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Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection
  1. Samuel Heuts1,2,
  2. Bouke P Adriaans2,3,4,
  3. Bartosz Rylski5,
  4. Casper Mihl2,3,
  5. Sebastiaan C A M Bekkers2,3,4,
  6. Jules R Olsthoorn1,6,
  7. Ehsan Natour1,7,
  8. Heleen Bouman8,
  9. Mikolaj Berezowski9,
  10. Kinga Kosiorowska9,
  11. Harry J G M Crijns2,4,
  12. Jos G Maessen1,2,
  13. Joachim Wildberger2,3,
  14. Simon Schalla2,3,4,
  15. Peyman Sardari Nia1,2
  1. 1Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
  2. 2Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Limburg, The Netherlands
  3. 3Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
  4. 4Department of Cardiology, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
  5. 5Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
  6. 6Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
  7. 7Department of Thoracic and Cardiovascular Surgery, Uniklinik RWTH Aachen, Aachen, Germany
  8. 8Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
  9. 9Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
  1. Correspondence to Samuel Heuts, Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, Limburg 6229HX, The Netherlands; sam.heuts{at}


Objective Management of thoracic aortic aneurysms (TAAs) comprises regular diameter follow-up until the indication criterion for prophylactic surgery is reached. However, this approach is unable to predict the majority of acute type A aortic dissections (ATAADs). The current study aims to evaluate the diagnostic accuracy of ascending aortic diameter, length and volume for occurrence of ATAAD.

Methods This two-centre observational cohort study retrospectively screened 477 consecutive patients who presented with ATAAD between 2009 and 2018. Of those, 25 (5.2%) underwent CT angiography (CTA) within 2 years before dissection onset. Aortic diameter, length and volume of these patients (‘pre-ATAAD’) were compared with those of TAA controls (n=75). Receiver operating curve analysis was performed to evaluate the predictive accuracy of the three different measurements.

Results 96% of patients with pre-ATAAD did not meet the surgical diameter threshold of 55 mm before dissection onset. Maximal aortic diameters (45 (40–49) mm vs 46 (44–49) mm, p=0.075) and volume (126 (95–157) cm3 vs 124 (102–136) cm3, p=0.909) were comparable between patients with pre-ATAAD and TAA controls. Conversely, ascending aortic length (84±9 mm vs 90±16 mm, p=0.031) was significantly larger in patients with pre-ATAAD. All three parameters had an area under the curve of >0.800. At the 55 mm cut-off point, the maximal diameter yielded a positive predictive value (PPV) of 20%. While maintaining same specificity levels, measurements of aortic volume and length showed superior diagnostic accuracy (PPV 55% and 70%, respectively).

Conclusion Measurements of aortic volume and length have superior diagnostic accuracy compared with the maximal diameter and could improve the timely identification of patients at risk for ATAAD.

  • aortic dissection or intramural hematoma
  • aortic aneurysm
  • cardiac computer tomographic (CT) imaging
  • cardiac risk factors and prevention
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  • SH and BPA contributed equally.

  • Contributors SH and BPA contributed equally to the creation of this manuscript. Study design: SH, BPA, JW, SS and PSN. Data collection: SH, BPA, JRO, BR, MB and KK. Data analysis: SH, BPA, CM. Statistical analysis: SH, HB. Scientific guarantor: JW. Manuscript draft: SH, BPA. Revision, editing and approval of the final manuscript: all authors.

  • Funding This study was supported by Stichting de Weijerhorst, Maastricht, Limburg, the Netherlands.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All participant data and analyses are available on reasonable request.

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