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Oliveira MFRA, Rocha WEM, 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. Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection. Front Cardiovasc Med 2022; 8:803283. [PMID: 35127863 PMCID: PMC8813851 DOI: 10.3389/fcvm.2021.803283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023] Open
Abstract
Objective This study compared clinical, echocardiographic, and prognostic characteristics among patients with aortic dissection (AD) with (HypHist) and without (No-HypHist) hypertension history and evaluated the association of blood pressure (BP) at presentation with 1-year mortality, left ventricular (LV) remodeling and renal dysfunction. Methods We investigated clinical and echocardiographic characteristics and 1-year mortality among 367 patients with AD (81% HypHist, 66% Type-A) from three Brazilian centers. Results Patients with No-HypHist were more likely to have Marfan syndrome, bicuspid aortic valve, to undergo surgical therapy, were less likely to have LV hypertrophy and concentricity, and had similar mortality compared with HypHist patients. Adjusted restricted cubic spline analysis showed that systolic BP (SBP) and diastolic BP (DBP) at presentation had a J-curve association with mortality among patients with No-HypHist, but did not associate with death among patients with HypHist (p for interaction = 0.001 for SBP and = 0.022 for DBP). Conversely, the association between SBP at presentation and mortality was influenced by previous use of antihypertensive medications in the HypHist group (p for interaction = 0.002). Results of multivariable logistic regression analysis comprising the whole sample showed direct associations of SBP and DBP at presentation with LV hypertrophy (p = 0.009) and LV concentricity (p = 0.015), respectively, and an inverse association between pulse pressure at presentation and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (p = 0.008). Conclusion Combined information on BP at presentation, previous diagnosis of hypertension, and use of antihypertensive medications might be useful to predict mortality risk and to estimate extra-aortic end-organ damage among patients with AD.
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Affiliation(s)
- Matheus F. R. A. Oliveira
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Walter E. M. Rocha
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Julia D. Soares
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Brazil
| | | | - Mayara P. G. Martins
- Department of Cardiology, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Aloísio M. Rocha
- Department of Cardiology, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Audes D. M. Feitosa
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Brazil
- Catholic University of Pernambuco Clinical Research Institute, Catholic University of Pernambuco, Recife, Brazil
| | - Ricardo C. Lima
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, 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
- *Correspondence: Wilson Nadruz Jr.
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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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