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Acute type B aortic intramural hematoma: the added prognostic value of a follow-up CT
Zhennan Li1, Bin Lu2, Yuan Chen1
1Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing, 100037, People's Republic of China.
Insights
Follow-up CT scans offer crucial prognostic insights for type B aortic intramural hematoma (IMH) patients treated medically. These findings aid in risk assessment and clinical decision-making for managing IMH.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Radiology
Background:
- Type B aortic intramural hematoma (IMH) requires careful monitoring.
- Prognostic indicators for medically treated IMH are essential for guiding management.
- Current follow-up strategies may benefit from refined prognostic tools.
Purpose of the Study:
- To evaluate the prognostic significance of follow-up computed tomography (CT) findings.
- To identify CT-based predictors of adverse aorta-related events in type B IMH.
- To inform risk stratification and clinical decision-making for these patients.
Main Methods:
- Retrospective pooled analysis of individual patient data.
- Inclusion of baseline and follow-up CT characteristics.
- Follow-up for adverse aorta-related events (death, repair).
Main Results:
- Baseline maximal aortic diameter, ulcer-like projection (ULP), changes in maximal hematoma thickness (MHT), newly developed ULP, and pleural effusion were significant predictors.
- Specific thresholds for MHT and presence of ULP were key in 1-month event prediction.
- Resorption of pleural effusion correlated with a lower risk of adverse events.
Conclusions:
- Follow-up CT findings provide robust and incremental prognostic information for type B IMH.
- CT imaging is highly recommended for patients not undergoing urgent invasive therapy.
- These findings enhance risk estimation and support clinical decision-making.
Objectives:
To investigate prognostic significance of follow-up CT findings for initially medically treated type B aortic intramural hematoma (IMH).
Methods:
We performed a retrospective pooled analysis of individual patient data, including baseline and follow-up CT characteristics. All enrolled patients were followed up for adverse aorta-related events, defined as a composite of aortic disease-related death and surgical or endovascular aortic repair.
Results:
A total of 238 patients (73.9% men) were included, with a mean age of 58.1 ± 9.8 years. During follow-up, 83 patients (34.9%) experienced adverse aorta-related events, most of the events (83.1%) occurred within 1 month after follow-up CT imaging (n = 69). In the Cox regression model for predicting adverse aorta-related events, baseline maximal aortic diameter (MAD) (HR = 1.05, p = 0.008), ulcer-like projection (ULP) (HR = 2.47, p < 0.001), changes of maximal hematoma thickness (MHT) (HR = 1.22, p < 0.001), newly developed ULP (HR = 4.44, p < 0.001), and newly developed pleural effusion (HR = 2.46, p = 0.002) were powerful independent predictors. In combined predictive model for 1-month aortic events, baseline MHT ≥ 11.8 mm (OR = 4.39, p = 0.001), ULP (OR = 3.98, p < 0.001), changes of MHT (OR = 1.46, p < 0.001), newly developed ULP (OR = 9.27, p = 0.002), and newly developed pleural effusion (OR = 3.45, p = 0.015) were independent predictors. Besides, in patients with pleural effusion at baseline, resorption of pleural effusion was associated with adverse aorta-related events (HR = 0.36, p = 0.027) and 1-month aortic events (OR = 0.23, p = 0.026).
Conclusions:
Follow-up CT findings provide strong and incremental prognostic information for initially medically treated type B IMH, which are helpful for risk estimates and decisions-making.
Key Points:
• Follow-up CT provides strong and incremental prognostic information for initially medically treated type B aortic intramural hematoma. • Follow-up CT is highly recommended for type B intramural hematoma in patients who did not receive urgent invasive therapy. • Follow-up CT is helpful for risk estimates and decisions-making.
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