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Goodacre S, Lechene V, Cooper G, Wilson S, Zhong J. Acute aortic syndrome. BMJ 2024; 386:e080870. [PMID: 39288946 DOI: 10.1136/bmj-2024-080870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Affiliation(s)
- Steve Goodacre
- Sheffield Centre for Health and Related Research, University of Sheffield
| | | | | | - Sarah Wilson
- Wexham Park Hospital Emergency Department, Frimley Health NHS Foundation Trust
| | - Jim Zhong
- Leeds Institute of Medical Research, University of Leeds
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Laletin V, Ayobi A, Chang PD, Chow DS, Soun JE, Junn JC, Scudeler M, Quenet S, Tassy M, Avare C, Roca-Sogorb M, Chaibi Y. Diagnostic Performance of a Deep Learning-Powered Application for Aortic Dissection Triage Prioritization and Classification. Diagnostics (Basel) 2024; 14:1877. [PMID: 39272662 PMCID: PMC11393899 DOI: 10.3390/diagnostics14171877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
This multicenter retrospective study evaluated the diagnostic performance of a deep learning (DL)-based application for detecting, classifying, and highlighting suspected aortic dissections (ADs) on chest and thoraco-abdominal CT angiography (CTA) scans. CTA scans from over 200 U.S. and European cities acquired on 52 scanner models from six manufacturers were retrospectively collected and processed by CINA-CHEST (AD) (Avicenna.AI, La Ciotat, France) device. The diagnostic performance of the device was compared with the ground truth established by the majority agreement of three U.S. board-certified radiologists. Furthermore, the DL algorithm's time to notification was evaluated to demonstrate clinical effectiveness. The study included 1303 CTAs (mean age 58.8 ± 16.4 years old, 46.7% male, 10.5% positive). The device demonstrated a sensitivity of 94.2% [95% CI: 88.8-97.5%] and a specificity of 97.3% [95% CI: 96.2-98.1%]. The application classified positive cases by the AD type with an accuracy of 99.5% [95% CI: 98.9-99.8%] for type A and 97.5 [95% CI: 96.4-98.3%] for type B. The application did not miss any type A cases. The device flagged 32 cases incorrectly, primarily due to acquisition artefacts and aortic pathologies mimicking AD. The mean time to process and notify of potential AD cases was 27.9 ± 8.7 s. This deep learning-based application demonstrated a strong performance in detecting and classifying aortic dissection cases, potentially enabling faster triage of these urgent cases in clinical settings.
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Affiliation(s)
| | - Angela Ayobi
- Avicenna.AI, 375 Avenue du Mistral, 13600 La Ciotat, France
| | - Peter D Chang
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Daniel S Chow
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Jennifer E Soun
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Jacqueline C Junn
- Department of Radiology and Imaging Science, Emory University Hospital, Atlanta, GA 30322, USA
| | | | - Sarah Quenet
- Avicenna.AI, 375 Avenue du Mistral, 13600 La Ciotat, France
| | - Maxime Tassy
- Avicenna.AI, 375 Avenue du Mistral, 13600 La Ciotat, France
| | | | | | - Yasmina Chaibi
- Avicenna.AI, 375 Avenue du Mistral, 13600 La Ciotat, France
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3
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Morello F, Bima P, Castelli M, Capretti E, de Matos Soeiro A, Cipriano A, Costantino G, Vanni S, Leidel BA, Kaufmann BA, Osman A, Candelli M, Capsoni N, Behringer W, Capuano M, Ascione G, Leal TDCAT, Ghiadoni L, Pivetta E, Grifoni S, Lupia E, Nazerian P. Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study. Eur J Intern Med 2024:S0953-6205(24)00234-6. [PMID: 38871565 DOI: 10.1016/j.ejim.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND In patients complaining common symptoms such as chest/abdominal/back pain or syncope, acute aortic syndromes (AAS) are rare underlying causes. AAS diagnosis requires urgent advanced aortic imaging (AAI), mostly computed tomography angiography. However, patient selection for AAI poses conflicting risks of misdiagnosis and overtesting. OBJECTIVES We assessed the safety and efficiency of a diagnostic protocol integrating clinical data with point-of-care ultrasound (POCUS) and d-dimer (single/age-adjusted cutoff), to select patients for AAI. METHODS This prospective study involved 12 Emergency Departments from 5 countries. POCUS findings were integrated with a guideline-compliant clinical score, to define the integrated pre-test probability (iPTP) of AAS. If iPTP was high, urgent AAI was requested. If iPTP was low and d-dimer was negative, AAS was ruled out. Patients were followed for 30 days, to adjudicate outcomes. RESULTS Within 1979 enrolled patients, 176 (9 %) had an AAS. POCUS led to net reclassification improvement of 20 % (24 %/-4 % for events/non-events, P < 0.001) over clinical score alone. Median time to AAS diagnosis was 60 min if POCUS was positive vs 118 if negative (P = 0.042). Within 941 patients satisfying rule-out criteria, the 30-day incidence of AAS was 0 % (95 % CI, 0-0.41 %); without POCUS, 2 AAS were potentially missed. Protocol rule-out efficiency was 48 % (95 % CI, 46-50 %) and AAI was averted in 41 % of patients. Using age-adjusted d-dimer, rule-out efficiency was 54 % (difference 6 %, 95 % CI, 4-9 %, vs standard cutoff). CONCLUSIONS The integrated algorithm allowed rapid triage of high-probability patients, while providing safe and efficient rule-out of AAS. Age-adjusted d-dimer maximized efficiency. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT04430400.
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Affiliation(s)
- Fulvio Morello
- Department of Medical Sciences, Università degli Studi di Torino, Torino, Italy; Department of Emergency Medicine, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy.
| | - Paolo Bima
- Department of Medical Sciences, Università degli Studi di Torino, Torino, Italy
| | - Matteo Castelli
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Elisa Capretti
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | | | - Alessandro Cipriano
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Simone Vanni
- Medicina d'Urgenza, Ospedale San Giuseppe, Empoli, Italy
| | - Bernd A Leidel
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
| | | | - Adi Osman
- Resuscitation & Emergency Critical Care Unit, Trauma and Emergency Department, Raja Permaisuri Bainun Hospital, Ipoh, Perak Darul Ridzuan, Malaysia
| | - Marcello Candelli
- Emergency, Anesthesiological and Reanimation Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University of Vienna, Austria; Department of Emergency Medicine, Universitätsklinikum Jena, Germany
| | - Marialessia Capuano
- Department of Emergency Medicine, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Giovanni Ascione
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | | | - Lorenzo Ghiadoni
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Emanuele Pivetta
- Department of Medical Sciences, Università degli Studi di Torino, Torino, Italy; Department of Emergency Medicine, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Enrico Lupia
- Department of Medical Sciences, Università degli Studi di Torino, Torino, Italy; Department of Emergency Medicine, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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Teurneau-Hermansson K, Ede J, Larsson M, Linton G, von Rosen D, Sjögren J, Wierup P, Nozohoor S, Zindovic I. Mortality after non-surgically treated acute type A aortic dissection is higher than previously reported. Eur J Cardiothorac Surg 2024; 65:ezae039. [PMID: 38310329 PMCID: PMC10871943 DOI: 10.1093/ejcts/ezae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/10/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES It has been commonly accepted that untreated acute type A aortic dissection (ATAAD) results in an hourly mortality rate of 1-2% during the 1st 24 h after symptom onset. The data to support this statement rely solely on patients who have been denied surgical treatment after reaching surgical centres. The objective was to perform a total review of non-surgically treated (NST) ATAAD and provide contemporary mortality data. METHODS This was a regional, retrospective, observational study. All patients receiving one of the following diagnoses: International Classification of Diseases (ICD)-9 4410, 4411, 4415, 4416 or ICD-10 I710, I711, I715, I718 in an area of 1.9 million inhabitants in Southern Sweden during a period of 23 years (January 1998 to November 2021) were retrospectively screened. The search was conducted using all available medical registries so that every patient diagnosed with ATAAD in our region was identified. The charts and imaging of each screened patient were subsequently reviewed to confirm or discard the diagnosis of ATAAD. RESULTS Screening identified 2325 patients, of whom 184 NST ATAAD patients were included. The mortality of NST ATAAD was 47.3 ± 4.4%, 55.0 ± 4.4%, 76.7 ± 3.7% and 83.9 ± 4.3% at 24 h, 48 h, 14 days and 1 year, respectively. The hourly mortality rate during the 1st 24 h after symptom onset was 2.6%. CONCLUSIONS This study observed higher mortality than has previously been reported. It emphasizes the need for timely diagnosis, swift management and emergent surgical treatment for patients suffering an acute type A aortic dissection.
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Affiliation(s)
- Karl Teurneau-Hermansson
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jacob Ede
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mårten Larsson
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gustaf Linton
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - David von Rosen
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Johan Sjögren
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Wierup
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Shahab Nozohoor
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Igor Zindovic
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
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5
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Shimamoto T, Tomotsuka S, Takehara M, Tsumaru S. Three cases of diagnostic delay of type A acute aortic dissection. Egypt Heart J 2024; 76:10. [PMID: 38285096 PMCID: PMC10825080 DOI: 10.1186/s43044-024-00444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Diagnostic delay (DD) can be lethal when patients with type A acute aortic dissection (TAAAD). We report 3 cases of DD associated with TAAAD. CASE PRESENTATION Case 1 is a female in her sixties presenting with severe back pain. A CT scan was taken, and TAAAD with a thrombosed false lumen was suspected by the radiology technician. He did not successfully transfer his concern to the physicians and the patient was sent home. The next day, she was transferred to another hospital with a recurrence of the symptom, and the diagnosis of TAAAD was made with a CT scan there. Case 2 was an 87-year-old female who was transferred to our hospital because of a loss of consciousness and bruises on the forehead. CT scan was taken and the displaced intimal flap in her aortic arch was overlooked by the part-time physician almost at the end of his shift. The diagnosis of TAAAD was made by the radiologist. Case 3 was the 44-year-old male who did not have health insurance and experienced severe back pain a few days before the visit to our clinic. On that day, he went to the nearby hospital's emergency room, and only pain medication was prescribed. A few days later, a CT scan was taken at our hospital to investigate the cause of pyuria and the diagnosis of TAAAD was made. CONCLUSION DD may be common and multifactorial in our practice. Physicians need to take every step to improve diagnostic accuracy.
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Affiliation(s)
- Takeshi Shimamoto
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Hamamatsu, Shizuoka, 430-8525, Japan.
| | - Sanae Tomotsuka
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Hamamatsu, Shizuoka, 430-8525, Japan
| | - Makoto Takehara
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Hamamatsu, Shizuoka, 430-8525, Japan
| | - Shinichi Tsumaru
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Hamamatsu, Shizuoka, 430-8525, Japan
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Routine Use of a Pocket-Sized Handheld Echoscopic Device Plus a Biomarker by Emergency Medicine Residents with an Early Screening Algorithm for Suspected Type A Acute Aortic Syndrome. J Clin Med 2023; 12:jcm12041346. [PMID: 36835881 PMCID: PMC9965843 DOI: 10.3390/jcm12041346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 02/11/2023] Open
Abstract
(1) Background: The early screening strategy for type A acute aortic syndrome (A-AAS) patients has always been challenging. (2) Methods: From September 2020-31 March 2022, 179 consecutive patients with suspected A-AAS were retrospectively reviewed. We assessed the diagnostic value of the use of handheld echocardiographic devices (PHHEs) by emergency medicine (EM) residents either alone or in combination with serum acidic calponin in this patient group. (3) Results: The direct sign of PHHE had a specificity (SP) of 97.7%. The sign of ascending aortic dilatation showed SE = 77.6%, SP = 68.5%, PPV = 48.1% and NPV = 89%. SE, SP, PPV and NPV of a positive PHHE direct sign were 55.6%, 100%, 100% and 71.4% in 19 hypotension/shock patients with suspected A-AAS, respectively. The area under curve (AUC) of acidic calponin combined with an ascending aorta diameter >40 mm was 0.927, with an SE and SP of 83.7% and 89.2%, respectively. These two combined indicators significantly improved the diagnostic efficiency of A-AAS compared with either of them alone (p = 0.017; standard error 0.016, Z value 2.39; p = 0.001, standard error 0.028, Z value 3.29). (4) Conclusion: EM resident-performed PHHE was highly indicative of A-AAS in patients presenting with shock or hypotension. An ascending aorta diameter > 40 mm combined with acidic calponin demonstrated acceptable diagnostic accuracy as a rapid first-line triage tool to identify patients with suspected A-AAS.
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Tong F, Wang Y, Sun Z. Development and validation of nomogram models to discriminate between acute aortic syndromes and non-S T-elevation myocardial infarction during troponin-blind period. Front Cardiovasc Med 2023; 10:1077712. [PMID: 36742067 PMCID: PMC9895376 DOI: 10.3389/fcvm.2023.1077712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
Background Blood-test-based methods of distinguishing between acute aortic syndromes (AASs) and non-ST-elevation myocardial infarction (NSTEMI) during the troponin-blind period of <2-3 h of symptom onset have not been studied previously. We aimed to explore whether routine biomarkers might facilitate differential diagnosis. Methods Data were retrospectively collected from 178 patients with AASs and 460 patients with NSTEMI within 3 h of onset. Differential risk factors related to AASs were identified by univariate and multivariate logistic regression analyses for patients with onset <2 h and onset ≥2 h, respectively, in the cardiac troponin (cTn) cohort. Nomograms were established in the cTn cohort as a training set and validated in the high-sensitivity cTn cohort. To assess the utility of the models in clinical practice, decision curve analyses were performed. Results D-dimer, fibrinogen, and age were identified as differential risk factors for AASs with the onset of <2 h. D-dimer at an optimal cutoff level of 281 ng/mL for AASs had a sensitivity of 86.4% and a specificity of 91.3%. A nomogram was developed and validated with areas under the curve (AUC) of 0.934 (95% CI: 0.880-0.988) and 0.952 (95% CI: 0.874-1.000), respectively. D-dimer, neutrophil, bilirubin, and platelet were the differential risk factors for AASs with the onset of ≥2 h. D-dimer at an optimal cutoff level of 385 ng/mL has a sensitivity of 91.8% and a specificity of 91.3%. The AUC of the second nomogram in the training set and the validation set were 0.965 (95% CI: 0.942-0.988) and 0.974 (95% CI: 0.944-1.000), respectively. Conclusion Time-dependent quality of D-dimer should be considered for discriminating AASs from NSTEMI. Both nomogram models may have a clinical utility for evaluating the probability of AASs.
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Affiliation(s)
- Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Wang
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China,*Correspondence: Zhijun Sun ✉
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Peng H, Liu W, Jian KT, Xia Y, Liu JS, Sun LZ, Mei YQ. Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study. BMC Cardiovasc Disord 2022; 22:383. [PMID: 36002794 PMCID: PMC9400216 DOI: 10.1186/s12872-022-02821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND This study investigated the impact of coronary angiography on outcomes of emergency operation in acute type A aortic dissection (ATAAD) patients who were initially misdiagnosed as an acute coronary syndrome. METHODS From October 2016 to April 2019, 129 patients underwent emergency operation for ATAAD in our institution, including 21 patients (16.3%, coronary angiography group) who received preoperative coronary angiography without knowledge of the ATAAD, and the rest 108 did not (Non-coronary angiography group). Preoperative clinical characteristics, 30-day mortality and postoperative complications were compared. Multivariable logistic regression was performed to confirm the independent prognostic factors for short-term and long-term outcomes. RESULTS Patients undergoing coronary angiography had higher prevalence of preoperative hypotension or shock (61.9% vs 35.2%, P = 0.022), ischemic changes on electrocardiogram (66.7% vs 37.0%, P = 0.012), platelet inhibition (ADP-induced inhibition 92.0% vs 46.0%, P = 0.001), and coronary involvement (66.7% vs 30.6%, P = 0.002). 30-day mortality was 4.8% versus 9.3% (P = 0.84). Coronary angiography group had more intraoperative bleeding (1900 ml vs 1500 ml, P = 0.013) and chest-tube drainage on the first postoperative day (1040 ml vs 595 ml, P = 0.028). However, preoperative coronary angiography was not independent risk factors for 30-day mortality (OR 0.171, 95%CI 0.013-2.174, P = 0.173) and overall survival (HR 0.407; 95%CI 0.080-2.057; P = 0.277). CONCLUSION Patients undergoing coronary angiography carried a higher risk of preoperative hemodynamic instability, myocardial ischemia, and perioperative bleeding. However, unintentional coronary angiography did not have a significant impact on short-term and long-term outcomes of emergency surgery in ATAAD.
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Affiliation(s)
- Hao Peng
- Department of Cardiovascular and Thoracic Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, People's Republic of China
- Department of Cardiovascular Surgery, Shanghai DeltaHealth Hospital, 109 Xule Rd, Shanghai, 201702, People's Republic of China
| | - Wei Liu
- Department of Cardiovascular Surgery, Shanghai DeltaHealth Hospital, 109 Xule Rd, Shanghai, 201702, People's Republic of China
| | - Kai-Tao Jian
- Department of Cardiovascular Surgery, Shanghai DeltaHealth Hospital, 109 Xule Rd, Shanghai, 201702, People's Republic of China
| | - Yu Xia
- Department of Cardiovascular Surgery, Shanghai DeltaHealth Hospital, 109 Xule Rd, Shanghai, 201702, People's Republic of China
| | - Jian-Shi Liu
- Department of Cardiovascular Surgery, Shanghai DeltaHealth Hospital, 109 Xule Rd, Shanghai, 201702, People's Republic of China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Shanghai DeltaHealth Hospital, 109 Xule Rd, Shanghai, 201702, People's Republic of China.
| | - Yun-Qing Mei
- Department of Cardiovascular and Thoracic Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, People's Republic of China.
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Kaito D, Yamamoto R, Nakama R, Hashizume K, Ueno K, Sasaki J. D-dimer for screening of aortic dissection in patients with ST-elevation myocardial infarction. Am J Emerg Med 2022; 59:146-151. [PMID: 35868207 DOI: 10.1016/j.ajem.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/22/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Acute aortic dissection (AAD) with concurrent ST-segment elevation myocardial infarction (STEMI) is relatively rare and sometimes overlooked. As D-dimer testing has been reported to have high sensitivity to diagnose AAD in a clinical scale, Aortic Dissection Detection Risk Score (ADD-RS), a point-of-care D-dimer analyzer capable of measuring in 10 min would be useful to deny AAD with concurrent STEMI. However, an optimal cut-off value of D-dimer in such population remains unclear. Therefore, the aim of this study was to elucidate the optimal D-dimer threshold in patients clinically diagnosed with STEMI. METHODS This retrospective cohort study was conducted at two tertiary care centers between 2014 and 2019. Patients clinically diagnosed with STEMI who underwent serum D-dimer measurement on hospital arrival were included. The primary outcome was the diagnosis of AAD. The area under the receiver operating characteristic curve (AUROC) for D-dimer values to diagnose AAD was evaluated, particularly in patients with low to moderate risks of AAD (1 of ADD-RS). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with several cut-off values. RESULTS A total of 322 patients were included, and 28 were diagnosed with AAD. The AUROC for D-dimer to diagnose AAD was 0.970 (95% confidence interval: 0.948-0.993) in 262 patients with 1 of ADD-RS. If D-dimer ≥750 ng/mL was used as a cut-off value, sensitivity, specificity, PPV and NPV were 100%, 86.4%, 37.7%, and 100%, respectively. AAD could be denied in 209 (79.8%) patients using the cut-off value (D-dimer <750 ng/mL). CONCLUSIONS Serum D-dimer ≥750 ng/mL exhibited high sensitivity and NPV to diagnose AAD with concurrent STEMI, while the ADD-RS originally utilized ≥500 ng/mL as a cut-off for any suspected AAD. A point-of-care D-dimer measurement with the new cut-off would be useful to rule-out AAD among patients with STEMI.
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Affiliation(s)
- Daiki Kaito
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Rakuhei Nakama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Kenichi Hashizume
- Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi 321-0974, Japan
| | - Koji Ueno
- Department of Cardiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi 321-0974, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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11
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Comparison of door-to-balloon time and in-hospital outcomes in patients with ST-elevation myocardial infarction between before versus after COVID-19 pandemic. Cardiovasc Interv Ther 2022; 37:641-650. [PMID: 35006544 PMCID: PMC8744386 DOI: 10.1007/s12928-022-00836-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/04/2022] [Indexed: 12/11/2022]
Abstract
The situation around primary percutaneous coronary intervention (PCI) has dramatically changed since coronavirus disease 2019 (COVID-19) pandemic. The impact of COVID-19 pandemic on clinical outcomes as well as door-to-balloon time (DTBT), which is known as one of the indicators of early reperfusion, has not been fully investigated in patients with ST-elevation acute myocardial infarction (STEMI). The purpose of this study was to compare DTBT and in-hospital outcomes in patients with STEMI between before versus after COVID-19 pandemic. The primary interest was DTBT and the incidence of in-hospital outcomes including in-hospital death. We included 330 patients with STEMI who underwent primary PCI, and divided them into the pre COVID-19 group (n = 209) and the post COVID-19 group (n = 121). DTBT was significantly longer in the post COVID-19 group than in the pre COVID-19 group (p < 0.001), whereas the incidence of in-hospital death was comparable between the 2 groups (p = 0.238). In the multivariate logistic regression analysis, chest CT before primary PCI (OR 4.64, 95% CI 2.58-8.34, p < 0.001) was significantly associated with long DTBT, whereas chest CT before primary PCI (OR 0.76, 95% CI 0.29-1.97, p = 0.570) was not associated with in-hospital death after controlling confounding factors. In conclusion, although DTBT was significantly longer after COVID-19 pandemic than before COVID-19 pandemic, in-hospital outcomes were comparable between before versus after COVID-19 pandemic. This study suggests the validity of the screening tests including chest CT for COVID-19 in patients with STEMI who undergo primary PCI.
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12
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Pan X, Zhou Y, Yang G, He Z, Zhang H, Peng Z, Peng W, Guo T, Zeng M, Ding N, Chai X. Lysophosphatidic Acid May Be a Novel Biomarker for Early Acute Aortic Dissection. Front Surg 2022; 8:789992. [PMID: 35083271 PMCID: PMC8784386 DOI: 10.3389/fsurg.2021.789992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Misdiagnosis and delayed diagnosis of acute aortic dissection (AAD) significantly increase mortality. Lysophosphatidic acid (LPA) is a biomarker related to coagulation cascade and cardiovascular-injury. The extent of LPA elevation in AAD and whether it can discriminate sudden-onset of acute chest pain are currently unclear. Methods: We measured the plasma concentration of LPA in a cohort of 174 patients with suspected AAD chest pain and 30 healthy participants. Measures to discriminate AAD from other acute-onset thoracalgia were compared and calculated. Results: LPA was significantly higher in AAD than in the AMI, PE, and the healthy (344.69 ± 59.99 vs. 286.79 ± 43.01 vs. 286.61 ± 43.32 vs. 96.08 ± 11.93, P < 0.01) within 48 h of symptom onset. LPA level peaked at 12 h after symptom onset, then gradually decreased from 12 to 48 h in AAD. LPA had an AUC of 0.85 (0.80–0.90), diagnosis threshold of 298.98 mg/dl, a sensitivity of 0.81, specificity of 0.77, and the negative predictive value of 0.85. The ROC curve of LPA is better than D-dimer (P = 0.041, Delong test). The decision curve showed that LPA had excellent standardized net benefits. Conclusion: LPA showed superior overall diagnostic performance to D-dimer in early AAD diagnosis may be a potential biomarker, but additional studies are needed to determine the rapid and cost-effective diagnostic tests in the emergency department.
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Affiliation(s)
- Xiaogao Pan
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Zhou
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guifang Yang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhibiao He
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongliang Zhang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenyu Peng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Peng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Tuo Guo
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Mengping Zeng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ning Ding
- Emergency Department, Changsha Central Hospital, University of South China, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Xiangping Chai
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13
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Lovatt S, Wong CW, Schwarz K, Borovac JA, Lo T, Gunning M, Phan T, Patwala A, Barker D, Mallen CD, Kwok CS. Misdiagnosis of aortic dissection: A systematic review of the literature. Am J Emerg Med 2021; 53:16-22. [PMID: 34968970 DOI: 10.1016/j.ajem.2021.11.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Aortic dissection is a rare but potentially catastrophic condition. Misdiagnosis of aortic dissection is not uncommon as symptoms can overlap with other diagnoses. OBJECTIVE We conducted a systematic review to better understand the factors contributing to incorrect diagnosis of this condition. METHODS We searched MEDLINE and EMBASE for studies that evaluated the misdiagnosis of aortic dissection. The rate of misdiagnosis was pooled and results were narratively synthesized. RESULTS A total of 12 studies with were included with 1663 patients. The overall rate of misdiagnosis of aortic dissection was 33.8%. The proportion of patients presenting with chest pain, back pain and syncope were 67.5%, 24.8% and 6.8% respectively. The proportion of patients with pre-existing hypertension was 55.4%, 30.5% were smokers while the proportion of patients with coronary artery disease, previous cardiovascular surgery or surgical trauma and Marfan syndrome was 14.7%, 5.8%, and 3.7%, respectively. Factors related to misdiagnosis included the presence of symptoms and features associated with other diseases (such as acute coronary syndrome, stroke and pulmonary embolism), the absence of typical features (such as widened mediastinum on chest X-ray) or concurrent conditions such congestive heart failure. Factors associated with more accurate diagnosis included more comprehensive history taking and increased use of imaging. CONCLUSIONS Misdiagnosis in patients with an eventual diagnosis of aortic dissection affects 1 in 3 patients. Clinicians should consider aortic dissection as differential diagnosis in patients with chest pain, back pain and syncope. Imaging should be used early to make the diagnosis when aortic dissection is suspected.
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Affiliation(s)
- Saul Lovatt
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Wai Wong
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Konstantin Schwarz
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Josip A Borovac
- Clinic for Heart and Cardiovascular Diseases, University Hospital of Split, Split, Croatia
| | - Ted Lo
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mark Gunning
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Thanh Phan
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ashish Patwala
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Diane Barker
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Chun Shing Kwok
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK; School of Medicine, Keele University, Stoke-on-Trent, UK.
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14
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Mahalingam S, Rajendran G, Balaraman N, Kumar K, Rajendran A, Nathan B, Ayyan M, Balassoundaram V, Gara M, Kumar P. Stanford - A Aortic Dissection Presenting as a Triple Mimic and Role of Point of Care Ultrasound in Deciphering It. J Emerg Trauma Shock 2021; 14:187-189. [PMID: 34759638 PMCID: PMC8527064 DOI: 10.4103/jets.jets_134_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 04/21/2021] [Accepted: 08/27/2021] [Indexed: 12/02/2022] Open
Abstract
Aortic dissection (AD) is a great imitator, and its diagnosis is quite challenging due to its varied presentations and unreliable clinical findings. Based on the literature search we found, this is the first case report of Stanford-A/DeBakey Type 1 AD reported as a triple mimic, namely stroke, acute limb ischemia, and pericarditis. Here, we describe the case of a 46-year-old male who presented to our emergency department with features suggestive of acute pericarditis, cerebrovascular accident, acute limb ischemia, which could have been attributed to athero-thrombo-embolic disease and AD could have been possibly missed. However, point-of-care ultrasound helped us in the diagnosis of this highly lethal condition.
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Affiliation(s)
- Sasikumar Mahalingam
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gunaseelan Rajendran
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nithya Balaraman
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kiran Kumar
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajithkumar Rajendran
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balamurugan Nathan
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Manu Ayyan
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vishwanath Balassoundaram
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mounika Gara
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Praveen Kumar
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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15
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Hu C, Huang W, Xiong N, Liu X. SP1-mediated transcriptional activation of PTTG1 regulates the migration and phenotypic switching of aortic vascular smooth muscle cells in aortic dissection through MAPK signaling. Arch Biochem Biophys 2021; 711:109007. [PMID: 34400144 DOI: 10.1016/j.abb.2021.109007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 02/05/2023]
Abstract
Pituitary tumor-transforming gene 1 (PTTG1) has been found to be associated with the process of cell proliferation and invasion, and is highly expressed in aortic dissection (AD). However, its potential role and underlying mechanism in AD remain uncertain. This study aims at elucidating the roles of specificity protein 1 (SP1) and PTTG1 in the migration and phenotypic switching of aortic vascular smooth muscle cells (VSMCs) in AD. Aortic samples were collected from 35 patients with AD for examination of PTTG1 expression in the tissues by qPCR, western blot and immunofluorescence. Human aortic vascular smooth muscle cells (HAVSMCs) were stimulated with platelet-derived growth factor-BB (PDGF-BB) to establish the cellular model of AD. PTTG1 expression in VSMCs was also examined by qPCR and western blot. Cell viability was detected by CCK-8, cell proliferation by EdU staining and cell migration by wound healing and transwell. Western blot was then performed to assay migration-related proteins. After interference with PTTG1, the levels of smooth muscle pthenotypic switch markers smooth muscle protein 22 alpha (SM22-α) and osteopontin (OPN) were detected by qPCR, western blot and immunofluorescence. The binding of SP1 and PTTG1 was verified with dual-luciferase reporter assay and chromatin immunoprecipitation assay (ChIP). PTTG1 overexpression was found in AD patients. Interference with PTTG1 attenuated the proliferation and migration of PDGF-BB-stimulated HAVSMCs, in addition to their switching from contractile phenotype to synthetic phenotype. Transcription factor SP1 was up-regulated in PDGF-BB-stimulated HAVSMCs, combined with PTTG1 promoter sequence and regulated PTTG1 expression, whose overexpression reversed the effects of PTTG1 interference on cell proliferation, migration and phenotypic switching. SP1 transcriptional activation of PTTG1 activated MAPK/ERK signaling pathway. In conclusion, SP1 transcriptional activation of PTTG1 regulates the migration and phenotypic transformation of HAVSMCs in AD by MAPK Signaling.
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Affiliation(s)
- Chuangjia Hu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China
| | - Weixing Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China
| | - Nianling Xiong
- Shantou University Medical College, Shantou, 515000, China
| | - Xiaoqiang Liu
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China.
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16
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Dreisbach JG, Rodrigues JC, Roditi G. Emergency CT misdiagnosis in acute aortic syndrome. Br J Radiol 2021; 94:20201294. [PMID: 34491770 DOI: 10.1259/bjr.20201294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This cross-sectional study assessed the accuracy of emergency CT reports at presentation in acute aortic syndrome (AAS). METHODS Retrospective identification of cases of AAS presenting within a large health board with three acute hospitals receiving adult patients between January 2013 and December 2016. CT studies and reports at presentation were reviewed for discrepancies related to diagnosis, complications and classification by two cardiovascular radiologists. The specialist interest of the original reporters, clinically suspected diagnosis at referral for CT and technical adequacy of the scans were also assessed. False-positive diagnoses were identified and evaluated separately. RESULTS Among 88 consecutive confirmed cases of AAS at least one discrepancy was identified in 31% (n = 27), including failure to identify or misinterpretation of the AAS itself in 15% (n = 13), haemorrhage in 13% (n = 11), branch involvement in 9% (n = 8), and misclassification in 3% (n = 3). All discrepancies occurred among the 80% (n = 70) of cases reported by radiologists without specialist cardiovascular interest. 26% (n = 23/88) of AAS cases were not clinically suspected at referral for CT and although this was associated with suboptimal protocols, only 51% of CT scans among suspected cases were technically adequate. Seven false-positive diagnoses were identified, three of which related to motion artefact. CONCLUSION Significant discrepancies are common in the emergency CT assessment of positive cases AAS and this study highlights important pitfalls in CT technique and interpretation. The absence of discrepancies among radiologists with specialist cardiovascular interest suggests both suspected and confirmed cases warrant urgent specialist review. ADVANCES IN KNOWLEDGE CT angiography is central to the diagnosis of AAS; however, significant radiology discrepancies are common among non-specialists. This study highlights important pitfalls in both CT technique as well as interpretation and supports routine specialist cardiovascular imaging input in the emergency assessment of AAS.
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Affiliation(s)
- John G Dreisbach
- Department of Radiology, Golden Jubilee National Hospital, Clydebank, United Kingdom.,Department of Radiology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Jonathan Cl Rodrigues
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, United Kingdom
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17
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Raja Shariff RE, Farook A, Lim CW, Kasim S. Pericarditis masking a localised thoracic aorta dissection: Making a point for point-of-care ultrasound. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/2010105820978665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Early detection of aortic dissection (AD) remains essential due to high mortality rates. We report a case of localised thoracic AD initially misdiagnosed as pericarditis, but subsequently diagnosed through point-of-care ultrasound (POCUS). A 35-year-old gentleman presented with sudden-onset jaw and chest pain. An initial electrocardiogram revealed changes consistent with pericarditis, and high-sensitive troponin levels on admission were not raised. An initial diagnosis of pericarditis was made. However, due to persistent symptoms despite treatment, an urgent POCUS was performed, revealing a prominently dilated aortic root, with evidence of an intimal flap near the coronary cusps. Computed tomography imaging revealed a focal aortic root dissection confined within the sinus of Valsalva, with no involvement of coronary arteries or descending thoracic or abdominal aorta. This case highlights how commonly a misdiagnosis of AD can occur and how concurrent pericarditis can often mask AD. Our report highlights the need for better incorporation of POCUS in the initial assessment of acute chest pain, as studies have shown both high sensitivity and specificity in diagnosing AD, with no additional burden on treatment start-up time and mortality.
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18
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Saha S, Fabry TG, Buech J, Ali A, Joskowiak D, Tsilimparis N, Hagl C, Pichlmaier M, Peterss S. Time is of the essence: where can we improve care in acute aortic dissection? Interact Cardiovasc Thorac Surg 2021; 33:941-948. [PMID: 34255060 DOI: 10.1093/icvts/ivab190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/10/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In acute aortic dissection type A various components of the diagnostic and logistic pathways may affect the time to definitive treatment. This study aimed to characterize these components and to identify factors delaying the optimal management within our institutional referral network. METHODS Between January 2017 and January 2020, 96 consecutive patients with classical aortic dissection type A were admitted (28%) or referred (72%) to our tertiary care centre and analysed retrospectively. Data are presented as medians (25th-75th quartile). RESULTS Median age was 66 years (56-74), 63% were male. Most of the patients were primarily admitted to a cardiology department (40%), whereas about a fourth were admitted to departments for internal medicine (26%) and general surgery (27%). The median interval from the onset of symptoms to hospital admission was 2.1 (1-4.4) h. From admission to confirmed diagnosis it took 2.1 (0.6-9.5) h and the median interval from confirmed diagnosis to admission at our specialized tertiary care aortic centre was 1.5 (0.9-2.4) h. Following admission to our centre, 1.1 (0.5-1.9) h passed until the induction of anaesthesia and 0.8 (0.0-1.1) h until the start of surgery. The total interval from the onset of symptoms to the start of surgery was 7.6 h (5.1-12.3). CONCLUSIONS The marked variability of the time from symptoms to diagnosis at any medical facility demonstrates the importance of awareness in the optimization of the treatment of acute aortic dissection type A.
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Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Thomas G Fabry
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Ahmad Ali
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | | | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | | | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
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19
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Ma C, Zhao H, Shi F, Li M, Liu X, Ji C, Han Y. Serum Ceruloplasmin Is the Candidate Predictive Biomarker for Acute Aortic Dissection and Is Related to Thrombosed False Lumen: a Propensity Score-Matched Observational Case-Control Study. Biol Trace Elem Res 2021; 199:895-911. [PMID: 32504399 DOI: 10.1007/s12011-020-02219-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/22/2020] [Indexed: 12/19/2022]
Abstract
Acute aortic dissection (AAD), one of the fatal diseases observed at the department of vascular surgery, is associated with a great mortality rate at the early stage. Ceruloplasmin (CP) is the plasma protein that functions as a copper transporter. The current retrospective research was carried out to assess CP contents and to examine the possible part in diagnosing patients with AAD. In addition, propensity score matching (PSM) was also utilized for reducing the bias in case screening as well as the clinical confounders. Using PSM, this study included 85 pairs of AAD cases (Stanford A and B dissection) and matched controls, and their CP levels were also detected through enzyme-linked immunosorbent assay (ELISA). Additionally, the relative clinical data were extracted from participants included in this study. After PSM adjustment for clinical variables, including gender, age, body mass index (BMI), heart ratio (HR), smoking, hypertension, diabetes mellitus, coronary heart disease (CHD), and stroke, the serum CP contents among AAD cases were remarkably increased compared with those among the normal subjects. Besides, the CP contents showed independent association with the AAD risk. Typically, the CP level was significantly positively correlated with platelet (R = 0.329) or C-reactive protein (R = 0.340) level. Meanwhile, the area under the receiver operating characteristic (ROC) curve (AUC) was 0.929 when CP was used to diagnose AAD, and the best threshold value was 36.82mg/dL. Serum CP content significantly increased in cases with thrombosed false lumen (FL) relative to those in patent FL cases. Results of logistic regression analysis suggested that a greater CP content indicated an increased thrombosed FL risk (OR = 1.11; 95% CI: 1.01-1.23; P = 0.040). Findings in this study suggest that serum ceruloplasmin contents evidently increased among acute aortic dissection cases. CP shows close correlation with the inflammatory factors among AAD cases. Further, CP may serve as the candidate biomarker to diagnose AAD and to identify an increased risk of thrombosed false lumen.
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Affiliation(s)
- Changcheng Ma
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haibin Zhao
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Feng Shi
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mu Li
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xun Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chao Ji
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanshuo Han
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, No. 2 Dagong Road, Liaodongwan New District, Panjin, 124221, China.
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20
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Nazerian P, Mueller C, Vanni S, Soeiro ADM, Leidel BA, Cerini G, Lupia E, Palazzo A, Grifoni S, Morello F. Integration of transthoracic focused cardiac ultrasound in the diagnostic algorithm for suspected acute aortic syndromes. Eur Heart J 2020; 40:1952-1960. [PMID: 31226214 DOI: 10.1093/eurheartj/ehz207] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/25/2018] [Accepted: 04/12/2019] [Indexed: 01/16/2023] Open
Abstract
AIMS The diagnosis of acute aortic syndromes (AASs) is challenging and requires integrated strategies. Transthoracic focused cardiac ultrasound (FoCUS) is endorsed by guidelines as a first-line/triage tool allowing rapid bedside assessment of the aorta. However, the performance of FoCUS in the European Society of Cardiology-recommended workup of AASs awaits validation. METHODS AND RESULTS This was a prespecified subanalysis of the ADvISED multicentre prospective study. Patients with suspected AAS underwent FoCUS for detection of direct/indirect signs of AAS. Clinical probability assessment was performed with the aortic dissection detection risk score (ADD-RS). Case adjudication was based on advanced imaging, surgery, autopsy, or 14-day follow-up. An AAS was diagnosed in 146 (17.4%) of 839 patients. Presence of direct FoCUS signs had a sensitivity and specificity of 45.2% [95% confidence interval (CI) 37-53.6%] and 97.4% (95% CI 95.9-98.4%), while presence of any FoCUS sign had a sensitivity and specificity of 89% (95% CI 82.8-93.6%) and 74.5% (95% CI 71-77.7%) for AAS. The additive value of FoCUS was most evident within low clinical probability (ADD-RS ≤1). Herein, direct FoCUS signs were identified in 40 (4.8%) patients (P < 0.001), including 29 with AAS. ADD-RS ≤1 plus negative FoCUS for AAS rule-out had a sensitivity of 93.8% (95% CI 88.6-97.1%) and a failure rate of 1.9% (95% CI 0.9-3.6%). Addition of negative D-dimer led to a failure rate of 0% (95% CI 0-1.2%). CONCLUSION FoCUS has additive value in the workup of AASs. Direct FoCUS signs can rapidly identify patients requiring advanced imaging despite low clinical probability. In integrated bundles, negative FoCUS is useful for rule-out of AASs.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital of Basel, Petersgraben 4, Basel, Switzerland
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Alexandre de Matos Soeiro
- Emergency Care Unit, Heart Institute, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 44 - Cerqueira César, São Paulo, Brazil
| | - Bernd A Leidel
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Gabriele Cerini
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Enrico Lupia
- Department of Emergency Medicine, S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, Torino, Italy
| | - Andrea Palazzo
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Fulvio Morello
- Department of Emergency Medicine, S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, Torino, Italy
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21
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Zaschke L, Habazettl H, Thurau J, Matschilles C, Göhlich A, Montagner M, Falk V, Kurz SD. Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:S40-S47. [DOI: 10.1177/2048872620914931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background:
Acute type A aortic dissection requires immediate surgical treatment, but the correct diagnosis is often delayed. This study aimed to analyse how initial misdiagnosis affected the time intervals before surgical treatment, symptoms associated with correct or incorrect initial diagnosis and the potential of the Aortic Dissection Detection Risk Score to improve the sensitivity of initial diagnosis.
Methods:
We conducted a retrospective analysis of 350 patients with acute type A aortic dissection. Patients were divided into two groups: initial misdiagnosis (group 0) and correct initial diagnosis of acute type A aortic dissection (group 1). Symptoms were analysed as predictors for the correct or incorrect initial diagnosis by multivariate analysis. Based on these findings, the Aortic Dissection Detection Risk Score was calculated retrospectively; a result ⩾2 was defined as a positive score.
Results:
The early suspicion of aortic dissection significantly shortened the median time from pain to surgical correction from 8.6 h in patients with an initial misdiagnosis to 5.5 h in patients with the correct initial diagnosis (p<0.001). Of all acute type A aortic dissection patients, 49% had a positive Aortic Dissection Detection Risk Score. Of all initial misdiagnosed patients, 41% had a positive score (⩾2). The presence of lumbar pain (p<0.001), any paresis (p=0.037) and sweating (p=0.042) was more likely to lead to the correct initial diagnosis.
Conclusion:
An early consideration of acute aortic dissection may reduce the delay of surgical care. The suggested Aortic Dissection Detection Risk Score may be a useful tool to improve the preclinical assessment.
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Affiliation(s)
- Lisa Zaschke
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
| | - Helmut Habazettl
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
| | - Jana Thurau
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
| | - Christian Matschilles
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
| | - Amélie Göhlich
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
| | - Matteo Montagner
- Department of Cardiothoracic Surgery, German Heart Center Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic Surgery, German Heart Center Berlin, Germany
- Department of Health Science and Technology, Swiss Federal Institute of Technology, Switzerland
| | - Stephan D Kurz
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany
- Institute for Anaesthesiology, German Heart Center Berlin, Germany
- Department of Cardiovascular Surgery, Charité – Universitätsmedizin Berlin, Germany
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22
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Axtell AL, Xue Y, Qu JZ, Zhou Q, Pan J, Cao H, Pan T, Jassar AS, Wang D, Sundt TM, Cameron DE. Type A aortic dissection in the East and West: A comparative study between two hospitals from China and the US. J Card Surg 2020; 35:2168-2174. [PMID: 32652637 DOI: 10.1111/jocs.14766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In this study, we compare the clinical characteristics, intraoperative management, and postoperative outcomes of patients with acute type A aortic dissection (ATAAD) between two academic medical hospitals in the United States and China. METHODS From January 2011 to December 2017, 641 and 150 patients from Nanjing Drum Tower Hospital (NDTH) and Massachusetts General Hospital (MGH) were enrolled. Patient demographics, clinical features, surgical techniques, and postoperative outcomes were compared. RESULTS The annual number of patients presenting with ATAAD at MGH remained relatively stable, while the number at NDTH increased significantly over the study period. The average age was 51 years at NDTH and 61 years at MGH (P < .001). The percentage of patients with known hypertension at the two centers was similar. The time interval from onset of symptoms to diagnosis was significantly longer at NDTH than MGH (11 vs 3.5 hours; P < .001). Associated complications at presentation were more common at NDTH than MGH. More than 90% of patients (91% NDTH and 92% MGH) underwent surgery. The postoperative stroke rate was higher at MGH (12% vs 4%; P < .001); however, the 30-day mortality rate was lower (7% vs 16%; P = .006). CONCLUSIONS There was a significant increase in the number of ATAAD at NDTH during the study period while the number at MGH remained stable. Hypertension was a common major risk factor; however, the onset of ATAAD at NDTH was nearly one decade earlier than MGH. Chinese patients tended to have more complicated preoperative pathophysiology at presentation and underwent more extensive surgical repair.
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Affiliation(s)
- Andrea L Axtell
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Yunxing Xue
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Jason Z Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Qing Zhou
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Jun Pan
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Hailong Cao
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Tuo Pan
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Arminder S Jassar
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Dongjin Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Thoralf M Sundt
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Duke E Cameron
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
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23
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Liu L, Zhang C, Zhang G, Gao Y, Luo J, Zhang W, Li Y, Mu Y. A study of aortic dissection screening method based on multiple machine learning models. J Thorac Dis 2020; 12:605-614. [PMID: 32274126 PMCID: PMC7138971 DOI: 10.21037/jtd.2019.12.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The main purpose of the study was to develop an early screening method for aortic dissection (AD) based on machine learning. Due to the rarity of AD and the complexity of symptoms, many doctors have no clinical experience with it. Many patients are not suspected of having AD, which lead to a high rate of misdiagnosis. Here, we report the preliminary study and feasibility of rapid and accurate screening method of AD with machine learning methods. Methods The dataset analyzed was composed by examination data provided by the Xiangya Hospital Central South University of China which include a total of 60,000 samples, including aortic patients and non-aortic ones. Each sample has 76 features which is consist of routine examinations and other easily accessible information. Since the proportion of people who are affected is usually imbalanced compared to non-diseased people, multiple machine learning models were used, include AdaBoost, SmoteBagging, EasyEnsemble and CalibratedAdaMEC. They used different methods such as ensemble learning, undersampling, oversampling, and cost-sensitivity to solve data imbalance problems. Results AdaBoost performed poorly with an average recall of 16.1% and a specificity of 99.8%. SmoteBagging achieved a statistically significant better performance for this problem with an average recall of 78.1% and a specificity of 79.2%. EasyEnsemble reached the values of 77.8% and 79.3% for recall and specificity respectively. CalibratedAdaMEC’s recall and specificity are 75.8% and 76%. Conclusions It was found that the screening performance of the models evaluated in this paper had a misdiagnosis rate lower than 25% except AdaBoost. The data used in these methods are only routine inspection data. This means that machine learning methods can help us build a fast, cheap, worthwhile and effective early screening approach for AD.
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Affiliation(s)
- Lijue Liu
- School of Information Science and Engineering, Central South University, Changsha 410075, China.,Hunan Zixing Artificial Intelligence Research Institute, Changsha 410007, China
| | - Caiwang Zhang
- School of Information Science and Engineering, Central South University, Changsha 410075, China
| | - Guogang Zhang
- Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yan Gao
- School of Information Science and Engineering, Central South University, Changsha 410075, China
| | - Jingmin Luo
- Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wei Zhang
- Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Li
- School of Information Science and Engineering, Central South University, Changsha 410075, China.,Hunan Zixing Artificial Intelligence Research Institute, Changsha 410007, China
| | - Yang Mu
- Hunan Zixing Artificial Intelligence Research Institute, Changsha 410007, China
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24
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Morello F, Bartalucci A, Bironzo M, Santoro M, Pivetta E, Ianniello A, Rumbolo F, Mengozzi G, Lupia E. Prospective diagnostic accuracy study of plasma soluble ST2 for diagnosis of acute aortic syndromes. Sci Rep 2020; 10:3103. [PMID: 32080259 PMCID: PMC7033105 DOI: 10.1038/s41598-020-59884-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/28/2020] [Indexed: 01/16/2023] Open
Abstract
Acute aortic syndromes (AASs) are difficult to diagnose emergencies. Plasma soluble ST2 (sST2), a prognostic biomarker for heart failure, has been proposed as a diagnostic biomarker of AASs outperforming D-dimer, the current diagnostic standard. We performed a prospective diagnostic accuracy study of sST2 for AASs in the Emergency Department (ED). In 2017–2018, patients were enrolled if they had ≥1 red-flag symptoms (chest/abdominal/back pain, syncope, perfusion deficit) and a clinical suspicion of AAS. sST2 was detected with the Presage® assay. Adjudication was based on computed tomography angiography (CTA) or on diagnostic outcome inclusive of 30-day follow-up. 297 patients were enrolled, including 88 with AASs. The median age was 67 years. In 162 patients with CTA, the median sST2 level was 41.7 ng/mL (IQR 29.4–103.2) in AASs and 34.6 ng/mL (IQR 21.4–51.5) in alternative diagnoses (P = 0.005). In ROC analysis, the AUC of sST2 was 0.63, as compared to 0.82 of D-dimer (P < 0.001). Sensitivity and specificity values of sST2 associated with different cutoffs were: 95.5% and 10.8% (≥12 ng/mL), 84.1% and 29.7% (≥23.7 ng/mL), 35.2% and 85.1% (≥66.5 ng/mL). Results were similar in the full cohort. In conclusion, in patients from a European ED, plasma sST2 provided modest accuracy for diagnosis of AASs.
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Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy. .,Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy.
| | - Alice Bartalucci
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Marco Bironzo
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Marco Santoro
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Emanuele Pivetta
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Alice Ianniello
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Francesca Rumbolo
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Giulio Mengozzi
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Enrico Lupia
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy.,Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
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25
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Dinh MM, Bein KJ, Delaney J, Berendsen Russell S, Royle T. Incidence and outcomes of aortic dissection for emergency departments in New South Wales, Australia 2017–2018: A data linkage study. Emerg Med Australas 2020; 32:599-603. [DOI: 10.1111/1742-6723.13472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/04/2019] [Accepted: 01/07/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - John Delaney
- Emergency Department, Royal Prince Alfred Hospital Sydney New South Wales Australia
| | | | - Tim Royle
- Emergency Department, Royal Prince Alfred Hospital Sydney New South Wales Australia
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