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

Dominik Fleischmann¹, Domenico Mastrodicasa¹, Martin J Willemink¹, Valery L Turner¹, Virginia Hinostroza¹, Nicholas S Burris², Bo Yang³, Kate Hanneman⁴, Maral Ouzounian⁵, Daniel Ocazionez Trujillo⁶, Rana O Afifi⁷, Anthony L Estrera⁷, Joan M Lacomis⁸, Ibrahim Sultan⁹, Thomas G Gleason^{9

10

11}, Davide Pacini¹², Gianluca Folesani¹², Luigi Lovato¹³, Arthur E Stillman¹⁴, Carlo N De Cecco¹⁴, Edward P Chen¹⁵, Ricarda Hinzpeter¹⁶, Hatem Alkadhi¹⁶, Sandeep Hedgire¹⁷, Thoralf M Sundt 3rd¹⁸, Sander M J van Kuijk¹⁹, Geert Willem H Schurink²⁰, Anne S Chin²¹, Marina Codari¹, Anna M Sailer¹, Gabriel Mistelbauer¹, Mohammad H Madani¹, Kathrin Bäumler¹, Jody Shen¹, Kendrick M Lai¹, Michael P Fischbein²², D Craig Miller²²

Affiliations

¹ Department of Radiology (D.F., D.M., M.J.W., V.L.T., V.H., M.C., A.M.S., G.M., M.H.M., K.B., J.S., K.M.L.), Stanford University School of Medicine, CA.
² Department of Radiology (N.S.B.), University of Michigan, Ann Arbor.
³ Department of Cardiac Surgery (B.Y.), University of Michigan, Ann Arbor.
⁴ Department of Radiology (K.H.), University of Toronto, ON, Canada.
⁵ Division of Cardiovascular Surgery (M.O.), University of Toronto, ON, Canada.
⁶ Department of Radiology (D.O.T.), University of Texas Houston.
⁷ Department of Cardiothoracic and Vascular Surgery (R.O.A., A.L.E.), University of Texas Houston.
⁸ Department of Radiology (J.M.L.), University of Pittsburgh, Pennsylvania.
⁹ Department of Cardiothoracic Surgery (I.S., T.G.G.), University of Pittsburgh, Pennsylvania.
¹⁰ Department of Bioengineering (T.G.G.), University of Pittsburgh, Pennsylvania.
¹¹ Asheville Heart, Mission Hospital, Asheville, NC (T.G.G.).
¹² Department of Cardiac Surgery (D.P., G.F.), S. Orsola-Malpighi Hospital, University of Bologna, Italy.
¹³ Department of Radiology (L.L.), S. Orsola-Malpighi Hospital, University of Bologna, Italy.
¹⁴ Department of Radiology, Emory University, Atlanta, GA (A.E.S., C.N.D.C.).
¹⁵ Department of Cardiothoracic Surgery, Duke University Hospital, Durham, NC (E.P.C.).
¹⁶ Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland (R.H., H.A.).
¹⁷ Department of Radiology (S.H.), Massachusetts General Hospital, Boston.
¹⁸ Department of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston.
¹⁹ Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Maastricht University Medical Center, the Netherlands.
²⁰ Department of Vascular Surgery (G.W.H.S.), Maastricht University Medical Center, the Netherlands.
²¹ Department of Radiology, University of Montreal, QC, Canada (A.S.C.).
²² Department of Cardiothoracic Surgery (M.P.F., D.C.M.), Stanford University School of Medicine, CA.

PMID: 39965039
PMCID: PMC11839160 (available on 2026-02-18)
DOI: 10.1161/CIRCIMAGING.124.016766

Multicenter Study

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

Dominik Fleischmann et al. Circ Cardiovasc Imaging. 2025 Feb.

. 2025 Feb;18(2):e016766.

doi: 10.1161/CIRCIMAGING.124.016766. Epub 2025 Feb 18.

Authors

Affiliations

¹ Department of Radiology (D.F., D.M., M.J.W., V.L.T., V.H., M.C., A.M.S., G.M., M.H.M., K.B., J.S., K.M.L.), Stanford University School of Medicine, CA.
² Department of Radiology (N.S.B.), University of Michigan, Ann Arbor.
³ Department of Cardiac Surgery (B.Y.), University of Michigan, Ann Arbor.
⁴ Department of Radiology (K.H.), University of Toronto, ON, Canada.
⁵ Division of Cardiovascular Surgery (M.O.), University of Toronto, ON, Canada.
⁶ Department of Radiology (D.O.T.), University of Texas Houston.
⁷ Department of Cardiothoracic and Vascular Surgery (R.O.A., A.L.E.), University of Texas Houston.
⁸ Department of Radiology (J.M.L.), University of Pittsburgh, Pennsylvania.
⁹ Department of Cardiothoracic Surgery (I.S., T.G.G.), University of Pittsburgh, Pennsylvania.
¹⁰ Department of Bioengineering (T.G.G.), University of Pittsburgh, Pennsylvania.
¹¹ Asheville Heart, Mission Hospital, Asheville, NC (T.G.G.).
¹² Department of Cardiac Surgery (D.P., G.F.), S. Orsola-Malpighi Hospital, University of Bologna, Italy.
¹³ Department of Radiology (L.L.), S. Orsola-Malpighi Hospital, University of Bologna, Italy.
¹⁴ Department of Radiology, Emory University, Atlanta, GA (A.E.S., C.N.D.C.).
¹⁵ Department of Cardiothoracic Surgery, Duke University Hospital, Durham, NC (E.P.C.).
¹⁶ Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland (R.H., H.A.).
¹⁷ Department of Radiology (S.H.), Massachusetts General Hospital, Boston.
¹⁸ Department of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston.
¹⁹ Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Maastricht University Medical Center, the Netherlands.
²⁰ Department of Vascular Surgery (G.W.H.S.), Maastricht University Medical Center, the Netherlands.
²¹ Department of Radiology, University of Montreal, QC, Canada (A.S.C.).
²² Department of Cardiothoracic Surgery (M.P.F., D.C.M.), Stanford University School of Medicine, CA.

PMID: 39965039
PMCID: PMC11839160 (available on 2026-02-18)
DOI: 10.1161/CIRCIMAGING.124.016766

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.

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Conflict of interest statement

None.

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources