title: Predictors of Stable Aortic Dimensions in Medically Managed Acute Aortic Syndromes.
abstract: BACKGROUND
  We aimed to identify predictors of stable aortic dimensions in medically managed type B aortic dissections (TBAD).
  
  
  METHODS
  Medically managed TBAD patients from the International Registry of Acute Aortic Dissection with available aortic measurements at up to 24 months were included. Growth rate was calculated by dividing the largest descending diameter at the latest end point not influenced by intervention minus initial descending diameter, by the recorded time interval. Patients were split into 2 groups: without aortic growth (<0.0 mm/year, group I) and with aortic growth (>0.0 mm/year, group II).
  
  
  RESULTS
  219 patients had available data for our inclusion criteria and comprised group I (n = 89, 40.6%) and group II (n = 130, 59.4%). Mean expansion rate of the total cohort was 0.19 ± 0.81 cm, mean expansion rate in group I was -0.47 ± 0.54 cm, and in group II, it was +0.63 ± 0.64 cm. Patients in group I were more frequently of Asian descent (15.9% vs. 3.1%, P = 0.001), showed more often intramural hematoma on imaging (57.3% vs. 30.0%, P < 0.001) and demonstrated complete false lumen thrombosis more frequently (25.0% vs. 9.9%, P = 0.009). Group II patients were more Caucasian (77.3% vs. 92.2%, P = 0.002), presented more with posterior chest pain (57.8% vs. 74.7%, P = 0.025), back pain (68.2% vs. 80.2%, P = 0.046), a visible double lumen (50.6% vs. 63.8%, P = 0.050), dissection originating from the left subclavian artery (51.2% vs. 68.5%, P = 0.011), and a completely patent false lumen (37.5% vs. 62.4%, P = 0.002). Mortality rates between groups were similar (2.2% vs. 1.5%, P = 0.708). Complete false lumen thrombosis was an independent predictor of no growth (hazard ratio [HR]: 3.640, P = 0.011), while a larger sinotubular junction (STJ) (HR: 0.304, P = 0.004) and female gender (HR: 0.325, P = 0.030) were negative predictors of no growth.
  
  
  CONCLUSIONS
  Complete false lumen thrombosis was a predictor of no growth, while a large STJ and female gender were predictors of aortic growth. This study might help predict which medically treated TBAD patients might show a stable clinical course during follow-up.
authors.affiliation: Department of Vascular Surgery, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy; Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI; Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI; Department of Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands. Electronic address: arnoudkamman@gmail.com.
authors.forename: Arnoud V
authors.initials: AV
authors.lastname: Kamman
authors.affiliation: Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Frederik H W
authors.initials: FHW
authors.lastname: Jonker
authors.affiliation: Department of Cardiology, Robert-Bosch Krankenhaus, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Department of Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Harris
authors.affiliation: Department of Cardiology, Hospital General Universitari Vall d'Hebron, University of Barcelona, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI; Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.affiliation: Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI; Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI.
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
authors.affiliation: Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI; Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Department of Vascular Surgery, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome