title: Acute heart failure in patients with acute aortic syndrome: pathophysiology and clinical-prognostic implications.
abstract: OBJECTIVE
  Although acute heart failure (AHF) is a potential complication of acute aortic syndromes (AAS), its clinical details and management implications have been scarcely evaluated. This study aimed to assess prevalence, pathophysiological mechanisms, impact on treatment, and in-hospital mortality of AHF in AAS.
  
  
  RESULTS
  Data were collected from a prospective AAS registry (398 patients diagnosed between 2000 and 2013). Patients with AHF were identified by the presence of dyspnoea as the presentation symptom or radiological signs of pulmonary congestion or cardiogenic shock, including patients with cardiac tamponade (CT). AHF frequency was 28% (Stanford type A 32% vs. type B 20%, P = 0.01). Four mechanisms leading to AHF were identified, alone or in combination: CT (26%), aortic regurgitation (25%), myocardial ischaemia (17%), and hypertensive crisis (10%). In type A patients, aortic regurgitation and CT were the most frequent mechanisms, whereas myocardial ischaemia and hypertensive crisis were the most frequent in type B patients. Although no difference was noted for diagnostic times, AHF at presentation led to a longer surgical delay in type A AAS. In-hospital mortality was higher in patients with AHF compared with those without (34% vs. 17%, P < 0.001). After multivariable analysis, AHF was associated with increased risk of in-hospital death (adjusted odds ratio 1.97, 95% confidence interval 1.14-3.36, P = 0.014).
  
  
  CONCLUSIONS
  AHF occurs in more than a quarter of patients with AAS of both type A and type B, is due to a variety of pathophysiological mechanisms, and is associated with increased surgical delay and in-hospital mortality.
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vagnarelli
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Corsini
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Lorenzini
authors.affiliation: Cardiac Surgery, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Ferlito
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Bacchi Reggiani
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Longhi
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Nanni
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Norscini
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cinti
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bugani
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Pasquale
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.affiliation: Cardiac Surgery, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.affiliation: Cardiology, Cardiovascular Department, 'Ospedali Riuniti di Ancona', Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marini
authors.affiliation: Cardiology, Cardiovascular Department, 'Ospedali Riuniti di Ancona', Ancona, Italy.
authors.forename: Gian Piero
authors.initials: GP
authors.lastname: Perna
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melandri
authors.affiliation: Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001014:Aortic Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D019468:Disease Management; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013577:Syndrome; D014057:Tomography, X-Ray Computed
keywords: Acute aortic syndromes; Acute heart failure; Cardiac tamponade; Cardiogenic shock