Kosuge Masami, Kimura Kazuo, Uchida Keiji, Masuda Munetaka, Tamura Kouichi
Division of Cardiology, Yokohama City University Medical Center.
Division of Cardiovascular Surgery, Yokohama City University Medical Center.
Circ J. 2017 Aug 25;81(9):1254-1260. doi: 10.1253/circj.CJ-17-0309. Epub 2017 May 19.
Type A acute aortic dissection (AAD) is a serious cardiovascular emergency requiring urgent surgery. Timely accurate diagnosis is essential, but often challenging, because of the wide spectrum of clinical presentations. In patients with type A AAD, chest pain is the most common symptom; furthermore, ischemic ST-T changes such as ST-segment elevation or depression or negative T waves are frequently observed on presentation ECG. These clinical presentations of type A AAD are difficult to differentiate from those of acute coronary syndrome (ACS), which could lead to delayed diagnosis and treatment of type A AAD or misdiagnosis of ACS followed by inappropriate treatment. Of note, ischemic ST-T changes have been shown to be associated with poor outcomes in patients with type A AAD. Because ECG is simple, inexpensive, noninvasive, readily available, and rapidly interpretable at the time of presentation, risk stratification based on ECG findings is considered very useful clinically. ECG findings of type A AAD thus have clinically important diagnostic, therapeutic, and prognostic implications; however, the relationships among these factors remain poorly understood. We review the prevalence of ECG abnormalities, clinical features associated with such changes, and the prognostic importance in patients with type A AAD.
A型急性主动脉夹层（AAD）是一种需要紧急手术的严重心血管急症。及时准确的诊断至关重要，但由于临床表现范围广泛，往往具有挑战性。在A型AAD患者中，胸痛是最常见的症状；此外，在首次心电图检查时经常观察到缺血性ST-T改变，如ST段抬高或压低或T波倒置。A型AAD的这些临床表现很难与急性冠状动脉综合征（ACS）的临床表现区分开来，这可能导致A型AAD的诊断和治疗延迟，或ACS误诊并随后进行不适当的治疗。值得注意的是，缺血性ST-T改变已被证明与A型AAD患者的不良预后相关。由于心电图简单、廉价、无创、随时可用且在就诊时可快速解读，基于心电图结果的风险分层在临床上被认为非常有用。因此，A型AAD的心电图结果具有重要的临床诊断、治疗和预后意义；然而，这些因素之间的关系仍知之甚少。我们回顾了A型AAD患者心电图异常的发生率、与此类改变相关的临床特征以及预后重要性。
