Nick Huynh1, Sarah Thordsen2, Taylor Thomas3, Shannon M Mackey-Bojack4, Emily R Duncanson5, Darlington Nwuado6, Ross F Garberich7, Kevin M Harris8. 1. Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN. 2. Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN. Electronic address: sthordse@gmail.com. 3. Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN. Electronic address: thomas.taylor1@mayo.edu. 4. Jesse E. Edwards Registry of Cardiovascular (CV) Disease, St Paul, MN. Electronic address: shannon.mackey-bojack@allina.com. 5. Jesse E. Edwards Registry of Cardiovascular (CV) Disease, St Paul, MN. Electronic address: emily.duncanson@allina.com. 6. Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN. Electronic address: dar.nwaudo@gmail.com. 7. Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN. Electronic address: ross.garberich@allina.com. 8. Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN. Electronic address: kevin.harris@allina.com.
Abstract
BACKGROUND: We aimed to characterize the clinical and pathologic findings of aortic dissection (AD) over a nearly 60-year period. METHODS: The Jesse E. Edwards Registry of Cardiovascular Disease database was queried for cardiac specimens from autopsies with AD as a diagnosis and compared 2 cohorts: early (1956-1992) and current (1993-2015). RESULTS: From 1956 to 2015, 338 cases (166 early, 170 current) with AD were included (mean age: 60; 62% male). The AD was 86% type A and 14% type B. Sixty-two percent of cases were under medical care at time of death (61% early, 62% current, P = not significant). Of those under medical care, 63% were not diagnosed prior to death (64% early, 62% current, P = not significant). Risks for dissection did not differ between time intervals and include left ventricular hypertrophy, suggestive of hypertension (84%), prior cardiovascular surgery (38%), bicuspid valve (14%), and connective tissue disease (9%). An intimal tear was identified in the ascending aorta in the majority (68%), followed by descending (14%), root (9.5%), and arch (7%). Aortic rupture occurred in 58%, most frequently in the ascending aorta (41%). CONCLUSIONS: In a large cardiovascular registry, >60% of cases of AD were not detected clinically and first identified at autopsy. Although diagnostic techniques have significantly improved over the time interval, the percentage of AD discovered at autopsy did not differ from the early to the current era. The most prevalent risk factors for dissection including hypertension and prior cardiovascular surgery remain similar in both time periods. AD death is related to rupture of the aorta in the majority of cases.
BACKGROUND: We aimed to characterize the clinical and pathologic findings of aortic dissection (AD) over a nearly 60-year period. METHODS: The Jesse E. Edwards Registry of Cardiovascular Disease database was queried for cardiac specimens from autopsies with AD as a diagnosis and compared 2 cohorts: early (1956-1992) and current (1993-2015). RESULTS: From 1956 to 2015, 338 cases (166 early, 170 current) with AD were included (mean age: 60; 62% male). The AD was 86% type A and 14% type B. Sixty-two percent of cases were under medical care at time of death (61% early, 62% current, P = not significant). Of those under medical care, 63% were not diagnosed prior to death (64% early, 62% current, P = not significant). Risks for dissection did not differ between time intervals and include left ventricular hypertrophy, suggestive of hypertension (84%), prior cardiovascular surgery (38%), bicuspid valve (14%), and connective tissue disease (9%). An intimal tear was identified in the ascending aorta in the majority (68%), followed by descending (14%), root (9.5%), and arch (7%). Aortic rupture occurred in 58%, most frequently in the ascending aorta (41%). CONCLUSIONS: In a large cardiovascular registry, >60% of cases of AD were not detected clinically and first identified at autopsy. Although diagnostic techniques have significantly improved over the time interval, the percentage of AD discovered at autopsy did not differ from the early to the current era. The most prevalent risk factors for dissection including hypertension and prior cardiovascular surgery remain similar in both time periods. AD death is related to rupture of the aorta in the majority of cases.
Authors: Walter E M Rocha; Matheus F R A Oliveira; Julia D Soares; Victor M F S L'Armée; Mayara P G Martins; Aloísio M Rocha; Audes D M Feitosa; Ricardo C Lima; Pedro P M Oliveira; Lindemberg M Silveira-Filho; Otavio R Coelho-Filho; José R Matos-Souza; Orlando Petrucci; Andrei C Sposito; Wilson Nadruz Journal: J Am Heart Assoc Date: 2021-02-18 Impact factor: 5.501