开发和验证用户友好型形态分级系统 (PATENT)，预测高风险无并发症 B 型主动脉夹层胸腔内血管主动脉修复术后的主动脉重塑。

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2024-11-01 DOI:10.1016/j.ejvs.2024.07.004

Yinzhi Shen , Jiarong Wang , Jichun Zhao , Bin Huang , Chengxin Weng , Tiehao Wang

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引用次数: 0

摘要

研究目的本研究旨在建立一个形态分级系统，该系统完全基于计算机断层扫描血管造影的二维图像，用于预测胸腔内血管主动脉修复术（TEVAR）后高危无并发症 B 型主动脉夹层（TBAD）患者的主动脉负重塑（NAR）：这项单中心回顾性队列研究抽取并分析了连续确诊的高风险无并发症 TBAD 患者。阴性主动脉重塑定义为假腔或全主动脉直径增大或真腔直径减小。多变量 Cox 回归模型确定了风险因素，并建立了两年内无 NAR 的预测模型。进一步开发了三类分级系统，将患者分为低、中、高风险组，并在内部进行了验证：在纳入的 351 名患者中，有 99 人（28%）发生了 NAR。中位年龄为 52 岁（四分位数范围为 45 岁至 62 岁），其中 56 人（16%）为女性。两年内无 NAR 的比例为 71% (95% CI 65 - 77%)。经过多变量考克斯回归分析，专利假腔、右锁骨下动脉畸形、锥体比率、腹部周径、腹腔动脉或再动脉受累以及四通道夹层（三个假腔）仍是独立的预测因素，并被纳入 PATENT 分级系统。风险评分与 NAR 显著相关（HR 1.21；95% CI 1.14 - 1.29；P < .001）。中度和高度风险组的 NAR 发生率更高（中度风险，HR 2.82；95% CI 1.57 - 5.01；p = .001；高度风险，HR 4.39；95% CI 2.58 - 7.48；p < .001）。该分级系统具有很强的辨别能力，哈雷尔 C 指数为 0.68 (95% CI 0.63 - 0.75)：PATENT分级系统具有良好的区分度和校准性，可作为临床医生的友好工具，帮助TEVAR术后的TBAD患者进行风险分层。

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Development and Validation of a User Friendly Morphology Grading System (PATENT) Predicting Aortic Remodelling After Thoracic Endovascular Aortic Repair in High Risk Uncomplicated Type B Aortic Dissection

Objective

This study aimed to create a morphology grading system, solely based on 2D images from computed tomography angiography, to predict negative aortic remodelling (NAR) for patients with high risk uncomplicated type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR).

Methods

This single centre retrospective cohort study extracted and analysed consecutive patients diagnosed with high risk uncomplicated TBAD. Negative aortic remodelling was defined as an increase in the false lumen or total aortic diameter, or decrease in the true lumen diameter. The multivariable Cox regression model identified risk factors and a prediction model was created for two year freedom from NAR. A three category grading system, in which patients were classified into low, medium, and high risk groups, was further developed and internally validated.

Results

Of 351 patients included, 99 (28%) developed NAR. The median age was 52 years (interquartile range 45, 62 years) and 56 (16%) were female. The rate of two year freedom from NAR was 71% (95% CI 65 – 77%). After the multivariable Cox regression analysis, Patent false lumen, Aberrant right subclavian artery, Taper ratio, abdominal circumferential Extent, coeliac artery or reNal artery involved, and four channel dissection (Three false lumens) remained independent predictors and were included in the PATENT grading system. The risk score was statistically significantly associated with NAR (HR 1.21; 95% CI 1.14 – 1.29; p < .001). The medium and high risk groups demonstrated a higher rate of NAR (medium risk, HR 2.82; 95% CI 1.57 – 5.01; p = .001; high risk, HR 4.39; 95% CI 2.58 – 7.48; p < .001). The grading system was characterised by robust discrimination with Harrell’s C index of 0.68 (95% CI 0.63 – 0.75).

Conclusion

The PATENT grading system was characterised by good discrimination and calibration, which may serve as a clinician friendly tool to aid risk stratification for TBAD patients after TEVAR.

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.