Armstrong W F, Bach D S, Carey L M, Froehlich J, Lowell M, Kazerooni E A
Departments of Medicine, Emergency Services, and Radiology, University of Michigan, Ann Arbor, MI 48109-0273, USA.
Am Heart J. 1998 Dec;136(6):1051-60. doi: 10.1016/s0002-8703(98)70162-0.
The objective of this study was to define the range of clinical presentations, echocardiographic findings, and underlying final diagnoses in patients with clinically suspected acute aortic dissection.
This study was designed as a retrospective review of clinical and echocardiographic data in consecutive patients evaluated for clinically suspected acute aortic dissection. The study population consisted of 75 studies in 74 consecutive patients referred for urgent or emergency evaluation because of signs and symptoms suggesting acute aortic dissection. A history and physical examination designed to elicit the cause of chest pain, evidence of congestive heart failure, and other cardiovascular abnormalities was performed in each patient. All patients underwent transesophageal echocardiography by experienced operators. Routine 12-lead electrocardiograms and chest radiographs were available for review in the majority of patients. Magnetic resonance imaging or computed tomography was performed in only 5 (6%) and 34 (44%) patients, respectively. Contrast aortography was performed in 21 (27%) patients. For the entire patient cohort, the most prevalent symptom was chest pain alone (n = 31; 41%) or chest pain in conjunction with back pain (n = 23; 31%). Classic "tearing" pain was an infrequent symptom. Syncope or other neurologic findings were present in 15 (20%) patients. Acute aortic dissection was responsible for 34 (45%) of the 75 presentations, with 31 (41% of total evaluations, 92% of dissections) involving the ascending aorta (Stanford type A, DeBakey type 1 or 2). Alternate major cardiovascular diagnoses, including acute myocardial infarction, primary valvular disease, or pericardial disease, were established in 12 (16%) cases. Aortic pathology, other than dissection, was found in 15 (20%) cases. Transesophageal echocardiography established the diagnosis responsible for the symptoms in 61 (81%) cases.
Symptoms in patients with acute aortic dissection are more variable than commonly recognized. Transesophageal echocardiography is an accurate primary diagnostic tool in patients with clinically suspected acute aortic dissection. It allows rapid diagnosis of dissection and can identify alternate cardiovascular pathology responsible for the symptoms in a significant number of patients without acute dissection.
本研究的目的是明确临床疑似急性主动脉夹层患者的临床表现范围、超声心动图检查结果及最终潜在诊断。
本研究设计为对连续评估临床疑似急性主动脉夹层患者的临床和超声心动图数据进行回顾性分析。研究人群包括74例连续患者的75项研究，这些患者因提示急性主动脉夹层的体征和症状而被转诊进行紧急或急诊评估。对每位患者进行了旨在明确胸痛病因、充血性心力衰竭证据及其他心血管异常的病史和体格检查。所有患者均由经验丰富的操作人员进行经食管超声心动图检查。大多数患者可获得常规12导联心电图和胸部X线片以供查阅。仅分别有5例（6%）和34例（44%）患者进行了磁共振成像或计算机断层扫描。21例（27%）患者进行了对比主动脉造影。对于整个患者队列，最常见的症状是单纯胸痛（n = 31；41%）或胸痛伴背痛（n = 23；31%）。典型的“撕裂样”疼痛是一种不常见的症状。15例（20%）患者出现晕厥或其他神经系统表现。75例临床表现中，急性主动脉夹层占34例（45%），其中31例（占总评估的41%，夹层的92%）累及升主动脉（斯坦福A型，德巴基1型或2型）。12例（16%）病例确立了其他主要心血管诊断，包括急性心肌梗死、原发性瓣膜病或心包疾病。15例（20%）病例发现了除夹层外的主动脉病变。经食管超声心动图在61例（81%）病例中确立了导致症状的诊断。
急性主动脉夹层患者的症状比通常认为的更具多样性。经食管超声心动图是临床疑似急性主动脉夹层患者准确的主要诊断工具。它能快速诊断夹层，并可在大量无急性夹层的患者中识别出导致症状的其他心血管病变。
