• Circ Cardiovasc Imaging · Apr 2017

    Computed Tomography Imaging Features in Acute Uncomplicated Stanford Type-B Aortic Dissection Predict Late Adverse Events.

    • Anna M Sailer, Sander M J van Kuijk, Patricia J Nelemans, Anne S Chin, Aya Kino, Mark Huininga, Johanna Schmidt, Gabriel Mistelbauer, Kathrin Bäumler, Peter Chiu, Michael P Fischbein, Michael D Dake, D Craig Miller, Geert Willem H Schurink, and Dominik Fleischmann.
    • From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
    • Circ Cardiovasc Imaging. 2017 Apr 1; 10 (4).

    BackgroundMedical treatment of initially uncomplicated acute Stanford type-B aortic dissection is associated with a high rate of late adverse events. Identification of individuals who potentially benefit from preventive endografting is highly desirable.Methods And ResultsThe association of computed tomography imaging features with late adverse events was retrospectively assessed in 83 patients with acute uncomplicated Stanford type-B aortic dissection, followed over a median of 850 (interquartile range 247-1824) days. Adverse events were defined as fatal or nonfatal aortic rupture, rapid aortic growth (>10 mm/y), aneurysm formation (≥6 cm), organ or limb ischemia, or new uncontrollable hypertension or pain. Five significant predictors were identified using multivariable Cox regression analysis: connective tissue disease (hazard ratio [HR] 2.94, 95% confidence interval [CI]: 1.29-6.72; P=0.01), circumferential extent of false lumen in angular degrees (HR 1.03 per degree, 95% CI: 1.01-1.04, P=0.003), maximum aortic diameter (HR 1.10 per mm, 95% CI: 1.02-1.18, P=0.015), false lumen outflow (HR 0.999 per mL/min, 95% CI: 0.998-1.000; P=0.055), and number of intercostal arteries (HR 0.89 per n, 95% CI: 0.80-0.98; P=0.024). A prediction model was constructed to calculate patient specific risk at 1, 2, and 5 years and to stratify patients into high-, intermediate-, and low-risk groups. The model was internally validated by bootstrapping and showed good discriminatory ability with an optimism-corrected C statistic of 70.1%.ConclusionsComputed tomography imaging-based morphological features combined into a prediction model may be able to identify patients at high risk for late adverse events after an initially uncomplicated type-B aortic dissection.© 2017 American Heart Association, Inc.

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