title: Electrocardiography changes in acute aortic dissection-association with troponin leak, coronary anatomy, and prognosis.
abstract: BACKGROUND
  Electrocardiography (ECG) offers some information that may be used to prognosticate acute type A aortic dissection (AAOD) for short- and long-term mortality.
  
  
  METHODS
  We retrospectively analyzed the electrocardiograms of patients with AAOD admitted from March 2004 to March 2015. The frequency of ECG findings and their prognostic value on hospital and follow-up mortality were investigated. Findings pertaining to coronary involvement and troponin level were also examined.
  
  
  RESULTS
  A total of 120 men and 64 women were admitted. Acute ischemic changes were reported in 38.0%, whereas T inversion was the most common recorded abnormality, which occurred in 38.6%. Acute ST-elevation myocardial infarction was detected in 16.3%. Troponin increased in 36.6%; 21.9% of the patients underwent coronary angiography among which 70% were normal. Coronary involvement or troponin increase was not different in patients with acute ECG changes. During hospitalization, 45.7% of the patients died. In multivariate analyses, ST elevation in lead aVR was associated with higher hospital death (odds ratio, 5.30; 95% confidence interval, 1.09-25.73; P = .038), whereas QRS greater than 120 milliseconds was associated with long-term mortality (hazard ratio, 2.45; 95% confidence interval, 1.25-3.76; P = .006).
  
  
  CONCLUSIONS
  Acute ischemic ECG changes are common in AAOD, and a completely normal ECG is infrequently encountered. Acute ECG changes were not associated with the increased troponin or the presence of coronary lesions in angiography.
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Anesthesiology, University at Buffalo, Buffalo, NY 14214. Electronic address: leili.p@gmail.com.
authors.forename: Leili
authors.initials: L
authors.lastname: Pourafkari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: arezou.tajlil@gmail.com.
authors.forename: Arezou
authors.initials: A
authors.lastname: Tajlil
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: ghafaris@gmail.com.
authors.forename: Samad
authors.initials: S
authors.lastname: Ghaffari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: Chavoshi.smr@gmail.com.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Chavoshi
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: Kakol_72@yahoo.com.
authors.forename: Kasra
authors.initials: K
authors.lastname: Kolahdouzan
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: Rezayatp@gmail.com.
authors.forename: Rezayat
authors.initials: R
authors.lastname: Parvizi
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: R_parizad2003@yahoo.com.
authors.forename: Raziyeh
authors.initials: R
authors.lastname: Parizad
authors.affiliation: Department of Anesthesiology, University at Buffalo, Buffalo, NY 14214. Electronic address: nnader@buffalo.edu.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D017023:Coronary Angiography; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin