Painless Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection

Tolenaar, Jip L.; Hutchison, Stuart J.; Montgomery, Dan; O’Gara, Patrick T.; Fattori, Rosella; Pyeritz, Reed E.; Pape, Linda; Suzuki, Toru; Evangelista, Arturo; Moll, Frans L.; Rampoldi, Vincenzo; Isselbacher, Eric M.; Nienaber, C.A.; Eagle, Kim A.; Trimarchi, Santi

doi:10.12945/j.aorta.2013.13-014

Cited by 10 publications

(7 citation statements)

References 15 publications

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“…However, most studies have focused their attention only on the risk factors without using specific scores. [1,6,7,9] We sought to provide a simple risk model that could give us better insight into this condition and predict the mortality in patients with BAAD.…”

Section: Introductionmentioning

confidence: 99%

Predicting in-hospital death in patients with type B acute aortic dissection

et al. 2019

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The outcome of patients with acute type B aortic dissection (BAAD) is largely dictated by whether or not the case is “complicated.” The purpose of this study was to investigate the risk factors leading to in-hospital death among patients with BAAD and then to develop a predictive model to estimate individual risk of in-hospital death. A total of 188 patients with BAAD were enrolled. Risk factors for in-hospital death were investigated with univariate and multivariable logistic regression analysis. Significant risk factors were used to develop a predictive model. The in-hospital mortality rate was 9% (17 of 188 patients). Univariate analysis revealed 7 risk factors to be statistically significant predictors of in-hospital death ( P < .1). In multivariable analysis, the following variables at admission were independently associated with increased in-hospital mortality: hypotension (odds ratio [OR], 4.85; 95% confidence interval [CI], 1.12–18.90; P = .04), ischemic complications (OR, 8.24; 95% CI, 1.25–33.85; P < .001), renal dysfunction (OR, 12.32; 95% CI, 10.63–76.66; P < .001), and neutrophil percentage ≥80% (OR, 5.76; 95% CI, 2.58–12.56; P = .03). Based on these multivariable results, a reliable and simple prediction model was developed, a total score of 4 offered the best point value. Independent risk factors associated with in-hospital death can be predicted in BAAD patients. The prediction model could be used to identify the prognosis for BAAD patients and assist physicians in their choice of management.

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Section: Introductionmentioning

confidence: 99%

Predicting in-hospital death in patients with type B acute aortic dissection

et al. 2019

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“…16 23 24 On the other hand, a reason that the non–head and neck group had fewer types of pain may be related to the fact that 15% of patients present with painless dissection, suggesting that there may be aortic dissection patients who are biologically predisposed to feel less pain. 8 25 In fact, in our second analysis, those who experienced isolated head and neck pain were more likely to be older, have more atherosclerosis, and had a higher prevalence of diabetes, all of which were shown to be higher in patients who presented with painless cardiac syndromes. 25 26 27 28 In addition, patients with head and neck pain had higher rates of syncope, coma/altered mental status, syncope, and CVA, which are neurologic phenomena, which may affect the ability to perceive pain, and which may explain why these patients did not report more types of pain.…”

Section: Discussionmentioning

confidence: 74%

“…8 25 In fact, in our second analysis, those who experienced isolated head and neck pain were more likely to be older, have more atherosclerosis, and had a higher prevalence of diabetes, all of which were shown to be higher in patients who presented with painless cardiac syndromes. 25 26 27 28 In addition, patients with head and neck pain had higher rates of syncope, coma/altered mental status, syncope, and CVA, which are neurologic phenomena, which may affect the ability to perceive pain, and which may explain why these patients did not report more types of pain. 29…”

Section: Discussionmentioning

confidence: 74%

Head and Neck Pain in Patients Presenting with Acute Aortic Dissection

Philip

Missov

Gilon

et al. 2018

Aorta

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Background Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied. Methods Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to March 2015 were included in this study. We analyzed the demographics, presentation, treatment, and outcomes of Type A aortic dissection patients presenting with head and neck pain (n = 812, 25.8%) and compared it with those without these symptoms (n = 2,341, 74.2%). Results Patients with head and neck pain were more likely to be white, female, with a family history of aortic disease. Patients with head and neck pain had higher percentages of back pain (43.3% vs. 37.5%, p = 0.005) and chest pain (87.6% vs. 79.3%, p < 0.001). On imaging, a higher percentage of those with head and neck pain had arch vessel involvement (44.3% vs. 38%, p = 0.010) and intramural hematoma (11.7% vs. 8.1%, p = 0.003). Surgical management was more common in patients with head and neck pain (89.8% vs. 85.2%, p = 0.001). Regarding outcomes, patients with head and neck pain had significantly higher rates of stroke than those without head and neck pain (13% vs. 9.9%, p = 0.016); however, overall mortality was lower for those with head and neck pain (19.5% vs. 23%, p = 0.038). Those with head and neck pain only had higher overall mortality compared to those with head and neck pain with chest or back pain (34.6% vs. 19.9%, p = 0.013). A logistic regression of mortality revealed that preoperative hypotension and age > 65 years were significantly associated with increased mortality. Conclusion Presence of head and neck pain in Type A dissection is associated with more arch involvement, intramural hematoma, and stroke. When isolating those with head and neck pain only, there appear to be a higher rate of comorbidity burden and higher overall mortality.

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“…It includes a significant difference in pulse volume (pulse differentials) and blood pressure (BP differentials) in two upper extremities due to partial compression of one or both subclavian arteries or a sudden loss of pulse with abrupt onset of chest pain raise a high suspicion of aortic dissection. The difference of >20 mmHg of systolic blood pressure may be found in 10% to 20% of unaffected individuals [50]. The presence of pulse differential is the most specific physical sign of aortic dissection in 38% of cases, may be transient, secondary to decompression of the false lumen by distal reentry into the true lumen or secondary to the movement of the intimal flap away from the occluded orifice.…”

Section: Clinical Perspectivesmentioning

confidence: 99%

Proximal Aortic Dissection with Rupture into the Main Pulmonary Artery—A Case Report

Muthiah¹

2017

CRCM

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Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.

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Painless Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection

Cited by 10 publications

References 15 publications

Predicting in-hospital death in patients with type B acute aortic dissection

Predicting in-hospital death in patients with type B acute aortic dissection

Head and Neck Pain in Patients Presenting with Acute Aortic Dissection

Proximal Aortic Dissection with Rupture into the Main Pulmonary Artery—A Case Report

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