Limited role of aortic size in the genesis of acute type A aortic dissection

Neri, Eugénio; Barabesi, Lucio; Buklas, Dimitrios; Vricella, Luca A.; Benvenuti, Antonio; Tucci, Enrico; Sassi, Carlo; Massetti, Massimo

doi:10.1016/j.ejcts.2005.10.013

Cited by 72 publications

(61 citation statements)

References 24 publications

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“…85 Among 220 ascending aortic dissections in another study, those associated with connective tissue disorders (nϭ94) had aortic diameters similar to those without connective tissue disorders (mean, 41.8 versus 41.3 mm, respectively); the proportion of dissections occurring in normal-sized or only mildly dilated aortas was actually higher in the group without connective tissue disease. 86 Similarly, from the International Registry of Acute Aortic Dissections, the proportion of dissections occurring at …”

Section: Aortic Dissection and Rupturementioning

confidence: 99%

Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve

2009

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Section: Aortic Dissection and Rupturementioning

confidence: 99%

Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve

2009

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“…17 With the use of a unique surgical technique, they retrieved cylinders of fresh aortic tissue and measured the inner layer of the true aortic lumen with a correction for the absence of perfusion pressure. The median diameter by this unique method was 41.4 mm for the entire cohort.…”

Section: Pape Et Al Aortic Diameter In Type a Dissectionmentioning

confidence: 99%

Aortic Diameter ≥5.5 cm Is Not a Good Predictor of Type A Aortic Dissection

et al. 2007

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03).Marfan syndrome patients were more likely to dissect at larger diameters (odds ratio, 14.3; 95% confidence interval, 2.7 to 100; Pϭ0.002). Mortality (27% of patients) was not related to aortic size. Conclusions-The majority of patients with acute type A acute aortic dissection present with aortic diameters Ͻ5.5 cm and thus do not fall within current guidelines for elective aneurysm surgery. Methods other than size measurement of the ascending aorta are needed to identify patients at risk for dissection.

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“…Additionally, several signs of the TTE are only picked up by doctors who specialize in echocardiography, consequently affecting its clinical application. Nevertheless, approximately 90% of patients with A-AAD demonstrate an ascending aorta diameter >40 mm (9,(15)(16)(17)(18), and the ascending aorta diameter can be obtained from the TTE by emergency physicians easily, immediately and accurately, which also makes its application possible for the early identification of A-AAD.…”

Section: Introductionmentioning

confidence: 99%

Values of aortic dissection detection risk score combined with ascending aorta diameter >40 mm for the early identification of type A acute aortic dissection

Wang

et al. 2018

J. Thorac. Dis.

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Background: Type A acute aortic dissection (A-AAD), involving the ascending aorta, is a life-threatening disease. To detect A-AAD early and rapidly in patients with acute chest pain, especially in patients with acute myocardial infarction (AMI) secondary to A-AAD, we investigated values of combined use of the risk score and the ascending aorta diameter >40 mm for the early identification of A-AAD.Methods: Our study retrospectively encompassed 239 patients with acute chest pain on admission to our hospital between July 2010 and December 2016. The risk score was calculated according to the aortic dissection detection (ADD) risk score system, and the ascending aorta diameter was accurately obtained from the transthoracic echocardiography (TTE). Results: A risk score ≥1 had an excellent sensitivity of 94.9% and a fair negative predictive value (NPV) of 77.8%, with a poor specificity of 8.7% and a positive predictive value (PPV) of 33.5% for the diagnosis of A-AAD. A risk score ≥2 had an excellent specificity of 91.3% and a fair NPV of 73.1%, whereas it had a lower sensitivity of 30.8% and a PPV of 63.2%. A risk score ≥1, combined with an ascending aorta diameter >40 mm, had a sensitivity, a specificity, a PPV, and an NPV of 84.6%, 87.6%, 76.7%, and 92.2%for the diagnosis of A-AAD, respectively. The combined use of a risk score ≥2 and an ascending aorta diameter >40 mm had an excellent specificity of 98.1% and a PPV of 86.4%, a fair NPV of 72.8%, and a poor sensitivity of 24.4% for the detection of A-AAD. Moreover, the omission diagnostic rate for A-AAD was significantly decreased from 33.3% to 7.4% using a risk score ≥1 combined with an ascending aorta diameter >40 mm in patients with AMI secondary to A-AAD. Conclusions: The combined use of an ADD risk score ≥1 and an ascending aorta diameter >40 mm was highly indicative of A-AAD in patients presenting with acute chest pain, especially in patients with AMI secondary to A-AAD, which urgently needed computed tomography angiography (CTA) or magnetic resonance imaging (MRI) to confirm the diagnosis of A-AAD.Keywords: Aortic dissection detection risk score (AAD risk score); ascending aorta diameter; type A acute aortic dissection (A-AAD); acute myocardial infarction (AMI); portable transthoracic echocardiography (portable TTE)

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Limited role of aortic size in the genesis of acute type A aortic dissection

Cited by 72 publications

References 24 publications

Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve

Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve

Aortic Diameter ≥5.5 cm Is Not a Good Predictor of Type A Aortic Dissection

Values of aortic dissection detection risk score combined with ascending aorta diameter >40 mm for the early identification of type A acute aortic dissection

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