Long-term prognosis of patients with type B aortic intramural hematoma

Article

关键词: PREDICTIVE FACTORS;    THORACIC AORTA;    HEMORRHAGE;    PROGRESSION;    DISSECTION;    OUTCOMES;    ULCER;   

DOI  :  10.1161/01.cir.0000087425.86049.74

来源: SCIE

【 摘 要 】

Background - The long-term clinical course of patients with type B aortic intramural hematoma (IMH) and predictors for progression remains unknown. The difference of aortic pathology may have a different impact on clinical course compared with classic aortic dissection ( AD). The purpose of this study was to investigate long-term clinical course and predictors of progression in patients with type B IMH. Methods and Results - Clinical data were compared retrospectively between 53 patients with acute type B IMH ( IMH group) and 57 patients with acute type B AD ( AD group). All patients were treated initially with medical therapy. Two patients in IMH group and 14 patients in AD group underwent surgical repair because of aortic enlargement. The in-hospital mortality rate in IMH group was significantly lower than that in AD group ( 0% and 14%, P = 0.006). Mean follow-up periods were 53 +/- 43 months, which revealed 3 and 5 late deaths, respectively. Eleven patients with IMH showed progression ( development of aortic dissection or aortic enlargement) in follow-up imaging study. The actuarial survival rates in IMH group were 100%, 97%, and 97% at 1, 2, and 5 years, which were significantly higher than those in AD group ( 83%, 79%, and 79%) ( P = 0.009). Multivariate analysis identified age > 70 years and new appearance of an ulcerlike projection as the strongest predictors of progression in patients with IMH. Conclusions - Patients with type B IMH have better long-term prognosis than patients with AD. Older age and appearance of an ulcerlike projection are predictive for progression in patients with type B IMH.

【 授权许可】

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