Analysis Of The Clinical Features And Adverse Prognostic Factors Of Acute Aortic Syndrome

Background:Acute aortic syndrome(AAS) describes a group of aortic disease with similar clinical characteristics and degree of risk, including aortic dissection(AD), intramural hematoma(IMH), and penetrating atherosclerotic aortic ulcer(PAU). In recent years, theyraisedconcern from experts and scholars. The three different pathological changes have similar clinical manifestations, and can be confused with other diseases thatcause chest pain. With the current increase in the the number of patients with high blood pressureand the development inthe diagnosis and treatment of cardiovascular disease, a growing number of clinicians have raised awareness of the diagnositic methods of this group of diseases. With their effort themisdiagnosis rate decreased.And with the development in surgery postoperative care and treatment technology the mortality rate of the three diseases has been significantly decreased.Now most of the patients can achieve good results through surgery. Howeverthis group of diseases hasacute onset and rapid progression, if the blood vesselsare broken mortality is highly likely. So they remaindangerous threats to human health.Objective:To summarize clinical features of acute aortic syndrome. Explore and analyze the method of treatment, clinical outcome and risk factors for poor prognosis. Raise awareness of the AAS, reduce misdiagnosis and missed diagnosis,Guard against risk factors for poor prognosis and improve prognosis.Methods:In this study, retrospective analysis selects acute aortic syndrome patients admitted to our hospital’s Cardiovascular Center during 2014 – 2015.The following factors were analyzed: general condition, risk factors, clinical features, treatment methods and clinicaloutcome. Univariate analysis and multivariate binary logistic regression analysis areapplied to patients who displayed poor prognostic factors.Results:(1) There are 269 cases of acute aortic syndromein total. 172 cases are simple aortic dissection patients(63.94%). In accordance with the Stanford classification of AD, 67 casesare A-type ADs, 105 cases are B type ADs; in accordance with Debakey type, 57 cases are Debaketype I ADs, 10 cases are Debaketype II ADs, 105 cases are Debaketype III ADs;pure aortic intramural hematoma occurred in 69 cases(25.65%), pure penetrating aortic ulcer occurred in 4 cases(1.49%), aortic dissection with aortic intramural hematomaoccurred in 2cases(0.74%), aortic dissection combined with penetrating ulcers occurred in 2 cases(0.74%), aortic intramural hematomacombined with penetrating ulcer occurred in 19 cases(7.06%), aortic dissection with aortic intramural hematoma and penetrating ulcer occurred in1 case(0.37%). By Stanford classification, 81 cases are A-type AAS(30.11%), 188 cases are B-type AAS(69.89%); 187 cases are male, accounting for 68.03% of the patients, 88 cases are female, accounting for 31.97%, M: F ratio is 2.128: 1. Age of patients span from 20 to 88 years, the mean age is(56.28 ± 13.61). The average age of men is(54.89 ± 13.37)years; the average age of women is(59.24 ± 13.83) years.The male and female age difference was statistically significant, theage of women older than men(P = 0.014).The average age of AD patients is(51.90 ± 13.07) years, The average age of IMH patients is(64.83 ± 10.14) years, The average age of PAU patients(65.00 ± 16.51) years, The age of onset of IMH was statistically greater than AD(P = 0.000). When classified by age group 10 patients are less that 30 years old(3.72%), 30-40 years old 18 cases(6.69%), 40-50 years old57 cases(21.29%), 50-60 years old 62 cases(23.05%), 60-70 years old 73 cases(27.14%),70-80 years old 39 cases(14.50%), ≥80 years 10 cases(3.72%).Most of the cases occur in the 50 to 70 years old age group accounting for 50.19% of the patients. According to admission time, 163 cases(60.59%) were admitted inthe following months: March,April,May, September, October, and December. 86 cases(31.97 %) were admitted during spring season.(2) Patients with a history of hypertension and those who were diagnosed with hypertentsion after admission totals to 229 cases, accounting for 85.13% of the patients. 5patients have Marfan syndrome(1.86%).Two cases have systemic lupus erythematosus(0.74%).1 case has hasaortic valve surgery(0.37%).2 cases hasaortic aneurysm(0.74%), 12 cases have history of diabetes(4.46%). 122 cases have history of smoking(45.35%),52 cases have history of alcohol(19.33%), 3 cases have had car accidents or a history of trauma(1.12%).23 cases of patients have unexplained cause of AAS(8.55%).(3) The group displayed complex and diverse clinical manifestations. 256 cases(95.2%)had symptoms of pain, mainly chest pain accounting for 196 cases(72.86%),179 cases(66.54%) experienced sudden chest pain.161 cases(59.85%) of patients experienced persistant pain. The pain experienced by the patients usually falls into the following 3catagories: 85 cases(31.0%) described the feeling as a tearing pain; 52 cases(19.33%)described the feeling as like being slashed and stabbed; 50 cases(18.59%) described the feeling as a severe pain. 200 cases(74.35%) dispayed an increase in blood pressure after admission.55.39% of the patients had hypertention level 2 orlevel 3, accounting for the majority of hypertension cases. 7 cases(2.60%) had hypotension or suffered shock.78 cases(29.00%) had abnormal blood pressure in limbs. Out of the 269 cases of AAS, the following complications were observed: 79 cases(29.37%)of pleural effusion,57 cases(21.19%) of pericardial effusion, 17 cases of aortic regurgitation(6.32 %), 37 cases(13.75%)of renal insufficiency.There were also a small number of patients with mediastinal hematoma(1.12%), acute myocardial infarction(0.74%), nervous system and digestive complications(4.09% and 2.97%).(4) Diagnostic examinations: 69.58%(183/263) of the patients displayedelevated white blood cell count. 95.06%(250/263) of the patients displayed increased neutrophil percentage.77.89%(155/199) of the patients displayed D- dimer liter high. 94.3%(50/53) of the patients displayed elevated hs-CRP.24.1%(38/158) of the patients displayed hyperlipidemia. 30.47%(78/256) of the patients displayed elevated creatinine.Of the 235 patients who had undergone ECG, 45.96%(108/235) displayed abnormal electrocardiogram. The majority of which falls into two catagories: left ventricular hypertrophy and nonspecific ST-T changes, accounting for 29.36% and 22.98%, respectively. 92(58.23%) of the patients who have undergone echocardiographyshowed aortic change. All 269 cases were diagnosed via CTA. 186 surgicalcases were reexamined using CTA. 95.7% of surgical patients experienced good recovery.(5) 3.7% of the patients were misdiagnosed as suffering other diseases during the initial visit, most often as acute coronary syndrome(1.86%).Other misdiagnoses includea variety of acute abdomen aliments and vocal cord paralysis.By statistical analysis the impact of misdiagnosis on death rate was not statistically significant(χ2 = 0.001, P = 0.980).(6) Out of the 269 patients, 83 underwent drug treatment only(30.86%); 186 cases(69.14%) underwent surgery. Out pf all the surgical casese,119 cases(44.24%) underwent interventional surgical treatment. 67 cases underwent thoracic surgery, including 38surgerycases(14.13%)and 29 hybrid surgerycases(10.78%).All hybrid surgery cases had type A AAS. 13 patients died, the mortality rate was 4.83%.Out ofall surgical cases, 178 cases improved, 3 cases healed, 5 died.Out of all cases who underwent drug theralpy only,28 cases improved, 47 cases was cured, 8 died.Surgery can improve the clinical outcomes ofpatients; the difference was statistically significant(P<0.05).(7) Multi-factor comparison was applied to Stanford A type and Stanford B type AAS patients.It was discovered that MFS, renal insufficiency, aortic regurgitation, pericardial effusion occurs more often in type Apatients compared to type B, the difference was statistically significant(P<0.05).Type B AAS patients showed higher systolic blood pressure and diastolic blood pressure than type A during admission.History of hypertension and past surgical treatmentsis more common in type B than type A; the difference was statistically significant(P<0.05).Type A AAS was more often treated withopen-heart surgery;Type B AAS was more often treated with interventional surgery, the difference was statistically significant(P<0.05).(8) Using poor prognosis as the dependent variable, univariate analysis was applied to the sample.The following factors were found to be different between the two groups: gender,surgery, pleural effusion, pericardial effusion, typing, shock, aortic regurgitation, smoking,renal insufficiency, nervous system and digestive system complications,the difference was statistically significant(P<0.05). Multivariate analysis showed to that adverse prognostic factors for AAS are: female, type A AAS, digestive complications, neurological complications, hypotension or shock.Conclusion:(1) Of all the AAS cases, the incidence of AD is the highest, followed by IMH and PAU.There is a link among all three kinds of disease in terms of occurrence and development; the incidence of type B AAS is higher than type A AAS; AAS incidence is age-dependent with predilection to age 50 to 70 year-old.There are more male patients than female patients. Age of onset forfemale patients is higher than male patients; age of onset for IMH is higher than AD; AAS onset is seasonal and occurs more in the spring.(2) The clinical manifestations of AAS are complex and diverse. It’s easy to be misdiagnosed, clinicians need to be aware of the clinical diagnosis and treatment of the disease.(3) Medication-based therapy is the basic therapy for patients with AAS. However itmust be reasonably and prudently administered. Surgical treatment remains the primary means of treatment for patients with AAS and can improve the patient’sclinical outcome and prognosis as well as reduce mortality. Thoracic surgery is the preferred sugicaltreatmentfor patients with type AAAS; interventional surgery is preferred for patients with type B AAS.(4) Compared with type B AAS, renal insufficiency, aortic regurgitation, pericardial effusion and other complications occur more in type A AAS. MFS is more commonly seen in type A AAS.The age of onset and the systolic and diastolic blood pressure during onset for type B AAS patients is higher than those with type A AAS;consequently they are more likely to be treated surgically.(5) Adverse prognostic factors for AAS are: female, type A AAS, digestive complications, neurological complications, hypotension or shock.