Natural history of 40–50 mm root/ascending aortic aneurysms in the current era of dedicated thoracic aortic clinics
Notice bibliographique
Résumé
OBJECTIVE: The natural history of root/ascending aortic aneurysms is based on studies from the 1980s to 1990s. Imaging and follow-up guidelines are based on these studies. Dedicated thoracic aortic clinics (TAC) ensure strict patient/imaging follow-up and tight blood pressure (BP) control. The aim of this study was to evaluate the natural history of medically treated root/ascending aortic aneurysms in the current era of dedicated TAC. METHOD: Two hundred and fifty-one patients with 40-50 mm root/ascending aneurysms (all other aortic segments of <40 mm) were identified through a prospective collected databank. Patients were followed in a dedicated TAC. Serial (12-18 months interval) thoraco-abdominal computed tomographies (CTs), tight BP control (24 h arterial blood pressure monitoring) and isometric and exercise BP monitoring were performed. RESULTS: The mean age was 65.4 ± 10.9 years; 29.5% of patients were female. Fifty-nine percent of patients had high BP. Aneurysm aetiology was atherosclerotic in 48.2% of patients, annulo-ectasia in 25.1% of patients, bicuspid valve-related in 21.5% of patients and another aetiology in 5.2% of patients. The initial aneurysm diameter was 46 ± 2.6 mm; 74.1% being between 46 and 50 mm. The mean follow-up (FU) was 4.3 ± 2.5 years, with a mean of 2.8 ± 1.1 CTs/pt. During FU, the increase in aortic size/year was 0.42 ± 0.82 mm/year for the root/ascending aorta (40-45 mm: 0.55 ± 0.77 mm/year vs 46-50 mm: 0.38 ± 0.84 mm/year; P = 0.14), 0.66 ± 1.11 mm/year for the arch, 0.45 ± 1.06 mm/year for the mid-descending aorta, 0.43 ± 1.0 mm/year for the aortic hiatus, 0.39 ± 0.87 mm/year for the suprarenal aorta and 0.41 ± 1.03 mm/year for the infrarenal aorta. Thirty patients (12%) were operated during FU. Surgical indication was disease progression on the aortic valve in 8 patients, root/ascending aorta progression of >50 mm in 14 patients and a root/ascending aorta replacement during FU without progression in 8 patients. One patient was operated emergently for an intramural haematoma after 3 years of follow-up. No patient required operation distal to the aortic arch. Operative mortality was 0/30 (0%). Thirty percent of patients required a concomitant hemiarch replacement. Four patients died during FU, with all deaths resulting from non-aortic causes. Freedom from acute aortic-related event and survival at 5 years were respectively 99.4 and 97.6%. CONCLUSION: The present study suggests that the growth rate of 40-50 mm root/ascending aneurysms followed in a dedicated TAC aorta is lower than that shown in previously reported series. Freedom from aortic-related events and survival are high, thus necessitating long-term follow-up. These results challenge the current guidelines in terms of interval between imaging examinations and the extent and type of aortic imaging.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».