Abstract：
OBJECTIVE: To identify independent predictors of thoracic aortic growth in patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR).
METHODS: A retrospective analysis of the patients undergoing TEVAR for TBAD or intramural hematoma (IMH) from April 2014 to April 2023 was performed. The baseline morphological data of TBAD was established through computed tomography angiography (CTA) before discharge. Patients were divided into two groups based on aortic growth: growth and no growth. Aortic growth defined as an increase ≥5 mm in thoracic maximal aortic diameter during any serial follow-up CTA measurement. Logistic regression following propensity score matching (PSM) was used to identify independent predictors for aortic growth. Receiver operating characteristic curve and cutoff value of independent predictors were calculated. Linear regression was used to establish a correlation between anatomical variables and follow-up aortic diameter.
RESULTS: A total of 145 patients with TBAD (n = 122) or IMH (n = 23) undergoing TEVAR were included, with a male of 83.4% and a mean age of 56 ± 14.1 years. Patients in growth group and no growth group was 26 (17.9%) and 119 (80.1%), respectively. After using PSM method, matched regression analysis showed residual maximal tear diameter (OR = 0.889, 95% CI 0.830-0.952, p = 0.001) and follow-up aortic diameter (OR = 0.977, 95% CI 0.965-0.989, p < 0.001) were independent predictors for aortic growth. The cutoff value was 8.55 mm for residual tear diameter and 40.65 mm for follow-up maximal aortic diameter. The residual maximal tear diameter showed a linear correlation with follow-up aortic diameter (DW = 1.74, R2 = 6.2%, p = 0.033).
CONCLUSIONS: This study suggested that residual maximal tear diameter >8.55 mm and follow-up aortic diameter >40.65 mm could predict aortic growth in patients with TBAD undergoing TEVAR.
METHODS: A retrospective analysis of the patients undergoing TEVAR for TBAD or intramural hematoma (IMH) from April 2014 to April 2023 was performed. The baseline morphological data of TBAD was established through computed tomography angiography (CTA) before discharge. Patients were divided into two groups based on aortic growth: growth and no growth. Aortic growth defined as an increase ≥5 mm in thoracic maximal aortic diameter during any serial follow-up CTA measurement. Logistic regression following propensity score matching (PSM) was used to identify independent predictors for aortic growth. Receiver operating characteristic curve and cutoff value of independent predictors were calculated. Linear regression was used to establish a correlation between anatomical variables and follow-up aortic diameter.
RESULTS: A total of 145 patients with TBAD (n = 122) or IMH (n = 23) undergoing TEVAR were included, with a male of 83.4% and a mean age of 56 ± 14.1 years. Patients in growth group and no growth group was 26 (17.9%) and 119 (80.1%), respectively. After using PSM method, matched regression analysis showed residual maximal tear diameter (OR = 0.889, 95% CI 0.830-0.952, p = 0.001) and follow-up aortic diameter (OR = 0.977, 95% CI 0.965-0.989, p < 0.001) were independent predictors for aortic growth. The cutoff value was 8.55 mm for residual tear diameter and 40.65 mm for follow-up maximal aortic diameter. The residual maximal tear diameter showed a linear correlation with follow-up aortic diameter (DW = 1.74, R2 = 6.2%, p = 0.033).
CONCLUSIONS: This study suggested that residual maximal tear diameter >8.55 mm and follow-up aortic diameter >40.65 mm could predict aortic growth in patients with TBAD undergoing TEVAR.
摘要：
目的：确定B型主动脉夹层（TBAD）患者行胸腔内主动脉修复术（TEVAR）时胸主动脉生长的独立预测因素。
方法：回顾性分析2014年4月至2023年4月因TBAD或壁内血肿（IMH）接受TEVAR治疗的患者。出院前通过计算机断层扫描血管造影（CTA）建立TBAD的基线形态学数据。根据主动脉生长将患者分为两组：生长和无生长。主动脉生长定义为在任何连续随访CTA测量期间胸主动脉最大直径增加≥5mm。使用倾向评分匹配（PSM）后的逻辑回归来确定主动脉生长的独立预测因子。计算了独立预测因子的接收器工作特征曲线和截止值。线性回归用于建立解剖变量与随访主动脉直径之间的相关性。
结果：共纳入145例接受TEVAR的TBAD（n=122）或IMH（n=23）患者，男性占83.4%，平均年龄56±14.1岁。生长组和非生长组患者分别为26例(17.9%)和119例(80.1%),分别。使用PSM方法后，配对回归分析显示,残余最大泪液直径(OR=0.889,95%CI0.830-0.952,p=0.001)和随访主动脉直径(OR=0.977,95%CI0.965-0.989,p<0.001)是主动脉生长的独立预测因子.残余泪液直径的截止值为8.55mm，随访最大主动脉直径的截止值为40.65mm。残余最大撕裂直径与随访主动脉直径呈线性相关(DW=1.74,R2=6.2%,p=0.033)。
结论：这项研究表明，在接受TEVAR的TBAD患者中，残余最大撕裂直径>8.55mm和随访主动脉直径>40.65mm可以预测主动脉生长。
方法：回顾性分析2014年4月至2023年4月因TBAD或壁内血肿（IMH）接受TEVAR治疗的患者。出院前通过计算机断层扫描血管造影（CTA）建立TBAD的基线形态学数据。根据主动脉生长将患者分为两组：生长和无生长。主动脉生长定义为在任何连续随访CTA测量期间胸主动脉最大直径增加≥5mm。使用倾向评分匹配（PSM）后的逻辑回归来确定主动脉生长的独立预测因子。计算了独立预测因子的接收器工作特征曲线和截止值。线性回归用于建立解剖变量与随访主动脉直径之间的相关性。
结果：共纳入145例接受TEVAR的TBAD（n=122）或IMH（n=23）患者，男性占83.4%，平均年龄56±14.1岁。生长组和非生长组患者分别为26例(17.9%)和119例(80.1%),分别。使用PSM方法后，配对回归分析显示,残余最大泪液直径(OR=0.889,95%CI0.830-0.952,p=0.001)和随访主动脉直径(OR=0.977,95%CI0.965-0.989,p<0.001)是主动脉生长的独立预测因子.残余泪液直径的截止值为8.55mm，随访最大主动脉直径的截止值为40.65mm。残余最大撕裂直径与随访主动脉直径呈线性相关(DW=1.74,R2=6.2%,p=0.033)。
结论：这项研究表明，在接受TEVAR的TBAD患者中，残余最大撕裂直径>8.55mm和随访主动脉直径>40.65mm可以预测主动脉生长。
