David Craig Miller

Allocation of key type B aortic dissection features to aortic zones, as defined by the 2020 Society for Vascular Surgery/Society of Thoracic Surgeons reporting standards, was poorly reproducible among experienced cardiovascular radiologists and surgeons.

BACKGROUND: Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries. METHODS: We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020. LAEs were defined as fatal or nonfatal aortic rupture, new refractory hypertension or pain, organ or limb ischemia, aortic aneurysm formation (≥6 cm), or rapid growth (≥1 cm per year). We applied the original model parameters to the validation cohort and examined the effect on risk categorization using LAE end points. RESULTS: One hundred and seventy-six patients (44%) with incomplete imaging or clinical data were excluded. Of 225 patients in the final cohort, 90 (40%) developed LAEs, predominantly driven by aneurysm formation. Baseline maximum aortic diameter was significantly larger in patients with (42.6 [95% CI, 39.1–45.8] mm) compared with patients without LAEs (39.9 [95% CI, 36.3–44.2] mm; P =0.001). A multivariable Cox regression model indicated that only maximum diameter was associated with LAEs (hazard ratio, 1.07 [95% CI, 1.03–1.11] per mm; P 0.05). Applying the original prediction model to the validation cohort resulted in a poor 5-year sensitivity (38%) and specificity (69%). CONCLUSIONS: A clinical and imaging-based prediction model performed poorly in the ROADMAP cohort. Maximum aortic diameter remains the strongest predictor of LAEs in uncomplicated Stanford type B aortic dissection.

This report presents the design and methodological approach of a multicenter, retrospective study to validate a clinical and imaging-based risk prediction model for late adverse events in patients ... Purpose To describe the design and methodological approach of a multicenter, retrospective study to externally validate a clinical and imaging-based model for predicting the risk of late adverse ev...

Aortomitral continuity calcification is a predictor of mortality within 1 year after transcatheter aortic valve replacement and, together with coronary calcium, substantially improves individual ri... Purpose To investigate the association of aortomitral continuity calcification (AMCC) with all-cause mortality, postprocedural paravalvular leak (PVL), and prolonged hospital stay in patients under...