Background
Methods
Study population
Computed tomography protocol
Cardiovascular magnetic resonance protocol
Aortic growth rate and anatomical features
Flow dynamics and biomechanics in the false lumen by 4D flow CMR
Statistical analysis
Results
Demographic and clinical data
Characteristics | Overall (n = 54) | Surgically-treated type A AD with residual tear (n = 35) | Medically-treated type B AD (n = 19) | P-value |
---|---|---|---|---|
Age [years] | 66 ± 11 | 68 ± 11 | 64 ± 10 | 0.174 |
Sex [male] | 44 (81%) | 27 (77%) | 17 (89%) | 0.265 |
BSA [m2] | 1.9 ± 0.2 | 1.9 ± 0.2 | 1.9 ± 0.2 | 0.701 |
SBP [mmHg] | 138 ± 20 | 140 ± 21 | 134 ± 20 | 0.278 |
DBP [mmHg] | 79 ± 13 | 76 ± 12 | 84 ± 15 | 0.128 |
Stroke volume [mL] | 55 ± 19 | 53 ± 19 | 57 ± 20 | 0.488 |
Active smoker | 10 (19%) | 6 (18%) | 4 (21%) | 0.800 |
Hypertension | 34 (65%) | 21 (64%) | 13 (68%) | 0.727 |
Diabetes mellitus | 5 (10%) | 3 (9%) | 2 (10%) | 0.866 |
Dyslipidaemia | 12 (23%) | 7 (21%) | 5 (26%) | 0.674 |
Mechanical prosthetic aortic valve | 10 (19%) | 9 (26%) | 1 (5%) | 0.058 |
Anticoagulation therapy | 24 (44%) | 18 (51%) | 6 (32%) | 0.163 |
Antiplatelet therapy | 14 (26%) | 12 (35%) | 2 (10%) | 0.051 |
Statin therapy | 22 (44%) | 14 (45%) | 8 (42%) | 0.833 |
Heart rate [bpm] | 63 ± 10 | 65 ± 10 | 61 ± 9 | 0.330 |
Follow-up duration between baseline and final CTAs [months] | 35 ± 11 | 33 ± 11 | 34 ± 12 | 0.878 |
Time between acute AD and 4D flow [months] | 78 ± 81 | 95 ± 92 | 47 ± 43 | 0.099 |
Aortic growth rate [mm/year] | 1.8 ± 1.6 | 1.7 ± 1.6 | 1.9 ± 1.6 | 0.550 |
Predictors of aortic growth rate
Overall (n = 54) | Surgically-treated type A AD with residual tear (n = 35) | Medically-treated type B AD (n = 19) | P-value | |
---|---|---|---|---|
Anatomical features | ||||
Maximum DAo diameter [mm] | 48 ± 10 | 48 ± 11 | 49 ± 8 | 0.368 |
Dominant entry tear area [cm2] | 1.2 ± 0.8 | 1.1 ± 0.8 | 1.3 ± 0.9 | 0.326 |
Local distance of the dominant entry tear [mm] | 28 ± 28 | 30 ± 26 | 26 ± 33 | 0.370 |
Thrombus in the false lumen [%] | 11 ± 14 | 11 ± 14 | 12 ± 16 | 0.636 |
Flow dynamics in the false lumen | ||||
Retrograde systolic flow [mL] | 1.6 ± 1.3 | 1.6 ± 1.1 | 1.6 ± 1.5 | 0.867 |
Retrograde diastolic flow [mL] | 9.7 ± 5.0 | 9.8 ± 4.5 | 9.5 ± 6.0 | 0.553 |
Retrograde flow fraction [%] | 82 ± 42 | 92 ± 42 | 66 ± 38 | 0.109 |
IRF [cm2/s] | 1.25 ± 5.79 | 1.04 ± 4.55 | 1.63 ± 7.72 | 0.923 |
WSS [N/m2] | 0.26 ± 0.10 | 0.26 ± 0.10 | 0.24 ± 0.10 | 0.475 |
KE [mJ] | 0.62 ± 0.48 | 0.54 ± 0.34 | 0.47 ± 0.30 | 0.523 |
MSDR [cm/s3] | 2996 ± 2552 | 3448 ± 2531 | 2193 ± 2453 | 0.055 |
Flow stasis [%] | 52 ± 18 | 54 ± 18 | 47 ± 18 | 0.200 |
Biomechanics in the false lumen | ||||
PWV [m/s] | 7.7 ± 3.7 | 7.7 ± 3.7 | 7.6 ± 3.6 | 0.808 |
Bivariate | Multivariate | ||||
---|---|---|---|---|---|
R | P-value | Beta | P-value | 95% CI | |
Demographics and clinical data | |||||
Age [years] | 0.018 | 0.899 | |||
Sex (male) | 0.398 | ||||
Body surface area | 0.101 | 0.494 | |||
Systolic blood pressure [mmHg] | 0.086 | 0.566 | |||
Diastolic blood pressure [mmHg] | 0.071 | 0.637 | |||
Smoking | 0.390 | ||||
Hypertension | 0.386 | ||||
Diabetes mellitus | 0.391 | ||||
Dyslipidaemia | 0.396 | ||||
Mechanical prosthetic aortic valve | 0.397 | ||||
Anticoagulation therapy | 0.396 | ||||
Antiplatelet therapy | 0.394 | ||||
Statin therapy | 0.394 | ||||
Type of aortic dissection | 0.481 | ||||
Anatomical features | |||||
Maximum DAo diameter [mm] | 0.280 | 0.042 | |||
Dominant entry tear area [cm2] | 0.257 | 0.096 | 0.371 | 0.018 | [0.130; 1.251] |
Local distance of the dominant entry tear [mm] | -0.094 | 0.513 | |||
Thrombus in the false lumen [%] | 0.336 | 0.037 | 0.293 | 0.049 | [0.000; 0.065] |
Flow dynamics in the false lumen | |||||
Retrograde systolic flow [mL] | 0.165 | 0.237 | |||
Retrograde diastolic flow [mL] | 0.102 | 0.465 | |||
Retrograde flow fraction [%] | 0.060 | 0.708 | |||
IRF [cm2/s] | 0.393 | 0.006 | 0.433 | 0.008 | [0.034; 0.202] |
WSS [N/m2] | 0.279 | 0.060 | |||
KE [mJ] | 0.015 | 0.919 | |||
MSDR [cm/s3] | -0.214 | 0.136 | |||
Flow stasis [%] | 0.106 | 0.457 | |||
Biomechanics in the false lumen | |||||
PWV [m/s] | 0.370 | 0.017 | 0.360 | 0.017 | [0.031; 0.281] |