title: Intramural hematoma of the aorta: predictors of progression to dissection and rupture.
abstract: BACKGROUND
  Aortic intramural hematoma (IMH) is a variant of overt aortic dissection. The predictors of progression of IMH to dissection and rupture are still unknown, and strategies for management are not established.
  
  
  RESULTS
  A multicenter study was conducted comprising 66 patients with IMH and hospital admission <or=48 hours after onset of initial symptoms. Among these, progression to aortic dissection or rupture occurred in 30 (45%) and death occurred in 13 (20%) patients within 30 days. Late progression was noted in 14 (21%) and death in 11 (17%) patients, yielding a 1-, 2-, and 5-year survival of 76%, 73%, and 43%, respectively. In a set of 9 variables, multivariate analysis identified IMH location in the ascending aorta (type A; P=0.02) and moderately ectatic aortic diameters (49+/-13 mm with progression versus 57+/-16 mm without progression; P=0.03) as independent predictors of early progression. In type A IMH, early mortality was 8% with swift surgery versus 55% without surgery (P=0.004). The risk of late progression of IMH was independently associated with age at index diagnosis (P=0.01) and absence of beta-blocker therapy during follow-up (P=0.03). Kaplan-Meier analysis confirmed improved 1-year survival of IMH with beta-blocker therapy (95% versus 67% without beta-blockers; P=0.004).
  
  
  CONCLUSIONS
  Regardless of aortic diameter, IMH of the ascending aorta (type A) is at high risk for early progression, and, thus, undelayed surgical repair should be performed. Moreover, oral beta-blocker therapy may improve long-term prognosis of IMH independent of anatomical location.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Yskert
authors.initials: Y
authors.lastname: von Kodolitsch
authors.forename: Susanne K
authors.initials: SK
authors.lastname: Csösz
authors.forename: Dietmar H
authors.initials: DH
authors.lastname: Koschyk
authors.forename: Ilka
authors.initials: I
authors.lastname: Schalwat
authors.forename: Roger
authors.initials: R
authors.lastname: Loose
authors.forename: Matthias
authors.initials: M
authors.lastname: Karck
authors.forename: Christoph
authors.initials: C
authors.lastname: Dieckmann
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Jürgen
authors.initials: J
authors.lastname: Berger
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D001019:Aortic Rupture / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed