Clinical Significance of Pleural Effusion in Acute Aortic Dissection

Hata, Noritake; Tanaka, Keiji; Imaizumi, Tsutomu; Ohara, Toshihiko; Ohba, Takayoshi; Shinada, Takurou; Takano, Teruo

doi:10.1378/chest.121.3.825

Cited by 57 publications

(37 citation statements)

References 18 publications

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“…Thus, pleural effusion might occur as a result of long-term bed rest. However, Hata, et al 2) reported long-term bed rest did not play a major role in the appearance of pleural effusion. In patients with acute aortic dissections, high doses of vasodilators are used to keep systolic blood pressure below 120 mmHg.…”

Section: Discussionmentioning

confidence: 96%

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C-reactive Protein Is Related to Impaired Oxygenation in Patients With Acute Aortic Dissection

2005

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SUMMARYImpaired oxygenation sometimes occurs in patients with acute aortic dissection, however, the mechanism has not been fully investigated. We hypothesized that impaired oxygenation is related to inflammation secondary due to aortic dissection. Patients with acute aortic dissection who had received 14 days of conservative treatment were retrospectively examined. Patients who had undergone surgery or died within 14 days were excluded. Patients who had evidence of having pneumonia or pulmonary congestion during this period were also excluded. Twenty-six patients were divided into a preserved oxygenation group (minimum oxygenation index 200, n = 13) and an impaired oxygenation group (minimum oxygenation index < 200, n = 13). Maximum serum C-reactive protein (max CRP) and other factors (age, gender, hypertension, diabetes mellitus, smoking, hyperlipidemia, Stanford type, thrombosed false lumen, pleural effusion, atelectasis, use of intravenous vasodilators) for the two groups were compared. Max CRP was the only predictor for impaired oxygenation as calculated by single/multiple logistic regression analysis. Max CRP was significantly higher in the impaired oxygenation group (20.1 ± 2.1 mg/dL) than in the preserved oxygenation group (10.5 ± 1.4 mg/dL, P < 0.05). These results suggest that impaired oxygenation is related to inflammation, which is secondary due to acute aortic dissection. (Int Heart J 2005; 46: 795-799)

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Section: Discussionmentioning

confidence: 96%

“…Hata, et al 2) reported that 18 out of 48 patients had pleural effusion on the day of onset. The fewer cases of pleural effusion on the day of onset in the present study might be due to the severity of the aortic dissection, as described above.…”

Section: Discussionmentioning

confidence: 99%

C-reactive Protein Is Related to Impaired Oxygenation in Patients With Acute Aortic Dissection

2005

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“…Partial False Luminal Thrombosis.-Studies have shown that completely thrombosed false lumens have improved outcomes, whereas patent false lumens carry an increased risk for aortic expansion and death. 197,210 However, in the IRAD series, partial thrombosis of the false lumen, defined as the concurrent presence of both flow and thrombus and present in a third of patients, was the strongest independent predictor of follow-up mortality, with a 2.7-fold increased risk for death compared to patients with patent false lumen without thrombus formation. 199 Prospective studies using CT or MR for assessing the whole aorta are required to confirm these results.…”

Section: Predictors Of Complications By Imaging Techniques Amentioning

confidence: 93%

“…Two mechanisms have been described: leakage of blood from the aorta through microperforations or a nonhemorrhagic exudate believed to be inflammatory in origin owing to the proximity of the IMH to the adventitia. 210,230 The likely different prognostic significance of the two pathogenic theories proposed may explain the discordance in the medical literature.…”

Section: Predictors Of Complicationsmentioning

confidence: 99%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

543

434

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“…Hypotension and shock that always indicate rupture or organ failure were significant independent predictors of death [10] . The presence of pleural effusion may indicate a periaortic hematoma due to the rupture of AD [12] . It was reported that branch vessel involvement was considered to be a risk factor of type B AD [13] , but in this study it was found to be a possible risk factor of type A AD, not be a risk factor of type B AD.…”

Section: Predictors Of Follow-up Mortalitymentioning

confidence: 99%

Analysis of 287 patients with aortic dissection: General characteristics, outcomes and risk factors in a single center

Jin

Zheng

Lai

et al. 2011

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The general characteristics, outcomes and risk factors of the patients with aortic dissection (AD) were evaluated in a single medical center. From January 2002 to December 2008, 284 patients with AD were treated and followed-up at our institution, including 105 cases of type A AD and 179 cases of type B AD. The patients in each type were divided into three groups according to management: medical treatment group (A or B), open surgery group (A or B), and stent-graft group (A or B). The characteristics and follow-up outcomes were compared between the groups or subgroups. The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group, but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group. Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis (HR, 3.807; 95% confidence interval [CI], 1.489 to 7.611; P=0.003), in-hospital hypotension/shock (HR, 4.687; 95% CI, 1.846 to 11.900; P=0.001), in-hospital myocardial ischemia or infarction (HR, 3.734; 95% CI, 1.613 to 8.643; P=0.002), pleural effusion (HR, 2.210; 95% CI, 1.080 to 4.521; P=0.030), branch vessel involvement (HR, 2.747; 95% CI, 1.202 to 6.278; P=0.016) and surgical treatment (HR, 0.177; 95% CI, 0.063 to 0.502; P=0.001). And there were insignificant independent predictors for mortality of the patients with type B AD. It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD, but after one year, there was no significant difference in the mortality and complications of them. There were several discordant risk factors of AD, such as female gender, age, thrombus, abrupt onset of pain that were considered as the risk factors in some papers. And there was no definite risk factor of mortality in this study in the patients with type B AD.

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Clinical Significance of Pleural Effusion in Acute Aortic Dissection

Cited by 57 publications

References 18 publications

C-reactive Protein Is Related to Impaired Oxygenation in Patients With Acute Aortic Dissection

C-reactive Protein Is Related to Impaired Oxygenation in Patients With Acute Aortic Dissection

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Analysis of 287 patients with aortic dissection: General characteristics, outcomes and risk factors in a single center

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