title: Age-related changes of thoracic aorta geometry used to predict the risk for acute type B dissection.
abstract: OBJECTIVE
  Risk models that use a single aortic diameter threshold have failed to successfully predict acute type B aortic dissection (TBAD). We sought to identify meaningful age-indexed anatomical variables to predict TBAD risk.
  
  
  RESULTS
  A geometric deformable model, consisting of virtual elastic balloons that inflate inside a vessel lumen, was developed to quantify thoracic aorta geometry. In the presence of TBAD, true and total artery lumen morphology were assessed. A stepwise logistic model was built to predict TBAD risk. Initial covariates included age, gender, body mass index and all anatomic variables not directly related to the dissected segment. Patients with acute TBAD (n=34, 62±12years old, 57% male gender) were compared with subjects with symptoms of dissection, but with a subsequent negative diagnosis (n=51, 62±12years old, 76% male gender). Patient risk factors did not differ between groups. Most aortic anatomical variables were age-dependent. Aortic size was larger in every segment of the dissected with respect to non-dissected aortas (p<0.001). Variables entering the TBAD risk prediction model were aortic arch diameter, thoracic aorta length and age (predictability=0.9764, r=0.85), confirmed by a bootstrap internal validation. In dissected aortas, the true lumen volume was correlated to age (r=0.72).
  
  
  CONCLUSIONS
  TBAD probability increases with a larger aortic arch diameter and a longer thoracic aorta, whereas threshold values increase with age. The aortic morphology was age-dependent. After dissection, true lumen volume correlated to age. The use of threshold values indexed to age should be encouraged to better prevent and eventually treat TBAD.
authors.affiliation: Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Argentina; Centre de Médecine Préventive Cardiovasculaire, APHP, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, APHP, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Paris-Centre de Recherche Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France. Electronic address: damian@craiem.com.ar.
authors.forename: Damian
authors.initials: D
authors.lastname: Craiem
authors.affiliation: Service de Chirurgie Cardiaque et Vasculaire, APHP, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Salma
authors.initials: S
authors.lastname: El Batti
authors.affiliation: Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Argentina.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Casciaro
authors.affiliation: INSERM U970, APHP, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Paris-Centre de Recherche Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France; Service d'Imagerie Cardiovasculaire, APHP, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Mousseaux
authors.affiliation: Centre de Médecine Préventive Cardiovasculaire, APHP, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Paris-Centre de Recherche Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Marie-Emmanuelle
authors.initials: ME
authors.lastname: Sirieix
authors.affiliation: Centre de Médecine Préventive Cardiovasculaire, APHP, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, APHP, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Paris-Centre de Recherche Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Simon
authors.affiliation: INSERM U970, APHP, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Paris-Centre de Recherche Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France; Service de Chirurgie Cardiaque et Vasculaire, APHP, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Alsac
mesh_terms: D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001027:Aortography; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular
keywords: Aging; Aortic arch diameter; Aortic length; Geometric deformable model; True lumen volume