Dataset Information

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma.

ABSTRACT: BACKGROUND:Aortic intramural hematoma (IMH) is a subset of acute aortic syndrome, and its prognosis may differ between races. This study aimed to study the prognosis of Chinese type B IMH patients and to find out risk factors. METHODS:A total of 71 type B IMH patients with or without penetrating atherosclerosis ulcer (PAU) administrated in our center between September 2013 and October 2017 were retrospectively studied. Both clinical and imaging data were collected and analyzed. The primary end point was aorta-related death, and the secondary end point was progression, which was defined as enlargement of aorta, increased aortic wall thickness, and aortic dissection or aneurysm formation. Kaplan-Meier survival analysis and Cox regression analysis were used for prognostic analysis. RESULTS:Among these 71 patients, 21 had simple type B IMH, when 50 had type B IMH in association with PAU. Twenty-five patients received optimal medical therapy (OMT) alone, while 46 patients received surgery and OMT. The mean follow-up time was 27.5?±?13.5?months. For type B IMH patients, association with PAU indicated poor prognosis and required more intensive management (HR?=?16.68, 1.96~141.87), while maximum aortic diameter (MAD) was an independent risk factor (HR?=?1.096, 1.016~1.182). For patients with PAU-IMH, MAD was an independent risk factor (HR?=?1.04, 1.021~1.194), while surgical treatment was independent protective factor (HR?=?0.172, 0.042~0.696). CONCLUSION:Association with PAU and MAD were independent risk factors for type B IMH patients. Surgery may improve the outcomes for type B IMH in association with PAU.

SUBMITTER: Li Z

PROVIDER: S-EPMC7092490 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma.

Li Zilun Z Liu Chenshu C Wu Ridong R Zhang Jian J Pan Hong H Tan Jinghong J Guo Zhuang Z Guo Yingying Y Yu Nan N Yao Chen C Chang Guangqi G

Journal of cardiothoracic surgery 20200323 1

<h4>Background</h4>Aortic intramural hematoma (IMH) is a subset of acute aortic syndrome, and its prognosis may differ between races. This study aimed to study the prognosis of Chinese type B IMH patients and to find out risk factors.<h4>Methods</h4>A total of 71 type B IMH patients with or without penetrating atherosclerosis ulcer (PAU) administrated in our center between September 2013 and October 2017 were retrospectively studied. Both clinical and imaging data were collected and analyzed. Th ...[more]

PMID: 32293486

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Project description:BACKGROUND:Patients with Stanford type B aortic dissections (ADs) are at risk of long-term disease progression and late complications. The aim of this study was to evaluate the natural course and evolution of acute type B AD and intramural hematomas (IMHs) in patients who presented without complications during their initial hospital admission and who were treated with optimal medical management (MM). METHODS:Databases from 2 aortic centers in Europe and the United States were used to identify 136 patients with acute type B AD (n = 92) and acute type B IMH (n = 44) who presented without complications during their index admission and were treated with MM. Computed tomography angiography scans were available at onset (?14 days) and during follow-up for those patients. Relevant data, including evidence of adverse events during follow-up (AE; defined according to current guidelines), were retrieved from medical records and by reviewing computed tomography scan images. Aortic diameters were measured with dedicated 3-dimensional software. RESULTS:The 1-, 2-, and 5-year event-free survival rates of patients with type B AD were 84.3% (95% confidence interval [CI], 74.4-90.6), 75.4% (95% CI, 64.0-83.7), and 62.6% (95% CI, 68.9-73.6), respectively. Corresponding estimates for IMH were 76.5% (95% CI, 57.8-87.8), 76.5% (95% CI, 57.8-87.8), and 68.9% (95% CI, 45.2-83.9), respectively. In patients with type B AD, risk of an AE increased with aortic growth within the first 6 months after onset. A diameter increase of 5 mm in the first half year was associated with a relative risk for AE of 2.29 (95% CI, 1.70-3.09) compared with the median 6 months' growth of 2.4 mm. In approximately 60% of patients with IMH, the abnormality resolved within 12 months and in the patients with nonresolving IMH, risk of an adverse event was greatest in the first year after onset and remained stable thereafter. CONCLUSIONS:More than one third of patients with initially uncomplicated type B AD suffer an AE under MM within 5 years of initial diagnosis. In patients with nonresolving IMH, most adverse events are observed in the first year after onset. In patients with type B AD an early aortic growth is associated with a greater risk of AE.

Project description:BackgroundThe prognosis of aortic intramural hematoma (IMH) is unpredictable, but computed tomography angiography (CTA) plays an important role of high diagnostic performance in the initial diagnosis and during follow-up of patients. In this study, we investigated the value of a radiomics model based on aortic CTA for predicting the prognosis of patients with medically treated IMH.MethodA total of 120 patients with IMH were enrolled in this study. The follow-up duration ranged from 32 to 1,346 days (median 232 days). Progression of these patients was classified as follows: destabilization, which refers to deterioration in the aortic condition, including significant increases in the thickness of the IMH, the progression of IMH to a penetrating aortic ulcer (PAU), aortic dissection (AD), or rupture; or stabilization, which refers to an unchanged appearance or a decrease in the size or disappearance of the IMH. The patients were divided into a training cohort (n=84) and a validation cohort (n=36). Six different machine learning classifiers were applied: random forest (RF), K-nearest neighbor (KNN), Gaussian Naive Bayes, decision tree, logistic regression, and support vector machine (SVM). The clinical-radiomics combined nomogram model was established by multivariate logistic regression. The area under the receiver operating characteristic (ROC) curve (AUC) was implemented to evaluate the discrimination performance of the models. The calibration curves and Hosmer-Lemeshow test were used for evaluating model calibration. DeLong's test was performed to compare the AUC performance of models.ResultsAmong all of the patients, 60 patients showed destabilization and 60 patients remained stable. A total of 12 radiomic features were retained after application of the least absolute shrinkage and selection operator (LASSO). These features were used for the machine learning model construction. The SVM-radial basis function (SVM-RBF) model obtained the best performance with an AUC of 0.765 (95% CI, 0.593-0.906). In the validation cohort, the combined clinical-radiomics model [AUC =0.787; 95% confidence interval (CI), 0.619-0.923] showed a significantly higher performance than did the clinical model (AUC =0.596; 95% CI, 0.413-0.796; P=0.021) and had a similar performance to the radiomics model (AUC =0.765; 95% CI, 0.589-0.906; P=0.672).ConclusionsA quantitative nomogram based on radiomic features of CTA images can be used to predict disease progression in patients with IMH and may help improve clinical decision-making.

Dataset Information

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma.

Publications

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma.

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