Aortic elongation and the risk for dissection: the Tübingen Aortic Pathoanatomy (TAIPAN) project†.
OBJECTIVE
We measured aortic dimensions, particularly length parameters, using 3D imaging with the aim of refining the risk-morphology for Stanford type A aortic dissection (TAD).


METHODS
Computer tomography angiography studies were analysed using the curved multiplanar reformats. At defined landmarks, the diameters and lengths of aortic segments were recorded. Three groups were compared retrospectively: patients actually suffering from a TAD (TAD-group; n  = 150), patients before suffering a TAD (preTAD-group n  = 15) and a healthy control group ( n  = 215). Receiver operating characteristic curves (ROCs) were analysed (control versus preTAD) to study the diagnostic value of the individual variables.


RESULTS
Median diameters of preTAD (43 mm) and TAD (50 mm) aortas were significantly ( P  < 0.001) larger than those of the control group (35 mm). Ninety-three percent of preTAD and 68% of TAD aortas were less than 55 mm in the mid-ascending aorta. The ascending aorta and the aortic arch were significantly longer in both preTAD and TAD aortas compared to control aortas ( P  < 0.001); in the control aortas the central line distance from the aortic valve to the brachiocephalic trunk was 93 mm. In preTAD aortas, it was 111 mm, and it was 117 mm in TAD aortas ( P  < 0.001). In ROC analysis, the area under the curve was 0.912 for the ascending diameter and 0.787 for the ascending and arch lengths.


CONCLUSIONS
TAD-prediction based on the aortic diameter is ineffective. Besides circumferential dilatation, ascending aorta elongation precedes TAD and appears to be a useful additional parameter for prognostication. We propose a diagnostic score involving ascending aorta diameter and length.
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Tobias
T
Krüger
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Alexandre
A
Oikonomou
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
David
D
Schibilsky
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Mario
M
Lescan
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Katharina
K
Bregel
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Luise
L
Vöhringer
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Wilke
W
Schneider
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Henning
H
Lausberg
Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University of Tübingen, Tübingen, Germany.
Gunnar
G
Blumenstock
Department of Diagnostic and Interventional Radiology, University Medical Center Tübingen, Tübingen, Germany.
Fabian
F
Bamberg
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Christian
C
Schlensak
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D001011:Aorta / Q000000981:diagnostic imaging* / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
Aneurysm; Aorta; Aortic dissection; Aortic elongation; Computed tomography