Determinants of Long-Term Mortality in Patients With Type B Acute Aortic Dissection

Sakakura, Kenichi; Kubo, Norifumi; Ako, Junya; Fujiwara, Naoki; Funayama, Hiroshi; Ikeda, Nahoko; Nakamura, Toshio; Sugawara, Yoshitaka; Yasu, Takanori; Kawakami, Masanobu; Momomura, Shin‐ichi

doi:10.1038/ajh.2009.5

Cited by 26 publications

(16 citation statements)

References 24 publications

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“…Earlier studies have identified long‐term predictors of morbidity and mortality in AAD, including old age,13, 14 female sex,15 a history of atherosclerosis,4 and impaired renal function,16 all of which may be more representative of a patient's high‐risk clinical background than the severity and nature of the AAD itself. Indeed, as of yet, there may be no effective and simple marker available for evaluating severity of AAD, predicting long‐term clinical outcomes, and optimizing surgical management.…”

Section: Introductionmentioning

confidence: 99%

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

et al. 2016

JAHA

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BackgroundThe long‐term association between the status of the false lumen and poor patient outcomes in acute aortic dissection (AAD) remains unclear. This systematic review and meta‐analysis investigated whether the status of the false lumen was a predictor of poor long‐term survival in AAD.Methods and ResultsEleven cohort studies (2924 participants) exploring the association between the false lumen status and long‐term outcomes (>1 year) in AAD were included. All studies reported multivariate‐adjusted hazard ratios (HRs) with 95% CIs for long‐term outcomes, according to false lumen status. Pooled HRs for mortality and aortic events were computed and weighted using generic inverse‐variance and random‐effect modeling. Residual patent false lumen was an independent predictor of long‐term mortality in AAD type A (HR, 1.71; 95% CI, 1.16–2.52; P=0.007) and type B (HR, 2.79; 95% CI, 1.80–4.32; P<0.001). AAD patients with residual patent false lumen exhibited an increased risk of aortic events (HR, 5.43; 95% CI, 2.95–9.99; P<0.001). Partial false lumen thrombosis was independently associated with long‐term mortality in type B AAD (HR, 2.24; 95% CI, 1.37–3.65; P=0.001). This association was not observed in AAD type A patients (HR, 1.75; 95% CI, 0.88–3.45; P=0.211).ConclusionsThe false lumen status influences late outcomes in AAD. Residual patent false lumen is independently associated with poor long‐term survival in AAD. However, only type B AAD patients with partial false lumen thrombosis had an increased late mortality risk.

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Section: Introductionmentioning

confidence: 99%

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

et al. 2016

JAHA

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“…3,19,20,22 In particular, multiple groups have reported that the maximum aortic diameter (Ն40 mm) and false lumen closure status are long-term predictors in type B AAD. 4,6 -9 Some of these predictors, including sex, history of previous aneurysm, and history of atherosclerosis, may be more representative of a patient's high-risk clinical background rather than the nature of the aortic dissection itself.…”

Section: Discussionmentioning

confidence: 99%

Peak C-Reactive Protein Level Predicts Long-Term Outcomes in Type B Acute Aortic Dissection

et al. 2010

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Abstract-Acute aortic dissection (AAD) is associated with an inflammatory reaction, as evidenced by elevated inflammatory markers, including C-reactive protein (CRP). The association between the peak CRP level and long-term outcomes in type B AAD has not been systematically investigated. The purpose of this study was to investigate whether the peak CRP level during admission predicts long-term outcomes in type B AAD. We conducted a clinical follow-up study of type B AAD. We divided the study population into 4 groups according to the tertiles of peak CRP levels (T1: 0.60 to 9.37 mg/dL; T2: 9.61 to 14.87 mg/dL; T3: 14.90 to 32.60 mg/dL; and unavailable peak CRP group). Multivariate Cox regression analysis was applied to investigate whether the tertiles of peak CRP predict adverse events even after adjusting for other variables. A total of 232 type B AAD patients were included in this analysis. The median follow-up period was 50 months. CRP reached its peak on day 4.5Ϯ1.7. Mean peak CRP values in T1, T2, and T3 were 6.4Ϯ2.

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“…Aortic dissection is a life-threatening disease with high inhospital mortality [1][2][3][4][5]. Although hypertension, age, and atherosclerosis have been known to be risk factors of aortic dissection [6], other factors associated with aortic dissection were not sufficiently elucidated.…”

Section: Introductionmentioning

confidence: 99%

Aortic dissection is associated with intermittent hypoxia and re-oxygenation

et al. 2011

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Aortic dissection is a life-threatening cardiovascular disease with high in-hospital mortality. However, the risk factors of aortic dissection have not been fully elucidated. Obstructive sleep apnea (OSA) has been increasingly recognized as an independent cardiovascular risk factor. Among the underlying mechanisms to explain the association between OSA and cardiovascular morbidity, previous studies reported that intermittent hypoxia and re-oxygenation (IHR) might induce cardiovascular diseases via atherosclerosis. However, little is known about an association between aortic dissection and IHR. The aims of the study were to investigate the prevalence of nocturnal IHR among patients with aortic dissection and compared with that in subjects without aortic dissection, and to investigate whether there is an independent association between aortic dissection and IHR. We enrolled 29 patients with aortic dissection and 59 control subjects. We performed sleep studies and compared the results between the groups. Frequency of IHR is expressed as 3% oxygen desaturation index (ODI). Multivariate analysis was performed to identify determinants of aortic dissection. The percentage of either moderate-to-severe IHR or severe IHR was significantly higher in the aortic dissection group (p = 0.04 and <0.001, respectively) than in the control group. The mean 3% ODI of patients with aortic dissection was significantly higher than that of control subjects (34.8 ± 23.1 and 19.0 ± 14.1, p = 0.003). In multivariate analysis, 3% ODI was significantly associated with aortic dissection (odds ratio 1.44; 95% confidence interval 1.08-1.91; p = 0.01). The present study showed the close association between aortic dissection and, IHR, a major component of OSA.

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Determinants of Long-Term Mortality in Patients With Type B Acute Aortic Dissection

Abstract: Impaired renal function was a predictor for adverse outcome in patients with type B AAD. The use of CCBs as antihypertensive medication at discharge was associated with increased survival.

Cited by 26 publications

References 24 publications

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

Peak C-Reactive Protein Level Predicts Long-Term Outcomes in Type B Acute Aortic Dissection

Aortic dissection is associated with intermittent hypoxia and re-oxygenation

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