Rahmanian Mahdi, Bazrafshan Mehdi, Kamali Farnaz, Zare Maryam, Keshavarz Mohammad, Bazrafshan Hanieh, Izadpanah Payman, Mohammadi Mohammad, Zare Marjan, Bazrafshan Drissi Hamed
Cardiovascular research center, Shiraz University of medical science, Shiraz, Iran.
Department of internal medicine, Shiraz University of medical science, Shiraz, Iran.
J Electrocardiol. 2023 Sep-Oct;80:58-62. doi: 10.1016/j.jelectrocard.2023.05.008. Epub 2023 May 24.
Aortic dissection is a rare but potentially lethal disorder and may be associated with electrocardiogram (ECG) changes. In this study, we aim to investigate ECG-related parameters alongside clinical presentations of type A aortic dissection to come up with the predictive factors for the severity of the disease and its mortality rate.
In this retrospective study, 201 patients with type A aortic dissection were studied between March 2015 and March 2020. Two expert cardiologists blinded to the diagnosis studied former and new patients' ECGs and recorded changes.
Two-hundred and one patients, including 143 (71.1%) men and 58 (28.9%) women, presented with acute dissection of the aorta, were studied. Forty-four (21.8%) and 84 (41.7%) patients had ST-segment elevation and depression in ECG, respectively. Bivariate analysis revealed that higher heart rate (p = 0.006), longer QTc (p = 0.044), and ST-segment elevation in aVR lead (p = 0.044) were associated with mortality in the patients. Multivariate regression showed higher heart rate (OR = 1.022, CI = 1.003-1.041, p = 0.012) and ST-segment elevation in aVR (OR = 4.854, CI = 2.255-10.477, p < 0.001) were independently associated with increased odds of mortality in aortic dissection patients. ROC curve analysis showed heart rate equal to or >60 per minute (AUC = 0.625, sensitivity = 86%, specificity = 10%, p = 0.019) and ST-segment elevation in aVR >0.5 mm (AUC = 0.854, sensitivity = 75%, specificity = 92%, p < 0.001) were associated with a higher mortality rate.
Heart rate equal or >60 and ST-segment elevation >0.5 mm in aVR lead can be used as predictive factors for mortality of patients with type A aortic dissection.
主动脉夹层是一种罕见但可能致命的疾病，可能与心电图（ECG）改变有关。在本研究中，我们旨在研究与A型主动脉夹层临床表现相关的心电图参数，以找出该疾病严重程度及其死亡率的预测因素。
在这项回顾性研究中，对2015年3月至2020年3月期间的201例A型主动脉夹层患者进行了研究。两名对诊断不知情的心脏专家研究了新老患者的心电图并记录变化。
研究了201例急性主动脉夹层患者，其中男性143例（71.1%），女性58例（28.9%）。心电图ST段抬高和压低的患者分别为44例（21.8%）和84例（41.7%）。双变量分析显示，心率较高（p = 0.006）、QTc较长（p = 0.044）以及aVR导联ST段抬高（p = 0.044）与患者死亡率相关。多变量回归显示，心率较高（OR = 1.022，CI = 1.003 - 1.041，p = 0.012）和aVR导联ST段抬高（OR = 4.854，CI = 2.255 - 10.477，p < 0.001）与主动脉夹层患者死亡率增加独立相关。ROC曲线分析显示，心率等于或>60次/分钟（AUC = 0.625，敏感性 = 86%，特异性 = 10%，p = 0.019）和aVR导联ST段抬高>0.5 mm（AUC = 0.854，敏感性 = 75%，特异性 = 92%，p < 0.001）与较高的死亡率相关。
心率等于或>60次/分钟以及aVR导联ST段抬高>0.5 mm可作为A型主动脉夹层患者死亡率的预测因素。
