While geometric parameters beyond diameter have shown promise in aortic disease risk stratification, the role of ascending aortic angle in type A intramural hematoma (IMH) remains unexplored. We retrospectively analyzed 105 patients with acute type A IMH initially managed medically over a 12-year period. Ascending aortic angle was measured on computed tomography as the angle formed between perpendicular lines drawn at the aortic valve-ascending aorta junction and at the brachiocephalic artery origin. The primary outcome was aortic progression. Among 105 patients, aortic progression occurred in 31 patients (29.5%) during median follow-up of 2.1 years. Patients with decreased ascending aortic angle (<95°) had significantly higher progression rates (42.6% vs. 15.7%, p = 0.001) and surgical intervention frequency (33.3% vs. 13.7%, p = 0.001) compared to those with non-decreased angles (≥95°). After adjusting for age and sex, ascending aortic angle remained a significant independent predictor of progression (hazard ratio HR: 0.96, 95% confidence interval (CI): 0.93-0.99, p = 0.004). Receiver operating characteristic (ROC) analysis revealed a sensitivity of 64.8% and specificity of 74.2% for predicting progression. Five-year progression-free survival rates were 57.1% and 83.7% for the decreased and non-decreased aortic angle groups, respectively (p = 0.001). Decreased ascending aortic angle is associated with adverse outcomes in type A IMH patients, potentially helping to identify patients at higher risk who might benefit from closer surveillance or earlier intervention. These findings are hypothesis-generating and require external validation.
Li et al. (Sun,) studied this question.