Methodology for Estimation of Annual Risk of Rupture for Abdominal Aortic Aneurysm
Methodology for Estimation of Annual Risk of Rupture for Abdominal Aortic Aneurysm
复制标题
DOI：
10.1016/j.cmpb.2020.105916
复制
发表时间：
2021-01-24
影响因子：
6.1
通讯作者：
Raghavan, Madhavan L.
中科院分区：
文献类型：
--
作者：
Polzer, Stanislav;Kracik, Jan;Raghavan, Madhavan L.
背景和目的：估计腹主动脉瘤（AAA）破裂的患者特异性年风险目前仅基于人群。基于患者特定数据的更准确的知识将允许仅对具有显著破裂风险的AAA进行手术治疗。这将是有益的患者和卫生保健system.Methods：估计每年的破裂风险（EARR）的腹主动脉瘤（AAA），利用贝叶斯统计，力学和患者特定的血压监测数据的方法。EARR估计考虑了通过患者特定有限元建模计算的AAA中的峰值壁应力、壁厚度、壁强度、收缩压的概率分布以及已知患者已经与完整AAA一起存活的时间段。对15例完整AAA患者（平均最大直径51 mm +/-8 mm）进行了申报入路的初始试验。他们配备了压力霍尔特和他们的血压记录超过24小时。然后，我们计算了四种可能情况下的EARR值-不考虑在计算机断层扫描（EARR_0）中识别AAA之前的任何生存天数，考虑过去30天（EARR_30），90天（EARR_90）和180天（EARR_180）的生存期。最后，病人的具体血压变异性的影响进行了analysed.Results：考虑过去的生存确实显着提高预测未来的风险：EARR_30（1.04% +/- 0.87%）、EARR_90（0.67% +/- 0.56%）及EARR_180（0.47% +/- 0.39%），在其他方面均不切实际地偏高（EARR_0 5.02% +/- 5.24%）。最后，EARR值被观察到变化的顺序作为一个后果的血压变异性和两个因素作为一个后果被忽略growth.Conclusions：每年的AAA破裂的风险计算方法开发的第一次。敏感性分析显示，尊重患者特定血压是重要因素，应纳入AAA破裂风险评估。所获得的EARR值通常较低，并且与所研究患者的确认生存时间非常一致，因此建议的方法应进一步临床验证。(c)2020爱思唯尔B. V.保留所有权利。
Background and Objective: Estimating patient specific annual risk of rupture of abdominal aortic aneurysm (AAA) is currently based only on population. More accurate knowledge based on patient specific data would allow surgical treatment of only those AAAs with significant risk of rupture. This would be beneficial for both patients and health care system.Methods: A methodology for estimating annual risk of rupture (EARR) of abdominal aortic aneurysms (AAA) that utilizes Bayesian statistics, mechanics and patient-specific blood pressure monitoring data is proposed. EARR estimation takes into consideration, peak wall stress in AAA computed by patient-specific finite element modeling, the probability distributions of wall thickness, wall strength, systolic blood pressure and the period of time that the patient is known to have already survived with the intact AAA. Initial testing of proposed approach was performed on fifteen patients with intact AAA (mean maximal diameter 51mm +/- 8mm). They were equipped with a pressure holter and their blood pressure was recorded over 24 hours. Then, we calculated EARR values for four possible scenarios - without considering any days of survival prior identification of AAA at computed tomography scans (EARR_0), considering past survival of 30 (EARR_30), 90 (EARR_90) and 180 days (EARR_180). Finally, effect of patient-specific blood pressure variability was analyzed.Results: Consideration of past survival does indeed significantly improve predictions of future risk: EARR_30 (1.04% +/- 0.87%), EARR_90 (0.67% +/- 0.56%) and EARR_180 (0.47% +/- 0.39%) which are unrealistically high otherwise (EARR_0 5.02% +/- 5.24%). Finally, EARR values were observed to vary by an order as a consequence of blood pressure variability and by factor of two as a consequence of neglected growth.Conclusions: Methodology for computing annual risk of rupture of AAA was developed for the first time. Sensitivity analyses showed respecting patient specific blood pressure is important factor and should be included in the AAA rupture risk assessment. Obtained EARR values were generally low and in good agreement with confirmed survival time of investigated patients so proposed method should be further clinically validated.(c) 2020 Elsevier B.V. All rights reserved.