Predictors of mortality due to type A aortic dissection based on electrocardiogram parameters and clinical picture (2023)

Entry

Aortic dissection is a rare but potentially life-threatening disorder that occurs when the layers of the aortic wall separate. As a result of blood entering between the intima and the median of the aorta, the rupture progresses and may lead to the patient's death [1]. According to the Stanford system, it is divided into two main subgroups, including type A, which involves the aorta ascending proximally to the brachiocephalic artery, regardless of the site of the primary intima rupture. Type B aortic dissection begins distal to the left subclavian artery and involves only the descending aorta [2]. The incidence of aortic dissection ranges from 5 to 30 cases per million people per year [3]. Although the sudden onset of severe chest pain remains the most important historical factor, the combination of chest and abdominal pain or chest pain with weakness or numbness in the extremities may be the initial symptom of aortic dissection [2].

Electrocardiography remains one of the most accessible, inexpensive, and critical diagnostic and screening tools in medicine that can help clinicians quickly and accurately diagnose many heart conditions [4]. Although an ECG can help distinguish other possible causes of chest pain (e.g., myocardial infarction), it can be misleading in the diagnosis of aortic dissection; therefore, other diagnostic tools are needed to confirm the diagnosis of dissection, such as computed tomography (CT) angiography, CT aortography, or transesophageal echocardiography [5]. In this study, we intend to examine ECG-related parameters together with clinical presentations of type A aortic dissection to obtain predictors of disease severity and mortality.

section excerpts

Study design and population

In this retrospective study, 237 patients were diagnosed with type A aortic dissection (AAD) between March 2015 and March 2020 at Al-Zahra, Namazi and Shahid Faghihi Hospitals affiliated with Shiraz University of Medical Sciences. Patients whose diagnosis was not confirmed by imaging or surgical examinations, those without a previous electrocardiogram (ECG), and those in whom a post-necropsy ECG was performed two weeks after the initial presentation were excluded from the study. Finally 201 patients

Results

211 patients were examined, including 143 (71.1%) men and 58 (28.9%) women with acute aortic dissection. The median age (IQR) of men and women was 58 (26) and 64.5 (19) respectively (P=0.006). Thirty-four (23.8%) men and 23 (39.7%) women had heart failure (P=0.024). In addition, 27 (18.9%) men and 20 (34.5%) women had known cases of coronary artery disease (P=0.018). The most common clinical symptom was chest pain. Thirty-seven (18.4%) patients died during the course

Discussion

In this study, we tried to find a relationship between the patients' clinical presentation, ECG results and mortality. We have found that nearly 90% of patients with type A aortic dissection experience chest pain. This result is consistent with the results of an earlier study by Levy et al., in which they found that only about 10% of aortic dissections are painless [2].

Almost two-thirds of the patients were men. This result was similar to that of Baliyan et al. study that found it

Limitations

Although our study was multi-case and multicenter, it had some limitations. Our study was conducted retrospectively and we were unable to follow the evolution of patients after hospital discharge.

Application

In conclusion, a heart rate of or > 60 and ST-segment elevation > 0.5 mm in lead aVR are independently associated with a higher chance of in-hospital death in patients with type A aortic dissection and can be used as ECG-related parameters to predict patient mortality.

Ethical acceptance and consent to participate

Patient privacy has been respected. This study was approved by the Ethics Committee of the Shiraz University of Medical Sciences (IR.SUMS.MED.REC. 1401.009) and written informed consent was obtained from the participants. All methods were performed in accordance with relevant guidelines and regulations.

Consent to publication

Not applicable.

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Availability of data and materials

Participant SPSS data can be obtained from the authors. If you are interested in such data, please write to the relevant author.

Financing

No financial support was received for this study.

Author's contribution

Hamed Bazrafshan Drissi., Farnaz Kamali and Mahdi Rahmanian are guided by the idea of ​​manuscrito. Mahdi Rahmanian, Maryam Zare, Marjan Zare, Mehdi Bazrafshan, Mohammad Keshavarz and Hanieh Bazrafshan collect tartare. Mahdi Rahmanian contributed to the interpretation of the data. Hamed Bazrafshan Drissi, Mahdi Rahmanian, Payman Izadpanah, Mohammad Mohammadi and Mehdi Bazrafshan redigiram or manuscript. Hamed Bazrafshan Drissi, Farnaz Kamali and Mahdi Rahmanian revised and edited the manuscript. Hamed

Declaration of conflict of interest

The authors declare that there are no conflicting interests.

Recognition

Not applicable.

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FAQs

What is the mortality of Type 1 aortic dissection? ›

For untreated acute dissection of the ascending aorta, the mortality rate is 1–2% per hour early after symptom onset. For type A dissection treated medically, it is approximately 20% within the first 24 hours and 50% by 1 month after presentation.

What is the mortality rate for aortic dissection? ›

The often-fatal dissection occurs when blood rushes through a tear in the ascending aorta, causing its layers to separate. Findings published in JAMA Cardiology reveal that 5.8% of patients with type A acute aortic dissection died within the first two days after hospital arrival, a mortality rate of 0.12% per hour.

What is the most common cause of death in aortic dissection? ›

Aortic dissection is life-threatening. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment.

What is the difference between Type 1 and Type 2 aortic dissection? ›

The DeBakey classification is based upon the site of origin of the dissection. Type 1 originates in the ascending aorta and to at least the aortic arch. Type 2 originates in and is limited to the ascending aorta.

What is a Type 1 aortic dissection? ›

Type A dissection occurs when the tear develops in the ascending part of the aorta just as it branches off the heart, while Type B dissection involves the lower aorta. While Type A dissection is the more dangerous form, chances of survival are significantly improved with early detection and management.

Is Type A or Type B aortic dissection worse? ›

Type A is the most common type of aortic dissection and is more likely to be acute than chronic. This makes it more dangerous than type B dissections because it is more likely to cause the aorta to rupture, leading to a potentially fatal heart condition.

What is the long term prognosis of aortic dissection? ›

Short-term and long-term survival rates after acute type A aortic dissection (TA-AAD) are unknown. Previous studies have reported survival rates between 52% and 94% at 1 year and between 45% and 88% at 5 years.

What kills you in aortic dissection? ›

The most common concerns of a Type A dissection are heart attacks due to injury to the coronary arteries from the dissection; acute failure of the aortic valve due to the tear, which prevents blood from being pumped from the heart correctly; and rupture that causes the sac that surrounds the heart to fill with blood.

What triggers aortic dissection? ›

Some of the things that may raise your risk of aortic dissection include: Uncontrolled high blood pressure (hypertension) Hardening of the arteries (atherosclerosis) Weakened and bulging artery (aortic aneurysm)

Are there warning signs of aortic dissection? ›

Aortic Dissection Symptoms

Symptoms usually begin suddenly and may include severe chest or back pain that may be felt as sharp or stabbing or as a tearing. Sometimes, the pain moves to the neck, jaw, shoulder, arm, or abdomen. Acute aortic dissection can be life-threatening and requires immediate treatment.

What is the gold standard for aortic dissection? ›

Magnetic Resonance Imaging.

Currently the gold standard for the identification of aortic dissection, magnetic resonance imaging has both a sensitivity and specificity of 98%.

What is the gold standard investigation for aortic dissection? ›

Computerized tomography (CT) scan of the chest.

A CT of the chest can confirm a diagnosis of aortic dissection.

How can you tell the difference between a Type A and B aortic dissection? ›

Type A which is the more common and dangerous of the two and involves a tear in the part of the aorta where it exits the heart or a tear in the upper, or ascending aorta, which may extend into the abdomen. Type B which involves a tear in the lower, or descending, aorta only, which may also extend into the abdomen.

What is the first line of treatment for aortic dissection? ›

Beta blockers are often the first treatment for a type B aortic dissection. These medications reduce blood pressure by blocking the effects of the hormone epinephrine, or adrenaline. This relaxes the heart, slowing it down. Less blood leaves the heart, and it leaves with less force.

Which drug can increase the risk of aortic dissection? ›

The risk was higher in patients who had used fluoroquinolones within 60 days (adjusted odds ratio: 1.53, 95% CI 1.46–1.62, p < 0.05). The risk of aortic aneurysm and aortic dissection positively correlated with the cumulative dose and duration of fluoroquinolone therapy (p < 0.001).

Is Type A aortic dissection hereditary? ›

About 20 percent of people with thoracic aortic aneurysm and dissection have a genetic predisposition to it, meaning it runs in the family.

How long can you live with type B aortic dissection? ›

Despite adequate antihypertensive therapy, the long-term prognosis of these patients is characterized by a significant aortic aneurysm formation in 25-30% within four years, and survival rates from 50 to 80% at five years and 30 to 60% at 10 years.

Can a Type B aortic dissection heal on its own? ›

All type B dissections require prompt medical treatment to prevent aortic rupture.

What is the best treatment for type B aortic dissection? ›

It has been generally recommended that patients who have type B aortic dissection without complications are treated with medical therapy in an intensive care unit. Usually, with aggressive antihypertensive therapy, up to 85% of patients may survive their initial hospital stay.

Can you live a long life with aortic dissection? ›

With excellent blood pressure control and conscious limits to physical activity, you can continue to live a long, full life after a dissection. This would include returning to most jobs.

What are poor prognostic factors for aortic dissection? ›

The risk factors that determine poor prognosis in the acute phase of dissections were type A dissection and serious complications (rupture of the aorta, shock, cerebral accident, myocardial infarction, severe aortic regurgitation, renal failure, mesenteric infarction, and arterial occlusion in the extremities).

What is the average age of aortic dissection? ›

The median age was 52.0 years old in whole cohort. The multiple comorbidities were more common in old age groups (60 s, 70 s, 80 s), while the 20 s group patients had the highest proportion of Marfan syndrome (28.1%). Preoperative hypotension was highest in 80 s (16.7%, P = 0.038).

Does COVID increase risk of aortic dissection? ›

The Covid-19 is known to cause increased risk of several cardiovascular complications; including acute myocardial injury, arrhythmias, cardiogenic shock, acute coronary syndrome, and venous thromboembolism. Among the cardiac complications, aortic dissection is an important yet underrated problem in Covid-19 patients.

What is the life expectancy after aortic surgery? ›

Long-Term Survival

For patients approximately 40 years old at the time of surgery, the life expectancy was reduced by 20 years compared to that of general population. This data suggests that a 42-year-old patient undergoing aortic valve replacement (AVR) with a tissue valve is expected to live to 58 years of age.

What is the most common site of aortic dissection? ›

The most common site of dissection is the first few centimeters of the ascending aorta, with 90% occurring within 10 cm of the aortic valve. The second most common site is just distal to the left subclavian artery.

What conditions is most associated with aortic dissection? ›

Risk factors increase the chance of aortic dissection. High blood pressure is one of the most common and can weaken the wall of the aorta over time, making it more likely to tear. Others risk factors include atherosclerosis (hardening of the arteries) and aortic coarctation (narrowing of the aorta at birth).

How painful is aortic dissection? ›

Pain: You may experience sudden severe pain in the chest, back or abdomen. A radiating pain in the chest or upper back is described as a tearing or ripping sensation. The pain can extend to the legs and make walking difficult. Difficulty breathing: You may feel short of breath or lose consciousness.

How often is aortic dissection misdiagnosed? ›

Aortic dissection is often difficult to diagnose, with studies showing up to 38% of patients with AD are missed on initial presentation.

Does blood work show aortic dissection? ›

Aortic dissection is usually diagnosed by using imaging techniques before the result of blood work is interpreted.

What neurological symptoms occur in aortic dissection? ›

Neurologists should be alert for aortic dissection in patients presenting unusual combinations of symptoms such as involvement of central and peripheral nervous system or simultaneous occurrence of syncope, seizure, and cerebral, spinal, or peripheral nerve ischemia.

What is the hallmark of aortic dissection? ›

Aortic dissection is a rare but fatal disease and requires a high degree of suspicion. Although the hallmark features of the disease are severe chest pain with a possible pulsus deficit or an unequal blood pressure reading on different arms. It can sometimes present silently.

What is the biomarker for aortic dissection? ›

However, d-dimer was also shown to be sufficient to rule out aortic dissection consistent with the other and previous reports59 at a cutoff level of 323 ng/mL (which is < 500 ng/mL, the generally accepted cutoff) to show a sensitivity of 93.9% and a specificity of 78.5%.

What is the first line investigation for aortic dissection? ›

Computed tomography scan is first-line for definitive diagnosis. Further investigations may include trans-oesophageal echocardiography, magnetic resonance imaging, and D-dimer. Involvement of the ascending aorta and/or arch (Stanford type A) warrants urgent surgical repair.

What is the best image for aortic dissection? ›

Preferred examinations for aortic dissection include contrast-enhanced spiral computed tomography (CT), transesophageal echocardiography (TEE) in the emergency setting, and magnetic resonance (MR) imaging for hemodynamically stable patients.

What is aortic dissection prediction score? ›

The aortic dissection detection risk score (ADD-RS) is a clinical decision tool that aids in grading the pretest probability of an acute aortic dissection. Scores range from 0-3, where 0 is classed as low risk, 1 is moderate risk and 2-3 is high risk 1.

What ECG features are seen in aortic dissection? ›

The ECG can be completely normal in aortic dissection, show chronic LVH, or show a variety of ischemic ST/T wave changes—including acute coronary occlusion secondary to aortic dissection.

Can an aortic dissection be misdiagnosed? ›

Conclusions. Misdiagnosis in patients with an eventual diagnosis of aortic dissection affects 1 in 3 patients. Clinicians should consider aortic dissection as differential diagnosis in patients with chest pain, back pain and syncope. Imaging should be used early to make the diagnosis when aortic dissection is suspected ...

Which arm has higher BP in aortic dissection? ›

After being admitted to the Intensive Care Unit, the mean arterial pressure on the left arm was noted to be significant higher. On physical examination, both lower limbs were dusky in appearance because of poor perfusion.

What is the most commonly used classification while describing aortic dissection? ›

Dissections of the thoracic aorta have been classified anatomically by 2 different methods. The more commonly used system is the Stanford classification, which is based on involvement of the ascending aorta and simplifies the DeBakey classification.

Is aortic dissection usually fatal? ›

An aortic dissection is a serious condition in which a tear occurs in the inner layer of the body's main artery (aorta). Blood rushes through the tear, causing the inner and middle layers of the aorta to split (dissect). If the blood goes through the outside aortic wall, aortic dissection is often deadly.

What is the survival rate for aortic dissection by age? ›

Five- and 10-year survival rates were 78.1% and 59.4%, respectively, for patients under 70 years of age, and 50.8% at 5 years and 26.1% at 10 years for those over 70. Conclusion: Patients might not be excluded from surgical intervention for acute type A aortic dissection (ATAAD) only due to age.

Can you live a full life after aortic dissection? ›

With excellent blood pressure control and conscious limits to physical activity, you can continue to live a long, full life after a dissection. This would include returning to most jobs.

Is death from aortic dissection quick? ›

Aortic dissection is instantaneous and deadly, but patients can be saved.

What is the difference between Type A and B aortic dissection? ›

Type A which is the more common and dangerous of the two and involves a tear in the part of the aorta where it exits the heart or a tear in the upper, or ascending aorta, which may extend into the abdomen. Type B which involves a tear in the lower, or descending, aorta only, which may also extend into the abdomen.

What is the prognosis for Type A dissection? ›

The mortality rate for type A acute aortic dissection (TAAAD) during the initial 24 to 48 hours after symptom onset is commonly described as 1% to 2% per hour, based on data from the 1950s, before medical therapy improved and cardiovascular surgery became routine.

What is the average time to diagnosis for aortic dissection? ›

We know from the International Registry of Acute Aortic Dissection (IRAD) (2) that the median time from presentation to diagnosis for all acute aortic dissection patients is over 4.3 hours.

How severe is the pain with an aortic dissection? ›

Pain: You may experience sudden severe pain in the chest, back or abdomen. A radiating pain in the chest or upper back is described as a tearing or ripping sensation. The pain can extend to the legs and make walking difficult. Difficulty breathing: You may feel short of breath or lose consciousness.

What are the odds of surviving aortic dissection with surgery? ›

Three-year survival was 68.8±4.7% (including hospital mortality). Hospital survivors had a three-year survival of 88.3±3.9%. International studies report an in-hospital mortality between 10 to 25% for surgically treated acute type A dissection (AAD).

Can I exercise with aortic dissection? ›

recommended mild to moderate intensity aerobic exercise (3–5 metabolic equivalents) in patients with aortic dissection for at least 30 min on most days of the week, for a total of 150 min/week, if the goal is a reduction in resting blood pressure and improved cardiovascular health, while possibly minimizing the risk of ...

Is aortic dissection hereditary? ›

About 20 percent of people with thoracic aortic aneurysm and dissection have a genetic predisposition to it, meaning it runs in the family. This type is known as familial thoracic aneurysm and dissection. Many people don't know they have a genetic predisposition to thoracic aortic aneurysm and dissection.

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