Aortic elongation part II: the risk of acute type A aortic dissection

Heuts, Samuel; Adriaans, Bouke P.; Gerretsen, Suzanne; Natour, Ehsan; Vos, Rein; Cheriex, Emile C.; Crijns, Harry J.G.M.; Wildberger, Joachim E.; Maessen, Jos G.; Schalla, Simon; Nia, Peyman Sardari

doi:10.1136/heartjnl-2017-312867

Cited by 56 publications

(46 citation statements)

References 26 publications

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“…This evolution has paved the way for more comprehensive radiological measurements, such as those of aortic length and volume shown here. Previous studies investigating vessel length have demonstrated that the healthy aorta gradually elongates with age and that the dissected aorta is notably longer than would have been expected based on age, gender and body surface area (BSA) 12–14 21–23. The current work adds to this knowledge by revealing that aortic length also serves as more discriminative ATAAD predictor than the maximal transverse diameter.…”

Section: Discussionmentioning

confidence: 59%

“…Therefore, measurements of aortic volume and length could provide additional information over diameters with regard to the detection of aneurysm progression. Whereas the predictive value of aortic volumetry has not yet been investigated, several studies have evaluated the potential role of excessive vessel lengthening in the pathophysiology of dissection 12–14. Although all of these studies reported that patients with ATAAD had elongated ascending aortas when compared with healthy controls, these reports mainly included postdissection measurements.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

Heuts

Adriaans

Rylski

et al. 2020

Heart

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ObjectiveManagement of thoracic aortic aneurysms (TAAs) comprises regular diameter follow-up until the indication criterion for prophylactic surgery is reached. However, this approach is unable to predict the majority of acute type A aortic dissections (ATAADs). The current study aims to evaluate the diagnostic accuracy of ascending aortic diameter, length and volume for occurrence of ATAAD.MethodsThis two-centre observational cohort study retrospectively screened 477 consecutive patients who presented with ATAAD between 2009 and 2018. Of those, 25 (5.2%) underwent CT angiography (CTA) within 2 years before dissection onset. Aortic diameter, length and volume of these patients (‘pre-ATAAD’) were compared with those of TAA controls (n=75). Receiver operating curve analysis was performed to evaluate the predictive accuracy of the three different measurements.Results96% of patients with pre-ATAAD did not meet the surgical diameter threshold of 55 mm before dissection onset. Maximal aortic diameters (45 (40–49) mm vs 46 (44–49) mm, p=0.075) and volume (126 (95–157) cm3 vs 124 (102–136) cm3, p=0.909) were comparable between patients with pre-ATAAD and TAA controls. Conversely, ascending aortic length (84±9 mm vs 90±16 mm, p=0.031) was significantly larger in patients with pre-ATAAD. All three parameters had an area under the curve of >0.800. At the 55 mm cut-off point, the maximal diameter yielded a positive predictive value (PPV) of 20%. While maintaining same specificity levels, measurements of aortic volume and length showed superior diagnostic accuracy (PPV 55% and 70%, respectively).ConclusionMeasurements of aortic volume and length have superior diagnostic accuracy compared with the maximal diameter and could improve the timely identification of patients at risk for ATAAD.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

Heuts

Adriaans

Rylski

et al. 2020

Heart

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“…Patients with type A aortic dissection have a longer ascending aorta than do healthy people [3]. Ascending aortic length per centimeter was reported to have an odds ratio of 5.3 for ascending aortic dissection [4]. However, these studies were cross-sectional studies, and the exact longitudinal change of aortic length was not clear.…”

Section: Introductionmentioning

confidence: 99%

Elongation of the Aorta after Thoracic Endovascular Aortic Repair: A longitudinal study

Chen

Chou

Chang

et al. 2020

IJERPH

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Aortic morphology is associated with age, with the diameter being larger in older people. Thoracic endovascular aortic repair (TEVAR) is a treatment for aortic diseases, such as aortic dissection. When evaluating patients, aortic elongation could interfere with the classification of TEVAR complications. The longitudinal change in aortic length has not been studied in detail. In patients receiving thoracic endovascular aortic repair between 2007 and 2013, we determined the aortic length between the sinotubular junction, left common carotid artery, subclavian artery, and celiac artery on their first five annual follow-up computed tomography (CT) exams. Using the immediate post-TEVAR follow-up CT as the comparison reference and a lengthening of the aortic segment by 10 mm or more as the definition of elongation, 16 of 41 (39%) showed elongation between the innominate artery and celiac artery. When compared with the immediate follow-up CT, a higher proportion of patients showed elongation at the fifth year’s follow-up CT than the first year’s follow-up CT (p < 0.01), and the average lengthening per year was 1.7 mm. There was progressive lengthening of the aorta after TEVAR.

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“…Over-diagnosis results in needless patient anxiety and excessive sequential imaging. Rather than using aortic diameter thresholds derived from younger populations, we should focus on identifying which patients are at risk of aortic dissection; possibly by considering aortic length, not just diameter, or by increased attention to genetic and clinical risk factors, including hypertension 4 5. In the accompanying editorial, Groepenhoff and den Ruijter6 point out several other differences in vascular properties between men and women related to coronary, carotid and aortic disease (figure 3).…”

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confidence: 99%

Heartbeat: time for action to eliminate sex disparities in management and outcomes of patients with an acute coronary syndrome

Otto

2019

Heart

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Aortic elongation part II: the risk of acute type A aortic dissection

Abstract: Ascending aortic length could serve as an independent predictor for ATAAD. Future studies addressing indications for prophylactic surgery should also investigate aortic length.

Cited by 56 publications

References 26 publications

Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

Elongation of the Aorta after Thoracic Endovascular Aortic Repair: A longitudinal study

Heartbeat: time for action to eliminate sex disparities in management and outcomes of patients with an acute coronary syndrome

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