Heartbeat: improving risk prediction and diagnosis of aortic dissection

In patients at risk of ascending aortic dissection, timing of surgery typically is based on serial imaging measurements of aortic diameter. Clearly, the risk of dissection in an individual patient is higher at larger aortic diameters. Even so, from a population point-of-view, most acute dissections occur in patients with a diameter below the recommended threshold for prophylactic root replacement. In this issue of Heart , Heuts and colleagues1 evaluated the hypothesis that measures of aortic length and volume would be better predictors of the risk of dissection than diameter alone. (figure 1) In an observation cohort study of 477 consecutive patients with a Type A aortic dissection, 96% did not meet the surgical diameter threshold of 55 mm before dissection onset. Compared with a cohort 75 patients with an aortic aneurysm who did not suffer a dissection, the positive predictive values of aortic measurements for prediction of dissection were 20% for maximal aortic diameter, 55% for aortic volume and 70% for aortic length. Figure 1 Methodology of the three different aortic measurements in a patient with TAA and a patient with pre-ATAAD.(A–C) demonstrate aortic measurements in a patient with TAA. panel a depicts a stretched view of the curved planar CT reconstruction with diameter measurement perpendicular to the centreline. the two right …