title: Prognostic role of transesophageal echocardiography in acute type A aortic dissection.
abstract: 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.
authors.affiliation: National Research Council, Lecce, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Eric
authors.initials: E
authors.lastname: Isselbacher
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: Stuart
authors.initials: S
authors.lastname: Hutchison
authors.forename: Dan
authors.initials: D
authors.lastname: Gilon
authors.forename: Alfredo
authors.initials: A
authors.lastname: Llovet
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Gara
authors.forename: Jeanna V
authors.initials: JV
authors.lastname: Cooper
authors.forename: Jianming
authors.initials: J
authors.lastname: Fang
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Alessandro
authors.initials: A
authors.lastname: Distante
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Kim
authors.initials: K
authors.lastname: Eagle
authors.forename: William F
authors.initials: WF
authors.lastname: Armstrong
mesh_terms: 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