Aortic elongation and the risk for dissection: The Tübingen Aortic Pathoanatomy (TAIPAN) project

Abstract

OBJECTIVES: We measured aortic dimensions, particularly length parameters, using 3D imaging with the aim of refining the riskmorphology 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 (43mm) and TAD (50mm) 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 55mm 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 93mm. In preTAD aortas, it was 111mm, and it was 117mm 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.