Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis†

Matsushita, Akihito; Hattori, Takashi; Tsunoda, Yu; Sato, Yasunori; Mihara, Wahei

doi:10.1093/icvts/ivx286

Cited by 17 publications

(22 citation statements)

References 18 publications

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“…Many risk factors for late aortic events have been identified [7][8][9][10][11][12][13][14][15] ; however, a robust risk model predicting late aortic events after UTBAD has not been established. This study was performed to build a risk prediction score model for late aortic events in patients with UTBAD and validate it using large-size clinical data with a high follow-up rate.…”

Section: Perspectivementioning

confidence: 99%

“…16 We described our acute aortic dissection protocol in a past study. 7 All cases of UTBAD were managed medically regardless of the false lumen status or the aortic diameter. Medical management included admission to the intensive care unit, continuous blood pressure monitoring, central venous access for intravenous antihypertensive medication, and urine output monitoring.…”

Section: Derivation Cohort Studymentioning

confidence: 99%

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Risk score system for late aortic events in patients with uncomplicated type B aortic dissection

Matsushita

Tabata²,

Mihara

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Several risk factors for late aortic events in patients with uncomplicated type B aortic dissection (UTBAD) have been reported; however, they remain controversial. We developed and validated a new risk prediction score system for late aortic events in patients with UTBAD.Methods: We reviewed 187 consecutive patients diagnosed with UTBAD from 2004 to 2017 at 2 centers (derivation cohort) and 219 consecutive patients diagnosed with UTBAD from 2012 to 2016 in 4 other centers (validation cohort). We explored predictors of late aortic events using Fine-Gray generalization of the proportional hazards model, then developed a risk prediction score model and determined the test reliability using time-dependent receiver operating characteristic analyses. Finally, we validated the model using external multicenter data.Results: The risk prediction score system was developed using the following independent predictors: initial aortic diameter of !40 mm (2 points), false lumen diameter larger than true lumen diameter (2 points), ulcer-like projection (1 point), and age !70 years (1 point). Receiver operating characteristic analysis showed that a cut-off total additive score of 2 points. In the validation cohort, the low-risk group (score, 0-1 point) demonstrated lower 1-and 3-year incidence rates of late aortic events than the high-risk group (score, 2-6 points) (0.9% vs 32.5% and 0.9% vs 47.1%, respectively; P <.0001).

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Section: Perspectivementioning

confidence: 99%

Section: Derivation Cohort Studymentioning

confidence: 99%

Risk score system for late aortic events in patients with uncomplicated type B aortic dissection

Matsushita

Tabata²,

Mihara

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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“…Acute type B was defined as that involving the descending aorta (without any tear in or involvement of the ascending aorta) appearing within 14 days of the onset of symptoms. [ 7 8 9 ] Patients were divided into two groups according to sex.…”

Section: Ethodsmentioning

confidence: 99%

Correlation between Sex and Prognosis of Acute Aortic Dissection in the Chinese Population

Liu

Wang

et al. 2018

Chinese Medical Journal

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Background:The prevalence, presentation, management, and prognosis of coronary heart disease differ according to sex. Greater understanding on the differences between men and women with acute aortic dissection (AAD) is needed. We aimed to investigate whether sex disparities are found in patients with AAD, and to study sex differences in complications, mortality in-hospital, and long-term.Methods:We included 884 patients enrolled in our institute between June 2002 and May 2016. Considering psychosocial factors, treatments, and the outcomes in men versus those in women with AAD, we explored the association of sex with psychosocial characteristics and mortality risk. For categorical variables, significant differences between groups were assessed with the Chi-square test or Fisher's exact test, and continuous parameters were assessed with Student's t-test. Univariate and stratified survival statistics were computed using Kaplan-Meier analysis.Results:A total of 884 patients (76.1% male, mean age 51.4 ± 11.8 years) were included in this study. There were fewer current smokers in female compared with male (17.5% vs. 67.2%, χ2 = 160.06, P < 0.05). The percentage of men who reported regular alcohol consumption was significantly higher than that in women (40.6% vs. 3.8%, χ2 = 100.18, P < 0.05). About 6.2% (55 of 884) of patients with AAD died before vascular or endovascular surgery was performed, 34.4% (304 of 884) of patients underwent surgical procedures, and 52.7% (466 of 884) and 12.8% (113 of 884) of patients received endovascular treatment and medication. Postoperative mortality similar (6.0% vs. 5.6%, respectively, χ2 = 0.03, P = 0.91) between men and women. Follow-up was completed in 653 of 829 patients (78.8%). Adjustment for age, history of coronary disease, hypertension, smoking and drinking, Type A and use of beta-blocker, angiotensin II receptor blockers, angiotensin converting enzyme (ACE) inhibitor, calcium-channel blockers and statins by multivariate logistic regression analysis suggested that age (odds ratios [ORs], 1.04; 95% confidence interval [CI], 1.01–1.07; P < 0.05), using of calcium-channel blockers (OR, 0.37; 95% CI, 0.18–0.74; P < 0.05), at discharge were independent predictors of late mortality, ACE inhibitors (OR, 1.91; 95% CI, 1.03–3.54; P = 0.04) was independent risk factor of late mortality.Conclusions:In Chinese with AAD, sex is not independently associated with long-term clinical outcomes. Age, the intake of calcium-channel blockers at discharge might help to improve long-term outcomes.

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“…12,13 However, a recent study of acute type B dissection, perhaps a surrogate for the distal segment following hemiarch repair, reported no effect of false lumen patency on late survival. 15 Many studies have shown that a frozen elephant trunk does promote false lumen thrombosis at the level of the stent, but not at the diaphragmatic and visceral segment levels. For example, Zhang and colleagues reported 100% proximal thrombosis at 6À12 months but only 45.1% distally.…”

Section: False Lumen Patency Post Hemiarchmentioning

confidence: 99%

“…A frequent cutoff differentiating excellent from inferior outcomes is 40 mm. 9,15,30,32,33 False lumen patency is another parameter often correlated with outcomes, and studies have variously focused on false lumen size, 11,30,35 shape, degree of thrombosis, 36 and capacity of outflow branches. 37 An important observation regarding false lumen measurements in the acute phase is that the dissection membrane is dynamic and moves throughout the cardiac cycle, making false lumen size measurement by one fixed CT image misleading.…”

Section: Selective Use Of Extended Procedures For Ataadmentioning

confidence: 99%

Extended Arch Procedures for Acute Type A Aortic Dissection: A Downstream Problem?

Lansman

Goldberg

Kai

et al. 2019

Seminars in Thoracic and Cardiovascular Surgery

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Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis†

Abstract: UMIN 000025388, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029229.

Cited by 17 publications

References 18 publications

Risk score system for late aortic events in patients with uncomplicated type B aortic dissection

Risk score system for late aortic events in patients with uncomplicated type B aortic dissection

Correlation between Sex and Prognosis of Acute Aortic Dissection in the Chinese Population

Extended Arch Procedures for Acute Type A Aortic Dissection: A Downstream Problem?

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