Predicting the risk for acute type B aortic dissection in hypertensive patients using anatomic variables

Area of Science:

• Cardiovascular imaging and radiology
• Thoracic aortic disease research
• Hypertension and aortic complications

Background:

• Hypertension is a known risk factor for acute type B aortic dissection (AAD).
• However, hypertension alone may not fully explain AAD development, suggesting other contributing factors.
• Limited research has explored specific anatomical predictors of AAD.

Purpose of the Study:

• To identify anatomical predictors of acute type B aortic dissection (AAD) in hypertensive individuals.
• To utilize multidetector computed tomography angiography (CTA) for detailed aortic assessment.
• To develop a predictive model for identifying high-risk hypertensive patients.

Main Methods:

• Comparative analysis of CTA scans from normotensive patients without AAD, hypertensive patients without AAD, and hypertensive patients with AAD.
• Measurement of aortic dimensions (length, diameter, volume) and tortuosity, along with aortic arch vessel angulation.
• Development and validation of a predictive model using stepwise logistic regression and bootstrapping.

Main Results:

• Patients with AAD exhibited significantly greater aortic length, diameter (ascending aorta and arch), and volume compared to controls.
• Increased aortic tortuosity was a significant finding in patients with AAD.
• A validated risk model incorporating aortic arch diameter, root-to-iliac length, and brachiocephalic artery angulation demonstrated high predictive accuracy (AUC = 0.974).

Conclusions:

• Ascending aorta and aortic arch enlargement, along with increased aortic tortuosity, indicate an aortopathy that elevates AAD risk.
• A validated three-variable anatomical model can identify hypertensive patients at higher risk for AAD.
• This model facilitates targeted medical management and consideration of preemptive surgical interventions.