Acute type B aortic intramural hematoma: the added prognostic value of a follow-up CT
- 120 Downloads
To investigate prognostic significance of follow-up CT findings for initially medically treated type B aortic intramural hematoma (IMH).
We performed a retrospective pooled analysis of individual patient data, including baseline and follow-up CT characteristics. All enrolled patients were followed up for adverse aorta-related events, defined as a composite of aortic disease–related death and surgical or endovascular aortic repair.
A total of 238 patients (73.9% men) were included, with a mean age of 58.1 ± 9.8 years. During follow-up, 83 patients (34.9%) experienced adverse aorta-related events, most of the events (83.1%) occurred within 1 month after follow-up CT imaging (n = 69). In the Cox regression model for predicting adverse aorta-related events, baseline maximal aortic diameter (MAD) (HR = 1.05, p = 0.008), ulcer-like projection (ULP) (HR = 2.47, p < 0.001), changes of maximal hematoma thickness (MHT) (HR = 1.22, p < 0.001), newly developed ULP (HR = 4.44, p < 0.001), and newly developed pleural effusion (HR = 2.46, p = 0.002) were powerful independent predictors. In combined predictive model for 1-month aortic events, baseline MHT ≥ 11.8 mm (OR = 4.39, p = 0.001), ULP (OR = 3.98, p < 0.001), changes of MHT (OR = 1.46, p < 0.001), newly developed ULP (OR = 9.27, p = 0.002), and newly developed pleural effusion (OR = 3.45, p = 0.015) were independent predictors. Besides, in patients with pleural effusion at baseline, resorption of pleural effusion was associated with adverse aorta-related events (HR = 0.36, p = 0.027) and 1-month aortic events (OR = 0.23, p = 0.026).
Follow-up CT findings provide strong and incremental prognostic information for initially medically treated type B IMH, which are helpful for risk estimates and decisions-making.
• Follow-up CT provides strong and incremental prognostic information for initially medically treated type B aortic intramural hematoma.
• Follow-up CT is highly recommended for type B intramural hematoma in patients who did not receive urgent invasive therapy.
• Follow-up CT is helpful for risk estimates and decisions-making.
KeywordsAortic diseases Hematoma Prognosis Computed tomography angiography
Acute aortic syndrome
Body mass index
Intramural blood pool
Maximal aortic diameter
Maximal hematoma thickness
Receiver operating characteristic
We thank the technician Lei Han for proofreading and we are grateful to Dr. Chuangshi Wang for statistical support.
The present study was supported by the Ministry of Science and Technology of China, National Key Research and Development Project (2016YFC1300400), and CAMS Innovation Fund for Medical Sciences (No. 2016-I2M-1-011).
Compliance with ethical standards
The scientific guarantor of this publication is Bin Lu.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Dr. Chuangshi Wang kindly provided statistical advice for this manuscript.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
- 2.Hiratzka LF, Bakris GL, Beckman JA et al (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol 55:e27–e129CrossRefGoogle Scholar
- 3.Erbel R, Aboyans V, Boileau C et al (2014) 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 35:2873–2926CrossRefGoogle Scholar
- 6.Timperley J, Ferguson JD, Niccoli G, Prothero AD, Banning AP (2003) Natural history of intramural hematoma of the descending thoracic aorta. Am J Cardiol 91:777–780Google Scholar
- 9.Sawaki S, Hirate Y, Ashida S, Takanohashi A, Yagami K, Usui M (2010) Clinical outcomes of medical treatment of acute type A intramural hematoma. Asian Cardiovasc Thorac Ann 18:354–359Google Scholar
- 14.Sebastià C, Evangelista A, Quiroga S, Cuellar H, Aguilar R, Muntanyà X (2012) Predictive value of small ulcers in the evolution of acute type B intramural hematoma. Eur J Radiol 81:1569–1574Google Scholar
- 26.Maslow A, Atalay MK, Sodha N (2018) Intramural hematoma. J Cardiothorac Vasc Anesth 32:1341–1362Google Scholar