Leili Pourafkari1, Arezou Tajlil2, Samad Ghaffari3, Mohammadreza Chavoshi4, Kasra Kolahdouzan5, Rezayat Parvizi6, Raziyeh Parizad7, Nader D Nader8. 1. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Anesthesiology, University at Buffalo, Buffalo, NY 14214. Electronic address: leili.p@gmail.com. 2. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: arezou.tajlil@gmail.com. 3. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: ghafaris@gmail.com. 4. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: Chavoshi.smr@gmail.com. 5. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: Kakol_72@yahoo.com. 6. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: Rezayatp@gmail.com. 7. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: R_parizad2003@yahoo.com. 8. Department of Anesthesiology, University at Buffalo, Buffalo, NY 14214. Electronic address: nnader@buffalo.edu.
Abstract
BACKGROUND: Electrocardiography (ECG) offers some information that may be used to prognosticate acute type A aortic dissection (AAOD) for short- and long-term mortality. METHODS: We retrospectively analyzed the electrocardiograms of patients with AAOD admitted from March 2004 to March 2015. The frequency of ECG findings and their prognostic value on hospital and follow-up mortality were investigated. Findings pertaining to coronary involvement and troponin level were also examined. RESULTS: A total of 120 men and 64 women were admitted. Acute ischemic changes were reported in 38.0%, whereas T inversion was the most common recorded abnormality, which occurred in 38.6%. Acute ST-elevation myocardial infarction was detected in 16.3%. Troponin increased in 36.6%; 21.9% of the patients underwent coronary angiography among which 70% were normal. Coronary involvement or troponin increase was not different in patients with acute ECG changes. During hospitalization, 45.7% of the patients died. In multivariate analyses, ST elevation in lead aVR was associated with higher hospital death (odds ratio, 5.30; 95% confidence interval, 1.09-25.73; P = .038), whereas QRS greater than 120 milliseconds was associated with long-term mortality (hazard ratio, 2.45; 95% confidence interval, 1.25-3.76; P = .006). CONCLUSION: Acute ischemic ECG changes are common in AAOD, and a completely normal ECG is infrequently encountered. Acute ECG changes were not associated with the increased troponin or the presence of coronary lesions in angiography. Published by Elsevier Inc.
BACKGROUND: Electrocardiography (ECG) offers some information that may be used to prognosticate acute type A aortic dissection (AAOD) for short- and long-term mortality. METHODS: We retrospectively analyzed the electrocardiograms of patients with AAOD admitted from March 2004 to March 2015. The frequency of ECG findings and their prognostic value on hospital and follow-up mortality were investigated. Findings pertaining to coronary involvement and troponin level were also examined. RESULTS: A total of 120 men and 64 women were admitted. Acute ischemic changes were reported in 38.0%, whereas T inversion was the most common recorded abnormality, which occurred in 38.6%. Acute ST-elevation myocardial infarction was detected in 16.3%. Troponin increased in 36.6%; 21.9% of the patients underwent coronary angiography among which 70% were normal. Coronary involvement or troponin increase was not different in patients with acute ECG changes. During hospitalization, 45.7% of the patients died. In multivariate analyses, ST elevation in lead aVR was associated with higher hospital death (odds ratio, 5.30; 95% confidence interval, 1.09-25.73; P = .038), whereas QRS greater than 120 milliseconds was associated with long-term mortality (hazard ratio, 2.45; 95% confidence interval, 1.25-3.76; P = .006). CONCLUSION: Acute ischemic ECG changes are common in AAOD, and a completely normal ECG is infrequently encountered. Acute ECG changes were not associated with the increased troponin or the presence of coronary lesions in angiography. Published by Elsevier Inc.