The following is a summary of “Prognostic Implications of Initial Focal Contrast Enhancement in Acute Type B Intramural Hematoma,” published in the January 2024 issue of Cardiology by Jiang et al.
The significance of initial focal contrast enhancement (FCE), such as focal intimal disruption (FID) and intramural blood pool (IBP), in acute type B intramural hematoma (IMH) is still uncertain.
Researchers conducted a retrospective study to assess the prognostic implications of IMH with and without associated FCE.
They enrolled 574 patients, defining FID as an intimal disruption with a contrast-filled out-pouching from the aorta lumen with a communicating orifice of >3 mm and IBP as a localized pool of contrast medium within the IMH.
The results showed that of 207 patients (36.1%) presented with initial FCE, comprising 132 (63.8%) FIDs and 75 (36.2%) IBPs. Patients with FCE accompanying IMH exhibited a higher likelihood of hypertension (P=0.001) and pleural effusion (P=0.006), fewer affected aortic segments (P<0.001), increased adverse aortic events (AAEs) (P<0.001), and decreased freedom from intervention (P=0.002). Pleural effusion (HR: 1.79; 95% CI: 1.25-2.55; P=0.001) and FCE (HR: 1.51; 95% CI: 1.12-2.02; P=0.006) emerged as independent risk factors for AAEs. Subgroup analysis indicated that IMH with initial FID had a higher progression likelihood than those with initial IBP (P<0.001). FIDs at the proximal descending aorta (HR: 2.95; 95% CI: 1.65-5.29; P<0.001) were associated with AAEs.
Investigators concluded that FCE presence alongside IMH, particularly with initial FID near the proximal descending aorta, indicated a higher likelihood of disease progression.