title: Predicting the risk for acute type B aortic dissection in hypertensive patients using anatomic variables.
abstract: OBJECTIVE
  This study sought to identify possible anatomic predictors of acute type B aortic dissection (AAD) in hypertensive patients using multidetector computed tomography angiography (CTA).
  
  
  BACKGROUND
  Although hypertension remains one of the most significant risk factors for AAD development, it is unlikely to be the only risk factor for AAD. Few studies have assessed anatomical predictors of AAD development.
  
  
  METHODS
  CTA of normotensive patients without AAD (group 1, n = 35), hypertensive patients without AAD (group 2, n = 37), and hypertensive patients with AAD (group 3, n = 37) were compared. The length, diameter, volume, and tortuosity of the aorta as well as arch vessel angulation were measured for each patient and normalized to group 1 averages. Stepwise logistic regression identified significant anatomical associations; the model was validated based on 1,000 bootstrapped samples.
  
  
  RESULTS
  The demographics of the groups were similar. The length of the proximal and entire aorta, the diameters in the proximal ascending aorta and aortic arch, and the aortic volumes were all greater (p < 0.0001, p = 0.0064 for ascending aortic diameter) in group 3 than in groups 1 and 2, as was entire aortic tortuosity (p < 0.0001). An AAD risk model was developed based on aortic arch diameter, length from the aortic root to the iliac bifurcation, and angulation of the brachiocephalic artery origin from the aorta. The bootstrap estimate of the area under the receiver operating curve was 0.974.
  
  
  CONCLUSIONS
  Enlargement of the ascending aorta and aortic arch and increased aortic tortuosity reflect an aortopathy which enhances the probability of AAD. A model based on 3 anatomical variables demonstrates significant associations with AAD: it may allow identification by aortic imaging of the hypertensive patient most at risk, and permit implementation of aggressive medical management and consideration of pre-emptive surgery to prevent dissection.
authors: Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA. aditya.shirali@mssm.edu
authors: Aditya S
authors: AS
authors: Shirali
authors: Moritz S
authors: MS
authors: Bischoff
authors: Hung-Mo
authors: HM
authors: Lin
authors: Irina
authors: I
authors: Oyfe
authors: Robert
authors: R
authors: Lookstein
authors: Randall B
authors: RB
authors: Griepp
authors: Gabriele
authors: G
authors: Di Luozzo
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001027:Aortography / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents