Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD)

Abstract

Acute dissection of the thoracic aorta is a catastrophic cardiovascular emergency that produces a cascade of potential life-threatening sequelae, including aortic rupture, cardiac tamponade, and acute aortic insufficiency, and requires rapid and accurate diagnosis. 1 Harris P.D Bowman Jr, F.O Malm J.R The management of acute dissections of the thoracic aorta. Am Heart J. 1969; 78: 419-422 Abstract Full Text PDF PubMed Scopus (24) Google Scholar , 2 Bansal R.C Chandrasekaran K Ayala K Smith D.C Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. J Am Coll Cardiol. 1995; 25: 1393-1401 Abstract Full Text PDF PubMed Scopus (104) Google Scholar , 3 DeSanctis R.W Doroghazi R.M Austen W.G Buckley M.J Aortic dissection. N Engl J Med. 1987; 317: 1060-1067 Crossref PubMed Scopus (373) Google Scholar , 4 Eagle K.A DeSanctis R.W Aortic dissection. Curr Probl Cardiol. 1989; 14: 225-278 Abstract Full Text PDF PubMed Scopus (51) Google Scholar , 5 Nienaber C.A Spielmann R.P von Kodolitsch Y Siglow V Piepho A Jaup T Nicolas V Weber P Triebel H.J Bleifeld W Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography. Circulation. 1992; 85: 434-447 Crossref PubMed Scopus (247) Google Scholar If untreated, the mortality rate at 24 hours approaches 25% and reaches 75% by 2 weeks. 6 Armstrong W.F Bach D.S Carey L Chen T Donovan C Falcone R.A Marcovitz P.A Spectrum of acute dissection of the ascending aorta a transesophageal echocardiographic study. J Am Soc Echocardiogr. 1996; 9: 646-656 Abstract Full Text PDF PubMed Scopus (39) Google Scholar , 7 Braverman A.C Aortic dissection. Curr Opin Cardiol. 1997; 12: 389-390 PubMed Google Scholar , 8 Chen K Varon J Wenker O.C Judge D.K Fromm Jr, R.E Sternbach G.L Acute thoracic aortic dissection the basics. J Emerg Med. 1997; 15: 859-867 Abstract Full Text PDF PubMed Scopus (65) Google Scholar With the sobering natural history of untreated dissections, it is of paramount importance for improving a patient’s chance of survival that a safe diagnostic test be available, which is capable not only of providing rapid and correct recognition of the diagnosis, but also guiding further therapy by ascertaining associated structural abnormalities. Retrograde aortography has been considered the reference standard for diagnosis of aortic dissection. 9 Dinsmore R.E Willerson J.T Buckley M.J Dissecting aneurysm of the aorta aortographic features affecting prognosis. Radiology. 1972; 105: 567-572 PubMed Google Scholar , 10 Arciniegas J.G Soto B Little W.C Papapietro S.E Cineangiography in the diagnosis of aortic dissection. Am J Cardiol. 1981; 47: 890-894 Abstract Full Text PDF PubMed Scopus (16) Google Scholar , 11 Soto B Harman M.A Ceballos R Barcia A Angiographic diagnosis of dissecting aneurysm of the aorta. Am J Roentgenol Radium Ther Nucl Med. 1972; 116: 146-154 Crossref PubMed Scopus (15) Google Scholar However, beginning in the early 1980s, advances in noninvasive imaging technology, specifically the development of computed tomography (CT), magnetic resonance imaging (MRI), and transesophageal echocardiography (TEE), have challenged this designation. The present study assesses the current status of diagnostic imaging in acute aortic dissection at several large cardiovascular referral centers throughout the world by analyzing data on test preference and performance gathered in the International Registry of Acute Aortic Dissection (IRAD). 12 Hagan P.G Nienaber C.A Isselbacher E.M Bruckman D Karavite D.J Russman P.L Evangelista A Fattori R Suzuki T Oh J.K et al. The International Registry of Acute Aortic Dissection (IRAD) new insights into an old disease. JAMA. 2000; 283: 897-903 Crossref PubMed Scopus (2637) Google Scholar