% in the MGB cohorts, with specificities of 98.1%, 99.2%, and 96.2%, respectively.Conclusions and RelevanceA prediction model based on common clinically available data was derived and validated to predict ascending aortic diameter. Further research is needed to optimize the prediction model and to determine whether its use is associated with improved outcomes.
“…Observations from the International Registry of Aortic Dissection suggest that most aortic dissections are associated with at least moderate aortic enlargement (90% ≥4 cm) with many having aneurysmal enlargement (75% ≥4.5 cm) . In the absence of dissection, aneurysms of the ascending aorta are asymptomatic and are usually discovered during thoracic imaging for other indications . Medical therapy has been used to slow growth and reduce risk of ascending aortic aneurysm, although evidence for effectiveness in nonsyndromic aneurysm remains understudied .…”
Section: Introductionmentioning
confidence: 99%
“…5 In the absence of dissection, aneurysms of the ascending aorta are asymptomatic and are usually discovered during thoracic imaging for other indications. 6,7 Medical therapy has been used to slow growth and reduce risk of ascending aortic aneurysm, [8][9][10] although evidence for effectiveness in nonsyndromic aneurysm remains understudied. 11 For severe enlargement, prophylactic aortic surgery has been used to prevent aortic dissection.…”
ImportanceAscending thoracic aortic disease is an important cause of sudden death in the US, yet most aortic aneurysms are identified incidentally.ObjectiveTo develop and validate a clinical score to estimate ascending aortic diameter.Design, Setting, and ParticipantsUsing an ongoing magnetic resonance imaging substudy of the UK Biobank cohort study, which had enrolled participants from 2006 through 2010, score derivation was performed in 30 018 participants and internal validation in an additional 6681. External validation was performed in 1367 participants from the Framingham Heart Study (FHS) offspring cohort who had undergone computed tomography from 2002 through 2005, and in 50 768 individuals who had undergone transthoracic echocardiography in the Community Care Cohort Project, a retrospective hospital-based cohort of longitudinal primary care patients in the Mass General Brigham (MGB) network between 2001-2018.ExposuresDemographic and clinical variables (11 covariates that would not independently prompt thoracic imaging).Main Outcomes and MeasuresAscending aortic diameter was modeled with hierarchical group least absolute shrinkage and selection operator (LASSO) regression. Correlation between estimated and measured diameter and performance for identifying diameter 4.0 cm or greater were assessed.ResultsThe 30 018-participant training cohort (52% women), were a median age of 65.1 years (IQR, 58.6-70.6 years). The mean (SD) ascending aortic diameter was 3.04 (0.31) cm for women and 3.32 (0.34) cm for men. A score to estimate ascending aortic diameter explained 28.2% of the variance in aortic diameter in the UK Biobank validation cohort (95% CI, 26.4%-30.0%), 30.8% in the FHS cohort (95% CI, 26.8%-34.9%), and 32.6% in the MGB cohort (95% CI, 31.9%-33.2%). For detecting individuals with an ascending aortic diameter of 4 cm or greater, the score had an area under the receiver operator characteristic curve of 0.770 (95% CI, 0.737-0.803) in the UK Biobank, 0.813 (95% CI, 0.772-0.854) in the FHS, and 0.766 (95% CI, 0.757-0.774) in the MGB cohorts, although the model significantly overestimated or underestimated aortic diameter in external validation. Using a fixed-score threshold of 3.537, 9.7 people in UK Biobank, 1.8 in the FHS, and 4.6 in the MGB cohorts would need imaging to confirm 1 individual with an ascending aortic diameter of 4 cm or greater. The sensitivity at that threshold was 8.9% in the UK Biobank, 11.3% in the FHS, and 18.8% in the MGB cohorts, with specificities of 98.1%, 99.2%, and 96.2%, respectively.Conclusions and RelevanceA prediction model based on common clinically available data was derived and validated to predict ascending aortic diameter. Further research is needed to optimize the prediction model and to determine whether its use is associated with improved outcomes.
“…Acute aortic syndrome (AAS) comprising aortic dissection and IMH is a commonly misdiagnosed life-threatening circumstance and one of the catastrophic complications of acute TBAD is aortic rupture with massive left hemothorax which is rare and leads to hemodynamic instability and poor outcome [7] , [8] . Fig.…”
“…However, some studies, predominantly from South Korea and Japan, showed favorable results with medical therapy in TAIMH ( 1 , 4 , 8 , 9 ). Initial medical therapy with a “watch-and-wait” strategy may be a reasonable option in patients without complications, particularly in elderly patients without high-risk radiologic features ( 6 , 10 – 12 ).…”
ObjectivesComputed tomography (CT) has been increasingly used in the diagnosis of acute aortic syndrome, and a number of high-risk CT imaging features have been reported. We aimed to identify CT imaging findings suggesting high-risk for acute aortic syndrome by examining clinical outcomes of patients with acute type A aortic intramural hematoma (TAIMH).MethodsThis retrospective study analyzed the relationship of clinical patient characteristics and imaging features with mortality and aortic events in 63 patients receiving initial medical treatment for TAIMH. Multivariate regression analysis was used to determine the predictors of aortic events, and the Kaplan–Meier method was used to analyze survival and aortic events.ResultsDuring a median follow-up of 4.2 years, 25 patients experienced aortic events and 40% of these occurred within 7 days of admission. In total, 12 patients experienced aortic death and 12 patients underwent open aortic surgery or endovascular stenting for aortic disease. In multivariate regression analysis, penetrating atherosclerotic ulcers (PAUs) or ulcer-like projections (ULPs) (P = 0.04) and pericardial effusion (P = 0.03) were independent predictors of aortic events. In the Cox regression model, PAUs/ULPs (P = 0.04) and pericardial effusion (P = 0.04) were independently associated with lower aortic event-free survival.ConclusionIdentification of high-risk CT features is important for clinical decision-making during TAIMH treatment. Early and frequent CT imaging follow-up is required in patients receiving medical treatment. PAUs/ULP and pericardial effusion were the strongest predictors of adverse aortic events.
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