Incidence Of Acute Aortic Dissection Research Articles

LPS-LBP complex induced endothelial cell pyroptosis in aortic dissection is associated with gut dysbiosis

Acute aortic dissection (AAD) is the most severe traumatic disease affecting the aorta. Pyroptosis-mediated vascular wall inflammation is a crucial trigger for AAD, and the exact mechanism requires further investigation. In this study, our proteomic analysis showed that Lipopolysaccharide (LPS)-binding protein (LBP) was significantly upregulated in the plasma and aortic tissue of patients with AAD. Further, 16S rRNA sequencing of stool samples suggested that patients with AAD exhibit gut dysbiosis, which may lead to an impaired intestinal barrier and LPS leakage. By comparing with control mice, we found that LBP, including Pyrin Domain Containing Protein3 (NLRP3), the CARD-containing adapter apoptosis-associated speck-like protein (ASC), and Cleaved caspase-1, were upregulated in the AAD aorta, whereas gut intestinal barrier-related proteins were downregulated. Moreover, treated with LBPK95A (an LBP inhibitor) attenuated the incidence of AAD, the expression levels of pyroptosis-related factors, and the extent of vascular pathological changes compared to those in AAD mice. In addition, LPS and LBP treatment of human umbilical vein endothelial cells (HUVECs) activated TLR4 signaling and intracellular reactive oxygen species (ROS) production, which stimulated NLRP3 inflammasome formation and mediated pyroptosis in endothelial cells. Our findings showed that gut dysbiosis mediates pyroptosis by the LPS-LBP complex, thus providing new insights into developing AAD.

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...

Population-Based Study of the Incidence and Mortality Rate of Acute Aortic Dissection.

Acute aortic dissection (AAD) has high morbidity and a high fatality rate for a cardiovascular disease. Recent studies suggested that the incidence of AAD is increasing. However, the actual incidence and mortality rates of AAD are not well known. This study investigated the current epidemiology of AAD within the Yatsushiro medical jurisdictional area. A population-based review of patients with AAD was performed in a geographically well-defined area. Data were collected retrospectively from January 2011 to December 2020 for a total of 196 patients with AAD (Stanford Type A, n=126 [64.3%]; Stanford Type B, n=70 [35.7%]). The mean patient age was 74.3 years, and 55.6% (109/196) were women. The crude and age-standardized incidence rates of AAD in our medical jurisdictional area were 13.6 and 11.4 per 100,000 inhabitants per year, respectively. The crude and age-standardized 30-day mortality rates of AAD were 4.9 and 4.0 per 100,000 inhabitants per year, respectively. There were upward tendencies for both the incidence and 30-day mortality rate of AAD with age, with both being significantly higher in patients aged ≥85 years (P<0.001). This population-based study detected a higher incidence of AAD than previous studies, but reported a lower incidence of AAD in men than in women. Increasing age was associated with an increased incidence and mortality rate of AAD.

MiR-590-3p Promotes the Phenotypic Switching of Vascular Smooth Muscle Cells by Targeting Lysyl Oxidase.

We investigated the clinical characteristics of patients with acute aortic dissection (AAD) and miR-590-3p levels in serum, tissue, and vascular smooth muscle cells. The effect of miR-590-3p on the vascular smooth muscle cell phenotype was assessed, and the regulation of lysyl oxidase by miR-5903p was determined. C57BL/6 mice were used to investigate the incidence of AAD and effects of miR-5903p on AAD. The miR-590-3p levels were measured in the aortae of mice, and hematoxylin and eosin staining and Masson staining were performed to identify the morphological features of the aorta. Comparative analysis revealed significant differences in clinical characteristics between patients with AAD and healthy control subjects, with most patients with AAD exhibiting concomitant hypertension and nearly 50% having atherosclerosis. Lysyl oxidase was a direct target of miR-590-3p. Lysyl oxidase overexpression inhibited switching of the vascular smooth muscle cell phenotype from contractile to synthetic, but miR-590-3p overexpression significantly reversed this change. In the mouse model, miR-590-3p upregulation increased the incidence of AAD to 93.3%, and its incidence decreased to 13.3% after miR-590-3p inhibition. Hematoxylin and eosin and Masson staining revealed that the miR-590-3p agomiR group had a greater loss of the contractile phenotype in the dissected aortic wall and an increased number of muscle fibers in the aortic wall, which contributed to thickening of the aortic wall and the formation of a false lumen in aortic dissection. miR-590-3p might be pivotal in the pathogenesis of AAD. Thus, targeting miR-590-3p or its downstream pathways could represent a therapeutic approach for AAD.

Incidence of acute aortic dissections in patients with out of hospital cardiac arrest: A systematic review and meta-analysis of observational studies.

ObjectivesAcute Aortic dissection (AAD) may present as out-of-hospital cardiac arrest (OHCA). However, the incidence of this presentation is not well known. Our aim was to perform a systematic review and meta-analysis of all observational studies reporting on the incidence of AAD in patients with OHCA.MethodsWe searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey databases from inception to March-2021, for observational studies reporting on the incidence of AAD in patients with OHCA. Data was pooled using a random-effects model of proportions. The primary outcome was the incidence of AAD in OHCA patients. Secondary outcomes were the incidence of type A aortic dissections (TAAD) and type B aortic dissections (TBAD) in OHCA patients, overall mortality following AAD-OHCA and risk of death in AAD-OHCA patients compared to risk of death of non-AAD-OHCA patients.ResultsFourteen studies were included. The pooled calculated incidence of OHCA due to AAD was 4.39% (95 %CI: 2.55; 6.8). Incidence of OHCA due to TAAD was 7.18% (95 %CI: 5.61; 8.93) and incidence of OHCA due to TBAD was 0.47% (95 %CI: 0.18; 0.85). Overall mortality following OHCA due to AAD was 100% (95 %CI: 97.62; 100). The risk of death in AAD-OHCA patients compared with non-AAD-OHCA patients was 1.10 (95 %CI: 0.94; 1.30).ConclusionAAD as a cause of OHCA is more frequent than previously thought. Prognosis is dire, as it is invariably lethal. These findings should lead to a higher awareness of AAD when approaching a patient with OHCA and to future studies on this matter.

Low ambient temperature and temperature drop between neighbouring days and acute aortic dissection: a case-crossover study.

The incidence of acute aortic dissection (AAD) has been shown to have seasonal variation, but whether this variation can be explained by non-optimum ambient temperature and temperature change between neighbouring days (TCN) is not clear. We performed a time-stratified case-crossover study in the Registry of Aortic Dissection in China covering 14 tertiary hospitals in 11 cities from 2009 to 2019. A total of 8182 cases of AAD were included. Weather data at residential address were matched from nearby monitoring stations. Conditional logistic regression model and distributed lag nonlinear model were used to estimate the associations of daily temperature and TCN with AAD, adjusting for possible confounders. We observed an increase of AAD risk with lower temperature cumulated over lag 0-1 day and this association became statistically significant when daily mean temperature was below 24°C. Relative to the referent temperature (28°C), the odds ratios (ORs) of AAD onset at extremely low (-10°C) and low (1°C) temperature cumulated over lag 0-1 day were 2.84 [95% confidence interval (CI): 1.69, 4.75] and 2.36 (95% CI: 1.61, 3.47), respectively. A negative TCN was associated with increased risk of AAD. The OR of AAD cumulated over lag 0-6 days was 2.66 (95% CI: 1.76, 4.02) comparing the extremely negative TCN (-7°C) to no temperature change. In contrast, a positive TCN was associated with reduced AAD risk. This study provides novel and robust evidence that low ambient temperature and temperature drop between neighbouring days were associated with increased risk of AAD onset. Incidence of acute aortic dissection (AAD) was reported to have seasonal trends, but it remains unclear whether non-optimum ambient temperature and temperature change between neighbouring days (TCN) is associated with AAD onset. Daily mean temperature lower than 24°C was significantly associated with increased risk of AAD at lag 0-1 day. A negative TCN (temperature drop) was associated with increased risk of AAD, whereas a positive TCN was associated with decreased risk. This multi-centre, case-crossover study provides novel and robust evidence that low ambient temperature and temperature drop between neighbouring days were associated with increased AAD risk.

Population-based incidence and outcomes of acute aortic dissection in Japan

Abstract Background The population-based incidence and outcomes of acute aortic dissection (AAD) are still unknown because some patients are already dead on arrival at the hospital, and the accurate diagnosis of AAD is difficult due to the low autopsy rate for patients with cardiopulmonary arrest outside of the hospital. We performed a population-based review of all patients with AAD in a well-defined geographical area in the southern part of Japan between 2016 and 2018. Methods Data of all patients with AAD at our Hospital, which performs medical care for 120,000 residents, were collected retrospectively. The emergency medical service is dedicated to the transfer of all patients in this area to the MPNH. For all patients who were dead on arrival, the diagnosis of AAD was made by autopsy imaging (AI) using computed tomography. The age-adjusted incidence and mortality per 100,000 population were calculated using the Japanese population distribution model in 2015. Results The total incidence of AAD was 79 (type A: 64.5%, n=51). Of those, 60.8% (31/51) of patients with type A and 21.4% (6/28) with type B were dead on arrival and diagnosed by AI. The 30-day mortality rates after the onset of AAD were 74.5% (38/51) in type A and 25.0% (7/28) in type B. Excluding the dead-on-arrival patients, the 30-day mortality rates were 35.0% (7/20) in type A and 4.5% (1/22) in type B. The age-adjusted incidence and mortality of AAD per 100,000 inhabitants were 17.3 (type A: 11.3, type B: 6.0) and 9.6 (type A: 8.4, type B: 1.2), respectively. Both values were significantly higher in men than in women. Conclusions The population-based survey of emergency medical care for AAD showed that the age-adjusted incidence of AAD was two-fold higher than in previous reports, and the actual mortality rates after AAD onset were markedly higher due to the high incidence of dead-on-arrival. Funding Acknowledgement Type of funding sources: None. Representative CT images of type A AAD

Changes in aortic collagen in β-aminopropionitrile-induced acute aortic dissection.

BackgroundThe precise role collagen plays in acute aortic dissection (AAD) was investigated in an animal model of β-aminopropinitrile (BAPN)-induced AAD.MethodsThe 30 3-week-old male specific-pathogen free (SPF)-grade Sprague-Dawley (SD) rats were randomly divided into two groups: 10 in the Control group and 20 in the Model group. The Model group was treated with 0.1% BAPN for 4 weeks, while the Control group received untreated water. Histopathological staining and western blot were used to detect changes of the extracellular matrix (ECM) and collagen content in the aorta.ResultsAt the end of the experiment, the incidence of AAD was 25%, the aortic ECM of surviving rats was severely damaged, and the arrangement was disordered. Fibroblast cells are unevenly distributed, with wide gaps, collagen fibers were also distributed unevenly in a disordered arrangement and their thickness was uneven. The elastic membrane disappeared over a large area. Compare to Control group, the Collagen types I, III and their subunits were upregulated (P<0.05), while matrix metalloproteinase (MMP) 2 and MMP9 were downregulated in the aorta of Model group (P<0.05).ConclusionsIn the animal model of BAPN-induced AAD, collagen types I, III and subunits were increased, while MMP2 and MMP9 were decreased in thoracic aorta, which may lead to stiffness of the aorta and be the cause of dissection.

THORACOABDOMINAL AORTIC DISSECTION: ATYPICAL PRESENTATION AND MULTIORGAN DAMAGE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute Aortic Dissection (AoD) is the disruption of the tunica intima and tunica media of the aortic wall forming a blood-filled dissection plane dividing into "true" and "false" lumen. We categorize AoD as Type A and Type B (Stanford classification) based on the part of the aorta involved. However, an accurate diagnosis is difficult due to inconsistent clinical presentations (typically present with tearing chest pain radiating to the back). This is a unique clinical case of an atypical presentation with a complicated clinical course. CASE PRESENTATION: A 53-year-old man with untreated hypertension presented to the emergency room (ER) with worsening right lower extremity (RLE) pain and numbness for 6 days, aggravated with ambulation along with right lower quadrant (RLQ) abdominal pain. He endorses extensive tobacco, alcohol, marijuana, and cocaine use. In the ER, the blood pressure was 275/142 mmHg, biventricular hypertrophy on the EKG. He also had RLQ tenderness and diminished pulses in the RLE. The abdominal computed tomography (CT) discovered a distal abdominal aortic division. The larger false lumen dissected the left renal artery, left common iliac artery, with thrombosis of the left internal iliac artery. The narrow true lumen minimizes perfusion to the RLE and the right kidney. CT angiography of the chest confirmed a Stanford Type B aortic dissection with the intimal tear distal to the left subclavian artery. Intravenous Nicardipine and Esmolol drip controlled the blood pressure, followed by a femorofemoral bypass to improve RLE perfusion. Post-operative contrast nephropathy improved on day 10. Subsequently, a persistent ileus due to poor intestinal perfusion was corrected by transverse loop colostomy on day 15. On day 20, the patient was discharged with oral antihypertensive medications. DISCUSSION: The incidence of AoD is 5-30 per million people per year. 38% of ER presentations are missed; 28% are diagnosed at autopsy. Hypertension, atherosclerosis, cocaine abuse, cardiac surgeries, and systemic inflammatory syndromes can increase risk. Sullivan et al. suggest that a physician suspects AoD in 86% of patients with chest and back pain, 45% with only chest pain, and only 8% with abdominal pain. Our case is a unique combination of an atypical presentation (abdominal pain, leg numbness) with significant malperfusion of RLE, small bowel, and the right kidney (IRAD registry). For Type B dissection, medical management is preferred followed by surgical techniques to improve perfusion. Estimated inpatient mortality is 30% in proximal dissection and 10% in distal dissection. After the acute phase, the 10-year survival rate for AoD is <50%. CONCLUSIONS: Even with atypical symptoms, AoD and associated complications were successfully diagnosed and treated. Even with current surgical and medical advancements, controversies regarding diagnosis, the timing of repair, and type of repair still exist. REFERENCE #1: Cebicci, Huseyin & Salt, Omer & Gurbuz, Sukru & Sahin, Taner & Cumaoglu, Mustafa & Koyuncu, Serhat. (2014). Atypical presentations of aortic dissections: A case series. Acta Medica Mediterranea. 30. 85-90. REFERENCE #2: Sullivan PR, Wolfson AB, Leckey RD, Burke JL. Diagnosis of acute thoracic aortic dissection in the emergency department. Am J Emerg Med. 2000 Jan;18(1):46-50. doi: 10.1016/s0735- 6757(00)90047-0. PMID: 10674531 REFERENCE #3: Crawford, Todd C, et al. "Malperfusion Syndromes in Aortic Dissections." Vascular Medicine, vol. 21, no. 3, 2016, pp. 264–273., doi:10.1177/1358863x15625371 DISCLOSURES: No relevant relationships by Saurabh Chokshi, source=Web Response No relevant relationships by David Goldgrab, source=Web Response No relevant relationships by Devansh Patel, source=Web Response no disclosure on file for Jorge Perez

Identification and Management of Abdominal Aortic Dissection With Concurrent Aneurysm

The incidence of acute aortic dissection ranges from 2.6 to 3.5 per 100,000 people per year. An abdominal aortic dissection is known to be the rarest of all types of aortic dissection, with high morbidity and mortality rates. In this case report, we are hoping to shed light on this unusual entity, its etiology, and management options.

Population-based incidence and outcomes of acute aortic dissection in Japan.

The population-based incidence and outcomes of acute aortic dissection (AAD) are still unknown because some patients are already dead on arrival, and the accurate diagnosis of AAD is difficult due to the low autopsy rate. We performed a population-based review of all patients with AAD in a well-defined geographical area in Japan between 2016 and 2018. Data of all patients with AAD at Miyazaki Prefectural Nobeoka Hospital (MPNH), which performs medical care for 120 000 residents, were collected retrospectively. The emergency medical service is dedicated to the transfer of all patients in this area to the MPNH. For all patients who were dead on arrival, the diagnosis of AAD was made by autopsy imaging (AI) using computed tomography. The age-adjusted incidence and mortality per 100 000 population were calculated using the Japanese population distribution model in 2015. The total incidence of AAD was 79 (type A: 64.5%, n = 51). Of those, 60.8% (31/51) of patients with type A and 21.4% (6/28) with type B were dead on arrival and diagnosed by AI. The 30-day mortality rates were 74.5% (38/51) in type A and 25.0% (7/28) in type B. The age-adjusted incidence and mortality of AAD per 100 000 inhabitants were 17.6 (type A: 11.3, type B: 6.2) and 9.9 (type A: 8.4, type B: 1.5), respectively. The population-based survey of AAD showed that the age-adjusted incidence of AAD was two-fold higher than in previous reports, and the actual mortality rates were markedly higher due to the high incidence of dead-on-arrival.

Association of Daily Mean Temperature and Temperature Variability With Onset Risks of Acute Aortic Dissection.

BackgroundThe association between ambient temperature and cardiovascular diseases has been well established, but evidence of temporal changes in the risk of acute aortic dissection (AAD) onset is lacking.Methods and ResultsWe conducted an 8‐year time‐series study based on data from 2120 patients diagnosed with AAD at Tongji Hospital (Wuhan, China). Daily meteorological parameters were measured in the study area. Spearman's rank correlation analysis was applied to measure the associations between daily meteorological data and air pollution indicators. A distributed lag nonlinear model following quasi‐Poisson regression was used to express the nonlinear exposure‐response relationships and lag effects of daily mean temperature and temperature variability on the occurrence of AAD. Considering a 25‐day lag effect, lower or higher temperatures with reference to 25°C did not alter the onset risk of AAD. The lag effect of daily mean temperature on the incidence of AAD is statistically significant within 2 days, and the impact of daily mean temperature on the risk is most influential on the day. The exposure‐response curve between daily mean temperature and onset risks of AAD at lag 0 showed that the extremely cold temperature (2.5th percentile, 0.5°C) significantly increased the AAD risk for the total (relative risk, 1.733; 95% CI, 1.130–2.658) and type A dissection (relative risk, 3.951; 95% CI, 1.657–9.418). Temperature variability within 1 week did not affect the onset risks of AAD for the total.ConclusionsWe confirmed that extremely cold temperatures significantly increased the AAD risk, which could contribute to early prevention and timely diagnosis of the disease.

The Relationship between Blood Groups and Aortic Dissection.

Plenty of diseases have been found having associations with blood types, especially cardiovascular diseases. The purpose of this study was to clarify whether there is a relationship between blood groups and acute aortic dissection. We also further studied the distribution of blood groups in different types of acute aortic dissection. A total of 291 patients diagnosed with acute aortic dissection from 2011 to 2018 were enrolled and analyzed retrospectively in this study. The control group consisted of 582 patients who received plastic surgery at West China hospital from 2011 to 2018. First, we analyzed the distribution of blood groups between the study group and the control group, including the ABO, Rh, O and non-O groups. Then, we further divided the study group into two groups by the type of acute aortic dissection to determine if there was difference in blood groups between the two types of acute aortic dissection. The analysis of the distribution of ABO blood groups (p = 0.302) and Rh blood groups (p = 0.502) did not reveal statistically significant differences. There were no statistically significant differences in the distributions of ABO blood groups and Rh blood groups in different types of acute aortic dissection. Our study did not prove the incidence of acute aortic dissection, or the type of acute aortic dissection had a relationship with common blood groups.

Examining the Relationships Between Air Pollutants and the Incidence of Acute Aortic Dissection with Electronic Medical Data in a Moderately Polluted Area of Northwest China.

This paper explored whether air pollutants influenced acute aortic dissection (AAD) incidence in a moderately polluted area. A total of 494 AAD patients’ data from 2013 to 2016 were analyzed. The results showed that AAD had the strongest associations with , , , , and on the day before an AAD incident (lag1) and with two days before an incident (lag2) in single-pollutant model. In the three-pollutant model, was associated with the highest risk of adverse effects (RR = 1.37, 95% CI: 1.22, 1.53), whereas was associated with the lowest risk (RR = .83, 95% CI: .79, .88). Both and were affected by season, and was significantly different between heating and non-heating seasons as well. This study revealed significant associations between short-term , , and exposure and daily AAD incidence, showing that and were strong predictors of AAD incidence in a moderately polluted area.

Risk of aortic disease in long-distance cross-country skiers; a study of 209,226 patients

Abstract Background/Introduction Aneurysmal dilatation and dissection of the aorta are two facets of aortic disease that can lead to major disability and death. Some risk factors for aortic disease are also risk factors for atherosclerotic disease, but the overall causes of aortic disease are diverse and largely unknown. Persons with aortic aneurysms are advised to limit their physical activity, but associations of physical activity with subsequent incidence of aortic disease are little known. Earlier studies have shown strong association of performance in Vasaloppet with incidence of hypertension, a major risk factor for aortic disease. Aim To investigate associations of high levels of physical activity with incidence of aortic disease. Methods We studied 209,226 participants in a 30–90 km cross-country skiing event (Vasaloppet) and 536,038 persons from the general population, matched to the skiers on age, sex and residence. The number of completed races during the study period and the fastest relative finishing time in a race was recorded. The main outcomes were: 1) aortic disease (defined as thoracic and abdominal aortic aneurysm and/or aortic dissection); and 2) aortic dissection. Results During a median time at risk of 8.8 years, 1,442 aortic disease events and 265 aortic dissections occurred. Skiers had lower incidence of aortic disease than non-skiers (Cox proportional hazards ratio [HR] 0.42; 95% confidence interval [CI] 0.36–0.50). An association of better finishing time with aortic disease was observed, with a dose-response gradient from the fastest third (HR 0.25; 95% CI 0.18–0.35), via the slowest third (HR 0.64; 95% CI 0.49–0.82) to the non-skiers (reference group). Among skiers the number of completed races was not associated with incidence of aortic disease. Skiers also had lower incidence of acute aortic dissection (HR 0.61; 95% CI 0.44–0.85) than non-skiers. Low event rate among skiers made conclusions in subgroups unreasonable. All results are adjusted for age, sex, education and income. Results were similar in models accounting for use of antihypertensive and cholesterol-lowering medicines and genetic syndromes associated with aortic disease. Conclusion Participation in a long-distance skiing event was associated with lower risk of aortic disease and aortic dissection. Faster completion of the race was strongly associated with lower incidence of aortic disease. If causal, this study suggests that high physical activity and exercise may be protective against aortic disease. Kaplan-Meier Aorta disease Funding Acknowledgement Type of funding source: None

Impact of meteorological factors on the occurrence of acute aortic dissection in Fujian Province, China: a single-center seven-year retrospective study

BackgroundThe aim of this study was to investigate the correlation between meteorological factors and the occurrence of acute aortic dissection (AAD) in Fujian Province, China.MethodsThe clinical data of 2004 patients diagnosed with AAD in our hospital and the relevant local meteorological data from January 2013 to November 2019 were retrospectively analyzed.ResultsThe incidence of AAD had a clear tendency toward concentration, and the corresponding peak in terms of the occurrence date was from January 13 to 14. The average minimum temperature, the average maximum temperature, and the average daily temperature differences on the “day with AAD” were significantly lower than those on the “day without AAD”. From 5 days to 3 days before AAD onset, the average daily temperature difference showed a downward trend, but statistical analysis showed that the average minimum, average maximum and average daily temperature differences were not significantly different from the values 5 days to 0 days before AAD onset.ConclusionsThe incidence of AAD is related to the season and month. The lowest average temperature may increase the incidence of AAD in patients with complicated cardiovascular diseases.

Unpreventable Maternal Death In Spite Of the Advances in Antenatal Care; a Case Report

Aortic dissection (AoD) is a very rare but potentially fatal entity during pregnancy. The incidence of acute aortic dissection during pregnancy is about 0.4 cases per 100 000 persons yearly. A 28-year-old 38-week primi was referred to the hospital following sudden onset of burning epigastric pain which developed while returning from the routine visit to the cardiologist. She was treated for gastritis in the ward and a few hours later she developed shortness of breath, tight chest pain and tachycardia. Emergency LSCS was done and a live baby was delivered and she had sudden cardiac arrest soon after the extubation, in spite of the intensive resuscitation measures including six units of blood transfusion. She was diagnosed with mild aortic regurgitation and trivial mitral regurgitation before the pregnancy and was referred to the cardiologist during the first trimester and was confirmed with low cardiac risk. She was seen by the cardiologist during all 3 trimesters and was concluded with low cardiac risk. The autopsy revealed 2750 ml of blood in the chest cavity and 750 ml of blood in the abdominal cavity. There was a collection of blood which was infiltrated into the mediastinal tissues around the aorta. There were macroscopic features of aortic dissection and the microscopy of the aorta revealed degeneration of tunica media, a through and through tear on intima with leakage of blood into the surrounding tissues. This case report illustrates that the pregnancy itself is a risk factor for the development of AoD which leads to the catastrophic disorder in pregnancy.

Clinical Features of Patients With Acute Aortic Dissection After an Earthquake: Experience from the Kumamoto Earthquake 2016.

While there is a concern about the increase in the occurrence of acute aortic dissection (AAD) caused by the worsening of hypertension, mental stress, etc., there is a lack of data regarding the influence of disasters on this event. The aim of this study was to address this issue in the acute-subacute phase after the Kumamoto Earthquake occurred on 14 April 2016. We retrospectively investigated the impacts of the Kumamoto Earthquake on various cardiovascular diseases, including AAD, utilizing the medical records of patients in 16 hospitals in Kumamoto Prefecture during the period from 14 April to 30 June (78 days) in 2014, 2015, 2016, and 2017. The occurrence of heart failure and venous thromboembolism increased significantly in the acute-subacute phase after the earthquake. When comparing the earthquake year (2016) to the non-earthquake years (2014, 2015, and 2017), the difference in the occurrences and mortalities of AADs were not significant. When other characteristics of the patients were compared between the earthquake year and the non-earthquake years, there were no differences. It might be possible that the Kumamoto Earthquake did not affect the incidence of AAD or deaths from AAD, possibly because the climate was mild and the preventive efforts based on previous experience were successful. University Hospital Medical Information Network (UMIN)-CTR (http://www.umin.ac.jp/ctr/). UMIN000023864. Opt-out materials were available at the following website: http://www.kumadai-junnai.com/home/wp-content/uploads/shinsai.pdf.

Aortic dissection masquerading as a code stroke: A single-centre cohort study.

IntroductionData on the incidence of acute aortic dissection in the code stroke population are scarce. We report estimated incidence, clinical manifestations, treatment and outcomes of patients with an acute aortic dissection in a code stroke cohort from a comprehensive stroke centre.Patients and methodsWe used data from a single-centre prospective registry of consecutive adult patients who presented to the emergency department between 2015 and 2018 with neurological deficits suggestive of an acute stroke (‘code stroke’). All patients routinely underwent non-contrast computed tomography of the brain and computed tomography-angiography of the aortic arch, cervical and intracranial arteries.ResultsOf 2874 code stroke patients, 1563 (54.4%) had acute ischaemia (ischaemic stroke or transient ischaemic attack). Fifteen patients (0.5% of code stroke patients and 0.8% of patients with acute ischaemia) had an acute aortic dissection (all Stanford classification type A). Discerning clinical manifestations were decreased consciousness in 11/15 (73%), pain in 8/15 (53%) and low systolic blood pressure (mean 106 mmHg, SD30). Acute aortic dissection was an incidental finding during computed tomography-angiography in 4/15 (27%). Two out of 15 patients (13%) received intravenous thrombolysis, 9/15 (60%) underwent aortic surgery and 10/15 (67%) died. Of those who survived, 3/5 (60%) had a good functional outcome (modified Rankin Scale 0–2).Discussion and ConclusionIn our comprehensive stroke centre, about 1/200 code stroke patients and 1/125 patients with acute ischaemia had an acute aortic dissection. Multicentre studies are necessary to acquire a more reliable estimate of the incidence of acute aortic dissection in the code stroke population. Given the ramifications of missing this diagnosis, imaging of the entire aortic arch is important in these patients.

EP34 ROLE OF SPECIALIZED CENTRE AND TEAMWORK IN THE DIAGNOSIS OF MARFAN SYNDROME AND PREVENTION OF ACUTE AORTIC DISSECTION

Objective: Marfan patients had an increasing risk of aortic dissection related to the quality of the aortic wall. The aortic size is not a safe indicator to prevent aortic dissection. Other factors need to be consedered such as the morphology of the aortic root, the Valsalva sinus prolapse, genetic and clinical aspects. We analysed the role of a specialized centre and a good teamwork in improving Marfan syndrome diagnosis and optimizing surgical indications. Materials and Methods: We enrolled patients admitted to the Marfan Syndrome Centre of Tor Vergata University from March 2008 to December 2017. These patients have been evaluated by a teamwork composed by different figures: cardiologists, cardiac surgeons, oculists, orthopaedics, dentists, genetics and nurses. Results: From 1323 patients admitted, we enrolled a total of 460 patients. Of these 260 patients had Marfan Syndrome, 10 patients had Loeys-Dietz Syndrome and the others 190 were Marfan like. 95 patients underwent cardiac surgery. In particular 47% had a Bentall-DeBono Operation, 40% a David Operation and 13% other operations. An increasing number of surgical procedures has been observed in the years. Accordingly we noticed a reducing incidence of acute aortic dissection and sudden deaths in our patients. Conclusions: A specialized Centre of Rare Disease is very important in the management of Marfan's patients in order to improve the diagnosis, optimize surgical indications and prevent catastrophic complication like acute aortic dissection and rupture.