Journal Article

Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

Wildberger, Joachim, Bouman, Heleen, Maessen, Jos G, Schalla, Simon, Heuts, Samuel, Bekkers, Sebastiaan C A M, Crijns, Harry J G M, Adriaans, Bouke P, Mihl, Casper, Olsthoorn, Jules R, Natour, Ehsan, Sardari Nia, Peyman, Rylski, Bartosz, Berezowski, Mikolaj, Kosiorowska, Kinga

2020

Overview

ObjectiveManagement of thoracic aortic aneurysms (TAAs) comprises regular diameter follow-up until the indication criterion for prophylactic surgery is reached. However, this approach is unable to predict the majority of acute type A aortic dissections (ATAADs). The current study aims to evaluate the diagnostic accuracy of ascending aortic diameter, length and volume for occurrence of ATAAD.MethodsThis two-centre observational cohort study retrospectively screened 477 consecutive patients who presented with ATAAD between 2009 and 2018. Of those, 25 (5.2%) underwent CT angiography (CTA) within 2 years before dissection onset. Aortic diameter, length and volume of these patients (‘pre-ATAAD’) were compared with those of TAA controls (n=75). Receiver operating curve analysis was performed to evaluate the predictive accuracy of the three different measurements.Results96% of patients with pre-ATAAD did not meet the surgical diameter threshold of 55 mm before dissection onset. Maximal aortic diameters (45 (40–49) mm vs 46 (44–49) mm, p=0.075) and volume (126 (95–157) cm3 vs 124 (102–136) cm3, p=0.909) were comparable between patients with pre-ATAAD and TAA controls. Conversely, ascending aortic length (84±9 mm vs 90±16 mm, p=0.031) was significantly larger in patients with pre-ATAAD. All three parameters had an area under the curve of >0.800. At the 55 mm cut-off point, the maximal diameter yielded a positive predictive value (PPV) of 20%. While maintaining same specificity levels, measurements of aortic volume and length showed superior diagnostic accuracy (PPV 55% and 70%, respectively).ConclusionMeasurements of aortic volume and length have superior diagnostic accuracy compared with the maximal diameter and could improve the timely identification of patients at risk for ATAAD.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Accuracy / Aneurysms / Aortic and vascular disease / aortic aneurysm / Aortic dissection / aortic dissection or intramural hematoma / cardiac computer tomographic (CT) imaging / cardiac risk factors and prevention / Coronary vessels / Heart surgery / Medical imaging / Mortality / Patients / Scanners / Software / Statistical analysis