The role of the angle of the ascending aortic curvature on the development of type A aortic dissection: ascending aortic angulation and dissection
The role of the angle of the ascending aortic curvature on the development of type A aortic dissection: ascending aortic angulation and dissection
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DOI：
10.1093/icvts/ivz144
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发表时间：
2019-10-01
影响因子：
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通讯作者：
Erentug, Vedat
中科院分区：
文献类型：
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作者：
Gode, Safa;Akinci, Okan;Erentug, Vedat
目的：A 型主动脉夹层（TAD）由主动脉内膜撕裂组成，需要紧急手术。文献中已经定义了与主动脉夹层相关的各种危险因素。根据我们的假设，升主动脉曲率角 (AAAC) 较窄可能是与主动脉夹层相关的另一个危险因素，因为对主动脉壁施加的力增加。 方法：因升主动脉瘤 (AsAA) 接受升主动脉手术的患者 (n = 105) 和因 TAD 发生而接受此类手术的患者 (n = 101) 纳入本研究。 AAAC采用Cobb法测量；仅由一名心血管放射科医生使用 3 维计算机断层扫描成像对所有患者进行了测量。该测量是通过使用主动脉瓣和头臂动脉间接进行的，以避免由于解剖造成的扭曲而获得误导性的达拉。还对 TAD 的传统危险因素与其他临床和超声心动图参数（升主动脉直径和 AAAC）进行了统计比较。 结果：发现 TAD 组的 AAAC（α = 76.2 度+/- 17.5 度）比 AsAA 组（α = 92.9 度+/- 13 度）更窄（P < 0.001）。此外，AsAA 组的平均升主动脉直径 (P = 0.019)、二尖瓣主动脉 (P = 0.007) 和主动脉瓣狭窄 (P = 0.005) 均较高。根据多变量分析，较窄的 AAAC 是 TAD 发生的重要预测因子（比值比 0.93，95% 置信区间 0.91-0.95；P < 0.001）。 TAD 组因中风、心肌梗塞、出血或肾衰竭等各种原因导致的住院总死亡率为 13%，AsAA 组为 7%。 结论：根据这项研究，主动脉夹层患者的 AAAC 明显小于主动脉瘤患者。这可能与 AAAC 较窄的患者升主动脉的剪切应力较高和压力升高有关。因此，狭窄的 AAAC 可能是 TAD 发展的另一个危险因素。因此，我们可能需要更加小心地寻找狭窄 AAAC 患者主动脉夹层的发生情况。
OBJECTIVES: Type A aortic dissection (TAD), which consists of an intimal tear in the aorta, necessitates emergency surgery. Various risk factors related to aortic dissection have been defined in the literature. According to our hypothesis, a narrower angle of ascending aortic curvature (AAAC) may be an additional risk factor in relation to aortic dissection due to the increased force applied to the aortic wall.METHODS: Patients undergoing ascending aortic surgery due to an ascending aortic aneurysm (AsAA) (n = 105) and patients undergoing such surgery because of the occurrence of TAD (n = 101) were enrolled in this study. The AAAC was measured using Cobb's method; the measurements were made on all patients by just 1 cardiovascular radiologist using 3-dimensional computerized tomographic imaging. This measurement was made indirectly by using the aortic valve and brachiocephalic artery to avoid obtaining misleading dara as a result of distortions due to dissection. A statistical comparison was also performed relating the traditional risk factors for TAD to other clinical and echocardiographic parameters: the diameter of the ascending aorta and the AAAC.RESULTS: The AAAC was found to be narrower statistically in the TAD group (alpha = 76.2 degrees +/- 17.5 degrees) than it was in the AsAA group (alpha = 92.9 degrees +/- 13 degrees) (P < 0.001). Furthermore, mean ascending aortic diameter (P = 0.019), the presence of a bicuspid aorta (P = 0.007) and aortic valve stenosis (P = 0.005) were higher in the AsAA group. According to multivariable analyses, a narrower AAAC is a significant predictor for the development of TAD (odds ratio 0.93, 95% confidence interval 0.91-0.95; P < 0.001). Overall hospital mortality from various causes including stroke, myocardial infarction, bleeding or renal failure was 13% in the TAD group and 7% in the AsAA group.CONCLUSIONS: According to this study, the AAAC was significantly smaller in aortic dissection patients than in aortic aneurysm patients. This may be related to higher shear stress and elevated pressure on the ascending aorta in patients with a narrower AAAC. Thus, a narrower AAAC may be an additional risk factor in the development of TAD. Therefore, we may need to be more careful in terms of looking for the development of aortic dissection in patients with narrower AAAC.