Low arterial pressure on admission as a predictor of mortality in operated patients with type A aortic dissection

Abstract

Background/Aim. Hypertension is a known predictor of proximal aortic dissection, but it is not commonly present in these patients on presentation. The associations between ascending aorta with left ventricular hypertrophy, cardiovascular risk factors and coronary atherosclerosis, and outcome of these patients are not fully elucidated. Methods. This retrospective study included 55 consecutive patients with acute type A aortic dissection treated surgically in our institution during the last 2 years. The diagnosis was based on imaging studies. Diameter of ascending aorta was measured with echocardiography. Results. The mean age of the patients was 55.4 ? 12.19 years, and 72.7% were men. A history of arterial hypertension was present in 76.4% of the patients. Maximal ascending aorta diameter was 4.09 ? 0.59 cm, while patients with frank aneurysm accounted for 5.5%. Systolic blood pressure on admission was < 150 mmHg in 58.2% of the patients. Diastolic blood pressure on admission was < 90 mmHg in 54.5% of the patients. Mean arterial pressure on admission was 104.9 ? 24.6 mmHg. No correlations were demonstrated between maximal ascending aorta diameter and diameter of the left ventricular wall, any obtained risk factor and with coronary artery atherosclerosis (p > 0.05). After six months 11 (20%) patients died, while intrahospital mortality was 72%. According to logistic regression analysis which included traditional risk factors, echo parameters, coronary artery disease and logistic euro scor, mean arterial blood pressure was the independent predictor of a six-month mortality [RR 0.956; CI (0.918-0.994 ); p = 0.024]. Conclusion. In our population the acute type A aortic dissection occurred rarely in the setting of frank ascending aortic aneurysms > 5.0 cm. The majority of patients had a history of arterial hypertension. A history of arterial hypertension was not associated with maximal ascending aorta diameter. Mean arterial blood pressure was the independent predictor of a six-months mortality.Uvod/Cilj. Arterijska hipertenzija je prediktor disekcije proksimalnog dela aorte, medjutim, cesto nije prisutna u vreme klinickog ispoljavanja ove bolesti. Povezanost precnika ascendentne aorte sa faktorima rizika, hipertrofijom leve komore i koronarnom aterosklerozom, kao i ishod bolesti kod bolesnika sa akutnom disekcijom proksimalog dela aorte nisu u potpunosti poznati. Metode. Retrospektivna studija obuhvatila je 55 bolesnika sa akutnom disekcijom aorte tipa A, lecenih hirurski u nasoj ustanovi u prethodne dve godine. Dijagnoza je postavljana tehnikama medicinskog slikanja. Precnik ascendentne aorte meren je ehokardiografski. Rezultati. Prosecna starost bolesnika (72,7% muskaraca) bila je 55,4 ? 12,19 godina. Arterijsku hipertenziju u anamnezi imalo je 76,4% bolesnika. Maksimalni precnik ascendentne aorte iznosio je 4,09 ? 0,59 cm, a aneurizma ascendentne aorte > 5,0 cm registrovana je kod 5,5% bolesnika. Sistolni krvni pritisak < 150 mmHg na prijemu imalo je 58,2% bolesnika, dijastolni < 90 mmHg 54,5% bolesnika, a srednji arterijski krvni pritisak bio je 104,9 ? 24,6 mmHg. Nije bilo povezanosti maksimalnog precnika ascendentne aorte sa hipertrofijom leve komore, faktorima rizika, kao i koronarnom bolescu (p > 0,05). Nakon 6 meseci smrtni ishod registrovan je kod 11 (20%) bolesnika, od cega je intrahospitalnih bilo osam (72%). U logisticku regresionu analizu bili su ukljuceni faktori rizika, ehokardiografski parametri, koronarna bolest i logisticki euro skor; srednji arterijski krvni pritisak na prijemu bio je nezavisni prediktor 6-mesecnog mortaliteta [0,956; 95% IP (0,918-0,994); p = 0,024]. Zakljucak. Akutna disekcija aorte tipa A retko se registrovala kod posmatranih bolesnika koji su imali aneurizmu ascendentne aorte precnika > 5,0 cm. Najveci broj bolesnika imao je ranije arterijsku hipertenziju, sto nije bilo u vezi sa precnikom ascendentne aorte. Srednji arterijski pritisak bio je nezavisni prediktor 6-mesecnog mortaliteta ovih bolesnika.