Background-Few data exist on gender-related differences in clinical presentation, diagnostic findings, management, and outcomes in acute aortic dissection (AAD). Methods and Results-Accordingly, we evaluated 1078 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) to assess differences in clinical features, management, and in-hospital outcomes between men and women. Of the patients enrolled in IRAD (32.1%) with AAD, 346 were women. Although less frequently affected by AAD (32.1% of AAD), women were significantly older and had more often presented later than men (Pϭ0.008); symptoms of coma/altered mental status were more common, whereas pulse deficit was less common. Diagnostic imaging suggestive of rupture, ie, periaortic hematoma, and pleural or pericardial effusion were more commonly observed in women. In-hospital complications of hypotension and tamponade occurred with greater frequency in women, resulting in higher in-hospital mortality compared with men. After adjustment for age and hypertension, women with aortic dissection die more frequently than men (OR, 1.4, Pϭ0.04), predominantly in the 66-to 75-year age group. Moreover, surgical outcome was worse in women than men (Pϭ0.013); type A dissection in women was associated with a higher surgical mortality of 32% versus 22% in men despite similar delay, surgical technique, and hemodynamics. Conclusions-Our analysis provides insights into gender-related differences in AAD with regard to clinical characteristics, management, and outcomes; important diagnostic and therapeutic implications may help shed light on aortic dissection in women to improve their outcomes.
Background-The evaluation of new therapeutic modalities to induce collateral growth in coronary artery disease require improved methods of angiographic characterization of collaterals, which should be validated by quantitative assessment of collateral function. Methods and Results-In 100 patients with total chronic occlusion of a major coronary artery (duration Ͼ2 weeks) collaterals were assessed angiographically by the Rentrop grading, by their anatomic location, and by a new grading of collateral connections (CC grade 0: no continuous connection, CC1: threadlike continuous connection, CC2: side branch-like connection). The interobserver variability was 10%. Collateral function was assessed by Doppler flow (average peak velocity) and pressure recordings distal to the occlusion before recanalization. A collateral resistance index (R Coll ) was calculated. Recruitable collateral flow was measured during a final balloon inflation Ͼ30 minutes after the baseline measurement. The comparison of the anatomic location, the Rentrop, and the collateral connection grade showed only for the latter an independent and significant relation with R Coll . CC2 collaterals preserved regional left ventricular function better than did CC1 collaterals and provided a higher collateral flow reserve during adenosine infusion. CC0 collaterals were predominantly observed in recent occlusions of 2 to 4 weeks' duration, with the highest R Coll . During balloon reocclusion, recruitable collateral function was best preserved with CC2 and least with CC0. Conclusions-The angiographic grading of collateral connections in total chronic occlusions could differentiate collaterals according to their functional capacity to preserve regional left ventricular function and was closely associated with invasively determined parameters of collateral hemodynamics.
Background-The role of QTc interval prolongation in heart failure remains poorly defined. To better understand it, we analyzed the QTc interval duration in patients with heart failure with high B-type natriuretic peptide (BNP) levels and analyzed the combined prognostic impact of prolonged QTc and elevated BNP. Methods and Results-QTc intervals were measured in 241 patients with heart failure who had BNP levels Ͼ400 pg/mL.QT interval duration was determined by averaging 3 consecutive beats through leads II and V 4 on a standard 12-lead ECG and corrected by using the Bazett formula. QTc intervals were prolonged (Ͼ440 ms) in 122 (51%) patients and normal in 119 (49%). The BNP levels in these 2 groups were not significantly different (786Ϯ321 pg/mL in the prolonged QTc group versus 733Ϯ274 pg/mL in the normal QTc group, Pϭ0.13). During 6 months of follow-up, 46 patients died, 9 underwent transplantation, and 17 underwent left ventricular assist device implantation. The deaths were attributed to pump failure (nϭ24, 52%), sudden cardiac death (nϭ18, 39%), or noncardiac causes (nϭ4, 9%). Kaplan-Meier survival rates were 3 times higher in the normal QTc group than in the prolonged QTc group (PϽ0.0001).On multivariate analysis, prolonged QTc interval was an independent predictor of all-cause death (Pϭ0.0001), cardiac death (Pϭ0.0001), sudden cardiac death (Pϭ0.004), and pump failure death (Pϭ0.0006). Conclusions-Prolonged QTc interval is a strong, independent predictor of adverse outcome in patients with heart failure with BNP levels Ͼ400 pg/mL.
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