DataSheet1_Identification of high-risk patients for development of type B aortic dissection based on novel morphological parameters.doc

Background: Predicting the development of sporadic type B aortic dissection (TBAD) always remains a difficult issue. This study aimed to identify high-risk patients for development of TBAD based on morphological parameters.Methods: This propensity-score-matched case-control study collected and reconstructed the computed tomography angiography of acute TBAD patients and hospital-based control participants without aortic dissection from January 2013 to December 2016. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). Discriminant and reclassification abilities were compared between our model and a previously established model.Results: Our study included 76 acute TBAD patients and 79 control patients (48 cases and 48 controls after propensity-score matching). The degree of question mark (aOR 1.07, 95% CI 1.04–1.11), brachiocephalic trunk diameter (aOR 1.49, 95% CI 1.20–1.85), brachiocephalic trunk angle (aOR 0.97, 95% CI 0.94–0.99), aortic root diameter (aOR 1.31, 95% CI 1.15–1.48), and aortic width (aOR 1.12, 95% CI 1.07–1.17) were associated with a significantly increased risk of TBAD formation. Similar findings were observed in the propensity-score matching and sensitivity analysis only including hyperacute TBAD patients. A novel prediction model was established based on the aforementioned parameters. The new model showed significantly improved discriminant ability compared with the previously established model (c-index 0.78 [95% CI 0.71–0.85] vs. 0.67 [95% CI 0.58–0.75], p = .03), driven by increased reclassification ability in identifying TBAD patients (NRI for events 0.16, 95% CI 0.02–0.30, p = .02).Conclusion: Morphological predictors, including the degree of question mark, aortic width, aortic root diameter, brachiocephalic trunk angle, and brachiocephalic trunk diameter, may be used to identify patients at high risk of TBAD.

背景：预测散发型B型主动脉夹层的进展始终是一项艰巨的任务。本研究旨在基于形态学参数识别出具有散发型B型主动脉夹层形成高风险的患者。方法：本研究通过倾向得分匹配的病例对照研究，收集并重建了2013年1月至2016年12月期间急性散发型B型主动脉夹层患者和未患有主动脉夹层的医院对照参与者的计算机断层扫描血管造影。运用多变量回归分析计算了调整后的比值比（aOR）和95%置信区间（CI）。比较了我们的模型与先前建立的模型之间的判别能力和再分类能力。结果：本研究包括76例急性散发型B型主动脉夹层患者和79例对照患者（经过倾向得分匹配后，各48例病例和对照）。问号程度（aOR 1.07，95% CI 1.04–1.11）、锁骨下动脉直径（aOR 1.49，95% CI 1.20–1.85）、锁骨下动脉角度（aOR 0.97，95% CI 0.94–0.99）、主动脉根部直径（aOR 1.31，95% CI 1.15–1.48）和主动脉宽度（aOR 1.12，95% CI 1.07–1.17）与散发型B型主动脉夹层形成的显著增加风险相关。在倾向得分匹配和仅包括超急性散发型B型主动脉夹层患者的敏感性分析中，也观察到了类似的结果。基于上述参数建立了新的预测模型。与先前建立的模型相比，新模型显示出显著的判别能力提升（c-index 0.78 [95% CI 0.71–0.85] vs. 0.67 [95% CI 0.58–0.75]，p = .03），这主要得益于识别散发型B型主动脉夹层患者再分类能力的提升（事件NRI 0.16，95% CI 0.02–0.30，p = .02）。结论：形态学预测因子，包括问号程度、主动脉宽度、主动脉根部直径、锁骨下动脉角度和锁骨下动脉直径，可用于识别具有散发型B型主动脉夹层高风险的患者。