Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

作者：Samuel Heuts, Bouke P. Adriaans, Bartosz Rylski, Casper Mihl, Sebastiaan C.A.M. Bekkers, Jules R. Olsthoorn, Ehsan Natour, Heleen J. Bouman, Mikołaj Berezowski, Kinga Kosiorowska, Harry J.G.M. Crijns, Jos G. Maessen, Joachim Ernst Wildberger, Simon M. Schalla, Peyman Sardari Nia · 发表于：Heart · 年份：2020 · DOI：10.1136/heartjnl-2019-316251 · 被引用次数：81 · 研究领域：Aortic Disease and Treatment Approaches、Aortic aneurysm repair treatments、Connective tissue disorders research

OBJECTIVE: Management of thoracic aortic aneurysms (TAAs) comprises regular diameter follow-up until the indication criterion for prophylactic surgery is reached. However, this approach is unable to predict the majority of acute type A aortic dissections (ATAADs). The current study aims to evaluate the diagnostic accuracy of ascending aortic diameter, length and volume for occurrence of ATAAD. METHODS: This two-centre observational cohort study retrospectively screened 477 consecutive patients who presented with ATAAD between 2009 and 2018. Of those, 25 (5.2%) underwent CT angiography (CTA) within 2 years before dissection onset. Aortic diameter, length and volume of these patients ('pre-ATAAD') were compared with those of TAA controls (n=75). Receiver operating curve analysis was performed to evaluate the predictive accuracy of the three different measurements. RESULTS: , p=0.909) were comparable between patients with pre-ATAAD and TAA controls. Conversely, ascending aortic length (84±9 mm vs 90±16 mm, p=0.031) was significantly larger in patients with pre-ATAAD. All three parameters had an area under the curve of >0.800. At the 55 mm cut-off point, the maximal diameter yielded a positive predictive value (PPV) of 20%. While maintaining same specificity levels, measurements of aortic volume and length showed superior diagnostic accuracy (PPV 55% and 70%, respectively). CONCLUSION: Measurements of aortic volume and length have superior diagnostic accuracy compared with the ma...