Aortic Agatston score correlates with the progression of acute type A aortic dissection.

Yasushi Tashima,Naoyuki Kimura,Takeshi Inoue,Taichi Sano,Noriyuki Nakamura,Shinichi Iwakoshi,Takashi Inoue,Koichi Adachi,Atsushi Yamaguchi,Xianwu Cheng

doi:10.1371/journal.pone.0263881

Abstract

Aortic calcification in the tunica media is correlated with aortic stiffness, elastin degradation, and wall shear stress. The study aim was to determine if aortic calcifications influence disease progression in patients with acute type A aortic dissection (ATAAD). We retrospectively reviewed a total of 103 consecutive patients who had undergone surgery for ATAAD at our institution between January 2009 and December 2019. Of these, 85 patients who had preoperatively undergone plain computed tomography angiography (CTA) for evaluation of their aortic calcification were included. Moreover, we assessed the progression of aortic dissection after surgery via postoperative CTA. Using a classification and regression tree to identify aortic Agatston score thresholds predictive of disease progression, the patients were classified into high-score (Agatston score ≥ 3344; n = 36) and low-score (<3344; n = 49) groups. Correlations between aortic Agatston scores and CTA variables were assessed. Higher aortic Agatston scores were significantly correlated with the smaller distal extent of aortic dissection (p < 0.001), larger true lumen areas of the ascending (p = 0.009) and descending aorta (p = 0.002), and smaller false lumen areas of the descending aorta (p = 0.028). Patients in the high-score group were more likely to have DeBakey type II dissection (p = 0.001) and false lumen thrombosis (p = 0.027) than those in the low-score group, thereby confirming the correlations. Aortic dissection in the high-score group was significantly less distally extended (p < 0.001). A higher aortic Agatston score correlates with the larger true lumen area of the ascending and descending aorta and the less distal progression of aortic dissection in patients with ATAAD. Interestingly, the findings before and after surgery were consistent. Hence, aortic Agatston scores are associated with aortic dissection progression and may help predict postoperative residual dissected aorta remodeling.

Highlights

To investigate the early progression of aortic dissection after surgery, we examined the association between aortic calcifications and postoperative computed tomography angiography (CTA) variable of the descending aorta in the patients, excluding those who had DeBakey type II dissection (n = 20) and those who died before performing the postoperative CTA (n = 4)
This study demonstrated the following: 1) aortic Agatston scores significantly correlated with the progression of aortic dissection and the true lumen areas and true lumen area/total lumen area ratios of the ascending and descending aortas; 2) DeBakey type II dissection and false lumen thrombosis were significantly more likely and aortic dissection was less distally extended in the high-score group than in the low-score group; and 3) consistent with the preoperative findings, in the postoperative CTA variables among the patients with DeBakey I or IIIb retrograde, the false lumens of the descending and abdominal aortas were more frequently totally thrombosed and the true lumen area of the descending aorta was significantly larger in the high-score group, no significant difference in the surgical procedure was noted
We found that high aortic Agatston scores were significantly correlated with larger true lumen areas of the ascending and descending aorta and with smaller false lumen areas of the descending aorta in patients with acute type A aortic dissection (ATAAD)

Summary

Methods

PatientsAfter obtaining approval and a waiver of informed consent from our Institutional Review Board, we retrospectively reviewed a total of 103 consecutive patients who had undergone emergency surgery for ATAAD at Yokosuka General Hospital Uwamachi between 2009 and 2019. We used a classification and regression tree (CART), a machine-learning algorithm for clinical decision-making that can be used to determine the breakpoint and identify aortic Agatston score thresholds predictive of disease progression (distal extent of aortic dissection) in patients with ATAAD (S1 Fig). CART is a nonparametric decision tree learning technique that produces either classification or regression trees based on whether the dependent variable is categorical or numeric, respectively [25, 26]. We examined the association between aortic calcifications and the extent of aortic dissection in these patient groups. To investigate the early progression of aortic dissection after surgery, we examined the association between aortic calcifications and postoperative CTA variable of the descending aorta in the patients, excluding those who had DeBakey type II dissection (n = 20) and those who died before performing the postoperative CTA (n = 4).

Results

Discussion

Conclusion