Analysis Of931Patients With Aortic Dissection Over10Years

Part One Analysis of931patients with aortic dissection over10years:general characteristics, outcomes and risk factors of in-hospital deathObjective:Acute aortic dissection (AAD) is a severe and potentially fatal disease which requires rapid diagnosis and appropriate treatment in order to improve survival. To assess incidence, clinical features and possible risk factors of in-hospital death of AD patients in single center.Methods:We retrospectively reviewed all patients from January2003to March2013with AD admitted to tongji hospital. The baseline and clinical information of931consecutive patients were collected. To analysis the clinical epidemiology features. Divided them into survival and death groups, single factor and multi-factors binary logistic regression calculations were performed to identify risk factors for in-hospital death.Result:The rate of hospitalized with AD is increasing. This study demonstrates that the occurrence of acute aortic dissection has significant seasonal. The frequency of acute aortic dissection was found to be significantly higher during winter versus other seasons, especially with a peak in January and December. Among931patients,746male(80.1%), mean age,53.36±11.87years,185female(19.9%), mean age,53.37±11.59years, male:female4.03:1;804acute aortic dissection(86.4%),127chronic aortic dissection(13.6%),294Stanford type A(31.6%),637Stanford type B(68.4%); in-hospital death was101patients (10.85%), mean age53.15±11.58years, hypertension was present in564(60.8%) of all patients. The time from admission to death were4.04±5.69days, the time from admission to operation were7.66±8.78days. The logistic regression analysis revealed that hypotension (P=0.045; OR1.398,95%CI0.658-2.178), fast pulse (P=0.036;OR1.318;95%CI1.001-1.036), pericardial effusion (P=0.016; OR2.029;95%CI1.141-3.610), White blood cell count(P=0.048; OR1.276;95%CI1.001-1.157), neutrophil percentage (P=0.004; OR1.266;95%CI1.021-1.114) were independent risk factor of in-hospital death. Treatment with beta-blockers and angiotensin-converting enzyme inhibitor were protection factors of in-hospital death.Conclusion:1. The rate of hospitalized with AD was increasing.2. The frequency of acute aortic dissection was found to be significantly higher during winter versus other seasons, especially with a peak in January and December.3. The time from admission to death were4.04±5.69days, the time from admission to operation were7.66±8.78days.4. Hypotension, fast pulse, pericardial effusion, increased levels of white blood cell count and neutrophil percentage were independent risk factors of in-hospital death, Treatment with beta-blockers and angiotensin-converting enzyme inhibitor were protection factors of in-hospital death. Part Two Clinical features of painless acute aortic dissectionObjective:To analysis clinical manifestations of patients with painless acute aortic dissection and to explore the value of echocardiography for diagnosis painless acute aortic dissection. To explore how to improve discovery rate and diagnosis rate of painless acute aortic dissection, reduce the mortality.Methods The56patients with painless acute aortic dissection admitted to Tongji hospital from January2003to March2013were selected.Results The time from the onset of symptoms to admission and the time from admission to a definite diagnosis were significantly longer in the painless patients. The mortality in painless group was significantly higher than that in pain group. Routine echocardiography was very helpful to initial diagnosis painless aortic dissection.35patients were diagnosed with echocardiography. The sensitivity rate of diagnosing type A painless AAD by echocardiography reached91.3%, type B53.85%, overall detection rate reached71.43%. The sensitivity to diagnose painless acute aortic dissection was61.5%, and the specificity was87.5%at ROC curve analysis.Conclusions Clinical symptoms of painless acute aortic dissection were more frequent complications. Routine echocardiography was very helpful to find and to diagnosis painless AAD. Rapidly diagnosis and therapy were criticality. Echocardiography plays an important role in the diagnosis of painless AAD. Part three To analyze the clinical features of patients with aortic dissection in different typesObject:To analyze the clinical features of patients with aortic dissection in different Stanford types, we investigated how to improve the discovery rate and diagnosis rate of two different types and to reduce the mortality.Method:We retrospectively reviewed all patients from January2003to March2013with AD admitted to tongji hospital. Clinical data were compared retrospectively between294Patients with type A dissection and637patients with type B dissection. All patients were treated initially with medical therapy.Results:Mean age of type A dissection was52.16±11.85years, type B was53.92±11.7years. The prevalence of hypertension, diabetes mellitus and history of ischemic heart disease did not show any significant difference between two groups. However, involvement of MFS was significantly more frequent in type A dissection group than in type B dissection group. The incidence of hypotension, pericardial effusion and painless aortic dissection was higher in the type A group. The level of WBC count and neutrophil percentage in patients with type A AD were significantly higher than that in patients with type B AD. The in-hospital mortality in patients with type AAD was significant higher than that in patients with type B AD.Conclusions:1Mean age of type A dissection was younger than that of type B dissection.2The in-hospital mortality in patients with type A AD was significant higher than that in patients with type B AD.3The in-hospital mortality in patients with AD undergone medical treatment was significant higher than that undergone surgery treatment. Part four Clinical features of patients with acute intramural hematomaObjects:To analyze the clinical features, management and outcomes of patients with acute intramural hematoma by comparing the patients with those with classic aortic dissection.Methods:Among804patients with AAD,83met(10.32%) the strict criterion of acute IMH.16acute type A IMH (19.27%) and67acute type B IMH (80.73%). To analyze the clinical features, management and outcomes of patients with acute IMH by comparing the patients with those with classic AD.Results:Patients with IMH were significantly older than those with classic AD. The involvement of hypertension was significantly more frequent in type A IMH group than in type AAD group(87.5%vs56.8%, P=0.037). The pulse of type A IMH was slower than that of type A AD((71.06±19.33vs83.38±20.29, P=0.025). Patients with IMH present with a nearly in distinguishable clinical, historical variables and symptoms compared with patients with classic aortic dissection. The in-hospital mortality in patients with type A IMH was significant lower than that in patients with type A AD(6.3%vs29.3%,P<0.05); Patients with type B IMH had a hospital mortality that was less but did not differ significantly from classic type B.(1.5%vs4.5%, P>0.05). The in-hospital mortality in patients with IMH undergone medical treatment did not differ significantly from that in patients with IMH undergone surgery treatment.Conclusions:1Patients with IMH were significantly older than those with classic AD.2Patients with type B IMH had a hospital mortality that was less but did not differ significantly from classic type B. The in-hospital mortality in patients with type A IMH was significant lower than that in patients with type A AD.3The in-hospital mortality in patients with IMH undergone medical treatment did not differ significantly from that in patients with IMH undergone surgery treatment.