Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)

Januzzi, James L.; Isselbacher, Eric M.; Fattori, Rossella; Cooper, Jeanna V.; Smith, Dean E.; Fang, Jianming; Eagle, Kim A.; Mehta, Rajendra H.; Nienaber, Christoph; Pape, Linda

doi:10.1016/j.jacc.2003.08.054

Cited by 444 publications

(248 citation statements)

References 13 publications

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“…High-risk conditions and historical features (see Table 8). 59,[75][76][77] 72 Age >50 y 3 criteria are present (sensitivity >90%; specificity >90%) Recent-onset localized headache Temporary artery tenderness or pulse attenuation Elevated erythrocyte sedimentation >50 mm/h Arterial biopsy shows necrotizing vasculitis Behçet disease 73 Oral ulceration Oral ulceration plus 2 of the other 3 criteria Recurrent genital ulceration Uveitis or retinal vasculits Skin lesions-erythema nodosum, pseudo-folliculitis, or pathergy Ankylosing spondylitis 74 Onset of pain <40 83 …”

Section: Recommendations For Estimation Of Pretest Risk Of Thoracic Amentioning

confidence: 99%

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

Hiratzka

Bakris

Beckman

et al. 2010

Cathet Cardio Intervent

273

105

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Section: Recommendations For Estimation Of Pretest Risk Of Thoracic Amentioning

confidence: 99%

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

Hiratzka

Bakris

Beckman

et al. 2010

Cathet Cardio Intervent

273

105

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“…2,10,11 In brief, 18 large referral centers in 6 countries agreed to participate in the ongoing registry, established in 1996. The main purpose of IRAD was to assess etiologic factors, modes of presentation, clinical features, treatment, and hospital outcomes of patients with acute AD.…”

Section: Irad Registrymentioning

confidence: 99%

Acute Intramural Hematoma of the Aorta

Evangelista¹,

Mukherjee²,

Mehta³

et al. 2005

Circulation

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432

180

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Background-The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma (IMH) continue to be debated. Methods and Results-We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection (IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection (AD). Fifty-eight (5.7%) patients had IMH, and this cohort tended to be older (68.7 versus 61.7 years; PϽ0.001) and more likely to have distal aortic involvement (60.3% versus 35.3%; PϽ0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD (20.7% versus 23.9%; Pϭ0.57), as was mortality in patients with IMH of the descending aorta (8.3% versus 13.1%; Pϭ0.60) and the ascending aorta (39.1% versus 29.9%; Pϭ0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8 (16%) progressed to AD on a serial imaging study. Conclusions-The IRAD data demonstrate a 5.7% prevalence of IMH in patients with acute aortic syndromes. Like classic AD, IMH is a highly lethal condition when it involves the ascending aorta and surgical therapy should be considered, but this condition is less critical when limited to the arch or descending aorta. Fully 16% of patients have evidence of evolution to dissection on serial imaging.

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“…Initially, patients younger than 40 years more commonly present without hypertension, are more likely to have a bicuspid aortic valve, and are more likely to have undergone prior aortic valve surgery. 42 In younger patients, the origin of type A dissections tends to be more proximal (eg, sinuses of Valsalva and sinotubular junction). 42 In contrast, elderly patients (≥70 years) are more likely to be hypertensive (≥150/90 mm Hg) at presentation, have underlying atherosclerosis, and present with a coexisting aneurysm.…”

Section: Clinical Presentation Acute Aortic Syndromesmentioning

confidence: 99%

“…42 In younger patients, the origin of type A dissections tends to be more proximal (eg, sinuses of Valsalva and sinotubular junction). 42 In contrast, elderly patients (≥70 years) are more likely to be hypertensive (≥150/90 mm Hg) at presentation, have underlying atherosclerosis, and present with a coexisting aneurysm. Furthermore, higher rates of diabetes mellitus and prior cardiac surgery occur among the elderly population.…”

Section: Clinical Presentation Acute Aortic Syndromesmentioning

confidence: 99%

“…38 This may be explained in part by the fact that a large number of patients with type A AAD within IRAD were younger than 40 years and had no history of hypertension. 42 Many of these younger patients are thought to have a connective-tissue defect (eg, Marfan syndrome or bicuspid aortic valve) rather than hypertension as their principal underlying cause of aortic dissection. A diastolic murmur of aortic insufficiency can often be auscultated at the time of presentation or soon after and is more common in type A (44%) than in type B (12%) dissections.…”

Section: Clinical Presentation Acute Aortic Syndromesmentioning

confidence: 99%

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Acute Aortic Syndromes and Thoracic Aortic Aneurysm

Ramanath

Sundt

et al. 2009

Mayo Clinic Proceedings

191

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Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. and studied by physicians for centuries. Descriptions of such pathologic conditions of the aorta as aneurysm and dissection date back as early as the 2nd century during the time of Galen, whose discoveries were largely made through studies of apes. More "recent" reports were described by Vesalius in 1557, followed by Nichols in 1732, who detailed the process of aortic dissection. In 1761, Morgagni reported detailed pathologic features of a patient with a ruptured aorta. 1 However, our true understanding of aortic pathology began with the dissertation by Shennan 2 in 1934, which included a description of penetrating atheromatous plaques of the thoracic aorta. His report was followed by the first successful management of aortic dissection by DeBakey in 1955. 1 Since then, our knowledge of the pathologic conditions of the aorta has grown considerably and continues to evolve with ongoing research into the pathophysiology of these conditions, technological advances in the modes of detection, and improved therapeutic options. Clinical databases, such as the International Registry of Acute Aortic Dissection (IRAD), the largest current registry for acute aortic syndromes, have also contributed tremendously to our knowledge of acute aortic pathology.For the practicing clinician, knowledge of aortic disease is paramount because patients with aortic conditions contribute significantly to the overall mortality from cardiovascular disease. This review discusses the pathophysiology, epidemiology, presentation, diagnosis, and therapeutic options for several forms of acute and chronic aortic pathology: aortic dissection (including its variants intramural hematoma [IMH] and penetrating atheromatous aortic ulcer) and thoracic aortic aneurysm (TAA). Literature searches were performed of the PubMed database using the following key words: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies conducted within the past 15 years, along with some data from years prior, were included in this review.

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Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)

Abstract: Compared with older patients with AoD, young patients have unique risk factors for dissection: Marfan syndrome, bicuspid aortic valves, and larger aortic dimensions. Surprisingly, the mortality risk for young AoD patients is not lower than older AoD patients.

Cited by 444 publications

References 13 publications

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

Acute Intramural Hematoma of the Aorta

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

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