Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil.
Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil.
J Am Heart Assoc. 2021 Feb;10(5):e018273. doi: 10.1161/JAHA.120.018273. Epub 2021 Feb 18.
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; <0.001; and OR, 0.55; 95% CI, 0.31-0.97; =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; =0.007 and HR, 2.06; 95% CI, 1.20-3.54; =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; <0.001 and HR, 4.38; 95% CI, 1.47-13.11; =0.008, respectively), whereas concentric remodeling was associated with late mortality (HR, 5.40; 95% CI, 1.91-15.26; <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.
背景 本研究比较了 A 型和 B 型主动脉夹层（AD）患者的左心室（LV）特征，并评估了 LV 重构表型（肥厚、同心或几何模式）预测两种 AD 类型患者死亡率的能力。
方法和结果 我们评估了来自 3 个中心的 236 例 A 型患者和 120 例 B 型患者，这些患者在 AD 诊断前或后 60 天内进行了超声心动图检查（超声心动图和 AD 诊断之间的中位[25 百分位数，75 百分位数]时间差=1[0，6]天）。根据 LV 表型对患者进行分层，并评估 AD 诊断后 90 天和 1 年的早期和晚期死亡率。在调整后的逻辑回归分析中，与 B 型患者相比，A 型患者的同心和偏心肥厚的比值更高（比值比[OR]，2.56；95%置信区间[CI]，1.50-4.36；<0.001；和 OR，0.55；95%CI，0.31-0.97；=0.039）。多变量 Cox 回归分析结果表明，LV 重构表型与 B 型患者的死亡率无关。相比之下，LV 同心性与更大的早期和晚期死亡率相关（危险比[HR]，2.22；95%CI，1.24-3.96；=0.007 和 HR，2.06；95%CI，1.20-3.54；=0.009）。在考虑正常 LV 几何形状为参考的进一步分析中，LV 同心性重构和同心性肥厚与 A 型患者的早期死亡率相关（HR，7.78；95%CI，2.35-25.78；<0.001 和 HR，4.38；95%CI，1.47-13.11；=0.008），而 LV 同心性重构与晚期死亡率相关（HR，5.40；95%CI，1.91-15.26；<0.001）。基于净重新分类改善和综合判别改善，LV 几何模式和同心性评估在预测 A 型患者的早期和晚期死亡率方面提供了比临床变量更大的预后价值。
结论 源自 LV 同心性的 LV 几何模式与 A 型患者的更高死亡率相关，并且可能是该人群不良预后的标志物。
