Acute Aortic Dissection Patients Research Articles

Associations of interfacility transfer with clinical presentation and early mortality in patients with type a acute aortic dissection: a registry study

Abstract Background Acute aortic dissection (AAD), particularly Stanford type A, is a life-threatening condition with high morbidity and mortality that requires prompt diagnosis and urgent intensive treatment including surgical repair. Our reginal aortic network has been established to develop the effective and safe transfer system for patients with AAD. Purpose This study aimed to assess how interfacility transfer impacts clinical presentation and early mortality in type A AAD patients using multicenter registry data. Methods We studied 1024 consecutive patients (age: 70 [58-79] years, 55% male) who were hospitalized for type A AAD within 24 hours after symptom onset during 2017–2018. Patients with cardiopulmonary arrest before hospital arrival were excluded. Multivariable logistic regression analysis was used to evaluate the association between interfacility transfer and operative mortality. Results In this study cohort, 539 patients were transferred from another facility, whereas the remaining 485 were directly admitted to the presenting hospital. Patients with transfer had a longer time from symptom onset to emergency surgery than those without transfer (326 [267–472] min vs. 282 [216–390] min, p<0.001). AAD-related complications (cardiac tamponade, cardiac arrest, shock, aortic rupture, end-organ malperfusion) were more frequent in patients without transfer (32.0% vs 24.5%, p=0.008). Patients with transfer underwent surgical and/or endovascular treatment more frequently (92.9% vs. 74.8%, p<0.001) and had a lower 30-day mortality rate than those without transfer (7.1% vs. 21.9%, p<0.001). The operative mortality was also lower in patients with transfer than in those without transfer (30/501 [6.0%] vs. 43/363 [11.8%], p=0.002). The multivariable analysis conducted in this study revealed that the presence of AAD-related complications at admission was associated with a higher operative mortality (odds ratio [OR]: 5.10; 95% confidence interval [CI]: 3.00–8.67, p<0.001), whereas interfacility transfer was associated with a lower operative mortality (OR: 0.54; 95% CI:0.31–0.95, p=0.031). Conclusion These findings underscore the critical role of efficient transfer systems and early intervention in managing type A AAD. Despite the delay from symptom onset to surgical intervention, interfacility transfer did not lead to adverse outcomes for patients with type A AAD.

Monocytes perturbation implicated in the association of stress hyperglycemia with postoperative poor prognosis in non-diabetic patients with Stanford type-A acute aortic dissection

ObjectivesThe study aimed to investigate the interaction of intraoperative stress hyperglycemia with monocyte functions and their impact on major adverse events (MAEs) in acute aortic dissection (AAD) patients who underwent open repair surgery.MethodsA total of 321 adults who underwent open surgery for AAD at two tertiary medical centers in China were enrolled in the study. The primary endpoint was defined as the incidence and characteristics of perioperative stress hyperglycemia. The secondary endpoints included the incidence of postoperative MAEs, postoperative monocyte counts and inflammatory cytokine expression. Multi-logistic, linear regression and receiver operating characteristic (ROC) curve analyses were used to establish relationships between intraoperative time-weighted average glucose (TWAG), day-one postoperative monocyte counts, serum inflammatory cytokines and postoperative outcomes. In addition, in vitro experiments were conducted to evaluate changes in the inflammatory features of monocytes under high glucose conditions.ResultsIntraoperative hyperglycemia, as indicated by a TWAG level over 142 mg/dL, was associated with elevated postoperative monocyte counts and inflammatory cytokines, which correlated with extended intensive care unit (ICU) stays and worsened outcomes. In vitro, high glucose treatment induced mitochondrial impairment in monocytes, increased the release of inflammatory cytokines and the proportion of classical monocytes from AAD patients.ConclusionsIntraoperative stress hyperglycemia, in combination with day-one postoperative monocyte counts, were clinically significant for predicting adverse outcomes in AAD patients undergoing open repair surgery. Elevated glucose concentrations shaped the inflammatory features of monocytes in AAD by impairing mitochondrial functions.Graphical abstractHigh glucose-driven mitochondrial functional impairment mediates a more pronounced monocytic inflammatory state in Stanford type-A AAD.

A smartphone-based multichannel magnetoelastic immunosensor for acute aortic dissection supplementary diagnosis

Some biomarkers of acute aortic dissection (AAD) can be used for the potential supplementary diagnosis of AAD, such as C-reactive protein (CRP), smooth muscle myosin heavy chain (SmMHC), and D-dimer (D-D). However, the current measurement methods for common markers primarily rely on sophisticated instruments. The operation process is complicated, and the reagents used are expensive. To provide chronic disease monitoring and home self-examination services for potential AAD patients in real time, we developed a smartphone-based multichannel magnetoelastic (ME) immunosensing device to detect protein levels. Our immunosensor reduced the aforementioned restrictions and demonstrated excellent performance for the supplementary diagnosis of AAD. In this paper, we successfully combined the intelligent terminal with the hardware system to sample the resonance frequency shift (RFS) on the multichannel ME immunosensor. According to the target detection objects with their respective antibodies in the immune binding response, multiple experiments were conducted to detect multiple groups of samples, and we found that a CRP concentration, a SmMHC concentration, and a D-D concentration in the range of 0.1−100μg/mL, 1−4ng/mL, and 0.25−5μg/mL were linearly proportional to the RFS of the ME immunosensor, respectively. For CRP, SmMHC, and D-D, the sensitivities were 13.37Hz/μg∙mL‐1, 155.19Hz/ng∙mL‐1, and 332.72Hz/μg∙mL‐1, respectively, and the detection limits were 2.634×10‐3μg/mL, 1.155×10‐2ng/mL, and 3.687×10‐3μg/mL, respectively. The experiments demonstrated that the accuracy and stability of our device were comparable to those of the vector network analyzer (VNA, Calibration instrument).

Effectiveness of chest pain center accreditation on the hospital outcome of acute aortic dissection: a nationwide study in China

BackgroundThe National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. The benefits of chest pain center (CPC) accreditation on acute coronary syndrome have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD).MethodsWe conducted a retrospective observational study of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016 to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis, and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions.ResultsThe analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.1% vs. 16.3%, P < 0.001 and 2.9% vs. 5.4%, P < 0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.1% vs. 42.1%, P < 0.001) compared with the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR 0.644, 95% CI 0.599–0.693) and misdiagnosis (adjusted OR 0.554, 95% CI 0.493–0.624), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR 1.973, 95% CI 1.797–2.165). Following CPC accreditation, there were significant reductions in in-hospital mortality across various regions, particularly in Western regions (from 21.5 to 14.1%). Moreover, CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities (adjusted OR 0.607 vs. 0.713).ConclusionCPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.

Systematic Review and Meta-Analysis With Reconstructed Time-To-Event Data of Frozen Elephant Trunk and Conventional Aortic Repair.

Frozen elephant trunk (FET) has gained popularity since its inception. Nevertheless, the optimal approach for managing aortic arch pathologies remains subject of debate. This meta-analysis compared outcomes between patients undergoing FET and those undergoing conventional aortic repair. Systematic searches were conducted up to February 2024. Pooled results of short and long-term outcomes were computed. A systematic review identified 21 non-randomized studies encompassing 3240 patients. Short-term mortality was lower in FET recipients than in those undergoing conventional repair (OR [95% CI] = 0.58 [0.44-0.78], P < .01). Postoperative paraplegia incidence was higher in the FET cohort (OR = 1.85 [1.02-3.34], P = .04), while subgroup analysis showed no difference between the two groups in patients with acute aortic dissection. Long-term all-cause mortality was lower among FET recipients. Subgroup analysis showed FET was associated with reduced all-cause mortality (HR = 0.55 [0.39-0.79], P < .01) and aortic re-intervention (HR = 0.62 [0.39-0.99], P = .05) in acute aortic dissection patients. This meta-analysis underscores the favorable association between the utilization of FET and improved short and long-term outcomes compared with conventional repair, while paraplegia incidence was higher in the FET group. FET appears to offer superior benefits, particularly evident in patients with acute aortic dissection.

Prognostic significance of serum secreted frizzled-related protein 5 in patients with acute aortic dissection

BackgroundSecreted frizzled-related protein 5 (SFRP5) is a novel adipokine that has been found to be closely associated with metabolic and cardiovascular diseases. We investigated serum SFRP5 levels during the acute phase and their predictive value for the prognosis of acute aortic dissection (AAD). MethodsIn total, 152 AAD patients and 164 controls were enrolled in this study. Serum SFRP5 levels were measured using an enzyme-linked immunosorbent assay (ELISA). AAD patients were divided into high-SFRP5 and low-SFRP5 groups based on the optimal cutoff value and followed up for prognosis. The primary endpoint was all-cause mortality, and the secondary endpoint focused on AAD-related events (including AAD-related mortality and unplanned reoperations). ResultsSerum SFRP5 levels were significantly higher in AAD patients than in non-AAD controls, regardless of whether they had Stanford type A or B AD. Multivariate logistic regression analysis revealed an independent association between SFRP5 and the presence of AAD (adjusted OR 1.267, 95 % CI 1.152–1.394; p < 0.001). The receiver operating characteristic curve demonstrated that the optimal cutoff value for SFRP5 to predict the presence of AAD was 10.26 ng/mL (AUC 0.7241, sensitivity 49.34 %, specificity 87.20 %). Notably, serum SFRP5 levels of patients in the death group were significantly higher than those in the survival group. Compared with patients in the low-SFRP5 group, those in the high-SFRP5 group exhibited a significantly increased risk of all-cause mortality (HR 9.540, 95 % CI 2.803–32.473; p < 0.001) and AAD-related events (HR 6.915, 95 % CI 2.361–20.254; p < 0.001) during the follow-up period. ConclusionSerum SFRP5 levels were significantly elevated in the acute phase of AAD, and high serum SFRP5 levels were independently associated with poor AAD prognosis. These results suggest that serum SFRP5 level during the acute phase may be an effective biomarker and therapeutic target for the prognosis of AAD.

A comparison between direct true lumen versus conventional cannulation for management of acute type- aortic dissection patients.

Objective: To compare the postoperative outcomes while using direct true lumen approach versus conventional cannulation approach in management of acute type-A aortic dissection patients. Study Design: Randomized Clinical Trial. Setting: Department of Vascular Surgery, Combined Military Hospital, Rawalpindi. Period: 1st June 2022 to 31st December 2022. Methods: A total of 22 patients age more than 18 years who presented in CMH Emergency Department with acute type A aortic dissection were included in this study. In group A (11 patients) were managed with direct true lumen cannulation while in group B (11 patients) were managed with conventional (axillary/femoral) cannulation. In both groups intra-operative parameters like procedure time, mean time of cardiopulmonary bypass, cross clamp and circulatory arrest time were measured. In both groups, outcome was measured in terms of occurrence of multi-organ failure, acute kidney injury, arrhythmias on ECG and in-hospital mortality. Data was analyzed using SPSS 26. Results: Mean age of our patients were 43.36±2.16yrs in group A while 43.36±2.94yrs in group B. Male gender predominates in both groups (gp A- 81.8% &amp; gp B-90.9%). We found no difference of statistical significance between two groups in terms of various intra-operative parameters like mean duration of procedure in group A was 428.15min and in group B was 427.36 min. Similarly mean circulatory arrest time was 31 min in group A and 29.09 min in group B. Patients in “direct true lumen cannulation” group had significantly shorter duration of intubation. In terms of post-operative outcomes, multi-organ failure occurred in 1 (9.09%) patient in group A while it occurred in 3(27.27%) patients in group B. In hospital mortality occurred in 2(18%) patients in group A as compared to 4(36%) in group B. So better results were observed in “direct true lumen cannulation” group as compared to “conventional (axillary/femoral) cannulation” group. Conclusion: In our study, acute type-A aortic dissection patients who had undergone direct true lumen cannulation during operative management showed better post-operative outcomes.

Impact of D-dimer on in-hospital mortality following aortic dissection: A systematic review and meta-analysis.

The utility of D-dimer (DD) as a biomarker for acute aortic dissection (AD) is recognized. Yet, its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence. To conduct a meta-analysis of AD-related in-hospital mortality (ADIM) with elevated DD levels. We searched PubMed, Scopus, Embase, and Google Scholar for AD and ADIM literature through May 2022. Heterogeneity was assessed using I 2 statistics and effect size (hazard or odds ratio) analysis with random-effects models. Sample size, study type, and patients' mean age were used for subgroup analysis. The significance threshold was P < 0.05. Thirteen studies (3628 patients) were included in our study. The pooled prevalence of ADIM was 20% (95%CI: 15%-25%). Despite comparable demographic characteristics and comorbidities, elevated DD values were associated with higher ADIM risk (unadjusted effect size: 1.94, 95%CI: 1.34-2.8; adjusted effect size: 1.12, 95%CI: 1.05-1.19, P < 0.01). Studies involving patients with a mean age of < 60 years exhibited an increased mortality risk (effect size: 1.43, 95%CI: 1.23-1.67, P < 0.01), whereas no significant difference was observed in studies with a mean age > 60 years. Prospective and larger sample size studies (n > 250) demonstrated a heightened likelihood of ADIM associated with elevated DD levels (effect size: 2.57, 95%CI: 1.30-5.08, P < 0.01 vs effect size: 1.05, 95%CI: 1.00-1.11, P = 0.05, respectively). Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients, highlighting the need for larger, prospective studies to improve risk prediction models.

Streamlining Acute Abdominal Aortic Dissection Management-An AI-based CT Imaging Workflow.

Life-threatening acute aortic dissection (AD) demands timely diagnosis for effective intervention. To streamline intrahospital workflows, automated detection of AD in abdominal computed tomography (CT) scans seems useful to assist humans. We aimed at creating a robust convolutional neural network (CNN)-based pipeline capable of real-time screening for signs of abdominal AD in CT. In this retrospective study, abdominal CT data from AD patients presenting with AD and from non-AD patients were collected (n 195, AD cases 94, mean age 65.9years, female ratio 35.8%). A CNN-based algorithm was developed with the goal of enabling a robust, automated, and highly sensitive detection of abdominal AD. Two sets from internal (n = 32, AD cases 16) and external sources (n = 1189, AD cases 100) were procured for validation. The abdominal region was extracted, followed by the automatic isolation of the aorta region of interest (ROI) and highlighting of the membrane via edge extraction, followed by classification of the aortic ROI as dissected/healthy. A fivefold cross-validation was employed on the internal set, and an ensemble of the 5 trained models was used to predict the internal and external validation set. Evaluation metrics included receiver operating characteristic curve (AUC) and balanced accuracy. The AUC, balanced accuracy, and sensitivity scores of the internal dataset were 0.932 (CI 0.891-0.963), 0.860, and 0.885, respectively. For the internal validation dataset, the AUC, balanced accuracy, and sensitivity scores were 0.887 (CI 0.732-0.988), 0.781, and 0.875, respectively. Furthermore, for the external validation dataset, AUC, balanced accuracy, and sensitivity scores were 0.993 (CI 0.918-0.994), 0.933, and 1.000, respectively. The proposed automated pipeline could assist humans in expediting acute aortic dissection management when integrated into clinical workflows.

Effect of the intraoperative infusion of recombinant activated coagulation factor VII on short-term prognosis and thoracic complications after acute aortic coarctation

Purpose: To investigate the impact of intraoperative infusion of recombinant human-activated coagulation factor VII (rFVIIa) on postoperative outcomes in patients with acute aortic dissection (AAD). Methods: This study involved 120 individuals who underwent aortic coarctation surgery between January 1, 2020, and December 31, 2022 in the First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China. The participants were divided into control (receiving only conventional treatment) and study (receiving rFVIIa infusion in addition to conventional treatment) groups. Various parameters, including patient status, postoperative measures, and complications were evaluated. Results: There was no significant difference in age, gender distribution, duration of myocardial block, onset time, or surgery duration (p &gt; 0.05) between both groups. However, the study group exhibited longer extracorporeal circulation duration (p &lt; 0.05). The study group also demonstrated lower levels of chest drainage compared to the control group 12 and 24 h after surgery (p &lt; 0.05). Moreover, fewer concentrated red blood cells and fresh frozen plasma transfusions were administered to study group (p &lt; 0.05). Despite having longer stays in the ICU (p &lt; 0.05), the study group required less postoperative mechanical ventilation (p &lt; 0.05). There was a significant difference in the incidence of postoperative thrombosis cases, positive gram-negative bacilli sputum culture results, and deaths within the study group (p &lt; 0.05). Conclusion: Intraoperative rFVIIа infusion in AAD patients enhances short-term prognosis, with elevated risk of chest complications. However, further studies with larger sample sizes is essential to comprehensively assess clinical advantages and drawbacks.

Combined blood pressure and heart rate trajectories are associated with prognosis in critically ill patients with acute aortic dissection: A group-based multi-trajectory analysis

BackgroundManaging systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) is pivotal in acute aortic dissection (AAD) care. However, no prior studies have jointly analyzed the trajectories of these parameters. This research aimed to characterize their joint longitudinal trajectories and investigate the influence on AAD prognosis. MethodsWe included AAD patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Using group-based multi-trajectory modeling (GBMTM), we identified combined trajectories of SBP, DBP, and HR within the initial 24 h of intensive care unit (ICU) admission. Cox proportional hazard regression, log-binomial regression, and logistic regression were employed to assess the association between trajectory groups and mortality outcomes. ResultsData from 337 patients were analyzed. GBMTM identified five combined trajectory groups. Group 1 featured rapidly declining SBP and DBP with high pulse pressure and low HR; Group 2 showed high to moderate SBP with slight rebound and persistently low HR; Group 3 displayed persistently moderate BP and HR; Group 4 was characterized by moderate blood pressure with persistently high HR; and Group 5 had high to moderate SBP with slight rebound, high but gradually declining DBP, and slightly high HR. Group 3 demonstrated a lower risk of mortality, with an adjusted hazard ratio of 0.32 (95 % CI, 0.14–0.74), and the adjusted relative risks for in-hospital, 30-day, and 1-year mortalities were 0.37 (95 % CI, 0.15–0.87), 0.25 (95 % CI, 0.10–0.62), and 0.41 (95 % CI, 0.22–0.79), respectively. The time-independent C-index curve demonstrated that the multi-trajectory groups had higher C-index values than any univariate trajectory groups or admission values of SBP, DBP, and HR. ConclusionsUtilization of GBMTM can yield data-driven insights to identify distinct subphenotypes in AAD patients. The combined trajectories of SBP, DBP, and HR within 24 h of ICU admission significantly influenced the mortality rate.

Eosinophil Recovery Time Is Associated with Clinical Outcomes in Patients with Type A Acute Aortic Dissection: a Retrospective Cohort Study.

Type A acute aortic dissection (TA-AAD) patients are prone to life-threatening complications and death. This study aimed to analyze the association between eosinophil (EOS) recovery and clinical outcomes in TA-AAD. A total of 274 patients with TA-AAD were eligible for inclusion, and 54 patients died within 1month. The patients with poor clinical outcomes showed significantly lower EOS count within 8days after surgery. The time-dependent ROC analysis showed that EOS recovery days predicted 1-month death with an AUC of 0.886 and a cutoff of 6days. EOS recovery within 6days was associated with a lower incidence of postoperative infection, a poorer prognosis, and a lower risk of 1-month and 6-month mortality than those requiring more recovery days. Collectively, postoperative early recovery of EOS predicted lower mortality and better prognosis and may be applied as an effective, rapid, and simple tool for the risk stratification and prognostic prediction of patients with TA-AAD.Clinical trial registration number: NCT05409677.

Incidence, presentation and outcome of acute aortic dissection: results from a population-based study

ObjectivesTo describe the incidence of acute aortic dissection in a clearly defined population, to assess onset symptoms and admission biochemical marker levels and to analyse variables potentially associated to mortality.MethodsMedical...

Risk factors for one-year mortality following discharge in patients with acute aortic dissection: development and validation of a predictive model in a cross-sectional study

PurposeThis study was aimed to identify the risk factors that influence the mortality risk in patients with acute aortic dissection (AAD) within one year after discharge, and aimed to construct a predictive model for assessing mortality risk.MethodsThe study involved 320 adult patients obtained from the Medical Information Mart for Intensive Care (MIMIC) database. Logistic regression analysis was conducted to identify potential risk factors associated with mortality in AAD patients within one year after discharge and to develop a predictive model. The performance of the predictive model was assessed using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). To further validate the findings, patient data from the First Affiliated Hospital of Guangxi Medical University (157 patients) were analyzed.ResultsUnivariate and multivariate logistic regression analyses revealed that gender, length of hospital stay, highest blood urea nitrogen (BUN_max), use of adrenaline, and use of amiodarone were significant risk factors for mortality within one year after discharge (p < 0.05). The constructed model exhibited a consistency index (C-index) and an area under the ROC curve of 0.738. The calibration curve and DCA demonstrated that these indicators had a good degree of agreement and utility. The external validation results of the model also indicated good predictability (AUC = 0.700, p < 0.05).ConclusionThe personalized scoring prediction model constructed by gender, length of hospital stays, BUN_max levels, as well as the use of adrenaline and amiodarone, can effectively identify AAD patients with high mortality risk within one year after discharge.

Pericoronary adipose tissue attenuation in patients with acute aortic dissection based on coronary computed tomography angiography.

Periaortic fat is associated with coronary disease. Thus, it was hypothesized that the inflammation associated with acute aortic dissection (AAD) spreads to pericoronary adipose tissue (PCAT) via thoracic periaortic fat. Pericoronary adipose tissue attenuation (PCATa) serves as a marker for inflammation of perivascular adipose tissue (PVAT). This study sought to examine PCATa in individuals diagnosed with AAD. Consecutive patients with chest pain from May 2020 to September 2022 were prospectively enrolled in this study and underwent coronary computed tomography angiography (CCTA) and/or aorta computed tomography angiography (CTA). Based on the results of the CTA, the patients were divided into the following two groups: (I) the AAD group; and (II) the non-AAD group. PCATa of the right coronary angiography (RCA), left anterior descending (LAD), and left circumflex (LCx) was quantified for each patient using semi-automated software. The PCATa values were compared between the AAD and non-AAD patients according to the atherosclerosis of the coronary arteries. Similarly, the PCATa values of the AAD patients were compared between the preoperative and postoperative steady states. A total of 136 patients (42 female, 94 male; mean age: 63.3±11.9 years) were divided into the two groups according to the presence of aortic dissection on CTA. The RCAPCATa, LADPCATa, and LCxPCATa values were significantly higher in the AAD subjects than the non-AAD subjects, regardless of the presence or absence of atherosclerosis in the coronary arteries [-85.1±9.3 vs. -92.9±10.0 Hounsfield unit (HU); -83.2±7.4 vs. -89.9±9.1 HU; -77.5±8.4 vs. -85.6±7.9 HU, all P<0.001). The preoperative RCAPCATa, LADPCATa, and LCxPCATa values were higher in the AAD patients than the postoperative steady-state patients (-82.9±8.7 vs. -97.6±8.8 HU; -79.8±7.6 vs. -92.8±6.8 HU; -74.6±7.1 vs. -87.7±6.9 HU, all P<0.001). According to the multivariable logistic regression analysis, high RCAPCATa and LADPCATa values were associated with AAD regardless of the degree of stenosis [odds ratio (OR) =0.014; 95% confidence interval (CI): 0.001-0.177; P=0.001 and OR =0.010; 95% CI: 0.001-0.189; P=0.002]. PCATa on computed tomography was increased in patients with AAD regardless of the presence or absence of coronary artery disease (CAD). This suggests that vascular inflammation is present in AAD independent of CAD. Further research should be conducted to investigate the potential of this imaging biomarker to predict AAD and monitor patients' responses to therapies for AAD.

Prognostic implications of thyroid hormones in acute aortic dissection: mediating roles of renal function and coagulation.

Thyroid hormones significantly influence cardiovascular pathophysiology, yet their prognostic role in acute aortic dissection (AAD) remains inadequately explored. This study assesses the prognostic value of thyroid hormone levels in AAD, focusing on the mediating roles of renal function and coagulation. We included 964 AAD patients in this retrospective cohort study. Utilizing logistic regression, restricted cubic splines, and causal mediation analysis, we investigated the association between thyroid hormones and in-hospital mortality and major adverse cardiovascular events (MACEs). In AAD patients overall, an increase of one standard deviation in FT4 levels was associated with a 31.9% increased risk of MACEs (OR 1.319; 95% CI 1.098-1.584) and a 36.1% increase in in-hospital mortality (OR 1.361; 95% CI 1.095-1.690). Conversely, a higher FT3/FT4 ratio was correlated with a 20.2% reduction in risk of MACEs (OR 0.798; 95% CI 0.637-0.999). This correlation was statistically significant predominantly in Type A AAD, while it did not hold statistical significance in Type B AAD. Key renal and coagulation biomarkers, including blood urea nitrogen, creatinine, cystatin C, prothrombin time ratio, prothrombin time, and prothrombin time international normalized ratio, were identified as significant mediators in the interplay between thyroid hormones and MACEs. The FT3/FT4 ratio exerted its prognostic influence primarily through the mediation of renal functions and coagulation, while FT4 levels predominantly impacted outcomes via a partial mediation effect on coagulation. FT4 levels and the FT3/FT4 ratio are crucial prognostic biomarkers in AAD patients. Renal function and coagulation mediate the association between the thyroid hormones and MACEs.

Expression of secreted frizzled-related proteins in acute aortic dissection patients and the effects on prognosis.

Secreted frizzled-related proteins (SFRPs) were reported to be involved in cardiovascular diseases. This study aimed to observe plasma SFRP levels in acute aortic dissection (AD) patients and the effects of SFRP expression on AD prognosis. Plasma levels of SFRP1, SFRP2, SFRP3, SFRP4, and SFRP5 were measured in AD patients and non-AD (NAD) patients. The end-point events information of AD patients, including all-cause death and various clinical complications due to aortic dissection, was collected during a 36-month follow-up. The SFRP1, SFRP2, SFRP3, and SFRP4 levels were increased in AD patients compared with those in NAD patients, while the SFRP5 concentrations were decreased. No differences in any of the SFRP levels were observed between the type A group and the type B group. The AD patients with end-point events exhibited higher SFRP1, SFRP2, SFRP3, and SFRP4 concentrations but lower SFRP5 levels than the patients without end-point events. In addition, the AD patients were divided into a high group and a low group based on the median SFRP levels, and Kaplan-Meier analysis revealed that the AD patients with high SFRP1, SFRP2, SFRP4, or SFRP5 levels had a better prognosis than those with low levels. However, the AD patients with high SFRP3 levels exhibited the opposite trends. The binary logistic regression analysis found that SFRP1, SFRP2, SFRP4, and SFRP5 were all negatively correlated with the occurrence of end-point events, while SFRP3 was positively correlated with its occurrence. SFRP levels are all changed in acute AD, which may affect the prognosis of AD patients. SFRPs may be a target to improve the prognosis of AD.

α-HBDH is a Superior to LDH in Predicting Cardiac Injury in Patients with Acute Aortic Dissection

Objective: Acute aortic dissection (AAD) has a high rate of mortality and postoperative complications, but fewer indicators can predict postoperative cardiac injury complications. This study aimed to investigate whether α-HBDH is superior to LDH as a predictor of in-hospital mortality and postoperative cardiac injury in patients with AAD. Methods: In this retrospective study, a total of 369 patients from 2015 to 2021 were enrolled and divided into three groups (T1: low, T2: medium and T3: high) based on the tertiles of α-HBDH levels on admission. The relationship between α-HBDH and AAD was determined by correlation analysis and logistic regression model, with the consolidation using Kaplan-Meier and restricted cubic spline (RCS) analysis for predicting the in-hospital death and cardiac injury complications. Last, the relationship between α-HBDH levels and in-hospital mortality and cardiac injury was further verified through subgroup analysis. Results: In the logistic regression model, α-HBDH in the high-level group was 9.869 times that in the low-level group [OR (95CI): 9.869 (2.148-45.349), P=0.003], while this feature was not observed in LDH [OR (95CI): 1.437 (0.342-6.034), P=0.621]. Kaplan-Meier analysis showed that increased α-HBDH levels within 30 days were associated with poor survival within 30 days in AAD patients (log rank test, P&lt;0.01), especially in acute stanford A dissection. RCS showed that 204 U/L was the optimal cut-off value of α-HBDH for in-hospital mortality and postoperative cardiac injury, which facilitated clinical stratification of patients with AAD. Subgroup analysis confirmed a stable correlation between α-HBDH level and hospital mortality and cardiac injury (P&gt;0.05). Conclusion: α-HBDH would be better than LDH in predicting the in-hospital death and postoperative cardiac injury, guiding admission stratification of patients with AAD.

Serum Sema7A is increased in patients with acute aortic dissection

ABSTRACT Background To observe the level of serum Sema7A in acute aortic dissection (AAD) and its diagnostic value for AAD. Research design and methods Patients with sudden chest pain including AAD, acute myocardial infarction (AMI) or pulmonary embolism (PE) were enrolled. Patients without chest pain or cardiovascular diseases were included as the controls. Serum Sema7A and plasma D-dimer were detected and compared in each group. Results 85 AAD patients, 55 AMI patients, 15 PE patients, and 30 controls were enrolled. The concentration of Serum Sema7A in the AAD group was significantly higher than that in the control, AMI and PE group. Serum Sema7A was positively correlated with D-dimer. In AAD patients who underwent invasive intervention therapy, serum Sema7A levels were significantly decreased after the intervention. Serum Sema7A was an independent risk factor for the presence of AAD. The areas under the ROC curve of Sema7A and D-dimer for differential diagnosis of AAD from other chest pain disorders were 0.842 (0.776, 0.909) and 0.788 (0.714, 0.862), respectively. Conclusions Sema7A is highly expressed in patients with AAD. Sema7A might be a valuable biomarker for the early diagnosis of AAD and has the potential to differentiate AAD from AMI and PE.

The risk factors of postoperative hypoxemia in patients with Stanford type A acute aortic dissection.

Hypoxemia is one of the most common complications in patients after Stanford type A acute aortic dissection surgery. The aim of this study was to investigate the association of circulating ANG II level with postoperative hypoxemia and to identify the risk factors for postoperative hypoxemia in Stanford type A acute aortic dissection patients. In this study, 88 patients who underwent Stanford type A acute aortic dissection surgery were enrolled. Postoperative hypoxemia is defined by the oxygenation index (OI). Perioperative clinical data were collected and the serum ANG II and sACE2 levels were measured. The differences in the basic characteristics, intraoperative details, biochemical parameters, laboratory test data and clinical outcomes were compared between the hypoxemia group and the non-hypoxemia group by univariate analysis. Multivariate logistic regression analysis was performed on the variables with P < .1 in univariate analysis or that were considered clinically important to identify risk factors for postoperative hypoxemia. Twenty-five patients (28.4%) were considered to have postoperative hypoxemia (OI ≤ 200 mm Hg). The ANG II concentration remained a risk factor associated with postoperative hypoxemia [OR = 1.018, 95% CI (1.003-1.034), P = .022]. The other risk factors remaining in the logistic regression model were BMI [OR = 1.417, 95% CI (1.159-1.733), P = .001] and cTnI [OR = 1.003, 95% CI (1.000-1.005), P = .032]. Elevated levels of ANG II, BMI and cTnI are risk factors for postoperative hypoxemia in patients with Stanford type A acute aortic dissection.