Predicting the Risk for Acute Type B Aortic Dissection in Hypertensive Patients Using Anatomic Variables
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...
Gespeichert in:
| Veröffentlicht in: | JACC. Cardiovascular imaging 2013-03, Vol.6 (3), p.349-357 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 357 |
|---|---|
| container_issue | 3 |
| container_start_page | 349 |
| container_title | JACC. Cardiovascular imaging |
| container_volume | 6 |
| creator | Shirali, Aditya S., BS Bischoff, Moritz S., MD Lin, Hung-Mo, PhD Oyfe, Irina, MS Lookstein, Robert, MD Griepp, Randall B., MD Di Luozzo, Gabriele, MD |
| description | 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. |
| doi_str_mv | 10.1016/j.jcmg.2012.07.018 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1316055542</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1936878X12009503</els_id><sourcerecordid>1316055542</sourcerecordid><originalsourceid>FETCH-LOGICAL-c468t-980be2588f6d568368b23b438d9f33bab1489a9d6429f41c520cfe073237c86a3</originalsourceid><addsrcrecordid>eNo9kctO3TAURa2qqDzaH2CAPOwkqR-JY08q3dJSKiEVFag6sxznBBwS52I7SPfvcXQpIx_Ja2_prIPQKSUlJVR8GcrBTvclI5SVpCkJle_QEZWNKJpa0fd5VlwUspH_DtFxjAMhgoiq-YAOGa84V0wcoYfrAJ2zyfl7nB4A_3HxEfdzwBu7JMC3uy3gb3gzh-Qs_u5ihMzOHjuPL_NfSOCjewZ8bZIDnyK-i2vVxps0Tzny1wRn2hHiR3TQmzHCp9f3BN1d_Lg9vyyufv_8db65KmwlZCqUJC2wWspedLWQXMiW8bbislM9561paSWVUZ2omOoramtGbA-k4Yw3VgrDT9Dnfe82zE8LxKQnFy2Mo_EwL1FTTgWp67piGWV71IY5xgC93gY3mbDTlOjVsB70alivhjVpdDacQ2ev_Us7QfcW-a80A1_3AOQtnx0EbUfnnTXjI-wgDvMSfBagqY65VN-sR1pvRBkhqiacvwBs6Yz4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1316055542</pqid></control><display><type>article</type><title>Predicting the Risk for Acute Type B Aortic Dissection in Hypertensive Patients Using Anatomic Variables</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Shirali, Aditya S., BS ; Bischoff, Moritz S., MD ; Lin, Hung-Mo, PhD ; Oyfe, Irina, MS ; Lookstein, Robert, MD ; Griepp, Randall B., MD ; Di Luozzo, Gabriele, MD</creator><creatorcontrib>Shirali, Aditya S., BS ; Bischoff, Moritz S., MD ; Lin, Hung-Mo, PhD ; Oyfe, Irina, MS ; Lookstein, Robert, MD ; Griepp, Randall B., MD ; Di Luozzo, Gabriele, MD</creatorcontrib><description>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.</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2012.07.018</identifier><identifier>PMID: 23433926</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting - diagnostic imaging ; Aneurysm, Dissecting - etiology ; Aneurysm, Dissecting - physiopathology ; Antihypertensive Agents - therapeutic use ; Aorta, Thoracic - diagnostic imaging ; Aortic Aneurysm - diagnostic imaging ; Aortic Aneurysm - etiology ; Aortic Aneurysm - physiopathology ; Aortography - methods ; Blood Pressure - drug effects ; Cardiovascular ; Chi-Square Distribution ; Female ; Humans ; Hypertension - complications ; Hypertension - drug therapy ; Hypertension - physiopathology ; Linear Models ; Logistic Models ; Male ; Middle Aged ; Multidetector Computed Tomography ; Multivariate Analysis ; Predictive Value of Tests ; Prognosis ; Reproducibility of Results ; Retrospective Studies ; Risk Assessment ; Risk Factors ; ROC Curve</subject><ispartof>JACC. Cardiovascular imaging, 2013-03, Vol.6 (3), p.349-357</ispartof><rights>American College of Cardiology Foundation</rights><rights>Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-980be2588f6d568368b23b438d9f33bab1489a9d6429f41c520cfe073237c86a3</citedby><cites>FETCH-LOGICAL-c468t-980be2588f6d568368b23b438d9f33bab1489a9d6429f41c520cfe073237c86a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23433926$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shirali, Aditya S., BS</creatorcontrib><creatorcontrib>Bischoff, Moritz S., MD</creatorcontrib><creatorcontrib>Lin, Hung-Mo, PhD</creatorcontrib><creatorcontrib>Oyfe, Irina, MS</creatorcontrib><creatorcontrib>Lookstein, Robert, MD</creatorcontrib><creatorcontrib>Griepp, Randall B., MD</creatorcontrib><creatorcontrib>Di Luozzo, Gabriele, MD</creatorcontrib><title>Predicting the Risk for Acute Type B Aortic Dissection in Hypertensive Patients Using Anatomic Variables</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>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.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Aneurysm, Dissecting - diagnostic imaging</subject><subject>Aneurysm, Dissecting - etiology</subject><subject>Aneurysm, Dissecting - physiopathology</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aortic Aneurysm - diagnostic imaging</subject><subject>Aortic Aneurysm - etiology</subject><subject>Aortic Aneurysm - physiopathology</subject><subject>Aortography - methods</subject><subject>Blood Pressure - drug effects</subject><subject>Cardiovascular</subject><subject>Chi-Square Distribution</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - physiopathology</subject><subject>Linear Models</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multidetector Computed Tomography</subject><subject>Multivariate Analysis</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kctO3TAURa2qqDzaH2CAPOwkqR-JY08q3dJSKiEVFag6sxznBBwS52I7SPfvcXQpIx_Ja2_prIPQKSUlJVR8GcrBTvclI5SVpCkJle_QEZWNKJpa0fd5VlwUspH_DtFxjAMhgoiq-YAOGa84V0wcoYfrAJ2zyfl7nB4A_3HxEfdzwBu7JMC3uy3gb3gzh-Qs_u5ihMzOHjuPL_NfSOCjewZ8bZIDnyK-i2vVxps0Tzny1wRn2hHiR3TQmzHCp9f3BN1d_Lg9vyyufv_8db65KmwlZCqUJC2wWspedLWQXMiW8bbislM9561paSWVUZ2omOoramtGbA-k4Yw3VgrDT9Dnfe82zE8LxKQnFy2Mo_EwL1FTTgWp67piGWV71IY5xgC93gY3mbDTlOjVsB70alivhjVpdDacQ2ev_Us7QfcW-a80A1_3AOQtnx0EbUfnnTXjI-wgDvMSfBagqY65VN-sR1pvRBkhqiacvwBs6Yz4</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Shirali, Aditya S., BS</creator><creator>Bischoff, Moritz S., MD</creator><creator>Lin, Hung-Mo, PhD</creator><creator>Oyfe, Irina, MS</creator><creator>Lookstein, Robert, MD</creator><creator>Griepp, Randall B., MD</creator><creator>Di Luozzo, Gabriele, MD</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130301</creationdate><title>Predicting the Risk for Acute Type B Aortic Dissection in Hypertensive Patients Using Anatomic Variables</title><author>Shirali, Aditya S., BS ; Bischoff, Moritz S., MD ; Lin, Hung-Mo, PhD ; Oyfe, Irina, MS ; Lookstein, Robert, MD ; Griepp, Randall B., MD ; Di Luozzo, Gabriele, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c468t-980be2588f6d568368b23b438d9f33bab1489a9d6429f41c520cfe073237c86a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Aneurysm, Dissecting - diagnostic imaging</topic><topic>Aneurysm, Dissecting - etiology</topic><topic>Aneurysm, Dissecting - physiopathology</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aortic Aneurysm - diagnostic imaging</topic><topic>Aortic Aneurysm - etiology</topic><topic>Aortic Aneurysm - physiopathology</topic><topic>Aortography - methods</topic><topic>Blood Pressure - drug effects</topic><topic>Cardiovascular</topic><topic>Chi-Square Distribution</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - physiopathology</topic><topic>Linear Models</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multidetector Computed Tomography</topic><topic>Multivariate Analysis</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shirali, Aditya S., BS</creatorcontrib><creatorcontrib>Bischoff, Moritz S., MD</creatorcontrib><creatorcontrib>Lin, Hung-Mo, PhD</creatorcontrib><creatorcontrib>Oyfe, Irina, MS</creatorcontrib><creatorcontrib>Lookstein, Robert, MD</creatorcontrib><creatorcontrib>Griepp, Randall B., MD</creatorcontrib><creatorcontrib>Di Luozzo, Gabriele, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shirali, Aditya S., BS</au><au>Bischoff, Moritz S., MD</au><au>Lin, Hung-Mo, PhD</au><au>Oyfe, Irina, MS</au><au>Lookstein, Robert, MD</au><au>Griepp, Randall B., MD</au><au>Di Luozzo, Gabriele, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting the Risk for Acute Type B Aortic Dissection in Hypertensive Patients Using Anatomic Variables</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>6</volume><issue>3</issue><spage>349</spage><epage>357</epage><pages>349-357</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>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.</abstract><cop>United States</cop><pmid>23433926</pmid><doi>10.1016/j.jcmg.2012.07.018</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1936-878X |
| ispartof | JACC. Cardiovascular imaging, 2013-03, Vol.6 (3), p.349-357 |
| issn | 1936-878X 1876-7591 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1316055542 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Acute Disease Adult Aged Aneurysm, Dissecting - diagnostic imaging Aneurysm, Dissecting - etiology Aneurysm, Dissecting - physiopathology Antihypertensive Agents - therapeutic use Aorta, Thoracic - diagnostic imaging Aortic Aneurysm - diagnostic imaging Aortic Aneurysm - etiology Aortic Aneurysm - physiopathology Aortography - methods Blood Pressure - drug effects Cardiovascular Chi-Square Distribution Female Humans Hypertension - complications Hypertension - drug therapy Hypertension - physiopathology Linear Models Logistic Models Male Middle Aged Multidetector Computed Tomography Multivariate Analysis Predictive Value of Tests Prognosis Reproducibility of Results Retrospective Studies Risk Assessment Risk Factors ROC Curve |
| title | Predicting the Risk for Acute Type B Aortic Dissection in Hypertensive Patients Using Anatomic Variables |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T18%3A14%3A27IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Predicting%20the%20Risk%20for%20Acute%20Type%20B%20Aortic%20Dissection%20in%20Hypertensive%20Patients%20Using%20Anatomic%20Variables&rft.jtitle=JACC.%20Cardiovascular%20imaging&rft.au=Shirali,%20Aditya%20S.,%20BS&rft.date=2013-03-01&rft.volume=6&rft.issue=3&rft.spage=349&rft.epage=357&rft.pages=349-357&rft.issn=1936-878X&rft.eissn=1876-7591&rft_id=info:doi/10.1016/j.jcmg.2012.07.018&rft_dat=%3Cproquest_cross%3E1316055542%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1316055542&rft_id=info:pmid/23433926&rft_els_id=1_s2_0_S1936878X12009503&rfr_iscdi=true |