Long-term follow-up and clinical implications in Chinese patients with aortic intramural hematomas

Liu, Yanjie; Zhang, Quanyu; Du, Zhenhong; Yang, Lin; Zhang, Lei; He, Rong; Ya, Wang; Han, Yaling; Wang, Xiaozeng

doi:10.1016/j.ijcard.2018.06.077

Cited by 8 publications

(13 citation statements)

References 19 publications

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“…As mentioned, ulcer-like projection as small ulcers associated with IMH has been reported as a high-risk factor for poor outcomes by previous studies (1,(27)(28)(29)(30). In addition, from a previous study on IMH, the factors related to IMH evolution including a maximum aortic diameter of > 40 mm, hematoma thickness of >10 mm (31) and ULP (1,(27)(28)(29)(30) from imaging are all associated with instability of the aortic wall which induces aneurysmal evolution in IMH. Bolomey et al also found that aortic diameter of >40 mm and at least one ULP comprised strong predictors of aortic related events (32).…”

Section: Discussionmentioning

confidence: 80%

“…T h e r e f o r e , p a t i e n t s w i t h e G F R <90 mL/min/1.73 m 2 and proteinuria (+) might accelerate the atherosclerosis change in the aorta, which is prone to ULP development and might lead to IMH expansion or aneurysm dilation (26). As mentioned, ulcer-like projection as small ulcers associated with IMH has been reported as a high-risk factor for poor outcomes by previous studies (1,(27)(28)(29)(30). In addition, from a previous study on IMH, the factors related to IMH evolution including a maximum aortic diameter of > 40 mm, hematoma thickness of >10 mm (31) and ULP (1,(27)(28)(29)(30) from imaging are all associated with instability of the aortic wall which induces aneurysmal evolution in IMH.…”

Section: Discussionmentioning

confidence: 94%

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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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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 94%

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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“…Of these, 17 studies were included in the present review, all observational and retrospective ( Figure 1 ). Two studies only reported on PAUs [ 11 , 14 ], two studies reported on PAUs and IMHs [ 5 , 10 ] and thirteen articles only concentrated on IMHs [ 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…ARM timing was specified in five studies [ 10 , 18 , 19 , 21 , 24 ], and it occurred in the acute phase in 17/433 cases (3.9%). The number of patients undergoing intervention was reported in 12 studies [ 10 , 12 , 13 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 ], with a rate of 21% during follow-up (241/1147 cases) ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review

et al. 2022

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Background: This work aims to review recent literature on penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs), in order to identify clinical and imaging factors connected to aortic-related adverse events (AAE). Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic review and Metanalyses (PRISMA) guidelines. An electronic search was conducted on Medline and Embase databases. We included articles reporting on PAUs and/or IMHs localized in the descending thoracic and/or abdominal aorta and analyzing clinical and/or radiological markers of AAE. Results: Of 964 records identified through database searching, 17 were incorporated in the present review, including 193 and 1298 patients with type B PAUs and IMHs, respectively. The 30-days aortic-related mortality (ARM) was 4.3% and 3.9% for PAUs and IMHs. A total of 21% of patients with IMHs underwent intervention during the follow-up period, and 32% experienced an AAE. PAU markers of AAE were minimum depth (ranging from 9.5 to 15 mm) and diameter (≥12.5 mm). Maximum aortic diameter (MAD) cut-off values ranging from 38 to 44.75 mm were related to AAE for IMHs, together with ulcer-like projection (ULP) of the aortic wall. Conclusions: Despite data heterogeneity in the literature, this PAU- and IMH-focused review has highlighted the imaging and clinical markers of disease progression, thus identifying patients that could benefit from an early intervention in order to reduce the AAE rate.

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Is the Natural Anatomical Evolution of Type B Intramural Hematomas Reliable to Identify the Patients at Risk of Aneurysmal Progression?

Bolomey

Blanchard

Barral

et al. 2020

Annals of Vascular Surgery

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Long-term follow-up and clinical implications in Chinese patients with aortic intramural hematomas

Cited by 8 publications

References 19 publications

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

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

Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review

Is the Natural Anatomical Evolution of Type B Intramural Hematomas Reliable to Identify the Patients at Risk of Aneurysmal Progression?

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