Aortic Calcification Severity Predicts Unfavorable Anatomy and Adverse Outcomes in Type B Aortic Dissection

Abstract

Objective:

Aortic calcification (AC) is increasingly recognized as a marker associated with cardiovascular disease, but its role in acute aortic syndromes such as type B aortic dissection (TBAD) is not well understood. This study aimed to characterize AC distribution in TBAD patients, examine its association with initial aortic anatomy, and assess its prognostic value after thoracic endovascular aortic repair (TEVAR).

Methods:

The study included 150 patients who were retrospectively enrolled from our center (cohort 1) and 120 patients from a clinical trial (cohort 2). First, based on the combined cohorts, the preoperative AC volume on different aortic segments, and the correlation between preoperative AC volume and initial TBAD anatomy, were cross-sectionally evaluated. Second, the prognostic value of AC volume on different segments were evaluated by survival analysis and multivariable Cox regression 1-year post-TEVAR in cohort 2

Results:

Based on the 2 cohorts (n=270), AC volume appears to intrinsically correlate to the preoperative unfavorable TBAD anatomy, characterized by increased aortic size and tortuosity. AC volume in the thoracic aorta may be a preferable predictor of composite events post-TEVAR (hazard ratio [HR] 2.396, 95% confidence interval [CI] 1.204–4.768, p=0.013), thoracic aorta expansion (HR 6.266; 95% CI 1.199–32.748; p=0.030), and abdominal aorta expansion (HR 2.569; 95% CI 1.113–5.929; p=0.027).

Conclusions:

Aortic calcification severity, particularly in the thoracic aorta, may closely link to unfavorable anatomical features in TBAD and may independently predict the risk of subsequent aortic expansion following TEVAR. These findings highlight the potential of AC volume as an image biomarker for risk stratification and management of TBAD patients.

Clinical Impact

Aortic calcification (AC) has long been an underestimated marker for understanding the development, severity, and progression of type B aortic dissection (TBAD). AC severity may be a surrogate for the initial unfavourable anatomy of TBAD. Increased calcification volume in the thoracic aorta may predict a high risk of postoperative aortic expansion after TEVAR.