Prognostic role of transesophageal echocardiography in acute type A aortic dissection.
BACKGROUND
Acute type A aortic dissection (AAD) remains a highly lethal entity for which emergent surgical correction is standard care. Prior studies have identified specific clinical findings as being predictive of outcome. The prognostic significance of specific findings on imaging studies is less well described. We sought to identify the prognostic value of transesophageal echocardiography (TEE) in medically and surgically treated patients with AAD.


METHODS
We studied 522 AAD patients enrolled over 6 years in the International Registry of Acute Aortic Dissection who underwent TEE. Multivariate analysis identified independent associations of inhospital mortality, first using clinical variables (model 1), after which TEE data were added to build a final model (model 2).


RESULTS
Inhospital mortality was 28.7%. Transesophageal echocardiographic evidences of pericardial effusion (P = .04), tamponade (P < .01), periaortic hematoma (P = .02), and patent false lumen (P = .08) were more frequent in nonsurvivors. Dilated ascending aorta (P = .03), dissection localized to the ascending aorta (P = .02), and thrombosed false lumen (P = .08) were less common in nonsurvivors. Model 1 identified age > or = 70 years, any pulse deficit, renal failure, and hypotension/shock as independent predictors of death. Model 2 identified dissection flap confined to ascending aorta (odds ratio 0.2, 95% CI 0.1-0.6) and complete thrombosis of false lumen (odds ratio 0.15, 95% CI 0.03-0.86) as protective. In the medically treated group, mortality was 31% for subjects with a partially or completely thrombosed false lumen versus 66% in the presence of a patent false lumen.


CONCLUSIONS
Transesophageal echocardiography provides prognostic information in AAD beyond that provided by clinical risk variables.
Bossone
Eduardo
E
National Research Council, Lecce, Italy.
Evangelista
Arturo
A
Isselbacher
Eric
E
Trimarchi
Santi
S
Hutchison
Stuart
S
Gilon
Dan
D
Llovet
Alfredo
A
O'Gara
Patrick
P
Cooper
Jeanna V
JV
Fang
Jianming
J
Januzzi
James L
JL
Mehta
Rajendra H
RH
Distante
Alessandro
A
Nienaber
Christoph A
CA
Eagle
Kim
K
Armstrong
William F
WF
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D015897:Comorbidity; D017548:Echocardiography, Transesophageal; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008382:Marfan Syndrome / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D016019:Survival Analysis; D014654:Vascular Patency