Certain aortic geometries and hemodynamics are associated with FID development and impact the evolution of uncomplicated type B intramural hematoma during the acute phase

Jiang, Daifeng; Feng, Ke; Lai, Yiquan; Zhang, Shan; Qu, Chen

doi:10.1111/jocs.14040

Cited by 4 publications

(1 citation statement)

References 34 publications

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“…However, there is still a lack of research on the involvement of aortic branches in patients with IMH, and thus its relationship to the prognosis of patients requires further research. Some aortic conditions are associated with “inflammatory-cell-mediated destructive remodeling” pathways ( 24 ). Higher WBC counts may be indirect evidence of these actions.…”

Section: Discussionmentioning

confidence: 99%

A radiomics model based on aortic computed tomography angiography: the impact on predicting the prognosis of patients with aortic intramural hematoma (IMH)

Ding¹,

Zhang²,

Wu³

et al. 2023

Quant Imaging Med Surg

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Background: The prognosis of aortic intramural hematoma (IMH) is unpredictable, but computed tomography angiography (CTA) plays an important role of high diagnostic performance in the initial diagnosis and during follow-up of patients. In this study, we investigated the value of a radiomics model based on aortic CTA for predicting the prognosis of patients with medically treated IMH.Method: A total of 120 patients with IMH were enrolled in this study. The follow-up duration ranged from 32 to 1,346 days (median 232 days). Progression of these patients was classified as follows: destabilization, which refers to deterioration in the aortic condition, including significant increases in the thickness of the IMH, the progression of IMH to a penetrating aortic ulcer (PAU), aortic dissection (AD), or rupture; or stabilization, which refers to an unchanged appearance or a decrease in the size or disappearance of the IMH. The patients were divided into a training cohort (n=84) and a validation cohort (n=36). Six different machine learning classifiers were applied: random forest (RF), K-nearest neighbor (KNN), Gaussian Naive Bayes, decision tree, logistic regression, and support vector machine (SVM). The clinical-radiomics combined nomogram model was established by multivariate logistic regression. The area under the receiver operating characteristic (ROC) curve (AUC) was implemented to evaluate the discrimination performance of the models. The calibration curves and Hosmer-Lemeshow test were used for evaluating model calibration.DeLong's test was performed to compare the AUC performance of models.Results: Among all of the patients, 60 patients showed destabilization and 60 patients remained stable.A total of 12 radiomic features were retained after application of the least absolute shrinkage and selection operator (LASSO). These features were used for the machine learning model construction. The SVMradial basis function (SVM-RBF) model obtained the best performance with an AUC of 0.765 (95% CI, 0.593-0.906). In the validation cohort, the combined clinical-radiomics model [AUC 0.787; 95% confidence interval (CI), 0.619-0.923] showed a significantly higher performance than did the clinical model (AUC 0.596; 95% CI, 0.413-0.796; P=0.021) and had a similar performance to the radiomics model (AUC 0.765; 95% CI, 0.589-0.906; P=0.672).Conclusions: A quantitative nomogram based on radiomic features of CTA images can be used to predict disease progression in patients with IMH and may help improve clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

A radiomics model based on aortic computed tomography angiography: the impact on predicting the prognosis of patients with aortic intramural hematoma (IMH)

Ding¹,

Zhang²,

Wu³

et al. 2023

Quant Imaging Med Surg

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Prognostic value of estimated glomerular filtration rate and presence of proteinuria in type B aortic intramural hematoma

Yang¹,

Li²,

Liu³

et al. 2021

J Thorac Dis

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Background: Although aggressive medical treatment is recommended in patients with type B aortic intramural hematoma (IMH), a variety of aortic events can occur during the later period. For early identification of these patients, the present study was aimed at evaluating the prognostic validity of estimated glomerular filtration rate (eGFR) and the presence of proteinuria in type B aortic IMH. Methods: Data of 61 patients with type B IMH in Peking University People's Hospital from January 2008 to December 2018 were retrospectively collected. The serum creatinine level and urine protein levels were measured at admission. And eGFR were calculated by the CKD-EPI equation. Adverse aortic-related events were defined as a composite of satisfaction of criteria for surgical conversion (with or without actual surgical intervention) and death from aortic rupture. Results: Initial eGFR was significantly different between patients with adverse aortic-related events and those without (P=0.003). On multivariate analysis, eGFR <90 mL/min/1.73 m 2 (OR, 8.726; 95% CI: 1.711-46.144; P=0.009) and ULP (OR, 17.516; 95% CI: 3.322-92.258; P=0.001) were independent predictorsof adverse aorta-related events. Furthermore, eGFR <90 mL/min/1.73 m 2 and proteinuria (+) (OR, 8.344; P=0.030) had significantly greater rates of aortic-related events. In addition, eGFR <90 mL/min/1.73 m 2 and proteinuria (+) had incremental prognostic value (C-statistic, 0.860, P=0.039) compared with ulcer-like projection (C-statistic, 0.815) alone. Conclusions: Initial eGFR and presence of proteinuria were able to provide incremental prognostic information in addition to ulcer-like projection in patients with type B aortic IMH.

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Clinical characteristics and prognosis of acute type B intramural hematoma among elderly patients

Li,

Liu,

Wang

et al. 2024

Preprint

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Background Intramural hematoma (IMH) within the aorta constitutes one of the acute aortic syndromes. Typically, individuals diagnosed with IMH tend to be of advanced age in comparison to those with aortic dissection (AD). The primary objective of this investigation was to gain insights into the prognosis of elderly patients suffering from type B IMH (TBIMH) and to ascertain the risk factors influencing their prognosis. Methods From January 2015 to October 2022, 71 consecutive elderly patients with TBIMH were admitted to the affiliated hospitals of China Medical University. Every patient in the cohort received their initial diagnosis of TBIMH. The basic information, initial imaging information, and survival outcomes of the patients were collected and analyzed. Results A total of 71 individuals (mean age 69.5 ± 6.6 years, 61% male) were included in this research. Among elderly patients with TBIMH, the 60–69 age group (33/71, 46.5%) was equivalent to patients in the 70 and older age group (38/71, 53.5%). The two groups exhibited no significant variation in terms of mid- and long-term survival. Kaplan–Meier survival curves suggested that alcoholism (P = 0.002), renal insufficiency (P = 0.031), presence of ulcer-like projections (ULPs; P = 0.039), and a maximum hematoma thickness of more than 13 mm (P = 0.026) were associated with aortic-related deaths. The Cox survival analysis demonstrated that a maximum hematoma thickness greater than 13 mm (HR = 3.782, 1.272–11.243; P = 0.017) was shown to significantly predict the progression of IMH. Conclusions In elderly patients with TBIMH, the presence of a hematoma exceeding 13 mm in thickness was identified as an independent risk factor for aortic-related mortality. Additionally, the coexistence of ULP and alcoholism appeared to be potentially correlated with an elevated risk of aortic-related mortality.

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Certain aortic geometries and hemodynamics are associated with FID development and impact the evolution of uncomplicated type B intramural hematoma during the acute phase

Cited by 4 publications

References 34 publications

A radiomics model based on aortic computed tomography angiography: the impact on predicting the prognosis of patients with aortic intramural hematoma (IMH)

A radiomics model based on aortic computed tomography angiography: the impact on predicting the prognosis of patients with aortic intramural hematoma (IMH)

Prognostic value of estimated glomerular filtration rate and presence of proteinuria in type B aortic intramural hematoma

Clinical characteristics and prognosis of acute type B intramural hematoma among elderly patients

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