Abstract
BackgroundAortic intramural hematoma (IMH) is a subset of acute aortic syndrome, and its prognosis may differ between races. This study aimed to study the prognosis of Chinese type B IMH patients and to find out risk factors.MethodsA total of 71 type B IMH patients with or without penetrating atherosclerosis ulcer (PAU) administrated in our center between September 2013 and October 2017 were retrospectively studied. Both clinical and imaging data were collected and analyzed. The primary end point was aorta-related death, and the secondary end point was progression, which was defined as enlargement of aorta, increased aortic wall thickness, and aortic dissection or aneurysm formation. Kaplan-Meier survival analysis and Cox regression analysis were used for prognostic analysis.ResultsAmong these 71 patients, 21 had simple type B IMH, when 50 had type B IMH in association with PAU. Twenty-five patients received optimal medical therapy (OMT) alone, while 46 patients received surgery and OMT. The mean follow-up time was 27.5 ± 13.5 months. For type B IMH patients, association with PAU indicated poor prognosis and required more intensive management (HR = 16.68, 1.96~141.87), while maximum aortic diameter (MAD) was an independent risk factor (HR = 1.096, 1.016~1.182). For patients with PAU-IMH, MAD was an independent risk factor (HR = 1.04, 1.021~1.194), while surgical treatment was independent protective factor (HR = 0.172, 0.042~0.696).ConclusionAssociation with PAU and MAD were independent risk factors for type B IMH patients. Surgery may improve the outcomes for type B IMH in association with PAU.
Highlights
Aortic intramural hematoma (IMH) is a subset of acute aortic syndrome, and its prognosis may differ between races
The epidemiology of IMH varies among different regions worldwide. 31.7% of patients were diagnosed as IMH relative to typical aortic dissection in Japan/Korea population, compared with 10.9% in North America (NA) /Europe
penetrating atherosclerosis ulcer (PAU) was considered as a focal disruption in the arterial intima and elastic lamina protruding into the media [4], whereas IMH associated with PAU was termed as PAUIMH
Summary
Aortic intramural hematoma (IMH) is a subset of acute aortic syndrome, and its prognosis may differ between races. 31.7% of patients were diagnosed as IMH relative to typical aortic dissection in Japan/Korea population, compared with 10.9% in North America (NA) /Europe. This difference might be partially due the diagnosis criteria in different countries. Significant difference of mortality rate between NA/Europe and Japan/Korea was observed [3] These differences suggest that the morbidity and mortality of IMH may be associated with race. This study aimed to demonstrate characteristics of Chinese patients with type B IMH, and to find out prognostic factors based on our single center experience.
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