The Correlation Between D-dimer And C-reactive Protein Levels And Geometric Parameters Of DeBakey Type Ⅲ Aortic Dissecting Aneurysm

Objective:Aortic dissection aneurysm(aortic dissection aneurysm,ADA)is a potentially catastrophic disease.With the development of the economy,changes in the spectrum of diseases and improvement in the level of diagnosis and treatment,the incidence and rate of diagnosis has increased in recent years.The significance of D-dimer(D-dimer,DD)in the diagnosis and treatment of ADA has been written into the European Society of Cardiology guidelines for the diagnosis and treatment of aortic diseases(2014).The significance of C-reactive protein(C-reactive protein,CRP)for the diagnosis and treatment of ADA is also seen in many clinical studies.Clinical findings:The geometric parameters of the ADA false lumen are closely related to the severity of the disease and its prognosis.At present,there are few reports on the correlation between the DD and CRP levels and the geometric parameters of the ADA false lumen.This study reviewed the hospitalization data of DeBakey III ADA patients who were treated with thoracic endovascular aortic repair(thoracic endovascular aortic repair,TEVAR)at cardiac surgery department in the Subei People’s Hospital between January 2012 and January 2018,and analyzed the DD,the CRP,the false lumen length(false lumen length,FLL),the maximum false lumen diameter(maximum false lumen diameter,MFLD),and the false lumen volume(the false lumen volume,FLV)levels(or values)before and after surgery to define whether there is a clear quantitative relationship between the values,and further explore the value of DD and CRP level in revealing the value of ADA geometric parameters,so as to find out a more ideal ADA early diagnosis and disease condition assessment model.Methods:Firstly,in our hospital’s electronic medical record system,the hospitalization data of DeBakey type III ADA patients diagnosed in our department between January 2012 and January 2018 is derived and their onset time(within two weeks for the acute phase,two weeks to three months are sub-acute phase,beyond three months for chronic phase),main symptoms(chest pain,back pain,chest and back pain,etc.),complications(high blood pressure,atherosclerosis,Marfan syndrome,etc.),smoking or not,treatment methods(conservative or surgical),surgical methods(TEVAR,TEVAR + chimney technology,TEVAR + cervical vascular bypass technology,TEVAR + open chest to branch technology,etc.),image number,DD and CRP values and other information materials are collected.Then,the aorta computed tomography angiography(computed tomography angiography,CTA)data of the aforementioned patients before and after surgery were found on the imaging department workstation in our hospital,imported into the post-processing work system,and processed with the GE Healthcare Volume ViewerTM(11.3 Ext 20)post-processing software for three-dimensional reconstruction,correction and measurement for their corresponding pre-operative FLV,FLL,MFLD values,and summary records.The specific methods are as follows:1.Reconstruction from the first section where the false lumen begins to the end of the last section where the false lumen is about to disappear;2.A quick review of each section after reconstruction from top to bottom(or from bottom to top),confirm the position of the false lumen(sometimes the false lumen is difficult to recognize from the aspects of size,contrast agent density,etc.),and correct the range of false lumen in each section after reconstruction from bottom to top(or from top to bottom),again from top to bottom(or from bottom to top)a quick view of each section to confirm the correction effect;3.After the reconstruction of the false lumens,a stretched white band with a scale can be obtained(when correcting the range of false lumens for each section,its width follows the change),its upper left reading is FLL value;4.The above white strip has a brown marking,move the marking upwards and downwards,the right reading of the marking changes,when the marking moves to the maximum reading obtains MFLD value;5.Carefully trim the reconstructed stereo image with the software’s own tool,cut out the images that were out of the beginning and end of the reconstruction,and then cut off others image other than the aortic false lumen between the two sections;6.Measure the finally image with the software’s own measurement tool and obtain FLV value;7.The corresponding FLL,MFLD and FLV values after surgery can be measured by the same method.Finally,the aforementioned data information(the normal range of DD is 0-0.5μg/ml,the normal range of CRP is 0-10mg/L,TEVAR or TEVAR +chimney technology is a simple operation,and TEVAR + cervical vascular bypass technology or TEVAR + open debranch technology for compound surgery,etc.)is imported into the software SPSS 20 for statistical analysis.Measured data are expressed as mean ± standard deviation(x±S).Paired t-tests were used for intragroup comparison.P<0.05 indicates statistical significance.Correlation analysis used Pearson correlation analysis.0.0<correlation coefficient<0.2,0.2 ≤correlation coefficient<0.4,0.4<correlation coefficient<0.6,0.6 ≤ correlation coefficient<0.8,0.8 ≤ correlation coefficient ≤ 1.0 indicates respectively very weak correlation or no Correlation,weak correlation,moderate correlation,strong correlation,strong correlation,P<0.05 indicates significant correlation.Results:The analysis found that the proportion of DD and CRP values above the upper limit of normal after surgery was higher than before(94.3%vs 100%and 40%vs 94.3%),and the postoperative average value was also higher than before(3.76±3.88 vs 5.14±3.68 and 35.35±54.92 vs 56.98±34.16).The DD and CRP values of most of the type DeBakey Ⅲ ADA patients decreased after operations(74.3%),but the FLL,MFLD,and FLV values decreased in the vast majority(94.3%)of type DeBakey Ⅲ ADA patients.The changes of CRP,FLL,MFLD,and FLV before and after operation were significant(P<0.05),but the DD value before and after surgery did not change significantly(P=0.088).Preoperative DD level was weakly associated with preoperative FLL,and postoperative CRP level was weakly associated with postoperative FLV.Conclusion:DD and CRP value can reflect the trend of geometric parameters of type DeBakey Ⅲ ADA false lumen to a certain extent.Preoperative DD level was weakly associated with preoperative FLL.Postoperative CRP level was weakly associated with postoperative FLV.