Aortic morphology post type A acute aortic syndrome: Prognosis significance and association with 24-hour blood pressure-monitoring parameters.
aortic dissection
blood pressure monitoring
false lumen
prognosis
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
pubmed:
17
3
2020
medline:
6
10
2020
entrez:
17
3
2020
Statut:
ppublish
Résumé
After an emergent surgery for type A acute aortic syndrome, medical management is based on optimal blood pressure (BP) control. We assessed the prognostic significance of BP monitoring and its relationship with aortic morphology following type A acute aortic syndrome. The data of 120 patients who underwent BP monitoring after a type A acute aortic syndrome from January 2005 to June 2016 were retrospectively collected. The first CT angiogram performed after surgery was used for the morphological analysis. The population included 79 males, with an overall mean age of 60 ± 12 years. Seven patients (5.8%) died during a median follow-up of 5.5 years. The median delay between BP monitoring and discharge was 3 (1-5) months. The mean 24-hour BP of the cohort was 127/73 mm Hg ± 10/17. During follow-up, different parameters of BP monitoring were not associated with the risk of aortic events. However, the diameter of the false lumen of the descending thoracic aorta was the best predictor associated with the risk of new aortic events during follow-up, particularly for the threshold of 28 mm or more (P < .001; Hazard ratio 4.7[2.7-8.2]). The diameter of the false lumen was associated with night-time systolic BP (P = .025; r = .2), 24-hour pulse pressure (P = .002; r = .28), and night-time pulse pressure (P = .008; r = .24). The risk of new aortic events following type A acute aortic syndrome is associated with the size of the residual false lumen, but not directly with BP parameters. Night-time BP parameters are associated with the size of the residual false lumen.
Sections du résumé
BACKGROUND
BACKGROUND
After an emergent surgery for type A acute aortic syndrome, medical management is based on optimal blood pressure (BP) control. We assessed the prognostic significance of BP monitoring and its relationship with aortic morphology following type A acute aortic syndrome.
METHODS
METHODS
The data of 120 patients who underwent BP monitoring after a type A acute aortic syndrome from January 2005 to June 2016 were retrospectively collected. The first CT angiogram performed after surgery was used for the morphological analysis.
RESULTS
RESULTS
The population included 79 males, with an overall mean age of 60 ± 12 years. Seven patients (5.8%) died during a median follow-up of 5.5 years. The median delay between BP monitoring and discharge was 3 (1-5) months. The mean 24-hour BP of the cohort was 127/73 mm Hg ± 10/17. During follow-up, different parameters of BP monitoring were not associated with the risk of aortic events. However, the diameter of the false lumen of the descending thoracic aorta was the best predictor associated with the risk of new aortic events during follow-up, particularly for the threshold of 28 mm or more (P < .001; Hazard ratio 4.7[2.7-8.2]). The diameter of the false lumen was associated with night-time systolic BP (P = .025; r = .2), 24-hour pulse pressure (P = .002; r = .28), and night-time pulse pressure (P = .008; r = .24).
CONCLUSION
CONCLUSIONS
The risk of new aortic events following type A acute aortic syndrome is associated with the size of the residual false lumen, but not directly with BP parameters. Night-time BP parameters are associated with the size of the residual false lumen.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
981-987Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Williams B, Mancia G, Spiering W, et al. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Press. 2018;27(6):314-340. https://doi.org/10.1080/08037051.2018.1527177.2018
Leontyev S, Haag F, Davierwala PM, et al. Postoperative changes in the distal residual aorta after surgery for acute type A aortic dissection: impact of false lumen patency and size of descending aorta. Thorac Cardiovasc Surg. 2017;65(2):90-98. https://doi.org/10.1055/s-0036-1571813
Kimura N, Itoh S, Yuri K, et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;149(2 suppl):S91-8.e1. https://doi.org/10.1016/j.jtcvs.2014.08.008
Song JM, Kim SD, Kim JH, et al. Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection. J Am Coll Cardiol. 2007;50(8):799-804.
Kato M, Bai H, Sato K, et al. Determining surgical indications for acute type B dissection based on enlargement of aortic diameter during the chronic phase. Circulation. 1995;92(9 suppl):II107-II112.
Marwick TH, Gillebert TC, Aurigemma G, et al. Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr. 2015;28(7):727-754. https://doi.org/10.1016/j.echo.2015.05.002
Prentice RL, Kalbfleisch JD, Peterson AV Jr, Flournoy N, Farewell VT, Breslow NE. The analysis of failure times in the presence of competing risks. Biometrics. 1978;34(4):541-554.
Fine JP, Gray RJ. A proportional hazards model for the distribution of a competing risk. J Am Stat Assoc. 1999;94:496-509.
Harrell FE Jr., Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361-387.
Tsai TT, Evangelista A, Nienaber CA, et al. International Registry of Acute Aortic Dissection. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357(4):349-359.
Li D, Ye L, He Y, et al. False lumen status in patients with acute aortic dissection: a systematic review and meta-analysis. J Am Heart Assoc. 2016;5(5):e003172. https://doi.org/10.1161/JAHA.115.003172
Larsen M, Bartnes K, Tsai TT, et al. Extent of preoperative false lumen thrombosis does not influence long-term survival in patients with acute type A aortic dissection. J Am Heart Assoc. 2013;2(4):e000112. https://doi.org/10.1161/JAHA.113.000112
Lin FY, Tseng YH, Huang JW, et al. Fate of distal aorta after acute type A aortic dissection repair: change and persistency of postoperative false lumen status. Int J Cardiol. 2018;266:50-55. https://doi.org/10.1016/j.ijcard.2018.01.010
Bing F, Rodière M, Martinelli T, et al. Type A acute aortic dissection: why does the false channel remain patent after surgery? Vasc Endovascular Surg. 2014;48(3):239-245. https://doi.org/10.1177/1538574413518611
Leone O, Pacini D, Foà A, et al. Redefining the histopathologic profile of acute aortic syndromes: clinical and prognostic implications. J Thorac Cardiovasc Surg. 2018;156(5):1776-1785.e6. https://doi.org/10.1016/j.jtcvs.2018.04.086
Islam MS. Ambulatory blood pressure monitoring in the diagnosis and treatment of hypertension. Adv Exp Med Biol. 2017;956:109-116.
Barone-Rochette G, Thony F, Boggetto-Graham L, et al. Aortic expansion assessed by imaging follow-up after acute aortic syndrome: effect of sleep apnea. Am J Respir Crit Care Med. 2015;192(1):111-114. https://doi.org/10.1164/rccm.201411-2127LE
Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62(7):569-576.
Delsart P, Juthier F, Clough RE, et al. Prognostic significance of sleep apnea syndrome on false lumen aortic expansion in post-acute aortic syndrome. Ann Thorac Surg. 2016;102(5):1558-1564. https://doi.org/10.1016/j.athoracsur.2016.03.102
Suzuki M, Ogawa H, Okabe S, et al. Digital recording and analysis of esophageal pressure for patients with obstructive sleep apnea-hypopnea syndrome. Sleep Breath. 2005;9(2):64-72.
Delsart P, Ledieu GJ, Ramdane N, et al. Impact of the management of type B aortic dissection on the long-term blood pressure. Am J Cardiol. 2017;120(3):484-488. https://doi.org/10.1016/j.amjcard.2017.04.052