title: Aortic expansion after acute type B aortic dissection.
abstract: BACKGROUND
  A considerable number of patients with acute type B aortic dissection (ABAD) treated with medical management alone will exhibit aortic enlargement during follow-up, which could lead to aortic aneurysm and rupture. The purpose of this study was to investigate predictors of aortic expansion among ABAD patients enrolled in the International Registry of Acute Aortic Dissection.
  
  
  METHODS
  We analyzed 191 ABAD patients treated with medical therapy alone enrolled in the registry between 1996 and 2010, with available descending aortic diameter measurements at admission and during follow-up. The annual aortic expansion rate was calculated for all patients, and multivariate regression analysis was used to investigate factors affecting the expansion rate.
  
  
  RESULTS
  Aortic expansion was observed in 59% of ABAD patients; mean expansion rate was 1.7±7 mm/y. In multivariate analysis, white race (regression coefficient [RC], 4.6; 95% confidence interval [CI], 1.4 to 7.7) and an initial aortic diameter less than 4.0 cm (RC, 6.3; 95% CI, 4.0 to 8.6) were associated with increased aortic expansion. Female sex (RC, -3.8; 95% CI, -6.1 to -1.4), intramural hematoma (RC, -3.8; 95% CI, -6.5 to -1.1), and use of calcium-channel blockers (RC, -3.8; 95% CI, -6.2 to -1.3) were associated with decreased aortic expansion.
  
  
  CONCLUSIONS
  White race and a small initial aortic diameter were associated with increased aortic expansion during follow-up, and decreased aortic expansion was observed among women, patients with intramural hematoma, and those on calcium-channel blockers. These data raise the possibility that the use of calcium-channel blockers after ABAD may reduce the rate of aortic expansion, and therefore further investigation is warranted.
authors: Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. jonkerf@maasstadziekenhuis.nl
authors: Frederik H W
authors: FH
authors: Jonker
authors: Santi
authors: S
authors: Trimarchi
authors: Vincenzo
authors: V
authors: Rampoldi
authors: Himanshu J
authors: HJ
authors: Patel
authors: Patrick
authors: P
authors: O'Gara
authors: Mark D
authors: MD
authors: Peterson
authors: Rossella
authors: R
authors: Fattori
authors: Frans L
authors: FL
authors: Moll
authors: Matthias
authors: M
authors: Voehringer
authors: Reed E
authors: RE
authors: Pyeritz
authors: Stuart
authors: S
authors: Hutchison
authors: Daniel
authors: D
authors: Montgomery
authors: Eric M
authors: EM
authors: Isselbacher
authors: Christoph A
authors: CA
authors: Nienaber
authors: Kim A
authors: KA
authors: Eagle
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001018:Aortic Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome