Key result
Aortic shape modeling outperforms maximum diameter for predicting aortic surgery with ~0.91 AUC.
Why the study?
ATAA is a heterogeneous disease with distinct clinical courses, motivating exploration of aortic morphology, shape-function associations, and risk models not based solely on aortic size.
Does a predictive model based on statistical shape analysis improve the stratification of surgically operated versus monitored ATAA patients compared to maximum aortic diameter?
Cohort (n=125)
Does a predictive model based on statistical shape analysis improve the stratification of surgically operated versus monitored ATAA patients compared to maximum aortic diameter?
Effect estimate: AUC 0.914 for shape modes vs AUC 0.805 for aortic diameter
Absolute Event Rate: 0.914% vs 0.805%
Three-dimensional statistical shape analysis of the aneurysmal aorta offers a more personalized and accurate approach to predicting the need for surgical repair than traditional maximum diameter measurements.
An ascending thoracic aortic aneurysm (ATAA) is a heterogeneous disease showing different patterns of aortic dilatation and valve morphologies, each with distinct clinical course. This study aimed to explore the aortic morphology and the associations between shape and function in a population of ATAA, while further assessing novel risk models of aortic surgery not based on aortic size. Shape variability of n = 106 patients with ATAA and different valve morphologies (i.e., bicuspid versus tricuspid aortic valve) was estimated by statistical shape analysis (SSA) to compute a mean aortic shape and its deformation. Once the computational atlas was built, principal component analysis (PCA) allowed to reduce the complex ATAA anatomy to a few shape modes, which were correlated to shear stress and aortic strain, as determined by computational analysis. Findings demonstrated that shape modes are associated to specific morphological features of aneurysmal aorta as the vessel tortuosity and local bulging of the ATAA. A predictive model, built with principal shape modes of the ATAA wall, achieved better performance in stratifying surgically operated ATAAs versus monitored ATAAs, with respect to a baseline model using the maximum aortic diameter. Using current imaging resources, this study demonstrated the potential of SSA to investigate the association between shape and function in ATAAs, with the goal of developing a personalized approach for the treatment of the severity of aneurysmal aorta.
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Cosentino et al. (2020) conducted a cohort in Ascending thoracic aortic aneurysm (ATAA) (n=125). Statistical shape analysis (principal shape modes) vs. Maximum aortic diameter (baseline model) was evaluated on Surgical repair of aorta and/or valve (AUC 0.914 for shape modes vs AUC 0.805 for aortic diameter). A predictive model using principal shape modes predicted the probability of aortic surgery with an AUC of 0.914, outperforming the standard baseline model based on maximum aortic diameter (AUC 0.805).
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