Wu Zhaoyu, Li Yixuan, Qiu Peng, Liu Haichun, Liu Kai, Li Weimin, Wang Ruihua, Chen Tao, Lu Xinwu
Department of Vascular Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada.
Front Cardiovasc Med. 2022 Jun 3;9:832770. doi: 10.3389/fcvm.2022.832770. eCollection 2022.
Hypertension is a predominant risk factor for aortic dissection (AD), and blood pressure (BP) control plays a vital role in the management of AD. However, the correlation between BP change and the prognosis for AD remains unclear. This study aims to demonstrate the impact of BP change patterns on AD prognosis.
This retrospective study included AD patients at two institutions (Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine and the Vascular Department of the First Affiliated Hospital of Anhui Medical University) between 2004 and 2018. The systolic BP (SBP) change patterns of these patients were analyzed by functional data analysis (FDA). The relationship between BP change patterns and the risk of adverse events (AEs) was assessed using survival analysis.
A total of 458 patients with AD were eligible for analysis. The logistic regression analysis indicated that compared with that in patients with low SBP variation (SBPV), the incidence of AEs in patients with high SBPV was significantly higher (35.84 vs. 20.35%, OR 2.19, < 0.001). The patients were divided into four categories (accelerating rise, accelerating drop, decelerating rise, and decelerating drop) based on their SBP patterns after FDA fitting. The results of Kaplan-Meier analysis showed that at the 15- and 20-min time points, the incidence of AEs in the decelerating-drop group was significantly lower than that in the accelerating-rise group (OR 0.19, = 0.031 and OR 0.23, = 0.050). However, at the 25- and 30-min time points, the difference between these four groups was not significant (OR 0.26, = 0.08 and OR 0.29, = 0.10).
This study classified AD patients into four groups according to the SBP change patterns the first 30 min following admission, of which those with accelerating rises in SBP are at the highest risk of AEs, while those with decelerating drops have the best prognosis in the first 24 h after admission. Clinical practitioners may benefit from analyzing patterns of in-hospital SBP.
高血压是主动脉夹层（AD）的主要危险因素，血压（BP）控制在AD的管理中起着至关重要的作用。然而，血压变化与AD预后之间的相关性仍不清楚。本研究旨在阐明血压变化模式对AD预后的影响。
这项回顾性研究纳入了2004年至2018年间上海交通大学医学院附属第九人民医院和安徽医科大学第一附属医院血管科的AD患者。通过功能数据分析（FDA）分析这些患者的收缩压（SBP）变化模式。使用生存分析评估血压变化模式与不良事件（AE）风险之间的关系。
共有458例AD患者符合分析条件。逻辑回归分析表明，与低收缩压变异性（SBPV）患者相比，高SBPV患者的AE发生率显著更高（35.84%对20.35%，OR 2.19，<0.001）。在FDA拟合后，根据患者的SBP模式将其分为四类（加速上升、加速下降、减速上升和减速下降）。Kaplan-Meier分析结果显示，在15分钟和20分钟时间点，减速下降组的AE发生率显著低于加速上升组（OR 0.19，=0.031和OR 0.23，=0.050）。然而，在25分钟和30分钟时间点，这四组之间的差异不显著（OR 0.26，=0.08和OR 0.29，=0.10）。
本研究根据入院后最初30分钟的SBP变化模式将AD患者分为四组，其中SBP加速上升的患者发生AE的风险最高，而减速下降的患者在入院后最初24小时预后最佳。临床医生可能会从分析住院期间SBP模式中受益。
