Correlations between aortic tortuosity, diameter and presence of acute type A aortic dissection

J Cardiovasc Surg (Torino). 2021 Dec;62(6):632-638. doi: 10.23736/S0021-9509.21.11657-X. Epub 2021 Jun 18.

Abstract

Background: Currently, only patients with ascending aorta diameter exceeding 55 mm will undergo prophylactic surgery. However, diameter alone is insufficient for precise risk stratification. An International Registry of Acute Aortic Dissections study showed that nearly 60% of patients with type A aortic dissection had a diameter <55 mm. This study aimed to compare the tortuosity of the ascending aorta between ATAAD patients and healthy controls and evaluate correlations between aortic tortuosity/diameter and presence of ATAAD.

Methods: A total of 75 cases in the ATAAD group and 83 cases in the Control group were enrolled. Tortuosity was calculated as the ratio of the total curve length (Lc) of the centerline to the linear distance (d) between its two endpoints, as assessed by an electronic caliper. The measurements were made on all patients by just one cardiovascular radiologist using 3-dimensional computerized tomographic imaging. ROC analysis was used to reckon the best cut-off level that prognosis occurrence of ATAAD. Correlation analysis was used to evaluate the correlation between ATAAD and tortuosity. Logistic regression was used to evaluate the relation between ATAAD and tortuosity. The tortuosity of ascending aorta was compared with a healthy control group using propensity score.

Results: According to the ROC analysis, the best cut-off level that prognosis occurrence of ATAAD was 0.135. In addition, the occurrence of ATAAD showed a strong correlation with maximum diameter of the ascending aorta (r=0.587, P<0.001), and moderate correlation with ascending aortic Tortuosity (r=0.425, P<0.001). Ninety-six patients were matched based on propensity scores (ATAAD N.=48, controls N.=48). The ascending aorta was more tortuous and more dilated in ATAAD patients compared with healthy controls (0.15±0.06 vs. 0.11±0.05, P<0.001, 37.96±7.31 mm vs. 31.67±2.78 mm, P<0.001, respectively).

Conclusions: Our study found that the occurrence of ATAAD showed a strong correlation with maximum diameter of the ascending aorta, and moderate correlation with ascending aortic tortuosity. Adding tortuosity to the ATAAD prediction system will improve the ability to identify high-risk groups of ATAAD. When the tortuosity is more significant than 0.135, prophylactic surgical intervention should be considered.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aorta / diagnostic imaging*
  • Aortic Aneurysm / diagnostic imaging*
  • Aortic Dissection / diagnosis*
  • Aortography*
  • Computed Tomography Angiography*
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors