Key result
Low true lumen area ratio linked to ~6-fold higher late aorta-related complications in TBAD.
Why the study?
Does a low true lumen area ratio predict aorta-related complications in patients with uncomplicated Stanford type B aortic dissection?
Cohort (n=213)
Yes
Does a low true lumen area ratio predict aorta-related complications in patients with uncomplicated Stanford type B aortic dissection?
A narrow true lumen area at the early subacute phase is a strong independent predictor of future aorta-related complications in uncomplicated type B aortic dissection, even when the aortic diameter is small.
Answers are grounded in this paper and cite their sources.
Supports incorporating true lumen area into type B dissection risk stratification; leaves open prospective validation before guiding therapy.
Background: Uncomplicated Stanford type B aortic dissection (TBAD) is associated with aortic complications in the subacute or chronic phase, but it is still unclear in which patients these complications occur. The objective of this study was to identify the ideal imaging parameter predictive of the risk of aorta-related complications in patients with uncomplicated TBAD. Methods: A retrospective study was conducted using prospectively collected data from patients with uncomplicated TBAD at two local hospitals in Japan. Computed tomography (CT) images were analyzed serially, and their association with "aorta-related complication" during follow-up was assessed. Results: During a mean follow-up of 3.5 years, 53 out of 213 patients with uncomplicated TBAD experienced the aorta-related complications, among which 50 (23.5%) were aortic enlargement. Receiver operating characteristic curve analysis revealed that a low true lumen area ratio (TLAR) (<2.9%) at initial subacute phase was a significant prognostic factor for late aorta-related complications (P<0.001). The Cox regression analysis indicated that low TLAR [hazard ratio (HR), 6.32; 95% confidence interval (CI): 2.72-14.69] and an enlargement of the false lumen area (HR, 6.09: 95% CI: 2.22-16.7) were independent predictors of aorta-related complications. Subanalysis revealed a TLAR of 52.9% or less increased the risk of future aorta-related complications, even when the aortic diameter was smaller than 40 mm (P<0.001). Conclusions: A narrow true lumen area at early subacute phase and an enlargement of the false lumen area are potentially good predictors to help us to identify a high-risk subgroup of patients who may benefit from earlier and more aggressive therapy. In particular, a narrow true lumen area is an independent risk factor for the future aorta-related complications, even when the aortic diameter is small.
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Nakamura et al. (2024) conducted a cohort in uncomplicated Stanford type B aortic dissection (TBAD) (n=213). Low true lumen area ratio (TLAR) vs. Higher true lumen area ratio was evaluated on aorta-related complications (HR 6.32, 95% CI 2.72-14.69, p=<0.001). A low true lumen area ratio at the initial subacute phase independently predicted late aorta-related complications in uncomplicated type B aortic dissection (HR 6.32; 95% CI 2.72-14.69; P<0.001).
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