Predictive factors for type A aortic dissection mortality based on electrocardiogram parameters and clinical presentations.

Abstract

Aortic dissection is a rare but potentially lethal disorder and may be associated with electrocardiogram (ECG) changes. In this study, we aim to investigate ECG-related parameters alongside clinical presentations of type A aortic dissection to come up with the predictive factors for the severity of the disease and its mortality rate. In this retrospective study, 201 patients with type A aortic dissection were studied between March 2015 and March 2020. Two expert cardiologists blinded to the diagnosis studied former and new patients' ECGs and recorded changes. Two-hundred and one patients, including 143 (71.1%) men and 58 (28.9%) women, presented with acute dissection of the aorta, were studied. Forty-four (21.8%) and 84 (41.7%) patients had ST-segment elevation and depression in ECG, respectively. Bivariate analysis revealed that higher heart rate (p=0.006), longer QTc (p=0.044), and ST-segment elevation in aVR lead (p=0.044) were associated with mortality in the patients. Multivariate regression showed higher heart rate (OR=1.022, CI=1.003-1.041, p=0.012) and ST-segment elevation in aVR (OR=4.854, CI=2.255-10.477, p<0.001) were independently associated with increased odds of mortality in aortic dissection patients. ROC curve analysis showed heart rate equal to or >60 per minute (AUC=0.625, sensitivity=86%, specificity=10%, p=0.019) and ST-segment elevation in aVR >0.5mm (AUC=0.854, sensitivity=75%, specificity=92%, p<0.001) were associated with a higher mortality rate. Heart rate equal or >60 and ST-segment elevation >0.5mm in aVR lead can be used as predictive factors for mortality of patients with type A aortic dissection.