Intramural hematoma of the aorta: predictors of progression to dissection and rupture.
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.
von Kodolitsch
Yskert
Y
Department of Internal Medicine, Division of Cardiology, University Hospital Eppendorf, Hamburg, Germany.
Csösz
Susanne K
SK
Koschyk
Dietmar H
DH
Schalwat
Ilka
I
Loose
Roger
R
Karck
Matthias
M
Dieckmann
Christoph
C
Fattori
Rossella
R
Haverich
Axel
A
Berger
Jürgen
J
Meinertz
Thomas
T
Nienaber
Christoph A
CA
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