Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study

Dominik Fleischmann; Domenico Mastrodicasa; Martin J. Willemink; Valery L. Turner; Virginia Hinostroza; Nicholas S. Burris; Bo Yang; Kate Hanneman; Maral Ouzounian; Daniel Ocazionez Trujillo; Rana O. Afifi; Anthony L. Estrera; Joan M. Lacomis; Ibrahim Sultan; Thomas G. Gleason; Davide Pacini; Gianluca Folesani; Luigi Lovato; Arthur E. Stillman; Carlo N. De Cecco; Edward P. Chen; Ricarda Hinzpeter; Hatem Alkadhi; Sandeep Hedgire; Thoralf M. Sundt; Sander M. J. van Kuijk; Geert Willem H. Schurink; Anne S. Chin; Marina Codari; Anna M. Sailer; Gabriel Mistelbauer; Mohammad H. Madani; Kathrin Baeumler; Jody Shen; Kendrick M. Lai; Michael P. Fischbein; D. Craig Miller

doi:10.1161/CIRCIMAGING.124.016766

Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study

Dominik Fleischmann^*, Domenico Mastrodicasa, Martin J. Willemink, Valery L. Turner, Virginia Hinostroza, Nicholas S. Burris, Bo Yang, Kate Hanneman, Maral Ouzounian, Daniel Ocazionez Trujillo, Rana O. Afifi, Anthony L. Estrera, Joan M. Lacomis, Ibrahim Sultan, Thomas G. Gleason, Davide Pacini, Gianluca Folesani, Luigi Lovato, Arthur E. Stillman, Carlo N. De CeccoEdward P. Chen, Ricarda Hinzpeter, Hatem Alkadhi, Sandeep Hedgire, Thoralf M. Sundt, Sander M. J. van Kuijk, Geert Willem H. Schurink, Anne S. Chin, Marina Codari, Anna M. Sailer, Gabriel Mistelbauer, Mohammad H. Madani, Kathrin Baeumler, Jody Shen, Kendrick M. Lai, Michael P. Fischbein, D. Craig Miller

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries. METHODS: We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020. LAEs were defined as fatal or nonfatal aortic rupture, new refractory hypertension or pain, organ or limb ischemia, aortic aneurysm formation (>= 6 cm), or rapid growth (>= 1 cm per year). We applied the original model parameters to the validation cohort and examined the effect on risk categorization using LAE end points. RESULTS: One hundred and seventy-six patients (44%) with incomplete imaging or clinical data were excluded. Of 225 patients in the final cohort, 90 (40%) developed LAEs, predominantly driven by aneurysm formation. Baseline maximum aortic diameter was significantly larger in patients with (42.6 [95% CI, 39.1-45.8] mm) compared with patients without LAEs (39.9 [95% CI, 36.3-44.2] mm; P=0.001). A multivariable Cox regression model indicated that only maximum diameter was associated with LAEs (hazard ratio, 1.07 [95% CI, 1.03-1.11] per mm; P<0.001), while the other parameters were not (P>0.05). Applying the original prediction model to the validation cohort resulted in a poor 5-year sensitivity (38%) and specificity (69%). CONCLUSIONS: A clinical and imaging-based prediction model performed poorly in the ROADMAP cohort. Maximum aortic diameter remains the strongest predictor of LAEs in uncomplicated Stanford type B aortic dissection.

Original language	English
Article number	e016766
Number of pages	10
Journal	Circulation-Cardiovascular Imaging
Volume	18
Issue number	2
DOIs	https://doi.org/10.1161/CIRCIMAGING.124.016766
Publication status	Published - 1 Feb 2025

Keywords

aneurysm, aortic
aortic dissection
aortic rupture
assessment, risk
computed tomography angiography
hypertension
validation study
FALSE-LUMEN THROMBOSIS
THORACIC SURGEONS
ENTRY TEAR
REPAIR
OUTCOMES
SOCIETY
GROWTH
INTERVENTIONS
ASSOCIATION
DIAGNOSIS

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10.1161/CIRCIMAGING.124.016766

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Fleischmann, D., Mastrodicasa, D., Willemink, M. J., Turner, V. L., Hinostroza, V., Burris, N. S., Yang, B., Hanneman, K., Ouzounian, M., Ocazionez Trujillo, D., Afifi, R. O., Estrera, A. L., Lacomis, J. M., Sultan, I., Gleason, T. G., Pacini, D., Folesani, G., Lovato, L., Stillman, A. E., ... Miller, D. C. (2025). Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study. Circulation-Cardiovascular Imaging, 18(2), Article e016766. https://doi.org/10.1161/CIRCIMAGING.124.016766

@article{8ad5e1660930456ab3bf7a4ad9c7f31a,

title = "Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study",

abstract = "BACKGROUND: Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries. METHODS: We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020. LAEs were defined as fatal or nonfatal aortic rupture, new refractory hypertension or pain, organ or limb ischemia, aortic aneurysm formation (>= 6 cm), or rapid growth (>= 1 cm per year). We applied the original model parameters to the validation cohort and examined the effect on risk categorization using LAE end points. RESULTS: One hundred and seventy-six patients (44%) with incomplete imaging or clinical data were excluded. Of 225 patients in the final cohort, 90 (40%) developed LAEs, predominantly driven by aneurysm formation. Baseline maximum aortic diameter was significantly larger in patients with (42.6 [95% CI, 39.1-45.8] mm) compared with patients without LAEs (39.9 [95% CI, 36.3-44.2] mm; P=0.001). A multivariable Cox regression model indicated that only maximum diameter was associated with LAEs (hazard ratio, 1.07 [95% CI, 1.03-1.11] per mm; P<0.001), while the other parameters were not (P>0.05). Applying the original prediction model to the validation cohort resulted in a poor 5-year sensitivity (38%) and specificity (69%). CONCLUSIONS: A clinical and imaging-based prediction model performed poorly in the ROADMAP cohort. Maximum aortic diameter remains the strongest predictor of LAEs in uncomplicated Stanford type B aortic dissection.",

keywords = "aneurysm, aortic, aortic dissection, aortic rupture, assessment, risk, computed tomography angiography, hypertension, validation study, FALSE-LUMEN THROMBOSIS, THORACIC SURGEONS, ENTRY TEAR, REPAIR, OUTCOMES, SOCIETY, GROWTH, INTERVENTIONS, ASSOCIATION, DIAGNOSIS",

author = "Dominik Fleischmann and Domenico Mastrodicasa and Willemink, {Martin J.} and Turner, {Valery L.} and Virginia Hinostroza and Burris, {Nicholas S.} and Bo Yang and Kate Hanneman and Maral Ouzounian and {Ocazionez Trujillo}, Daniel and Afifi, {Rana O.} and Estrera, {Anthony L.} and Lacomis, {Joan M.} and Ibrahim Sultan and Gleason, {Thomas G.} and Davide Pacini and Gianluca Folesani and Luigi Lovato and Stillman, {Arthur E.} and {De Cecco}, {Carlo N.} and Chen, {Edward P.} and Ricarda Hinzpeter and Hatem Alkadhi and Sandeep Hedgire and Sundt, {Thoralf M.} and {van Kuijk}, {Sander M. J.} and Schurink, {Geert Willem H.} and Chin, {Anne S.} and Marina Codari and Sailer, {Anna M.} and Gabriel Mistelbauer and Madani, {Mohammad H.} and Kathrin Baeumler and Jody Shen and Lai, {Kendrick M.} and Fischbein, {Michael P.} and Miller, {D. Craig}",

year = "2025",

month = feb,

day = "1",

doi = "10.1161/CIRCIMAGING.124.016766",

language = "English",

volume = "18",

journal = "Circulation-Cardiovascular Imaging",

issn = "1941-9651",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "2",

}

Fleischmann, D, Mastrodicasa, D, Willemink, MJ, Turner, VL, Hinostroza, V, Burris, NS, Yang, B, Hanneman, K, Ouzounian, M, Ocazionez Trujillo, D, Afifi, RO, Estrera, AL, Lacomis, JM, Sultan, I, Gleason, TG, Pacini, D, Folesani, G, Lovato, L, Stillman, AE, De Cecco, CN, Chen, EP, Hinzpeter, R, Alkadhi, H, Hedgire, S, Sundt, TM, van Kuijk, SMJ , Schurink, GWH, Chin, AS, Codari, M, Sailer, AM, Mistelbauer, G, Madani, MH, Baeumler, K, Shen, J, Lai, KM, Fischbein, MP & Miller, DC 2025, 'Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study', Circulation-Cardiovascular Imaging, vol. 18, no. 2, e016766. https://doi.org/10.1161/CIRCIMAGING.124.016766

TY - JOUR

T1 - Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection

T2 - Results From the ROADMAP Validation Study

AU - Fleischmann, Dominik

AU - Mastrodicasa, Domenico

AU - Willemink, Martin J.

AU - Turner, Valery L.

AU - Hinostroza, Virginia

AU - Burris, Nicholas S.

AU - Yang, Bo

AU - Hanneman, Kate

AU - Ouzounian, Maral

AU - Ocazionez Trujillo, Daniel

AU - Afifi, Rana O.

AU - Estrera, Anthony L.

AU - Lacomis, Joan M.

AU - Sultan, Ibrahim

AU - Gleason, Thomas G.

AU - Pacini, Davide

AU - Folesani, Gianluca

AU - Lovato, Luigi

AU - Stillman, Arthur E.

AU - De Cecco, Carlo N.

AU - Chen, Edward P.

AU - Hinzpeter, Ricarda

AU - Alkadhi, Hatem

AU - Hedgire, Sandeep

AU - Sundt, Thoralf M.

AU - van Kuijk, Sander M. J.

AU - Schurink, Geert Willem H.

AU - Chin, Anne S.

AU - Codari, Marina

AU - Sailer, Anna M.

AU - Mistelbauer, Gabriel

AU - Madani, Mohammad H.

AU - Baeumler, Kathrin

AU - Shen, Jody

AU - Lai, Kendrick M.

AU - Fischbein, Michael P.

AU - Miller, D. Craig

PY - 2025/2/1

Y1 - 2025/2/1

N2 - BACKGROUND: Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries. METHODS: We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020. LAEs were defined as fatal or nonfatal aortic rupture, new refractory hypertension or pain, organ or limb ischemia, aortic aneurysm formation (>= 6 cm), or rapid growth (>= 1 cm per year). We applied the original model parameters to the validation cohort and examined the effect on risk categorization using LAE end points. RESULTS: One hundred and seventy-six patients (44%) with incomplete imaging or clinical data were excluded. Of 225 patients in the final cohort, 90 (40%) developed LAEs, predominantly driven by aneurysm formation. Baseline maximum aortic diameter was significantly larger in patients with (42.6 [95% CI, 39.1-45.8] mm) compared with patients without LAEs (39.9 [95% CI, 36.3-44.2] mm; P=0.001). A multivariable Cox regression model indicated that only maximum diameter was associated with LAEs (hazard ratio, 1.07 [95% CI, 1.03-1.11] per mm; P<0.001), while the other parameters were not (P>0.05). Applying the original prediction model to the validation cohort resulted in a poor 5-year sensitivity (38%) and specificity (69%). CONCLUSIONS: A clinical and imaging-based prediction model performed poorly in the ROADMAP cohort. Maximum aortic diameter remains the strongest predictor of LAEs in uncomplicated Stanford type B aortic dissection.

AB - BACKGROUND: Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries. METHODS: We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020. LAEs were defined as fatal or nonfatal aortic rupture, new refractory hypertension or pain, organ or limb ischemia, aortic aneurysm formation (>= 6 cm), or rapid growth (>= 1 cm per year). We applied the original model parameters to the validation cohort and examined the effect on risk categorization using LAE end points. RESULTS: One hundred and seventy-six patients (44%) with incomplete imaging or clinical data were excluded. Of 225 patients in the final cohort, 90 (40%) developed LAEs, predominantly driven by aneurysm formation. Baseline maximum aortic diameter was significantly larger in patients with (42.6 [95% CI, 39.1-45.8] mm) compared with patients without LAEs (39.9 [95% CI, 36.3-44.2] mm; P=0.001). A multivariable Cox regression model indicated that only maximum diameter was associated with LAEs (hazard ratio, 1.07 [95% CI, 1.03-1.11] per mm; P<0.001), while the other parameters were not (P>0.05). Applying the original prediction model to the validation cohort resulted in a poor 5-year sensitivity (38%) and specificity (69%). CONCLUSIONS: A clinical and imaging-based prediction model performed poorly in the ROADMAP cohort. Maximum aortic diameter remains the strongest predictor of LAEs in uncomplicated Stanford type B aortic dissection.

KW - aneurysm, aortic

KW - aortic dissection

KW - aortic rupture

KW - assessment, risk

KW - computed tomography angiography

KW - hypertension

KW - validation study

KW - FALSE-LUMEN THROMBOSIS

KW - THORACIC SURGEONS

KW - ENTRY TEAR

KW - REPAIR

KW - OUTCOMES

KW - SOCIETY

KW - GROWTH

KW - INTERVENTIONS

KW - ASSOCIATION

KW - DIAGNOSIS

U2 - 10.1161/CIRCIMAGING.124.016766

DO - 10.1161/CIRCIMAGING.124.016766

M3 - Article

SN - 1941-9651

VL - 18

JO - Circulation-Cardiovascular Imaging

JF - Circulation-Cardiovascular Imaging

IS - 2

M1 - e016766

ER -

Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study

Abstract

Keywords

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