Aortic enlargement in two weeks is associated with subsequent aortic events in patients with type B acute aortic syndrome
Aortic enlargement in two weeks is associated with subsequent aortic events in patients with type B acute aortic syndrome
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B 型急性主动脉综合征患者两周内主动脉扩大与随后的主动脉事件相关
DOI：
10.1016/j.jtcvs.2021.09.014
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Furukawa Yutaka
中科院分区：
文献类型：
--
作者：
Miyoshi Yutaro;Kaji Shuichiro;Masumoto Akiko;Kim Kitae;Kitai Takeshi;Kinoshita Makoto;Furukawa Yutaka
ObjectivesTo determine whether aortic expansion in 2 weeks in patients with type B acute aortic syndrome is associated with aorta-related adverse events.MethodsThis retrospective，single center study included 183 patients who were diagnosed with uncomplicated B acute aortic syndrome（classic aortic dissection and intrauterior hematoma）between 2010 and 2019 and had follow-up computed tomography at the second or third week.在入院时和出院前随访时测量主动脉直径。主动脉相关不良事件的定义为主动脉破裂，手术或腔内修复术，再夹层，严重肠灌注不良，和aorbiter.ResultsThe主动脉直径扩大≥2 mm，但<5 mm的患者在2周内被归类为中度主动脉扩大组。随访期间，51例患者（28%）发生了主动脉瓣相关不良事件，36例患者（20%）发生了中度主动脉瓣扩大。主动脉中度扩大患者的无心血管事件生存率低于无中度扩大患者（1年时48 ± 9% vs 90 ± 3%，P<0.001）。在多变量分析中，中度主动脉扩张（亚危险比，3.64; 95%置信区间，2.08-6.35;P< .001）和入院时主动脉直径≥40 mm（亚危险比，2.96; 95%可信区间，1.60-5.48; P< .001）与主动脉瓣相关不良事件有关。无并发症的B型急性主动脉综合征患者的相关不良事件。中度主动脉扩张的患者应仔细随访，并可能成为后续血管内治疗的候选人。
ObjectivesTo determine whether aortic enlargement in 2 weeks in patients with type B acute aortic syndrome is associated with aorta-related adverse events.MethodsThis retrospective, single-center study included 183 patients who were diagnosed with uncomplicated type B acute aortic syndrome (classic aortic dissection and intramural hematoma) between 2010 and 2019 and had follow-up computed tomography at second or third week. Aortic diameter was measured at admission and at predischarge follow-up. Aorta-related adverse events were defined by a composite of aortic rupture, surgical or endovascular aortic repair, redissection, severe intestinal malperfusion, and aortic enlargement.ResultsThe patients whose aortic diameter enlarged ≥2 mm but <5 mm in 2 weeks were categorized as moderate aortic enlargement group. During follow-up, 51 patients (28%) had aorta-related adverse events and 36 patients (20%) had moderate aortic enlargement. Patients with moderate aortic enlargement showed lower aorta-related event-free survival rates than those without moderate enlargement (48 ± 9% vs 90 ± 3% at 1 year,P< .001). On multivariable analysis, moderate aortic enlargement (subhazard ratio, 3.64; 95% confidence interval, 2.08-6.35;P< .001) and aortic diameter ≥40 mm at admission (subhazard ratio, 2.96; 95% confidence interval, 1.60-5.48;P< .001) were associated with aorta-related adverse events.ConclusionsModerate aortic enlargement in 2 weeks is a significant risk factor of aorta-related adverse events in patients with uncomplicated type B acute aortic syndrome. Patients with moderate aortic enlargement should be followed up carefully and may be candidates for subsequent endovascular treatment.