Long-term follow-up and clinical implications in Chinese patients with aortic intramural hematomas.

Abstract Background Intramural hematomas (IMHs) are reported to dynamically evolve into different clinical outcomes ranging from regression to aortic rupture, but no practice guidelines are available in China. Objective To determine the evolution of IMHs after long-term follow-up and to identify the predictive factors of IMH outcomes in the Chinese population. Methods A total of 123 IMH patients with clinical and imaging follow-up data were retrospectively studied. The primary endpoints were aortic disease-related death, aortic dissection, penetrating aortic ulcer (PAU), thickening of the aortic hematoma and aortic complications requiring surgical or endovascular treatment. Results All 123 IMH patients were monitored clinically. The follow-up duration ranged from 1.4 to 107 months (median, 20 months). Thirty-nine patients had type A IMH, and 84 had type B. The multivariate analysis showed that a baseline MAD ≥ 44.75 mm (2.9% vs 61.4%, P < 0.001) and acute PAUs (2.9% vs 34.1%, P = 0.008) were independent predictors of aorta-related events. Conclusions Medication and short-term imaging are recommended for Chinese IMH patients with a hematoma thickness < 10.45 mm and a baseline MAD < 44.75 mm. Rigorous medical observation should also be performed during the acute phase of IMH. Graphical abstract Figure legend IMH evolution to AD over a 12-day period. A, C, E, and G, in the acute phase, MDCT shows a high signal intensity suggestive of IMH. B, Twelve days later, MDCT reveals a typical dissection; D, at 8 days of follow-up, MDCT shows an atherosclerotic ulcerated plaque (arrow) with IMH in the upper part of the descending aorta; F, at 2 months of follow-up, a CT scan shows that the intima has almost completely disappeared; H, 15 days later, the intima became enlarged. Unlabelled Image Highlights • Most adverse aorta-related events occur within 30 days in Chinese aortic intramural hematomas patients • The cutoff values for predicting aorta-related events are a hematoma thickness of 10.45 mm and a baseline maximal aorta diameter of 44.75 mm • An acute penetrating aortic ulcer and a maximal aorta diameter ≥44.75 mm in aortic intramural hematoma patients predict a poor prognosis [ABSTRACT FROM AUTHOR]