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Lorenz V, Muzzi L, Neri E. Analysis of current mortality risk scores for acute type A aortic dissection: The Siena experience. Asian Cardiovasc Thorac Ann 2024; 32:116-122. [PMID: 38317575 DOI: 10.1177/02184923241230344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE In literature, various risk scores have been described to predict in-hospital mortality of patients undergoing surgery for acute type A dissection. We want to evaluate which factors are most correlated with a negative outcome and testing the validity of the current scores in literature analyzing our experience of over 20 years in the surgery of type A aortic dissections. MATERIALS AND METHODS A total of 324 patients were included in the study. Patients were divided into two groups according to 30-day survival or mortality. The preoperative variables analyzed are the parameters necessary for the calculation of scores: Penn Classification, Leipzig Halifax and adjusted Leipzig Halifax score, GERAADA score and EuroSCORE II. Intra- and post-operative mortality were 10.2% and 17.5%, respectively. In multivariate analysis, the preoperative predictors of 30-day mortality were age greater than 70 years, low eject fraction levels, visceral and coronary malperfusion. Both GERAADA and EuroSCORE II were statistically significant predictors of 30-day mortality. However, EuroSCORE II underestimates the mortality compared to GERAADA score probably due to the lack of evaluation of fundamental preoperative factors in the course of type A aortic dissection. RESULTS The study has demonstrated the efficacy of the GERAADA score in predicting the outcome of patients undergoing surgery and the underestimation of the mortality of EuroSCORE II in our population.
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Affiliation(s)
- Veronica Lorenz
- Cardiac Surgery - Aortic Unit, University of Study of Siena, Siena, Italy
| | - Luigi Muzzi
- Cardiac Surgery - Aortic Unit, University of Study of Siena, Siena, Italy
| | - Eugenio Neri
- Cardiac Surgery - Aortic Unit, University of Study of Siena, Siena, Italy
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2
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Ma M, Cao H, Li K, Pan J, Zhou Q, Tang X, Qin X, Zhu F, Wang D. Evaluation of Two Online Risk Prediction Models for the Mortality Rate of Acute Type A Aortic Dissection Surgery: The German Registry of Acute Aortic Dissection Type A Score and the European System for Cardiac Operative Risk Evaluation II. J Clin Med 2023; 12:4728. [PMID: 37510842 PMCID: PMC10381328 DOI: 10.3390/jcm12144728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
EuroSCORE II is one of the most widely utilized cardiovascular surgery risk scoring systems. Recently, a new online score calculator, namely the German Registry of Acute Aortic Dissection Type A (GERAADA), was launched to predict 30-day surgical mortality for acute type A aortic dissection (ATAAD) patients. The aim of this study is to evaluate the predictive performance of these two scores. We calculated the two scores for 1346 ATAAD patients from January 2012 to December 2021. The overall performance was evaluated using Brier scores and Hosmer-Lemeshow statistics. Receiver Operating Characteristic (ROC) curves were employed to assess diagnostic ability, and the standardized mortality ratio (SMR) was utilized to evaluate calibration. The GERAADA score and EuroSCORE II predicted 30-day mortality rates of 14.7% and 3.1%, respectively, while the observed rate was 12.5%. The predictive ability of EuroSCORE II (AUC 0.708, 95% CI: 0.664-0.792) was superior to that of the GERAADA score (0.648, 95% CI: 0.605-0.692). The GERAADA score had higher sensitivity but lower specificity than EuroSCORE II. And the GERAADA score may overestimate mortality (0.76, 95% CI: 0.65-0.89), while EuroSCORE II may underestimate the mortality rate (3.17, 95% CI: 2.92-3.44). The EuroSCORE II was superior in predicting surgical mortality among ATAAD patients. But the observed 30-day mortality rate certified a good calibration for the GERAADA score.
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Affiliation(s)
- Ming Ma
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
| | - Hailong Cao
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
| | - Kai Li
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
| | - Jun Pan
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
| | - Qing Zhou
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
| | - Xinlong Tang
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
| | - Xichun Qin
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
| | - Feng Zhu
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
| | - Dongjin Wang
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China
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3
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Sutarjono B, Ahmed AJ, Ivanova A, Buchel B, Rauscher J, O'Connell A, Riekena J, Gift A, Kessel M, Grewal E. Diagnostic accuracy of transthoracic echocardiography for the identification of proximal aortic dissection: a systematic review and meta-analysis. Sci Rep 2023; 13:5886. [PMID: 37041307 PMCID: PMC10090068 DOI: 10.1038/s41598-023-32800-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
This systematic review and meta-analysis evaluated the performance of transthoracic echocardiography (TTE) for diagnosis of proximal aortic dissections based on the identification of specific sonographic features. A systematic literature search of major databases was conducted on human studies investigating the diagnostic accuracy of TTE for proximal aortic dissection. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies 2 tool. Data were gathered for the following sonographic findings: intimal flap, tear, or intramural hematoma; enlargement of aortic root or widening of aortic walls; aortic valve regurgitation; or pericardial effusion. Sensitivity, specificity, diagnostic odds ratio, number needed to diagnose values, and likelihood ratios were determined. Fourteen studies were included in our final analysis. More than half of the included studies demonstrated low risk of bias. The identification of intimal flap, tear, or intramural hematoma was shown to have an exceptional ability as a diagnostic tool to rule in proximal aortic dissections. TTE should be considered during the initial evaluation of patients presenting to the emergency department with suspected proximal aortic dissection. Positive sonographic findings on TTE may aid in rapid assessment, coordination of care, and treatment of individuals awaiting advanced imaging.
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Affiliation(s)
- Bayu Sutarjono
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA.
| | - Abrar Justin Ahmed
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Anna Ivanova
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Brandon Buchel
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Joseph Rauscher
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Alanna O'Connell
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Jeremy Riekena
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Aluko Gift
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Matthew Kessel
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
| | - Ekjot Grewal
- Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA
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4
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Huang PF, Zhang YJ, Lou XZ, Ma D, Wu YY, Zhao YB. Predictive value of admission CO 2 combining power combined with serum sodium for the prognosis in acute Stanford type A aortic dissection patients. Sci Rep 2023; 13:1048. [PMID: 36658204 PMCID: PMC9852255 DOI: 10.1038/s41598-022-27099-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/26/2022] [Indexed: 01/20/2023] Open
Abstract
Acute Stanford type A aortic dissection (ATAAD) with sudden onset and high mortality requiries a standard Bentall operation and a accurate prognosis in common, together with alteration of CO2 combining power (CO2CP) and serum sodium rase concern, hence, we evaluated the prognostic value of CO2CP combined with serum sodium in ATAAD patients. This retrospective study included 183 patients who underwent Bentall operation for ATAAD from 2015 to 2021 in the Fourth Hospital of Hebei Medical University, subsequently followed grouping by the levels of CO2CP and serum sodium. The study endpoint was 30-day all-cause mortality, and the prognostic value of CO2CP combined with serum sodium levels in ATAAD patients were evaluated with multivariate logistic regression method. The postoperative incidence of in-hospital death and adverse events in patients with ATAAD were 18% and 25.7%, respectively. Combination of CO2CP and serum sodium for predicting ATAAD death and adverse events presented a higher predictive value than each single indicator with ROC curve analysis (the AUC of CO2CP combined with serum sodium was 0.786, 95% CI 0.706-0.869, P < 0.001), along with CO2CP < 22.5 mmol/L + serum sodium > 138.5 mmol/L group had the worst prognostic. Multivariate regression analyse showed that CO2CP < 22.5 mmol/L combined with serum sodium > 138.5 mmol/L preferably predicted the prognosis of ATAAD (OR =6.073, 95% CI 2.557-14.425, P < 0.001). Consistently, the cumulative 30-day survival after surgery in ATAAD patients with the low CO2CP and high serum sodium simultaneously was the worst (log-rank P < 0.05). The combination of CO2CP and serum sodium increases the predictive value of prognosis, which is conducive to risk stratification of patients with ATAAD.
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Affiliation(s)
- Peng-Fei Huang
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Yun-Jing Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Xian-Zhe Lou
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China
| | - Dong Ma
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei, People's Republic of China. .,Department of Biochemistry and Molecular Biology, Key Laboratory of Neural and Vascular Biology, Ministry of Education, Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
| | - Yun-Yan Wu
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Yong-Bo Zhao
- Cardiac Surgery Department, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
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5
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Yang G, Chai X, Ding N, Yang D, Ding Q. A retrospective observational study of serum uric acid and in-hospital mortality in acute type A aortic dissection. Sci Rep 2022; 12:12289. [PMID: 35853989 PMCID: PMC9296441 DOI: 10.1038/s41598-022-16704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
There is currently insufficient evidence of correlation between on-admission serum uric acid and in-hospital mortality of patients with acute type A aortic dissection. Thus, this study analysed the relation between serum uric acid and in-hospital deaths in patients with acute type A aortic dissection. A total of 1048 patients with acute type A aortic dissection participated in this study between January 2010 and December 2018. The independent variable was on-admission serum uric acid, whilst the dependent variable was in-hospital deaths. The covariates of the study included patient age, gender, body mass index, smoking status, hypertension, diabetes, Marfan syndrome, bicuspid aortic valve, chronic renal insufficiency, stroke, atherosclerosis, time to presentation, systolic blood pressure, diastolic blood pressure, aortic diameter, aortic regurgitation, abdominal vessel involvement, arch vessel involvement, ejection fraction value, laboratory parameters, symptom, coronary malperfusion, mesenteric malperfusion, cerebral malperfusion, hypotension/shock, cardiac tamponade and operation status. The mean age of the sample was 50.17 ± 11.47 years, with approximately 24.24% of the participants being female. After analysis, it was found that the admission serum uric acid of patients with acute type A aortic dissection was positively correlated with in-hospital death (OR = 1.04, 95% CI 1.02–1.06). Subsequently, a non-linear relationship was determined between admission serum uric acid (point 260 µmol/L) and in-hospital mortality for patients with acute type A aortic dissection. The effect sizes and confidence intervals of the right (serum uric acid > 260 µmol/L) and left (serum uric acid ≤ 260 µmol/L) aspects of the inflection point were 1.04 (1.02–1.05) and 1.00 (0.99–1.02), respectively. Furthermore, subgroup analysis indicated a stable relationship between serum uric acid and in-hospital mortality, whilst an insignificant difference was found for the interactions between different subgroups. Overall, a non-linear correlation was determined between admission serum uric acid and in-hospital mortality of patients with acute type A aortic dissection. When serum uric acid > 260 µmol/L, it showed a positive correlation with in-hospital mortality.
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Affiliation(s)
- Guifang Yang
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.,Trauma Center of Hunan Province, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.,Trauma Center of Hunan Province, Changsha, China
| | - Ning Ding
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.,Trauma Center of Hunan Province, Changsha, China
| | - Donghua Yang
- Department of Nursing, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, 410004, Hunan, China
| | - Qiong Ding
- Department of Nursing, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, 410004, Hunan, China.
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6
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Nežić DG, Živković IS, Miličić MD, Milačić PA, Košević DN, Boričić MI, Krasić SD, Mićović SV. On-line risk prediction models for acute type A aortic dissection surgery: validation of the German Registry of Acute Aortic Dissection Type A score and the European System for Cardiac Operative Risk Evaluation II. Eur J Cardiothorac Surg 2021; 61:1068-1075. [PMID: 34915555 DOI: 10.1093/ejcts/ezab517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The German Registry of Acute Aortic Dissection Type A (GERAADA) on-line score calculator to predict 30-day mortality in patients undergoing surgery for acute type A aortic dissection (ATAAD) was recently launched. Using the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), it is also possible to predict operative mortality for the same type of surgery. The goal of our study was to validate the prediction accuracy of these 2 on-line risk prediction models. METHODS Prospectively collected data for EuroSCORE II risk factors as well as all data for GERAADA scoring were extracted from an institutional database for 147 patients who underwent surgery for ATAAD between April 2018 and April 2021. The discriminative power was assessed using area under the receiver operating characteristic curve. The calibration of the models was tested by the Hosmer-Lemeshow statistics and by using the observed-to-expected (O/E) mortality ratio with the 95% confidence interval. RESULTS The observed operative mortality was 14.3%. The mean predicted mortality rates for the GERAADA score and the EuroSCORE II were 15.6% and 10.6%, respectively. The EuroSCORE II discriminative power (area under the curve = 0.799) significantly outperformed the discriminatory power of the GERAADA score (area under the curve = 0.550). The Hosmer-Lemeshow statistics confirmed good calibration for both models (P-values of 0.49 and 0.29 for the GERAADA score and the EuroSCORE II, respectively). The O/E mortality ratio certified good calibration for both scores [GERAADA score (O/E ratio of 0.93, 95% confidence interval: 0.53-1.33); EuroSCORE II (O/E ratio of 1.35, 95% confidence interval: 0.77-1.93)]. CONCLUSIONS The EuroSCORE II has better discriminative power for predicting operative mortality in ATAAD surgery than the GERAADA score. Both scores confirmed good calibration ability.
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Affiliation(s)
- Duško G Nežić
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Igor S Živković
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Miroslav D Miličić
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Petar A Milačić
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Dragana N Košević
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Mladen I Boričić
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | - Staša D Krasić
- Department of Pediatric Cardiology, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
| | - Slobodan V Mićović
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
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7
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Kofler M, Heck R, Seeber F, Montagner M, Gasser S, Stastny L, Kurz SD, Grimm M, Falk V, Kempfert J, Dumfarth J. Validation of a novel risk score to predict mortality after surgery for acute type A dissection. Eur J Cardiothorac Surg 2021; 61:378-385. [PMID: 34676413 DOI: 10.1093/ejcts/ezab401] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The aim of this study was to externally validate a lab-based risk score (lactate, creatinine, aspartate aminotransferase, alanine aminotransferase or bilirubin) by Ghoreishi et al. to predict perioperative mortality in patients undergoing surgical repair for acute type A aortic dissection. METHODS The risk score to predict operative mortality was applied to a large and homogenous validation cohort that consisted of 632 patients undergoing surgery for acute type A aortic dissection in 2 centres. Multivariable regression analysis was performed to determine the impact on survival. Receiver operating characteristics with deduced area under the curve were used to assess the ability to predict perioperative mortality. RESULTS A total of 632 patients (54% male, mean age 62 ± 14 years) were assigned to 3 different risk groups according to the calculated mortality score [low risk <7 (31.2%), moderate risk 7-20 (36.1%) and high >20 (32.7%)]. Perioperative mortality was 8% in the low-risk group, 10% in the moderate-risk group and 24% in the high-risk group (P < 0.0001). Receiver operating characteristic analysis of this new score revealed an area under the curve of 0.69 with adequate calibration. In addition, multivariable analysis revealed an independet assocation with perioperative mortality (odds ratio 1.509; 95% confidence interval 1.042-2.185). While overall survival differed between the risk groups (P < 0.0001), the score does not serve as an independent predictor of long-term mortality when adjusted for relevant covariates. CONCLUSIONS The external validation process confirmed that a newly proposed risk score offers clinicians a helpful and reliable tool to improve the preoperative risk assessment of acute type A aortic dissection patients based on easily accessible and broadly available laboratory parameters.
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Affiliation(s)
- Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Roland Heck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Fabian Seeber
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Simone Gasser
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Lukas Stastny
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Stephan D Kurz
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Grimm
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Health Sciences and Technology, Translational Cardiovascular Technologies, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Julia Dumfarth
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
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8
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Nezic D. GERAADA score for the prediction of mortality rate in acute type A aortic dissection surgery. Eur J Cardiothorac Surg 2021; 59:923. [PMID: 33006597 DOI: 10.1093/ejcts/ezaa339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dusko Nezic
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
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9
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Rocha WEM, Oliveira MFRA, Soares JD, L'Armée VMFS, Martins MPG, Rocha AM, Feitosa ADM, Lima RC, Oliveira PPM, Silveira-Filho LM, Coelho-Filho OR, Matos-Souza JR, Petrucci O, Sposito AC, Nadruz W. Left Ventricular Concentric Geometric Patterns Are Associated With Worse Prognosis Among Patients With Type-A Aortic Dissection. J Am Heart Assoc 2021; 10:e018273. [PMID: 33599150 PMCID: PMC8174278 DOI: 10.1161/jaha.120.018273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background This study compared left ventricular (LV) characteristics between patients with type‐A and type‐B aortic dissection (AD) and evaluated the ability of LV remodeling phenotypes (hypertrophy, concentricity, or geometric patterns) to predict mortality in both AD types. Methods and Results We evaluated 236 patients with type A and 120 patients with type B who had echocardiograms within 60 days before or after AD diagnosis (median [25th, 75th percentiles] time difference between echocardiogram and AD diagnosis=1 [0, 6] days) from 3 centers. Patients were stratified according to LV phenotypes, and early (90‐day) and late (1‐year) mortality after AD diagnosis were assessed. In adjusted logistic regression analysis, patients with type A had higher and lower odds of concentric and eccentric hypertrophy (odds ratio [OR], 2.56; 95% CI, 1.50–4.36; P<0.001; and OR, 0.55; 95% CI, 0.31–0.97; P=0.039, respectively) than those with type B. Results of multivariable Cox‐regression analysis showed that LV remodeling phenotypes were not related to mortality in patients with type B. By contrast, LV concentricity was associated with greater early and late mortality (hazard ratio [HR], 2.22; 95% CI, 1.24–3.96; P=0.007 and HR, 2.06; 95% CI, 1.20–3.54; P=0.009, respectively) in type A. In further analysis considering normal LV geometry as reference, LV concentric remodeling and concentric hypertrophy were associated with early mortality (HR, 7.78; 95% CI, 2.35–25.78; P<0.001 and HR, 4.38; 95% CI, 1.47–13.11; P=0.008, respectively), whereas concentric remodeling was associated with late mortality (HR, 5.40; 95% CI, 1.91–15.26; P<0.001) among patients with type A. Assessment of LV geometric patterns and concentricity provided incremental prognostic value in predicting early and late mortality beyond clinical variables in patients with type A based on net reclassification improvement and integrated discrimination improvement. Conclusions LV geometric patterns derived from LV concentricity were associated with greater mortality among patients with type A and may be markers of adverse prognosis in this population.
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Affiliation(s)
- Walter E M Rocha
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Matheus F R A Oliveira
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Julia D Soares
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Victor M F S L'Armée
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Mayara P G Martins
- Department of Cardiology Pontifical Catholic University of Campinas Campinas SP Brazil
| | - Aloísio M Rocha
- Department of Cardiology Pontifical Catholic University of Campinas Campinas SP Brazil
| | - Audes D M Feitosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil.,Laboratory of Immunopathology Keizo Asami Federal University of Pernambuco Recife PE Brazil
| | - Ricardo C Lima
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Pedro P M Oliveira
- Department of Surgery School of Medical Sciences State University of Campinas São Paulo Brazil
| | | | - Otavio R Coelho-Filho
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - José R Matos-Souza
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Orlando Petrucci
- Department of Surgery School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Andrei C Sposito
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Wilson Nadruz
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
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10
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Thurau J, Habazettl H, El Al AA, Mladenow A, Zaschke L, Adam U, Kuppe H, Wundram M, Kukucka M, Kurz SD. Response: The Effects of Cardiac Dysfunction on Survival After Surgery for Type A Aortic Dissection. J Cardiothorac Vasc Anesth 2019; 33:2882-2883. [PMID: 31257056 DOI: 10.1053/j.jvca.2019.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jana Thurau
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany
| | - Helmut Habazettl
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany
| | - Alaa Abd El Al
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alexander Mladenow
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Lisa Zaschke
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany
| | - Uyanga Adam
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany
| | - Hermann Kuppe
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maximilian Wundram
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany
| | - Marian Kukucka
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Stephan D Kurz
- Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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11
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Kawada T. Poor Prognosis of Left Ventricular Systolic Dysfunction in Patients With Type-A Aortic Dissection. J Cardiothorac Vasc Anesth 2019; 33:2882. [PMID: 31227376 DOI: 10.1053/j.jvca.2019.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/22/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
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12
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Heringlake M, Berggreen AE. Type-A Aortic Dissection—More Than a Surgical Disease? J Cardiothorac Vasc Anesth 2019; 33:58-59. [DOI: 10.1053/j.jvca.2018.08.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Indexed: 11/11/2022]
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