Analysis Of Risk Factors For Prognosis Of Type B Aortic Intramural Hematoma Based On CTA

Objective(s):To explore the imaging features of aortic intramural hematoma of Type B and the risk factors affecting its prognosis.Methods:From January 2017 to November 2022,the patients with acute type B aortic intramural hematoma confirmed by CTA in our hospital and received initial drug treatment.According to the occurrence of adverse events,they were divided into good prognosis group(n=36)and bad prognosis group(n=41).The independent sample t-test was used to test the difference between groups for the normal count data,nonparametric rank sum test for the skewed count data,X~2test or Fisher’s exact test for the grade or classification data,and the logistic multiple factor regression was used to analyze the risk factors for the prognosis of type B IMH,and the ROC curve was used to analyze the diagnostic efficacy and critical value of the predictive factors.Results:1.Compared with Type A IMH,type B IMH caused fewer pericardial effusion,smaller a MAD and AAAC,and larger dMAD(p<0.05).2.The time of aortic dilatation and aortic aneurysm in Type B IMH was middle and late stage(p<0.05),FID occurred in aortic arch,IBP occurred in abdominal aorta(p<0.05)There was no significant difference in detection time between FID and IBP in IMH(P>0.05).3.The effect of FID treated by surgery was better than that treated by medicine(p<0.05),and there was no significant difference between the two methods for IBP(P>0.05).4.FID,MTH and dMAD were the risk factors of aortic adverse events in patients with IMH(P<0.05),Multivariate Logistic regression analysis showed that MTH(OR=1.221;95%CI:1.019-1.463),dMAD(OR=1.198;95%CI:1.019-1.408),FID(OR=8.327;95%CI:1.958.35.414)were independent predictors of aortic adverse events in IMH(P<0.05).5.After constructing the ROC curve for independent predictors,MTH had good predictive power with an AUC(95%CI)of0.720(0.603-0.836),the sensitivity was 80.6%,the specificity was 61.0%.The AUC(95%CI)of dMAD and FID were 0.645(0.522-0.768)and 0.667(0.546-0.788),respectively.The sensitivity and specificity of dMAD and FID were 73.2%and39.0%,52.8%and 91.7%,respectively.The Cut-off values of MTH and dMAD were8.30 mm and 30.60 mm.Conclusion:Focal intimal disruption and the largest diameter of descending aorta are the risk factors for poor prognosis of Type B acute aortic intramural hematoma.When the thickness of hematoma was more than 8.3 mm and the maximum diameter of descending aorta was more than 30.6 mm with l focal intimal disruption at the first diagnosis,It is necessary to be alert to the occurrence of adverse events and timely surgical intervention,improve patients’quality of life.