Monitoring period may be increased for small thoracic aortic aneurysms considering their slow Growth rate: Study
UK: A recent study in the European Heart Journal has suggested that for small aneurysms, international guidelines should consider increasing monitoring intervals to 12 months and increasing intervention thresholds. Also, age, size, sex, growth, surgical risk, and patient characteristics should be considered in individualized decisions about surveillance/intervention.
Chronic thoracic aortic aneurysm (CTAA) of the arch or descending thoracic aorta (DTA) if undiagnosed or neglected as aneurysms expand, is life-threatening. Aneurysm growth is related to dissection (tearing) or rupture of the aortic wall. After diagnosis, 6-month mortality in treated and untreated patients with CTAA is estimated to be 17.7% and 30%, respectively.
Against the above background, Linda Sharples, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK, and colleagues aimed to observe, describe, and evaluate the management and timing of intervention for patients with untreated thoracic aortic aneurysms.
For this purpose, the researchers conducted a prospective study of UK National Health Service (NHS) patients aged ≥18 years, with new/existing arch or descending thoracic aortic aneurysms of ≥4 cm diameter. They were followed up until death, intervention, withdrawal, or July 2019.
Outcomes included survival, aneurysm growth, hospital admissions, and quality of life (using the EQ-5D-5L utility index). 886 patients were recruited between 2014 and 2018 from 30 NHS vascular/cardiothoracic units.
Key findings of the study include:
- The maximum aneurysm diameter was in the descending aorta in 725 (82%) patients, growing at 0.2 cm per year.
- Aneurysms of ≥4 cm in the arch increased by 0.07 cm per year.
- Baseline diameter was related to age and comorbidities, and no clinical correlates of growth were found.
- During follow-up, 129 patients died, 64 from aneurysm-related events.
- Adjusting for age, sex, and New York Heart Association dyspnoea index, the risk of death increased with aneurysm size at baseline [hazard ratio (HR): 1.88 per cm] and with growth [HR: 2.02 per cm,].
- Hospital admissions increased with aneurysm size [relative risk: 1.21 per cm].
- Quality of life decreased annually for each 10-year increase in age [–0.013] and for current smoking [–0.043].
- Aneurysm size was not associated with a change in the quality of life.
To summarize, the paper reported aneurysm growth, hospital admissions, survival, and health-related quality of life in a large group of patients.
"International guidelines should consider increasing monitoring intervals to 12 months for small aneurysms and increasing intervention thresholds, the researchers concluded.
Reference:
Linda Sharples, Priya Sastry, Carol Freeman, Colin Bicknell, Yi Da Chiu, Srinivasa Rao Vallabhaneni, Andrew Cook, Joanne Gray, Andrew McCarthy, Peter McMeekin, Luke Vale, Stephen Large, on behalf of the ETTAA Collaborative Group, Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: the effective treatments for thoracic aortic aneurysms study, European Heart Journal, Volume 43, Issue 25, 1 July 2022, Pages 2356–2369, https://doi.org/10.1093/eurheartj/ehab784
