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False Lumen Flow Assessment by Magnetic Resonance Imaging and Long-Term Outcomes in Uncomplicated Aortic Dissection
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2022-06-13 , DOI: 10.1016/j.jacc.2022.04.017
Arturo Evangelista 1 , Victor Pineda 2 , Andrea Guala 1 , Bart Bijnens 3 , Hug Cuellar 2 , Paula Rudenick 1 , Augusto Sao-Aviles 1 , Aroa Ruiz 1 , Gisela Teixido-Tura 1 , Rafael Rodriguez-Lecoq 4 , Sergi Bellmunt 5 , Ignacio Ferreira 1 , Jose Rodríguez-Palomares 1
Affiliation  

Background

Despite the absence of clinical complications after an acute aortic dissection (AD) with persistent patent false lumen (FL), a high risk for clinical events may persist.

Objectives

The aim of this study was to assess the natural evolution of noncomplicated AD and ascertain whether different FL flow patterns by magnetic resonance imaging (MRI) have independent prognostic value for AD-related events beyond established morphologic parameters.

Methods

One hundred thirty-one consecutive patients, 78 with surgically treated type A dissections and 53 with medically treated type B dissections, were followed up prospectively after acute AD with persistent patent FL in the descending aorta. Maximum aortic diameter, true lumen compression, entry tear, and partial FL thrombosis by computed tomography were assessed. Systolic antegrade true lumen and FL flow volumes and diastolic antegrade and retrograde flows were analyzed by MRI during the first year after AD.

Results

After a median follow-up period of 8.0 years (IQR: 4.6-10.9 years), 43 patients presented aorta-related events (25 died and 18 required endovascular treatment). FL systolic antegrade flow ≥30% with respect to total systolic antegrade flow and retrograde diastolic flow ≥80% with respect to total diastolic FL flow were predictors of aortic events. In multivariate analysis, aortic diameter >45 mm (HR: 2.91), type B dissection (HR: 2.44), and MRI flow pattern (HR: 16.87) were independent predictors of AD-related events.

Conclusions

High systolic antegrade flow volume in the FL with significant diastolic retrograde flow assessed by MRI and aortic diameter >45 mm identify patients with higher risk for complications in whom more aggressive management would be indicated.



中文翻译:

磁共振成像的假腔流量评估和简单主动脉夹层的长期结果

背景

尽管伴有持续性假腔 (FL) 的急性主动脉夹层 (AD) 后没有临床并发症,但临床事件的高风险可能会持续存在。

目标

本研究的目的是评估非复杂性 AD 的自然演变,并通过磁共振成像 (MRI) 确定不同的 FL 流动模式是否具有超出既定形态学参数的 AD 相关事件的独立预后价值。

方法

131 名连续患者,其中 78 名接受手术治疗的 A 型夹层和 53 名接受药物治疗的 B 型夹层,在降主动脉持续性 FL 未闭急性 AD 后进行了前瞻性随访。通过计算机断层扫描评估最大主动脉直径、真管腔压缩、入口撕裂和部分 FL 血栓形成。在 AD 后的第一年,通过 MRI 分析收缩期顺行真腔和 FL 流量以及舒张期顺行和逆行流量。

结果

中位随访 8 年(IQR:4.6-10.9 年)后,43 名患者出现主动脉相关事件(25 人死亡,18 人需要血管内治疗)。FL 收缩前向血流≥30%(相对于总收缩前向血流)和逆向舒张期血流≥80%(相对于总舒张 FL 流量)是主动脉事件的预测指标。在多变量分析中,主动脉直径 >45 mm (HR: 2.91)、B 型夹层 (HR: 2.44) 和 MRI 血流模式 (HR: 16.87) 是 AD 相关事件的独立预测因子。

结论

FL 中的高收缩期顺行血流量、MRI 评估的显着舒张期逆行血流量和主动脉直径 > 45 mm 可识别出并发症风险较高的患者,这些患者需要进行更积极的管理。

更新日期:2022-06-13
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