Author + information
- Received April 2, 2012
- Revision received June 13, 2012
- Accepted July 26, 2012
- Published online March 1, 2013.
- Aditya S. Shirali, BS⁎,⁎ (, )
- Moritz S. Bischoff, MD⁎,
- Hung-Mo Lin, PhD⁎,
- Irina Oyfe, MS†,
- Robert Lookstein, MD†,
- Randall B. Griepp, MD⁎ and
- Gabriele Di Luozzo, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Aditya S. Shirali, Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, New York 10029
Objectives This study sought to identify possible anatomic predictors of acute type B aortic dissection (AAD) in hypertensive patients using multidetector computed tomography angiography (CTA).
Background Although hypertension remains one of the most significant risk factors for AAD development, it is unlikely to be the only risk factor for AAD. Few studies have assessed anatomical predictors of AAD development.
Methods CTA of normotensive patients without AAD (group 1, n = 35), hypertensive patients without AAD (group 2, n = 37), and hypertensive patients with AAD (group 3, n = 37) were compared. The length, diameter, volume, and tortuosity of the aorta as well as arch vessel angulation were measured for each patient and normalized to group 1 averages. Stepwise logistic regression identified significant anatomical associations; the model was validated based on 1,000 bootstrapped samples.
Results The demographics of the groups were similar. The length of the proximal and entire aorta, the diameters in the proximal ascending aorta and aortic arch, and the aortic volumes were all greater (p < 0.0001, p = 0.0064 for ascending aortic diameter) in group 3 than in groups 1 and 2, as was entire aortic tortuosity (p < 0.0001). An AAD risk model was developed based on aortic arch diameter, length from the aortic root to the iliac bifurcation, and angulation of the brachiocephalic artery origin from the aorta. The bootstrap estimate of the area under the receiver operating curve was 0.974.
Conclusions Enlargement of the ascending aorta and aortic arch and increased aortic tortuosity reflect an aortopathy which enhances the probability of AAD. A model based on 3 anatomical variables demonstrates significant associations with AAD: it may allow identification by aortic imaging of the hypertensive patient most at risk, and permit implementation of aggressive medical management and consideration of pre-emptive surgery to prevent dissection.
This study was funded by the Ousman Akram Memorial Fund and the Mount Sinai Medical Center. Dr. Lookstein has consulted for Bayer Interventional and Cordis; and has received honoraria from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Pim J. de Feyter, MD, PhD, served as Guest Editor for this article.
- Received April 2, 2012.
- Revision received June 13, 2012.
- Accepted July 26, 2012.
- American College of Cardiology Foundation