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Diniz RGS, Oliveira MFRA, Rocha WEM, Cipolli JA, Soares JD, L'Armée VMFS, Martins MPG, Rocha AM, Diniz PGS, Feitosa ADM, Lima RC, Oliveira PPM, Silveira-Filho LM, Coelho-Filho OR, Matos-Souza JR, Petrucci O, Sposito AC, Nadruz W. The influence of sex on left ventricular remodeling in patients with aortic dissection. J Cardiovasc Med (Hagerstown) 2024; 25:674-681. [PMID: 39012646 DOI: 10.2459/jcm.0000000000001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
AIMS Patients with aortic dissection have a high prevalence of left ventricular structural alterations, including left ventricular hypertrophy (LVH), but little is known about the impact of sex on this regard. This study compared clinical, cardiac, and prognostic characteristics between men and women with aortic dissection. METHODS We retrospectively assessed clinical and echocardiographic characteristics, and 1-year mortality in 367 aortic dissection patients (30% women; 66% with Stanford-A) who underwent echocardiography 60 days before or after the diagnosis of aortic dissection from three Brazilian centers. RESULTS Men and women had similar clinical characteristics, except for higher age (59.4 ± 13.4 vs. 55.9 ± 11.6 years; P = 0.013) and use of antihypertensive classes (1.4 ± 1.3 vs. 1.1 ± 1.2; P = 0.024) and diuretics (32 vs. 19%; P = 0.004) in women compared with men. Women had a higher prevalence of LVH (78 vs. 65%; P = 0.010) and lower prevalence of normal left ventricular geometry (20 vs. 10%; P = 0.015) than men. Logistic regression analysis adjusted for confounding factors showed that women were less likely to have normal left ventricular geometry (odds ratio, 95% confidence interval = 0.42, 0.20-0.87; P = 0.019) and were more likely to have LVH (odds ratio, 95% confidence interval = 1.91, 1.11-3.27; P = 0.019). Conversely, multivariable Cox-regression analysis showed that women had a similar risk of death compared to men 1 year after aortic dissection diagnosis (hazard ratio, 95% confidence interval = 1.16, 0.77-1.75; P = 0.49). CONCLUSION In aortic dissection patients, women were typically older, had higher use of antihypertensive medications, and exhibited a greater prevalence of LVH compared with men. However, 1-year mortality after aortic dissection diagnosis did not differ between men and women.
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Affiliation(s)
- Roberto G S Diniz
- Pernambuco Cardiology Emergency Room (PROCAPE), University of Pernambuco, Recife, PE
| | - Matheus F R A Oliveira
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo
| | - Walter E M Rocha
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo
| | - José A Cipolli
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo
| | - Julia D Soares
- Pernambuco Cardiology Emergency Room (PROCAPE), University of Pernambuco, Recife, PE
| | - Victor M F S L'Armée
- Pernambuco Cardiology Emergency Room (PROCAPE), University of Pernambuco, Recife, PE
| | - Mayara P G Martins
- Department of Cardiology, Pontifical Catholic University of Campinas, Campinas, SP
| | - Aloísio M Rocha
- Department of Cardiology, Pontifical Catholic University of Campinas, Campinas, SP
| | - Paulo G S Diniz
- Pernambuco Cardiology Emergency Room (PROCAPE), University of Pernambuco, Recife, PE
| | - Audes D M Feitosa
- Pernambuco Cardiology Emergency Room (PROCAPE), University of Pernambuco, Recife, PE
- UNICAP Institute of Clinical Research, Catholic University of Pernambuco, Recife, PE
| | - Ricardo C Lima
- Pernambuco Cardiology Emergency Room (PROCAPE), University of Pernambuco, Recife, PE
| | - Pedro P M Oliveira
- Department of Surgery, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | | | - Otavio R Coelho-Filho
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo
| | - José R Matos-Souza
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo
| | - Orlando Petrucci
- Department of Surgery, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo
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Al-Tawil M, Geragotellis A, Jubouri M, Tan SZ, Mohammed I, Williams I, Bashir M. Population risk profile analysis of acute uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair. Asian Cardiovasc Thorac Ann 2023; 31:549-556. [PMID: 35532028 DOI: 10.1177/02184923221099771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Uncomplicated type B aortic dissection (unTBAD) comprises the estimated majority of type B aortic dissection (TBAD), presenting without any of the complications associated with complicated TBAD (coTBAD). Although first-line treatment for coTBAD is thoracic endovascular aortic repair (TEVAR), and despite the fact that TEVAR has proven its safety and effectiveness in the treatment of unTBAD, unTBAD is still being predominantly managed conservatively with medical therapy, with a small proportion of patients being offered TEVAR. AIMS The main scope of this review is to highlight the evidence in the literature of the demographic characteristics and associated co-morbidities of unTBAD patients undergoing TEVAR in order to produce a risk stratification system to achieve favourable outcomes. METHODS A comprehensive literature search was conducted using multiple electronic databases including PubMed, Ovid, Scopus, and EMBASE. RESULTS Multiple demographic characteristics and associated co-morbidities of unTBAD patients affecting TEVAR outcomes were identified, assessed, and investigated, including age, gender, race, genetics, medical conditions, such as hypertension and diabetes, and lifestyle factors such as smoking. Most factors were associated with increased risks of mortality and morbidity, while others, such as race, were identified as being protective against those when it comes to TEVAR. CONCLUSION Despite the favourable results yielded by TEVAR in unTBAD, there remains a grey area concerning its management. Thus, it is important to incorporate the demographics and co-morbidities of unTBAD patients' when into clinical judgement when assessing indications for TEVAR intervention to ensure optimum results can be achieved.
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Affiliation(s)
| | | | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Sven Zcp Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Ian Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
| | - Mohamad Bashir
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
- Vascular & Endovascular Surgery, Velindre University NHS Trust, Health Education & Improvement Wales (HEIW), Cardiff, UK
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Zhao Q, Yin K, Zhou N, Wu Q, Xiao Y, Zheng J, Zheng D, Bi Q, Quan L, Hu B, Cheng J. The characteristics of thoracic aortic dissection in autopsy-diagnosed individuals: An autopsy study. Front Cardiovasc Med 2022; 9:973530. [PMID: 36304553 PMCID: PMC9592848 DOI: 10.3389/fcvm.2022.973530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic aortic dissection (TAD) is the most common cause of sudden cardiac death associated with aortic diseases. The age of TAD victims in forensic studies is significantly younger than hospitalized patients with TAD, while only a few studies have been conducted on autopsy-diagnosed TAD deceased. A retrospective study was conducted at the Medicolegal Center of Sun Yat-sen University from 1999 to 2019 to address the characteristics of TAD victims. A total of 200 deceased from spontaneous rupture of TAD were assessed, with 165 (82.5%) males and 175 (87.5%) Stanford type A deceased. Our main results showed that compared with patients with TAD diagnosed during their lifetime, individuals diagnosed with TAD until an autopsy showed an earlier onset (43.80 years old) and less accompanied hypertension (<50%). Sudden death was the initial symptom of 32 decedents. Instead of chest/back pain (40 decedents), abdominal pain (59 decedents) was the most common initial symptom, and 42 decedents presented with no accompanying pain. A higher proportion of abdominal pain and the painless symptom was associated with a higher risk of misdiagnosis. Women showed a more atypical clinical presentation and rapid progression than men. Younger decedents showed more pronounced left heart changes. The present study implicated the TAD individuals diagnosed until an autopsy as a particular entity, indicating the urgent need for further investigation on early diagnosis and pathogenesis of patients with TAD with atypical pain and painless or with younger age to reduce the burden of TAD-related sudden death.
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Affiliation(s)
- Qianhao Zhao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Kun Yin
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Nan Zhou
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Qiuping Wu
- Division of Forensic Medicine, Department of Pathology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Yuxi Xiao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Jinxiang Zheng
- Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China,Henan Key Laboratory of Molecular Pathology, Zhengzhou, China
| | - Da Zheng
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Qiming Bi
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Li Quan
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China
| | - Bingjie Hu
- Division of Forensic Medicine, Department of Pathology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China,*Correspondence: Bingjie Hu
| | - Jianding Cheng
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, China,Jianding Cheng
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Ikeno Y, Truong VTT, Tanaka A, Prakash SK. The Effect of Ascending Aortic Repair on Left Ventricular Remodeling. Am J Cardiol 2022; 182:89-94. [PMID: 36068098 DOI: 10.1016/j.amjcard.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/01/2022]
Abstract
Left ventricular (LV) hypertrophy is common in patients with thoracic aortic diseases and is associated with increased long-term mortality. Thoracic aortic aneurysms are reported to increase LV afterload because of kinetic energy loss within the aneurysm sac, which may improve after surgical repair. However, LV afterload may also increase because of the stiffness of prosthetics used for aortic repair. We sought to investigate the long-term effect of surgical aortic repair with prostheses on postsurgical LV mass. We reviewed patients who underwent ascending aortic replacement with a prosthesis at our institution from January 2008 to December 2018. We calculated the LV mass index based on pre- and postoperative echocardiogram measurements. The primary outcome was the change in LV mass index 6 months after aortic repair. Patients aged <18 years and those who had concomitant cardiac operations, severe aortic valve disease, or who had no echocardiographic data were excluded. Of 1,008 patients who underwent ascending aortic replacement, 134 (51 with acute aortic dissections) were included. The median baseline and follow-up LV mass index were 107 (90 to 135) g/m2 and 101 (83 to 123) g/m2, respectively. Overall, there was a significant reduction of LV mass index over time (p = 0.03). LV mass index decreased in 77 patients (59%). Presentation due to acute aortic dissection (p = 0.03) and baseline LV mass index (p <0.001) were significant predictors of LV mass reduction. In conclusion, LV mass index may significantly decrease over time after the aortic repair, but the course is highly variable. The largest decrease occurred in patients who presented because of aortic dissections rather than for elective repair of aneurysms.
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Affiliation(s)
- Yuki Ikeno
- Department of Cardiothoracic and Vascular Surgery, Houston, Texas
| | - Van Thi Thanh Truong
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, Houston, Texas
| | - Akiko Tanaka
- Department of Cardiothoracic and Vascular Surgery, Houston, Texas
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
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5
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Oliveira MFRA, Rocha WEM, Soares JD, L'Armée VMFS, Martins MPG, Rocha AM, Feitosa ADM, Lima RC, Oliveira PPM, Silveira-Filho LM, Coelho-Filho OR, Matos-Souza JR, Petrucci O, Sposito AC, Nadruz W. Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection. Front Cardiovasc Med 2022; 8:803283. [PMID: 35127863 PMCID: PMC8813851 DOI: 10.3389/fcvm.2021.803283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023] Open
Abstract
Objective This study compared clinical, echocardiographic, and prognostic characteristics among patients with aortic dissection (AD) with (HypHist) and without (No-HypHist) hypertension history and evaluated the association of blood pressure (BP) at presentation with 1-year mortality, left ventricular (LV) remodeling and renal dysfunction. Methods We investigated clinical and echocardiographic characteristics and 1-year mortality among 367 patients with AD (81% HypHist, 66% Type-A) from three Brazilian centers. Results Patients with No-HypHist were more likely to have Marfan syndrome, bicuspid aortic valve, to undergo surgical therapy, were less likely to have LV hypertrophy and concentricity, and had similar mortality compared with HypHist patients. Adjusted restricted cubic spline analysis showed that systolic BP (SBP) and diastolic BP (DBP) at presentation had a J-curve association with mortality among patients with No-HypHist, but did not associate with death among patients with HypHist (p for interaction = 0.001 for SBP and = 0.022 for DBP). Conversely, the association between SBP at presentation and mortality was influenced by previous use of antihypertensive medications in the HypHist group (p for interaction = 0.002). Results of multivariable logistic regression analysis comprising the whole sample showed direct associations of SBP and DBP at presentation with LV hypertrophy (p = 0.009) and LV concentricity (p = 0.015), respectively, and an inverse association between pulse pressure at presentation and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (p = 0.008). Conclusion Combined information on BP at presentation, previous diagnosis of hypertension, and use of antihypertensive medications might be useful to predict mortality risk and to estimate extra-aortic end-organ damage among patients with AD.
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Affiliation(s)
- Matheus F. R. A. Oliveira
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Walter E. M. Rocha
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Julia D. Soares
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Brazil
| | | | - Mayara P. G. Martins
- Department of Cardiology, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Aloísio M. Rocha
- Department of Cardiology, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Audes D. M. Feitosa
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Brazil
- Catholic University of Pernambuco Clinical Research Institute, Catholic University of Pernambuco, Recife, Brazil
| | - Ricardo C. Lima
- Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco, Recife, Brazil
| | - Pedro P. M. Oliveira
- Department of Surgery, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | | | - Otavio R. Coelho-Filho
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - José R. Matos-Souza
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Orlando Petrucci
- Department of Surgery, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Andrei C. Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
- *Correspondence: Wilson Nadruz Jr.
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6
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Rocha WEM, Oliveira MFRA, Soares JD, L'Armée VMFS, Martins MPG, Rocha AM, Feitosa ADM, Lima RC, Oliveira PPM, Silveira-Filho LM, Coelho-Filho OR, Matos-Souza JR, Petrucci O, Sposito AC, Nadruz W. Left Ventricular Concentric Geometric Patterns Are Associated With Worse Prognosis Among Patients With Type-A Aortic Dissection. J Am Heart Assoc 2021; 10:e018273. [PMID: 33599150 PMCID: PMC8174278 DOI: 10.1161/jaha.120.018273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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; P<0.001; and OR, 0.55; 95% CI, 0.31–0.97; P=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; P=0.007 and HR, 2.06; 95% CI, 1.20–3.54; P=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; P<0.001 and HR, 4.38; 95% CI, 1.47–13.11; P=0.008, respectively), whereas concentric remodeling was associated with late mortality (HR, 5.40; 95% CI, 1.91–15.26; P<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.
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Affiliation(s)
- Walter E M Rocha
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Matheus F R A Oliveira
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Julia D Soares
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Victor M F S L'Armée
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Mayara P G Martins
- Department of Cardiology Pontifical Catholic University of Campinas Campinas SP Brazil
| | - Aloísio M Rocha
- Department of Cardiology Pontifical Catholic University of Campinas Campinas SP Brazil
| | - Audes D M Feitosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil.,Laboratory of Immunopathology Keizo Asami Federal University of Pernambuco Recife PE Brazil
| | - Ricardo C Lima
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) University of Pernambuco Recife PE Brazil
| | - Pedro P M Oliveira
- Department of Surgery School of Medical Sciences State University of Campinas São Paulo Brazil
| | | | - Otavio R Coelho-Filho
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - José R Matos-Souza
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Orlando Petrucci
- Department of Surgery School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Andrei C Sposito
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
| | - Wilson Nadruz
- Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil
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Hysa L, Khor S, Starnes BW, Chow WB, Sweet MP, Nguyen J, Shalhub S. Cause-specific mortality of type B aortic dissection and assessment of competing risks of mortality. J Vasc Surg 2020; 73:48-60.e1. [PMID: 32437949 DOI: 10.1016/j.jvs.2020.04.499] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Natural history studies of type B aortic dissection (TBAD) commonly report all-cause mortality. Our aim was to determine cause-specific mortality in TBAD and to evaluate the clinical characteristics associated with aorta-related and nonaorta-related mortality. METHODS Clinical and administrative records were reviewed for patients with acute TBAD between 1995 and 2017. Demographics, comorbidities, presentation, and initial imaging findings were abstracted. Cause of death was ascertained through a multimodality approach using electronic health records, obituaries, social media, Social Security Death Index, and state mortality records. Causes of death were classified as aorta related, nonaorta related, or unknown. A Fine-Gray multivariate competing risk regression model for subdistribution hazard ratio was employed to analyze the association of clinical characteristics with aorta-related and nonaorta-related mortality. RESULTS A total of 275 individuals met inclusion criteria (61.1 ± 13.7 years, 70.9% male, 68% white). Mean survival after discharge was 6.3 ± 4.7 years. Completeness of follow-up Clark C index was 0.87. All-cause mortality was 50.2% (n = 138; mean age, 70.1 ± 14.6 years) including an in-hospital mortality of 8.4%. Cause-specific mortality was aorta related, nonaorta related, and unknown in 51%, 43%, and 6%, respectively. Compared with patients with nonaorta-related mortality, patients with aorta-related mortality were younger at acute TBAD (69.5 ± 11.2 years vs 61.6 ± 15.5 years; P = .001), underwent more descending thoracic aortic repairs (19.4% vs 45.8%; P = .002), and had a shorter survival duration (5.7 ± 3.9 vs 3.4 ± 4.5 years; P = .002). There was clear variation in cause of death by each decade of life, with higher aorta-related mortality among those younger than 50 years and older than 70 years and a stepwise increase in nonaorta-related mortality with each increasing decade (P < .001). All-cause mortality at 1 year, 3 years, and 10 years was 15%, 24%, and 57%, respectively. After accounting for competing risks, the cumulative incidence of aorta-related mortality at 1 year, 3 years, and 10 years was 8.9%, 16.5%, and 27.2%, respectively, and that of nonaorta-related mortality was 2.7%, 7.2%, and 29%, respectively. A maximum descending thoracic aortic diameter >4 cm was associated with an increase in hazard of aorta-related mortality by 84% (subdistribution hazard ratio, 1.84; 95% confidence interval, 1.03-3.28) on multivariate competing risk regression analysis. CONCLUSIONS TBAD is associated with high 10-year mortality. Those at risk for aorta-related mortality have a clinical phenotype different from that of individuals at risk for nonaorta-related mortality. This information is important for building risk prediction models that account for competing mortality risks and to direct optimal and individualized surgical and medical management of TBAD.
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Affiliation(s)
- Lisa Hysa
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Sara Khor
- Department of Surgery, University of Washington, Seattle, Wash
| | - Benjamin W Starnes
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Warren B Chow
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Jimmy Nguyen
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
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8
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Shalhub S, Roman MJ, Eagle KA, LeMaire SA, Zhang Q, Evangelista A, Milewicz DM. Type B Aortic Dissection in Young Individuals With Confirmed and Presumed Heritable Thoracic Aortic Disease. Ann Thorac Surg 2020; 109:534-540. [DOI: 10.1016/j.athoracsur.2019.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023]
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Dobbins NJ, Spital CH, Black RA, Morrison JM, de Veer B, Zampino E, Harrington RD, Britt BD, Stephens KA, Wilcox AB, Tarczy-Hornoch P, Mooney SD. Leaf: an open-source, model-agnostic, data-driven web application for cohort discovery and translational biomedical research. J Am Med Inform Assoc 2020; 27:109-118. [PMID: 31592524 PMCID: PMC6913227 DOI: 10.1093/jamia/ocz165] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Academic medical centers and health systems are increasingly challenged with supporting appropriate secondary use of clinical data. Enterprise data warehouses have emerged as central resources for these data, but often require an informatician to extract meaningful information, limiting direct access by end users. To overcome this challenge, we have developed Leaf, a lightweight self-service web application for querying clinical data from heterogeneous data models and sources. MATERIALS AND METHODS Leaf utilizes a flexible biomedical concept system to define hierarchical concepts and ontologies. Each Leaf concept contains both textual representations and SQL query building blocks, exposed by a simple drag-and-drop user interface. Leaf generates abstract syntax trees which are compiled into dynamic SQL queries. RESULTS Leaf is a successful production-supported tool at the University of Washington, which hosts a central Leaf instance querying an enterprise data warehouse with over 300 active users. Through the support of UW Medicine (https://uwmedicine.org), the Institute of Translational Health Sciences (https://www.iths.org), and the National Center for Data to Health (https://ctsa.ncats.nih.gov/cd2h/), Leaf source code has been released into the public domain at https://github.com/uwrit/leaf. DISCUSSION Leaf allows the querying of single or multiple clinical databases simultaneously, even those of different data models. This enables fast installation without costly extraction or duplication. CONCLUSIONS Leaf differs from existing cohort discovery tools because it does not specify a required data model and is designed to seamlessly leverage existing user authentication systems and clinical databases in situ. We believe Leaf to be useful for health system analytics, clinical research data warehouses, precision medicine biobanks, and clinical studies involving large patient cohorts.
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Affiliation(s)
- Nicholas J Dobbins
- Department of Biomedical Informatics and Medical Education, UW Medicine Research IT, University of Washington, Seattle, Washington, USA
| | - Clifford H Spital
- UW Medicine Research IT, University of Washington, Seattle, Washington, USA
| | - Robert A Black
- Population Health Analytics, University of Washington, Seattle, Washington, USA
| | - Jason M Morrison
- Clinical Research Informatics, St. Jude’s Children’s Research Hospital, Memphis, Tennessee, USA
| | - Bas de Veer
- UW Medicine Research IT, University of Washington, Seattle, Washington, USA
| | - Elizabeth Zampino
- UW Medicine Research IT, University of Washington, Seattle, Washington, USA
| | - Robert D Harrington
- Department of Medicine, Division of Infectious Disease, University of Washington, Seattle, Washington, USA
| | - Bethene D Britt
- UW Medicine Analytics, University of Washington, Seattle, Washington, USA
| | - Kari A Stephens
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Adam B Wilcox
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Peter Tarczy-Hornoch
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
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