Diagnosis Of Aortic Dissection Research Articles

Identification of Key Immune Infiltration Related Genes Involved in Aortic Dissection Using Bioinformatic Analyses and Experimental Verification.

Immune microenvironment plays an important role in aortic dissection (AD). Therefore, novel immune biomarkers may facilitate AD prevention, diagnosis, and treatment. This study aimed at mining key immune-related genes and relevant mechanisms involved in AD pathogenesis. Key immune cells in AD were identified by ssGESA algorithm. Next, genes associated with key immune cells were screened by weighted gene coexpression network analysis (WGCNA). Then hub immune genes were picked from protein-protein interaction network of overlapped genes from differential expression and WGCNA analyses by cytohubba plug-in. Their diagnostic potential was evaluated in two independent cohorts from GEO database. In addition, the expressions of hub immune genes were determined by quantitative RT-PCR, immunohistochemistry, and Western blotting in dissected and normal aortic tissues. Activated B cells, CD56dim natural killer cells, eosinophils, gamma delta T cells, immature B cells, natural killer cells and type 17 T helper cells were identified as key immune cells in AD. Thereafter, a gene module significantly correlated with key immune cells were found by WGCNA method. Subsequently, KDR, IGF1, NOS3, PECAM1, GAPDH, FLT1, DLL4, CDH5, VWF, and TEK were identified as hub immune cell related genes by PPI network analysis, which may be potential diagnostic markers for AD, as evidenced by ROC curves. Moreover, the decreased expression of VWF in AD was validated at both mRNA and protein levels, and its expression was significantly positive correlated with the marker of smooth muscle cells, ACTA2, in AD. Further immunofluorescent results showed that VWF was colocalized with ACTA2 in aortic tissues. We identified key immune cells and hub immune cell-related genes involved in AD. Moreover, we found that VWF was co-expressed with the smooth muscle cell marker ACTA2, indicating the important role of VWF in smooth muscle cell loss in AD pathogenesis.

Vascular Endothelial Growth Factor Inhibitors and the Risk of Aortic Aneurysm and Aortic Dissection

Vascular endothelial growth factor pathway inhibitors (VPIs) pose a concern for aortic aneurysm (AA) and aortic dissection (AD), signaling potential vascular disease development. To investigate VPI-associated AA and AD. This case-control study with a nested design used full population data from a national claims database in Taiwan between 2011 and 2019. Eligible participants were aged 20 years or older with kidney, hepatic, gastrointestinal, or pancreatic cancer diagnosed between January 1, 2012, and December 31, 2019. The first cancer diagnosis date was defined as the cohort entry date. Cases were patients who received a diagnosis of AA or AD in hospitalizations or emergency visits between the cohort entry date and December 31, 2019. Controls were matched by ratio (up to 1:5) based on age, sex, cancer type, cohort entry date, and the index date (ie, the first AA or AD event date). Data analysis was performed between January 2022 and December 2023. Use of the oral VPIs sorafenib, sunitinib, and pazopanib between cohort entry date and index date. In the primary analysis, AA and AD were evaluated compositely, while in the secondary analyses, they were evaluated separately. Adjusted odds ratios (aORs) were calculated using conditional logistic regression to assess the association with VPI use (sorafenib, sunitinib, and pazopanib) considering various VPI exposure windows and cumulative use. A total of 1461 cases were included (mean [SD] age, 73.0 [12.3] years; 1118 male patients [76.5%]), matched to 7198 controls. AA or AD risk increased with a VPI exposure of 100 days or less before the index date (aOR, 2.10; 95% CI, 1.40-3.15), mainly from VPI-associated AD (aOR, 3.09; 95% CI, 1.77-5.39). Longer VPI duration (68 days or more: aOR, 2.64; 95% CI, 1.66-4.19) and higher cumulative dose (61 or more defined daily doses: aOR, 2.65; 95% CI, 1.66-4.23) increased the risk. The use of the 3 study VPIs (sorafenib, sunitinib, and pazopanib) was associated with an increased risk of AA and AD in patients with cancer, essentially all of the risk from VPI-associated AD. Future studies are needed to determine the risk factors of VPI-associated AA and AD, as well as to establish a class effect.

Deep learning-based diagnosis of aortic dissection using an electrocardiogram: Development, validation, and clinical implications of the AADE score.

Aortic dissection (AD) is frequently associated with abnormalities in electrocardiographic findings. Advancements in medical technology present an opportunity to leverage these observations to improve patient diagnosis and care. This study aimed to develop a deep learning artificial intelligence (AI) model for AD detection using electrocardiograms (ECGs) and introduce the AI-Aortic-Dissection-ECG (AADE) score to provide clinicians with a measure to determine AD severity. From a cohort of 1878 patients, including 313 with AD, and 313 with chest pain (control group), we created training and validation subsets (7:3 ratio). A convolutional neural networks (CNN) model was trained for AD detection, with performance metrics like accuracy and F1 score (the harmonic mean of precision and recall) monitored. The AI-derived AADE score (0-1) was investigated against clinical parameters and ECG features over a median follow-up of 21.2 months. The CNN model demonstrated robust performance with an accuracy of 0.93 and an F1 score of 0.93 for the AD group, and an accuracy of 0.871 with an F1 score of 0.867 for the chest pain group. The AADE score showed correlations with specific ECG patterns and demonstrated that higher scores aligned with increased mortality risk. Our CNN-based AI model offers a promising approach for AD detection using ECG. The AADE score, based on AI, can serve as a pivotal tool in refining clinical assessments and management strategies.

Anatomically realistic aortic dissection simulator as a potential training tool for point-of-care ultrasound.

Simulators for aortic dissection diagnosis are limited by complex anatomy influencing the accuracy of point-of-care ultrasound for diagnosing aortic dissection. Therefore, this study aimed to create a healthy ascending aorta and class DeBakey, type II aortic dissection simulator as a potential point-of-care ultrasound training model. 3D mould simulators were created based on computed tomography images of one healthy and one DeBakey type II aortic dissection patient. In the next step, two polyvinyl alcohol-based and two silicone-based simulators were synthesised. The results of the scanning electron microscope assessment showed an aortic dissection simulator's surface with disorganised surface texture and higher root mean square (RMS or Rq) value than the healthy model of polyvinyl alcohol (RqAD = 20.28 > RqAAo = 10.26) and silicone (RqAD = 33.8 > RqAAo = 23.07). The ultrasound assessment of diameter aortic dissection showed higher than the healthy ascending aorta in polyvinyl alcohol (dAD = 28.2 mm > dAAo = 20.2 mm) and Si (dAD = 31.0 mm > dAAo = 22.4 mm), while the wall thickness of aortic dissection showed thinner than the healthy aorta in polyvinyl alcohol, which is comparable with the actual aorta measurement. The intimal flap of aortic dissection was able to replicate and showed a false lumen in the ultrasound images. The flap was measured quantitatively, indicating that the intimal flap was hyperechoic. The simulators were able to replicate the surface morphology and echogenicity of the intimal flap, which is a linear hyperechoic area representing the separation of the aorta wall.

Thoracic and abdominal aortic dissection in a hypertensive hyperthyroid cat

Aortic dissection is an uncommon finding in both dogs and cats. The precise pathophysiological mechanisms responsible for the development of aortic dissection remain unclear. In humans, aortic dissection is usually secondary to another systemic disease, such as systemic arterial hypertension, an abnormality of connective tissues or a parietal trauma. This is a case of an aortic dissection in a hypertensive hyperthyroid cat, presenting with haemorrhagic pericardial effusion. The dissection affected both thoracic and abdominal aorta, with histopathological confirmation. This case is an example of the utility of both thoracic and abdominal ultrasound for the diagnosis of aortic dissection in cats and it highlights the importance of rigorous clinical examination. Aortic dissection should be considered in the differential diagnosis of pericardial effusion in cats. Further investigations are fundamental to understand how dissections develop and extend to achieve good clinical results.
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Blue esophagus as a diagnosis of aortic dissection.

A 76-year-old patient, admitted to the department of cardiac surgery, anticoagulated, started with acute dysphagia. An upper endoscopy revealed a blue mucosa from the upper to distal esophagus, with narrowing of the lumen caused by an extrinsic compression. A computed to¬mography (CT) of the thorax was performed, showing a 85x55 mm mediastinal hematoma causing extrinsic compression of the esophagus. Subsequently, a contrast-enhanced CT scan was performed, confirming a contained rupture of descending thoracic aortic dissection as the cause of the hematoma.

Improved detection of aortic dissection in non-contrast-enhanced chest CT using an attention-based deep learning model

Rationale and objectivesThis study investigated the effects of implementing an attention-based deep learning model for the detection of aortic dissection (AD) using non-contrast-enhanced chest computed tomography (CT). Materials and methodsWe analysed the records of 1300 patients who underwent contrast-enhanced chest CT at 2 medical centres between January 2015 and February 2023. We considered an internal cohort of 200 patients with AD and 200 patients without AD and an external test cohort of 40 patients with AD and 40 patients without AD. The internal cohort was divided into training and test sets, and a deep learning model was trained using 9600 CT images. A convolutional block attention module (CBAM) and a traditional deep learning architecture (namely, You Only Look Once version 5 [YOLOv5]) were combined into an attention-based model (i.e., YOLOv5-CBAM). Its performance was measured against the unmodified YOLOv5 model, and the accuracy, sensitivity, and specificity of the algorithm were evaluated by two independent radiologists. ResultsThe CBAM-based model outperformed the traditional deep learning model. In the external testing set, YOLOv5-CBAM achieved an area under the curve (AUC) of 0.938, accuracy of 91.5 %, sensitivity of 90.0 %, and specificity of 92.9 %, whereas the unmodified model achieved an AUC of 0.844, accuracy of 83.6 %, sensitivity of 71.2 %, and specificity of 96.0 %. The sensitivity results of the unmodified algorithms were not significantly different from those of the radiologists; however, the proposed YOLOv5-CBAM algorithm outperformed the unmodified algorithms in terms of detection. ConclusionsIncorporating the CBAM attention mechanism into a deep learning model can significantly improve AD detection in non-contrast-enhanced chest CT. This approach may aid radiologists in the timely and accurate diagnosis of AD, which is important for improving patient outcomes.

Role of Multidetector Computed Tomography Angiography in Association with Virtual Computed Tomography in Diagnosis of Aortic Dissection

Role of Multidetector Computed Tomography Angiography in Association with Virtual Computed Tomography in Diagnosis of Aortic Dissection

Retracted: SERPINE1 Gene Is a Reliable Molecular Marker for the Early Diagnosis of Aortic Dissection.

[This retracts the article DOI: 10.1155/2022/5433868.].

Analysis of clinical characteristics and imagological features of the aortic dissection patients with negative D-dimer results.

D-dimer (DD) is a vital biomarker to rule out the diagnosis of aortic dissection (AD). However, the DD level in some patients with AD is not high in clinical practice, which often leads to missed diagnosis; therefore, understanding the characteristics of patients with AD and negative DD is of great clinical value. From May 2015 to October 2020, 286 patients with AD who visited the first medical contact (FMC) within 24 h of symptom onset and were hospitalized in the Xiamen Cardiovascular Hospital of Xiamen University were enrolled in this study. Clinical characteristics and outcomes of patients were assessed. Among them, 13 cases (approximately 4.5%) had negative DD results. Compared to patients with positive DD results, patients with negative DD results had significantly higher platelet counts and lower aortic dissection detection risk scores (ADD-RS). The imagological analysis showed that patients with AD and negative DD had lower extension scores and milder damage to the mesenteric artery and three branches of the aortic arch. Furthermore, the results of the multivariable analysis showed that white blood cell count (WBC) [odds ratio (OR): 1.379, P = 0.028], FMC (OR: 0.904, P = 0.028), and extension score (OR: 1.623, P = 0.046) were associated with negative DD result. Patients with AD and negative DD results had longer FMC and lower WBC. Imaging showed a smaller tear extension range and less damage to the mesenteric artery and three branches of the aortic arch. A negative DD result could not completely rule out AD even if the ADD-RS was zero.

The Successful Replacement of Aortic Valve and Ascending Aorta in Patients with Type A Aortic Dissection in the Postpartum Period. The Analysis of Literature and Demonstration of Own Observations

Abstract. Aortic dissection is a rupture of the inner layer of the aorta with subsequent penetration of blood into the degeneratively altered middle layer with the formation of false lumen and true lumen. Pregnancy is one of the risk factors for the development of aortic dissection. The incidence of aortic dissection during pregnancy is only 0.0004% of cases.Aim of the study. To analyze national and foreign literature, as well as share own clinical observations in the diagnosis and treatment of patients with aortic dissection in the postpartum period.Material and methods. Two patients after successful childbirth, in the late postpartum period, were admitted with a diagnosis of aortic dissection type A according to Stanford.CT angiography confirmed the presence of Stanford type A aortic dissection. After additional examination, surgical treatment was performed to replace the aortic valve and ascending aorta under artificial circulation, with a satisfactory clinical result.Conclusion. The diagnosis of aortic dissection should be considered in all pregnant women with chest pain, as this condition often goes undiagnosed.The pregnancy period is one of the risk factors for the development of aortic dissection with a high mortality rate. The likelihood of developing aortic dissection in women at risk peaks in the third trimester and the first 12 weeks after delivery.The risk group should include women with confirmed syndromic and non-syndromic genetic diseases, bicuspid aortic valve, coarctation of the aorta, or at least one major criterion indicating the presence of aortopathy (ectopia lentis, aortic aneurysm, habitus, genetic testing).If Marfan syndrome is present, surgical intervention should be considered if the maximum aortic diameter is more than 4.5 cm before pregnancy. In women with Marfan syndrome and aortic dissection in the family history, as well as in the presence of more aggressive genetic diseases (Loeys-Dietz syndrome, Ehlers-Danlos syndrome), it is possible to consider preventive surgical treatment for an aortic diameter of 4.0 cm or more.The delivery in high-risk patients is recommended to be performed in a hospital that has a cardiac surgery service and an “aortic” team.

Study on preoperative treatment of acute Type-A aortic dissection with endotracheal intubation combined with deep analgesia and sedation.

To investigate the efficacy and safety of endotracheal intubation combined with deep analgesia and sedation in the prevention of preoperative dissection rupture in acute Standford type A aortic dissection. This study evaluated the impact of preoperative endotracheal intubation combined with deep analgesia and sedation on acute Stanford Type-A aortic dissection. Conducted at the First Affiliated Hospital of the University of South China's cardiac intensive care unit from June 2018 to December 2021, 134 diagnosed patients participated. They were divided into experimental (n=42) and control (n=92) groups. Data collected included clinical details, biochemical markers, VAS and SAS scores, and preoperative dissection rupture occurrences. Criteria involved acute Stanford Type-A aortic dissection diagnosis and complete data. Exclusions encompassed rupture, vital sign instability after vasoactive drugs, or prolonged coma. Standardized methods were used for sample collection and analysis. The study's design, duration, and location ensured comprehensive evaluation of the intervention's effects on patients. The experimental group showed significantly fewer deaths due to dissection rupture compared to the control group (P < 0.05). Initial VAS and SAS scores (T0) were similar between groups (P > 0.05), indicating good comparability. However, at T1, T2, and T3, analgesia and sedation were significantly better in the experimental group (P < 0.05). By T4, patient numbers were too low in both groups for a significant difference (P > 0.05). Preoperative endotracheal intubation combined with deep analgesia and sedation in patients with acute Stanford Type-A aortic dissection can produce good analgesic and sedative effects, effectively reduce the incidence of preoperative dissection rupture, and create conditions for subsequent surgical treatment of patients.

Clinical analysis of 908 patients with aortic dissection under different Stanford types: A cross-sectional study.

This study aims to investigate the difference of clinical characteristics and risk factors in aortic dissection (AD) of patients with 2 Stanford subtypes. A retrospective analysis was conducted on 908 patients admitted to Tongji Hospital from July 2019 to January 2021, and the aortic computed tomography angiography was used to clearly diagnose the artery dissection. Patient basic information as well as blood test indicators containing leukocytes, neutrophils, lymphocytes, hemoglobin, myoglobin, hypersensitive cardiac troponin, γ-glutamyl transferase, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, ultrasensitive C-reactive protein, glucose were recorded and analyzed. There was no significant difference in gender, heart rate, smoking history, hypertension history and diabetes history between the 2 groups (P > .05), however, compared with type A patients, type B patients were older, and had a significantly higher frequency of alcohol consumption (P < .05); On laboratory tests, type A patients had significantly higher mean leukocytes and neutrophils (P < .05), and significantly lower frequency of reduced hemoglobin than type B patients (P < .05), although there was no statistical difference in lymphocyte, γ-glutamyl transferase, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein and glucose counts between the 2 groups. Additionally, type A patients had a significantly higher number of abnormal myoglobin, hypersensitive cardiac troponin and ultrasensitive C-reactive protein test results than type B patients (P < .05). The receiver operating characteristic curve analysis showed that the area under the curve for each parameter was 0.605 (0.538-0.673) for hemoglobin, 0.610 (0.543-0.677) for leukocytes and 0.627 (0.561-0.693) for neutrophils. Understanding the relevant clinical indicators and risk factors of patients with different types of AD can provide a new perspective to assist the classification and diagnosis of AD and a basis for effective and rational treatment.

The clinical value of echocardiography combined with transabdominal vascular ultrasound in the diagnosis of different types of aortic dissection.

To analyze the clinical values of echocardiography combined with vascular ultrasound in the diagnosis of aortic dissection according to the DeBakey classification. The clinical data of 77 patients with aortic dissection admitted to our hospital from August 2016 to January 2022 were retrospectively analyzed. All patients were examined with ultrasound and CT angiography (CTA), the consistency between ultrasound and CTA ± intraoperative diagnosis for the classification of AD was checked, as well as the differences in ultrasound signs and Ultrasound parameters between different types of AD were analyzed. The results of Kappa value: There was a high level of agreement between echocardiography combined with transabdominal vascular ultrasound and CTA ± intraoperative diagnosis for the classification of AD (Kappa = 0.897, p = 0.000). In the ultrasound signs, the proportion of pericardial effusion, aortic regurgitation, aortic widening, and coronary artery involvement in type DeBakey I and II aortic dissection was significantly higher than that in Type III. There was no significant difference in the proportion of intimal floating, true and false lumen, and intimal rupture in Types I, II, and III aortic dissections. In the comparison of ultrasound parameters, there is a statistically significant difference in the values of LAD (left atrial diameter), LAV (left atrial volume), and LVEDD (left ventricular end-diastolic diameter) among different types of aortic dissection. There is no significant difference in IVS (interventricular septum thickness), LVPW (left ventricular posterior wall thickness), LVEF (left ventricular ejection fraction), and E/e' ratio among different types of aortic dissection. Echocardiography combined with transabdominal vascular ultrasound can accurately evaluate aortic dissection with real-time dynamic images and provide important clinical significance for early individualized treatment of patients through accurate classification of different aortic dissection.

Aortic dissection induced by vascular endothelial growth factor inhibitors.

Vascular endothelial growth factor (VEGF) contributes to angiogenesis and vasculogenesis. The occurrence and progression of tumors are accompanied by angiogenesis. Vascular endothelial growth factor inhibitors (VEGFI) have been used in anti-tumor treatment. However, aortic dissection (AD) is one of the VEGFI-associated adverse reactions with cute onset, rapid progression, and high case fatality rate. We collected case reports of VEGFI related to aortic dissection in PubMed and CNKI (China National Knowledge Infrastructure) from inception to 28 April 2022. Seventeen case reports were selected. The medication included sunitinib, sorafenib, pazopanib, axitinib, apatinib, anlotinib, bevacizumab, and ramucirumab. This review discusses the pathology, risk factors, diagnosis, and treatment of AD. Vascular endothelial growth factor inhibitors are related to aortic dissection. Although current literature lacks clear statistical evidence on the population, we offer points to encourage further confirmation of the best methods of care for these patients.

P304 ACUTE ST–ELEVATION MYOCARDIAL INFARCTION DUE TO AORTIC DISSECTION: HISTORY OF A LATE DIAGNOSIS AFTER PRIMARY ANGIOPLASTY

Abstract Introduction We report a case of aortic type A dissection, involving the right coronary ostium, presented as an inferior STEMI. The aortic dissection diagnosis was formulated only after the coronary angioplasty on the right coronary was successfully done, leading to chest pain resolution. Dual antiplatelet therapy was administered. We want to underline how sometimes, mostly in emergencies, can be difficult to do the right diagnosis at the right time, even if some angiographic findings could help us to avoid life–threatening mistakes. Case presentation: 60 years–old man with typical angina chest pain started after an effort. The electrocardiogram showed ST elevation in inferior leads, while the echocardiogram akinesia of the inferior wall, a preserved EF, a normal diameter of the aortic root, no dissection signs, no pericardial effusion. The coronary angiography showed ostial RCA occlusion, critical stenosis in mid–distal LAD. Angioplasty on the RCA ostium with one drug–eluting stent (DES 3.5 x 18 mm) achieving reperfusion with TIMI 3 flow, complete resolution of ECG alteration and symptoms. Then PCI of LAD with DES was performed. During hospitalization in ICU recurrence of mild chest pain without ECG alterations. Routine echocardiogram performed the following day showed signs of aortic root dissection and moderate aortic valve regurgitation; an angio–CT scan was immediately performed confirming the aortic dissection, and cardiac surgery was immediately performed with good result. Reanalysis of the angiographic images showed some signs that should have made us think right away of an aortic dissection: abnormal convexity of the right coronary sinus, extravascular stagnation of contrast medium, and ostial RCA stent create a communication between the real and the false lumen, visible at the final injection. Conclusion Aortic root dissection, involving coronary ostium, could be a sneaky diagnosis since signs and symptoms could be very similar to myocardial infarction ones. A correct diagnosis is very important, leading to the right surgery treatment, the PCI and the dual antiplatelet therapy could lead to worsening outcomes. It is mandatory to pay attention to the signs that could help us doing the right diagnosis when we are performing coronary angiography. Always check the patient accurately during the ICU stay in order not to lose signs that can let us change the wrong to the correct diagnosis.

Surrogate-Assisted Hybrid-Model Estimation of Distribution Algorithm for Mixed-Variable Hyperparameters Optimization in Convolutional Neural Networks.

The performance of a convolutional neural network (CNN) heavily depends on its hyperparameters. However, finding a suitable hyperparameters configuration is difficult, challenging, and computationally expensive due to three issues, which are 1) the mixed-variable problem of different types of hyperparameters; 2) the large-scale search space of finding optimal hyperparameters; and 3) the expensive computational cost for evaluating candidate hyperparameters configuration. Therefore, this article focuses on these three issues and proposes a novel estimation of distribution algorithm (EDA) for efficient hyperparameters optimization, with three major contributions in the algorithm design. First, a hybrid-model EDA is proposed to efficiently deal with the mixed-variable difficulty. The proposed algorithm uses a mixed-variable encoding scheme to encode the mixed-variable hyperparameters and adopts an adaptive hybrid-model learning (AHL) strategy to efficiently optimize the mixed-variables. Second, an orthogonal initialization (OI) strategy is proposed to efficiently deal with the challenge of large-scale search space. Third, a surrogate-assisted multi-level evaluation (SME) method is proposed to reduce the expensive computational cost. Based on the above, the proposed algorithm is named s urrogate-assisted hybrid-model EDA (SHEDA). For experimental studies, the proposed SHEDA is verified on widely used classification benchmark problems, and is compared with various state-of-the-art methods. Moreover, a case study on aortic dissection (AD) diagnosis is carried out to evaluate its performance. Experimental results show that the proposed SHEDA is very effective and efficient for hyperparameters optimization, which can find a satisfactory hyperparameters configuration for the CIFAR10, CIFAR100, and AD diagnosis with only 0.58, 0.97, and 1.18 GPU days, respectively.

A CASE SERIES ON AORTIC DISSECTION – A CODE BLUE MEDICAL EMERGENCY

Introduction: Aortic dissection (AD) is a life-threatening clinical emergency requiring rapid diagnosis and effective intervention to improve patient survival and prognosis. Computed tomography angiography (CTA) can be used to diagnose AD accurately and quickly, making it the rst choice for diagnosing AD in an emergency. Early and accurate diagnosis will save a life. Here we present six cases we faced in sequence over a period of 1 year. A case of extensive dissection involving ascending and descending aorta till left common iliac artery and right proximal femoral artery up to brachiocephalic trunk , left common carotid and left subclavian artery- Stanford Type A/ Debakey Type I , is displayed in detail. Four cases with Stanford type A and one case with Type B Stanford Classication of Aortic Dissection will be discussed here. CTA is the best imaging method for the rapid diagnosis of AD, showing high specicity and sensitivity. Thus, this case series emphasizes the value of CTA as a gold standard diagnostic modality in cases with AD.

Clinical analysis of 11 cases of pregnancy with aortic dissection

Objective: To investigate the treatment and maternal and fetal outcomes of pregnant women with aortic dissection (AD). Methods: The clinical data of 11 pregnant women with AD treated at the First Affiliated Hospital of Air Force Military Medical University from January 1st, 2011 to August 1st, 2022 were collected, and their clinical characteristics, treatment plans and maternal and fetal outcomes were analyzed retrospectively. Results: (1) Clinical characteristics: the age of onset of 11 pregnant women with AD was (30±5) years old, and the week of pregnancy of onset was (31.4±8.0) weeks. Clinical manifestations: the main symptoms were sudden onset of chest and back pain or low back pain. Type of AD: 8 cases of Stanford type A, and 3 cases of type B. The aortic width was (42±11) mm. Diagnostic methods: the diagnosis of AD was confirmed by transthoracic echocardiography (TTE), computed tomography angiography (CTA) or enhanced CT examination, among which 4 cases were confirmed by CTA examination, 4 cases by TTE examination, and 3 cases by enhanced CT examination. Laboratory results: white blood cell count was (15.4±8.7) ×109/L, neutrophil count was (13.5±8.5) ×109/L, the median D-dimer level was 2.7 mg/L (2.1-9.2 mg/L), and the median fibrin degradation products level was 12.0 mg/L (5.4-36.1 mg/L). (2) Treatments: all 11 patients were admitted to hospital in emergency. Before operation, the departments of cardiac surgery, obstetrics, pediatrics and anesthesiology cooperated to develop individualized treatment plan. Aortic surgery was performed in 11 pregnant women with AD. In 6 of them, pregnancy termination was performed at the same time as aortic surgery, and aortic surgery was performed after cesarean section. Four cases of pregnancy termination and aortic operation were performed by stages, including aortic operation after cesarean section in 2 cases, and cesarean section after aortic operation in 2 cases. One case (12+6 weeks of gestation) had spontaneous abortion on the day after aortic surgery. The gestational age of the 11 patients on pregnancy termination was (32.9±7.4) weeks. Aorta surgical methods: 7 patients received under extracorporeal circulation ascending aorta replacement ± aortic valve replacement ± coronary artery transplantation (or coronary artery bypass transplantation)± left and right coronary Cabrol + total arch replacement (or aortic arch replacement)± stent implantation, 1 patient received under extracorporeal circulation aortic root replacement, and 3 patients underwent aortic endoluminal isolation. (3) Maternal and fetal outcomes: among the 11 pregnant women with AD, 9 (9/11) survived, 2 (2/11) died with lower limb ischemia before the onset of the disease. A total of 10 newborns were born in 9 pregnant women after delivery (1 of them was twins), and the 2 cases were spontaneous abortion after aortic surgery in the first trimester (12+6 weeks) and fetal death after hysterotomy in the second trimester (26+3 weeks), respectively. Among the 10 surviving neonates, 3 were full-term infants and 7 were premature infants. The birth weight of newborn was (2 651±784) g. Respiratory distress syndrome was found in 6 cases. The newborns were followed up for (5.6±3.6) years after birth, and the infants developed well during the follow-up period. Conclusions: Pregnancy complicated with AD is dangerous, and chest and back pain is the main clinical manifestation of this disease. With early identification and selection of appropriate diagnostic methods, multidisciplinary diagnosis and treatment, mother and children could obtain good outcomes.

The combined use of D-dimer testing and the neutrophil-to-lymphocyte ratio in the early differential diagnosis of aortic dissection

ABSTRACT Background The study aimed to ascertain whether a diagnostic strategy combining D-dimer with the neutrophil-to-lymphocyte ratio (NLR) could improve the discriminative performance for aortic dissection (AD). Research design and methods Baseline levels of D-dimer and NLR were measured in patients suspected of AD. The diagnostic performance and clinical usefulness of D-dimer, NLR, and their combination were assessed and compared using receiver operating characteristics (ROC) curve analysis, logistic regression analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). Results The levels of D-dimer and NLR were both significantly higher in AD patients. The combined use displayed good discriminatory performance with an area under ROC curve (AUC) of 0.869, which was preferable to that of D-dimer. Although no meaningful improvement was found in the AUC by comparison with NLR alone, the combined use could significantly improve the discrimination power with a continuous NRI of 60.0% and an IDI of 4.9%. DCA demonstrated that the net benefit of the combined use was preferred over that of either single test. Conclusions The combined use of D-dimer and NLR could improve the discriminatory efficiency for AD with the potential in clinical application. This study may provide a novel diagnostic strategy for AD. More studies need to be done to confirm the findings of this study.