Usefulness of the initial noninvasive imaging study to predict the adverse outcomes in the medical treatment of acute type A aortic intramural hematoma

Article

关键词: TRANSESOPHAGEAL ECHOCARDIOGRAPHY;    CLINICAL-FEATURES;    HEMORRHAGE;    PROGNOSIS;    ULCER;   

DOI  :  10.1161/01.cir.0000087651.30078.38

来源: SCIE

【 摘 要 】

Background - There have been contradictory reports about the outcomes of medically treated patients with type A aortic intramural hematoma (AIH), and it is not certain if the initial noninvasive imaging studies can provide any useful predictors for the adverse outcomes. Methods and Results - Imaging studies and clinical outcomes of 25 consecutive patients with type A AIH who initially received medical treatment were analyzed retrospectively. Adverse outcomes ( death, surgery, and development of dissection) occurred in 9 patients ( group A), whereas the other 16 patients showed an uneventful course ( group B). The hematoma thickness ( 14 +/- 4 versus 8 +/- 4 mm, P < 0.005) and hematoma area ( 988 +/- 316 versus 555 +/- 352 mm(2), P < 0.01) in the imaging study performed less than or equal to 48 hours after onset of initial symptoms were significantly larger in group A; maximal aortic diameter ( 53 +/- 6 versus 48 +/- 8 mm, P = 0.10) and aortic cross-sectional area ( 2247 +/- 501 versus 1809 +/- 626 mm2, P = 0.09) were also somewhat larger in group A. The hematoma thickness was the only independent predictor for the adverse outcomes by stepwise multiple logistic regression analysis ( odds ratio 1.41, 95% confidence interval 1.07 to 1.86, P < 0.05). Hematoma thickness >= 11 mm predicted the adverse outcomes with sensitivity 89% and specificity 69%. No one with hemodynamically stable initial condition and the hematoma thickness >= 11 mm experienced the adverse outcomes. Conclusion - Noninvasive imaging study provides important prognostic information in the medical treatment of acute type A AIH, and initial hematoma thickness seems to be the best index for predicting adverse clinical outcome.

【 授权许可】

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