Analysis of Short-Term Clinical Outcomes and Influencing Factors in Patients with Acute Type B Aortic Intramural Hematoma Treated with Optimal Medical Therapy

• Published in: International Heart Journal Vol. 64; no. 4; pp. 708 - 716
• Main Authors: Meng, Dujuan, Gu, Ruoxi, Wang, Yasong, Zhang, Zhiqiang, Xu, Tianshu, Wang, Xiaozeng
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 29.07.2023; Japan Science and Technology Agency
• Subjects: Adverse events; Aorta; Aortic diseases; Aortic-related adverse events; Arteriosclerosis; Blood pressure; Clinical outcomes; Diuretics; Hematoma; Patients; Prognosis; Regression analysis; Risk factors; Statistical analysis; Aortic-related adverse events; Aortic diseases; Prognosis
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.23-023

This study aimed to investigate the short-term predictors of aortic-related adverse events in patients with acute type B aortic intramural hematoma (IMH) initially treated with optimized medical therapy.A total of 157 patients with acute type B IMH were included in this study. These patients were divided into worsening group (n = 45) and stable group (n = 112) based on the incidence of aortic-related adverse events. The clinical data and imaging features of the two groups were compared. Multivariate logistic regression analysis of predictors of aortic-related adverse events in type B IMH was performed. Receiver operating characteristic (ROC) curve was applied to determine the optimal cutoff value for maximum descending aorta diameter (MDAD). Kaplan-Meier survival curve was used to analyze the incidence of aortic-related adverse events.Worsening and stable groups were statistically significant in diuretics, abnormal D-dimer level, observation endpoint systolic blood pressure (SBP), MDAD, aortic atherosclerosis, ulcer-like projection (ULP), and thickness of hematoma (P < 0.05). Multivariate logistic regression showed that abnormal D-dimer level (OR = 12.464, P = 0.025), MDAD (OR = 1.113, P = 0.030), and ULP (OR = 5.849, P = 0.022) were powerful independent risk factors for predicting aortic-related adverse events in type B IMH, and observation endpoint SBP within 100-120 mmHg (OR = 0.225, P = 0.014) was a protective factor for predicting aortic-related adverse events in type B IMH. The cutoff value of MDAD was 35.2 mm.Short-term imaging is recommended for type B IMH patients with abnormal D-dimer level, MDAD > 35.2 mm, and ULP. Blood pressure should also be strictly monitored and controlled during the acute phase of IMH.