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Published on: March 28, 2025
Aortic Agatston score correlates with the progression of acute type A aortic dissection
Yasushi Tashima1,2, Shinichi Iwakoshi3, Takeshi Inoue3
1Department of Cardiovascular Surgery, Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan.
Insights
Higher aortic calcification scores in patients with acute type A aortic dissection (ATAAD) correlate with less disease progression and better aortic remodeling. This finding suggests aortic Agatston scores may predict outcomes after surgery for ATAAD.
Area of Science:
- Cardiovascular Imaging and Intervention
- Aortic Disease Research
- Biomarkers in Cardiovascular Medicine
Background:
- Aortic calcification is linked to aortic stiffness and elastin degradation.
- Understanding the role of aortic calcification in acute type A aortic dissection (ATAAD) progression is crucial for patient management.
Purpose of the Study:
- To investigate the association between aortic calcification, quantified by Agatston scores, and disease progression in patients with ATAAD.
- To determine if preoperative aortic calcification predicts postoperative aortic remodeling after ATAAD surgery.
Main Methods:
- Retrospective review of 85 patients who underwent surgery for ATAAD and had preoperative computed tomography angiography (CTA).
- Aortic calcification was assessed using the Agatston score, with patients categorized into high-score (≥3344) and low-score (<3344) groups.
- Disease progression and aortic remodeling were evaluated using serial CTAs, analyzing dissection extent, true lumen, and false lumen dimensions.
Main Results:
- Higher aortic Agatston scores were significantly correlated with smaller distal dissection extent, larger true lumen areas (ascending and descending aorta), and smaller false lumen areas (descending aorta).
- Patients with high Agatston scores were more likely to have DeBakey type II dissection and false lumen thrombosis.
- Preoperative aortic calcification levels were consistent with postoperative findings, indicating stable associations.
Conclusions:
- Elevated aortic Agatston scores in ATAAD patients are associated with less distal disease progression and favorable aortic remodeling, including larger true lumen volumes.
- Aortic Agatston scores may serve as a valuable imaging biomarker for predicting disease progression and postoperative outcomes in ATAAD.
- These findings highlight the potential of using aortic calcification burden to guide clinical decision-making and anticipate residual aortic changes post-surgery.
Abstract:
Aortic calcification in the tunica media is correlated with aortic stiffness, elastin degradation, and wall shear stress. The study aim was to determine if aortic calcifications influence disease progression in patients with acute type A aortic dissection (ATAAD). We retrospectively reviewed a total of 103 consecutive patients who had undergone surgery for ATAAD at our institution between January 2009 and December 2019. Of these, 85 patients who had preoperatively undergone plain computed tomography angiography (CTA) for evaluation of their aortic calcification were included. Moreover, we assessed the progression of aortic dissection after surgery via postoperative CTA. Using a classification and regression tree to identify aortic Agatston score thresholds predictive of disease progression, the patients were classified into high-score (Agatston score ≥ 3344; n = 36) and low-score (<3344; n = 49) groups. Correlations between aortic Agatston scores and CTA variables were assessed. Higher aortic Agatston scores were significantly correlated with the smaller distal extent of aortic dissection (p < 0.001), larger true lumen areas of the ascending (p = 0.009) and descending aorta (p = 0.002), and smaller false lumen areas of the descending aorta (p = 0.028). Patients in the high-score group were more likely to have DeBakey type II dissection (p = 0.001) and false lumen thrombosis (p = 0.027) than those in the low-score group, thereby confirming the correlations. Aortic dissection in the high-score group was significantly less distally extended (p < 0.001). A higher aortic Agatston score correlates with the larger true lumen area of the ascending and descending aorta and the less distal progression of aortic dissection in patients with ATAAD. Interestingly, the findings before and after surgery were consistent. Hence, aortic Agatston scores are associated with aortic dissection progression and may help predict postoperative residual dissected aorta remodeling.
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