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Meng D, Wang Y, Zhou T, Gu R, Zhang Z, Zhao T, He H, Min Y, Wang X. A nomogram prediction model for short-term aortic-related adverse events in patients with acute Stanford type B aortic intramural hematoma: development and validation. Front Cardiovasc Med 2024; 11:1364361. [PMID: 39049955 PMCID: PMC11266148 DOI: 10.3389/fcvm.2024.1364361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Background This study is to examine the factors associated with short-term aortic-related adverse events in patients with acute type B aortic intramural hematoma (IMH). Additionally, we develop a risk prediction nomogram model and evaluate its accuracy. Methods This study included 197 patients diagnosed with acute type B IMH. The patients were divided into stable group (n = 125) and exacerbation group (n = 72) based on the occurrence of aortic-related adverse events. Logistic regression and the Least Absolute Shrinkage and Selection Operator (LASSO) method for variables based on baseline assessments with significant differences in clinical and image characteristics were employed to identify independent predictors. A nomogram risk model was constructed based on these independent predictors. The nomogram model was evaluated using various methods such as the receiver operating characteristic curve, calibration curve, decision analysis curve, and clinical impact curve. Internal validation was performed using the Bootstrap method. Results A nomogram risk prediction model was established based on four variables: absence of diabetes, anemia, maximum descending aortic diameter (MDAD), and ulcer-like projection (ULP). The model demonstrated a discriminative ability with an area under the curve (AUC) of 0.813. The calibration curve indicated a good agreement between the predicted probabilities and the actual probabilities. The Hosmer-Lemeshow goodness of fit test showed no significant difference (χ 2 = 7.040, P = 0.532). The decision curve analysis (DCA) was employed to further confirm the clinical effectiveness of the nomogram. Conclusion This study introduces a nomogram prediction model that integrates four important risk factors: ULP, MDAD, anemia, and absence of diabetes. The model allows for personalized prediction of patients with type B IMH.
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Affiliation(s)
- Dujuan Meng
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- The General Hospital of Northern Theater Command Training Base for Graduate, Dalian Medical University, Shenyang, China
| | - Yasong Wang
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Tienan Zhou
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ruoxi Gu
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiqiang Zhang
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Tinghao Zhao
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Houlin He
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ying Min
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozeng Wang
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
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Jung JC, Chang HW, Lee JH, Park KH. Features and outcomes of focal intimal disruption in acute type B intramural haematoma. Eur J Cardiothorac Surg 2024; 65:ezae193. [PMID: 38733570 DOI: 10.1093/ejcts/ezae193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/16/2024] [Accepted: 05/10/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES A focal intimal disruption (FID) is a risk factor for adverse aorta-related events in patients with acute type B intramural haematoma. This study evaluated the impact of FIDs on overall survival with a selective intervention strategy for large or growing FIDs. Additionally, this study evaluated the risk factors associated with the growth of FIDs. METHODS This retrospective study included all consecutive patients admitted for acute type B intramural haematomas between November 2004 and April 2021. The primary outcome was overall survival. The secondary outcome was the cumulative incidence of composite aortic events and the growth of FIDs. The latter was calculated on centreline-reconstructed computed tomography images. RESULTS A total of 105 patients were included. A total of 106 FIDs were identified in 73 patients (73/105, 69.5%). The 1- and 5-year cumulative incidence rates of composite aortic events were 36.2% and 39.2%, respectively. The 1- and 5-year overall survival was 93.3% and 81.5%, respectively. Initial maximal aortic diameter and large FIDs during acute phase were significant risk factors for composite aortic events, but not risk factors for overall survival. The early appearance interval of an FID was a significant risk factor for growth of an FID. CONCLUSIONS With a selective intervention strategy for large or growing FIDs, the presence of large FIDs during the acute phase does not affect overall survival. The early appearance interval was associated with the growth of FIDs.
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Affiliation(s)
- Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Hang Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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Hu X, Yang F, Liu J, Liu Y, Fan R, Luo J. A single-center experience of type B aortic intramural hematoma. J Vasc Surg 2024; 79:514-525. [PMID: 38941265 DOI: 10.1016/j.jvs.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 06/30/2024]
Abstract
OBJECTIVE The outcomes of the best medical treatment (BMT) and intervention treatment (INT) in a single-center experience were reported in type B intramural hematoma (IMH). METHODS From February 2015 to February 2021, a total of 195 consecutive patients with type B IMH were enrolled in the study. The primary end point was mortality, and the secondary end points included clinical and imaging outcomes. The clinical outcomes were aortic-related death, retrograde type A aortic dissection, stent graft-induced new entry tear, endoleak, and reintervention. The imaging outcome was evaluated through the latest follow-up computed tomography angiography, which included aortic rupture, aortic dissection, aortic aneurysm, rapid growth of aortic diameter, newly developed or enlarged penetrating aortic ulcer or ulcer-like projection (ULP) and increased aortic wall thickness. Kaplan-Meier curves were used to assess the association between different treatments. RESULTS Among the enrolled patients, 115 received BMT, and 80 received INT. There was no significant difference in early (1.7% vs 2.5%; P = 1.00) and midterm all-cause death (8.3% vs 5.2%; P = .42) between the BMT and INT groups. However, patients who underwent INT were at risk of procedure-related complications such as stent graft-induced new entry tear and endoleaks. The INT group was associated with a profound decrease in the risk of ULP, including newly developed ULP (4.3% vs 26.9%; P < .05), ULP enlargement (6.4% vs 31.3%; P < .05), and a lower proportion of high-risk ULP (10.9% vs 45.6%; P < .05). Although there was no significant difference in the incidence of IMH regression between the two groups, the maximum diameter of the descending aorta in patients receiving INT was larger compared with those treated with BMT. CONCLUSIONS Based on our limited experience, patients with type B IMH treated with BMT or INT shared similar midterm clinical outcome. Patients who underwent INT may have a decreased risk of ULPs, but a higher risk of procedure-related events and patients on BMT should be closely monitored for ULP progression.
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Affiliation(s)
- Xiaolu Hu
- School of Medicine, South China University of Technology, Guangzhou, China; Department of Cardiology, Guangdong Cardiovascular Institution, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Fan Yang
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jitao Liu
- Department of Cardiology, Guangdong Cardiovascular Institution, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yuan Liu
- Department of Cardiology, Guangdong Cardiovascular Institution, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ruixin Fan
- Department of Cardiovascular Surgery, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jianfang Luo
- School of Medicine, South China University of Technology, Guangzhou, China; Department of Cardiology, Guangdong Cardiovascular Institution, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
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Spanos K, Kölbel T. Role of Initial Focal Contrast Enhancement in Type B Intramural Hematoma. J Am Coll Cardiol 2024; 83:514-515. [PMID: 38267113 DOI: 10.1016/j.jacc.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece; German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Orii M, Sone M, Fujiwara J, Sasaki T, Chiba T, Kin H, Morino Y, Tanaka R, Yoshioka K. A Comparison of Retrospective ECG-Gated CT and Surgical or Angiographical Findings in Acute Aortic Syndrome. Int Heart J 2023; 64:839-846. [PMID: 37704411 DOI: 10.1536/ihj.23-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The best cardiac phases in retrospective ECG-gated CT for detecting an intimal tear (IT) in aortic dissection (AD) and an ulcer-like projection (ULP) in an intramural hematoma (IMH) have not been established. This study aimed to compare the detection accuracy of diastolic-phase and systolic-phase ECG-gated CT for IT in AD and ULP in IMH, with subsequent surgical or angiographical confirmation as the reference standard.In total, 81 patients (67.6 ± 11.8 years; 41 men) who underwent emergency ECG-gated CT and subsequent open surgery or thoracic endovascular aortic repair for AD (n = 52) or IMH (n = 29) were included. The accuracies of detecting IT and ULP were compared among only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase methods of retrospective ECG-gated CT; surgical or angiographical findings were used as the reference standard. The detection accuracy for IT and ULP using only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase methods of ECG-gated CT was 93% [95% CI: 87-97], 94% [95% CI: 88-97], and 95% [95% CI: 90-97], respectively. There were no significant differences in detection accuracy among the 3 acquisition methods (P = 0.55). Similarly, there were no significant differences in the accuracy of detecting IT in AD (P = 0.55) and ULP in IMH (P > 0.99) among only diastolic-phase, only systolic-phase, and both diastolic- and systolic-phase ECG-gated CT.Retrospective ECG-gated CT for detecting IT in AD and ULP in IMH yields highly accurate findings. There were no significant differences seen among only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase ECG-gated CT.
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Affiliation(s)
- Makoto Orii
- Department of Radiology, Iwate Medical University
| | - Misato Sone
- Department of Radiology, Iwate Medical University
| | - Jumpei Fujiwara
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tadashi Sasaki
- Center for Radiological Science, Iwate Medical University
| | - Takuya Chiba
- Center for Radiological Science, Iwate Medical University
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Ryoichi Tanaka
- Division of Dental Radiology, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
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Meng D, Gu R, Wang Y, Zhang Z, Xu T, Wang X. Analysis of Short-Term Clinical Outcomes and Influencing Factors in Patients with Acute Type B Aortic Intramural Hematoma Treated with Optimal Medical Therapy. Int Heart J 2023; 64:708-716. [PMID: 37460317 DOI: 10.1536/ihj.23-023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This study aimed to investigate the short-term predictors of aortic-related adverse events in patients with acute type B aortic intramural hematoma (IMH) initially treated with optimized medical therapy.A total of 157 patients with acute type B IMH were included in this study. These patients were divided into worsening group (n = 45) and stable group (n = 112) based on the incidence of aortic-related adverse events. The clinical data and imaging features of the two groups were compared. Multivariate logistic regression analysis of predictors of aortic-related adverse events in type B IMH was performed. Receiver operating characteristic (ROC) curve was applied to determine the optimal cutoff value for maximum descending aorta diameter (MDAD). Kaplan-Meier survival curve was used to analyze the incidence of aortic-related adverse events.Worsening and stable groups were statistically significant in diuretics, abnormal D-dimer level, observation endpoint systolic blood pressure (SBP), MDAD, aortic atherosclerosis, ulcer-like projection (ULP), and thickness of hematoma (P < 0.05). Multivariate logistic regression showed that abnormal D-dimer level (OR = 12.464, P = 0.025), MDAD (OR = 1.113, P = 0.030), and ULP (OR = 5.849, P = 0.022) were powerful independent risk factors for predicting aortic-related adverse events in type B IMH, and observation endpoint SBP within 100-120 mmHg (OR = 0.225, P = 0.014) was a protective factor for predicting aortic-related adverse events in type B IMH. The cutoff value of MDAD was 35.2 mm.Short-term imaging is recommended for type B IMH patients with abnormal D-dimer level, MDAD > 35.2 mm, and ULP. Blood pressure should also be strictly monitored and controlled during the acute phase of IMH.
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Affiliation(s)
- Dujuan Meng
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command
- The General Hospital of Northern Theater Command Training Base for Graduate, Dalian Medical University
| | - Ruoxi Gu
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command
| | - Yasong Wang
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command
| | - Zhiqiang Zhang
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command
| | - Tianshu Xu
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command
| | - Xiaozeng Wang
- National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command
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Masumoto A, Azumi Y, Kaji S, Miyoshi Y, Kim K, Kitai T, Furukawa Y. Impact of antithrombotic therapy on clinical outcomes in patients with type B acute aortic syndrome. JTCVS OPEN 2023; 14:36-45. [PMID: 37425476 PMCID: PMC10328807 DOI: 10.1016/j.xjon.2023.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 07/11/2023]
Abstract
Objective Antithrombotic therapy has the potential to interfere with false lumen thrombosis. In type B acute aortic syndrome, the degree of false lumen thrombosis affects clinical outcomes. We aimed to explore the association of antithrombotic therapy with the prognosis of patients with type B acute aortic syndrome. Methods We reviewed 406 patients with type B acute aortic syndrome who were discharged alive with and without antithrombotic therapy. The primary outcome was aorta-related adverse events, defined as a composite of aorta-related death, aortic rupture, aortic repair, and progressive aortic dilation. Results Of the 406 patients, 64 (16%) were discharged with antithrombotic therapy and 342 (84%) were discharged without antithrombotic therapy. A total of 249 patients (61%) presented with intramural hematoma with complete thrombosis of the false lumen, and 157 patients (39%) presented with aortic dissection. During a median follow-up of 4.6 years, 32 patients (50%) in the antithrombotic group and 93 patients (27%) in the nonantithrombotic group had a primary outcome event. Cumulative incidence of aorta-related events at 1 and 3 years with death as the competing risk was higher in the antithrombotic group than in the nonantithrombotic group (19% ± 5% vs 9% ± 2% at 1 year and 40% ± 7% vs 17% ± 2% at 3 years, P < .001). Conclusions Antithrombotic therapy might be associated with an increased risk of aorta-related events in patients with type B acute aortic syndrome.
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Affiliation(s)
| | | | - Shuichiro Kaji
- Address for reprints: Shuichiro Kaji, MD, PhD, Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku 650-0047, Kobe, Japan.
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Colacchio EC, Squizzato F, Piazza M, Menegolo M, Grego F, Antonello M. Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review. Diagnostics (Basel) 2022; 12:2727. [PMID: 36359569 PMCID: PMC9689060 DOI: 10.3390/diagnostics12112727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/29/2022] [Accepted: 11/06/2022] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND This work aims to review recent literature on penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs), in order to identify clinical and imaging factors connected to aortic-related adverse events (AAE). METHODS We performed a systematic review according to the Preferred Reporting Items for Systematic review and Metanalyses (PRISMA) guidelines. An electronic search was conducted on Medline and Embase databases. We included articles reporting on PAUs and/or IMHs localized in the descending thoracic and/or abdominal aorta and analyzing clinical and/or radiological markers of AAE. RESULTS Of 964 records identified through database searching, 17 were incorporated in the present review, including 193 and 1298 patients with type B PAUs and IMHs, respectively. The 30-days aortic-related mortality (ARM) was 4.3% and 3.9% for PAUs and IMHs. A total of 21% of patients with IMHs underwent intervention during the follow-up period, and 32% experienced an AAE. PAU markers of AAE were minimum depth (ranging from 9.5 to 15 mm) and diameter (≥12.5 mm). Maximum aortic diameter (MAD) cut-off values ranging from 38 to 44.75 mm were related to AAE for IMHs, together with ulcer-like projection (ULP) of the aortic wall. CONCLUSIONS Despite data heterogeneity in the literature, this PAU- and IMH-focused review has highlighted the imaging and clinical markers of disease progression, thus identifying patients that could benefit from an early intervention in order to reduce the AAE rate.
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Affiliation(s)
- Elda Chiara Colacchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Section, University of Padova, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
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Maas A, van Bakel PAJ, Ahmed Y, Patel HJ, Burris NS. Natural history and clinical significance of aortic focal intimal flaps. Front Cardiovasc Med 2022; 9:959517. [PMID: 36267637 PMCID: PMC9576867 DOI: 10.3389/fcvm.2022.959517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/14/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Focal intimal flaps (FIF) are a variety of defects of the aorta that result in a short, flap-like projection into the lumen, and are often encountered in asymptomatic patients undergoing computed tomography angiography (CTA) surveillance for aortic aneurysm, but the natural history and clinical significance of such lesions has not yet been studied. Methods We retrospectively identified patients with an asymptomatic FIF and available imaging follow-up (>1 year). FIF was defined as flap-like intimal irregularity < 4 cm in length involving the thoracic aorta (TA), abdominal aorta (AA) or common iliac arteries (CIA). FIF characteristics included length and circumferential extent as well as the presence and size (width and depth) of associated penetrating aortic ulcers (PAUs). Patient characteristics, adverse events and history of surgical repair was determined by chart review. FIFs and associated PAUs were assessed for progression by comparing baseline and follow-up CTA studies. Results A total of 84 FIFs were identified in 77 patients. Average age was 69.2 ± 10.1 years, and 81% were male (81%). Common co-morbidities included: hypertension (78%), hyperlipidemia (68%), smoking (60%), coronary artery disease (41%), aortic aneurysm (34%), type II diabetes mellitus (27%) and prior cardiovascular surgery (25%). FIFs were most commonly located in the abdominal aorta (n = 50, 60%). Nearly all FIFs were associated with local atherosclerotic plaque (93%). Mean follow-up interval was 3.5 ± 2.6 years (259 cumulative follow-up years). Change in FIF length and local aortic diameter over follow-up were 0.7 ± 2.3 mm and 0.8 ± 1.1 mm, respectively. Nearly half (47%) of FIFs were associated with penetrating aortic ulcers (PAU) with baseline depth of 7.3 mm (IQR: 6.1–10.2) and change in depth of 0.5 ± 1.4 mm. Only 12% of FIFs and 0% of associated PAUs demonstrated growth (≥3 mm) at follow-up. No acute pathology developed in the location of FIFs and no aortic interventions were performed specifically to treat FIFs. Conclusion Focal intimal flaps identified in asymptomatic patients with aortic disease were co-localized with atherosclerotic plaque and PAUs, and demonstrated indolent behavior, not leading to significant growth or acute aortic events, supporting a conservative management approach.
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Affiliation(s)
- Austin Maas
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Pieter A. J. van Bakel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Yunus Ahmed
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Himanshu J. Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas S. Burris
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States,*Correspondence: Nicholas S. Burris,
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Takamatsu A, Yoshida K, Toshima F, Kozaka K, Yamamoto N, Sai Y, Gabata T. Single-Center Analysis of Pegfilgrastim-induced Aortitis Using a Drug Prescription Database and CT Findings. Radiology 2022; 305:729-740. [PMID: 35943335 DOI: 10.1148/radiol.220357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Pegfilgrastim-induced aortitis is a rare but serious adverse event in patients undergoing anticancer therapy with granulocyte colony-stimulating factor analogs. Despite previous case series and systemic reviews, the exact incidence, clinical presentation, and CT manifestations of pegfilgrastim-induced aortitis remain unclear. Purpose To clarify the incidence and clinicoradiologic characteristics of pegfilgrastim-induced aortitis. Materials and Methods Pegfilgrastim administration records from January 2015 to March 2021 were retrospectively collected from the drug prescription database of a single center and were matched with the relevant findings in the CT database. Corresponding CT images within 6 months were available for a total of 1462 doses of pegfilgrastim in 674 patients. Four radiologists reviewed the CT images for the presence of aortitis in two steps. Clinical information and the distribution of aortitis on CT images were examined for patients with a diagnosis of pegfilgrastim-induced aortitis. Results Pegfilgrastim-induced aortitis was observed in 18 of 674 patients (mean age, 62 years ± 13 [SD]; 424 men), resulting in incidence rates of 2.7% per patient (95% CI: 1.6, 4.2) and 1.2% per dose (95% CI: 0.7, 1.9). The most common original primary malignancies were esophageal cancer (n = 10, 9%), breast cancer (n = 3, 4%), and pancreatic cancer (n = 2, 2%). The most common anticancer drugs used at onset were 5-fluorouracil, cisplatin, and docetaxel. Seven cases were symptomatic, while the remaining 11 (61%) were asymptomatic. CT findings indicated that aortitis involved branches of the aortic arch in 13 cases (72%), aortic arch in 10 cases (56%), and abdominal aorta in two cases (11%). Conclusion Pegfilgrastim-induced aortitis may be more prevalent than previously reported and may be more common in patients with esophageal cancer and those who received 5-fluorouracil, cisplatin, and docetaxel as anticancer drugs. The findings also suggest that pegfilgrastim-induced aortitis is often characterized by aortic arch and proximal branch involvement at CT. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Krinsky in this issue.
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Affiliation(s)
- Atsushi Takamatsu
- From the Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan (A.T., K.Y., F.T., K.K., T.G.); and Department of Hospital Pharmacy, University Hospital (N.Y., Y.S.), and AI Hospital/Macro Signal Dynamics Research and Development Center (Y.S.), Kanazawa University, Kanazawa, Japan
| | - Kotaro Yoshida
- From the Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan (A.T., K.Y., F.T., K.K., T.G.); and Department of Hospital Pharmacy, University Hospital (N.Y., Y.S.), and AI Hospital/Macro Signal Dynamics Research and Development Center (Y.S.), Kanazawa University, Kanazawa, Japan
| | - Fumihito Toshima
- From the Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan (A.T., K.Y., F.T., K.K., T.G.); and Department of Hospital Pharmacy, University Hospital (N.Y., Y.S.), and AI Hospital/Macro Signal Dynamics Research and Development Center (Y.S.), Kanazawa University, Kanazawa, Japan
| | - Kazuto Kozaka
- From the Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan (A.T., K.Y., F.T., K.K., T.G.); and Department of Hospital Pharmacy, University Hospital (N.Y., Y.S.), and AI Hospital/Macro Signal Dynamics Research and Development Center (Y.S.), Kanazawa University, Kanazawa, Japan
| | - Naho Yamamoto
- From the Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan (A.T., K.Y., F.T., K.K., T.G.); and Department of Hospital Pharmacy, University Hospital (N.Y., Y.S.), and AI Hospital/Macro Signal Dynamics Research and Development Center (Y.S.), Kanazawa University, Kanazawa, Japan
| | - Yoshimichi Sai
- From the Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan (A.T., K.Y., F.T., K.K., T.G.); and Department of Hospital Pharmacy, University Hospital (N.Y., Y.S.), and AI Hospital/Macro Signal Dynamics Research and Development Center (Y.S.), Kanazawa University, Kanazawa, Japan
| | - Toshifumi Gabata
- From the Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan (A.T., K.Y., F.T., K.K., T.G.); and Department of Hospital Pharmacy, University Hospital (N.Y., Y.S.), and AI Hospital/Macro Signal Dynamics Research and Development Center (Y.S.), Kanazawa University, Kanazawa, Japan
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