Electrocardiography changes in acute aortic dissection-association with troponin leak, coronary anatomy, and prognosis
Leili Pourafkari1, Arezou Tajlil2, Samad Ghaffari2
1Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Anesthesiology, University at Buffalo, Buffalo, NY 14214.
Insights
Electrocardiography (ECG) can predict mortality in acute type A aortic dissection (AAOD). Specific ECG findings like ST elevation in lead aVR and prolonged QRS duration are linked to increased hospital and long-term mortality, respectively.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Electrocardiography (ECG) provides prognostic information for short- and long-term mortality in acute type A aortic dissection (AAOD).
- Understanding ECG patterns in AAOD is crucial for risk stratification and patient management.
Purpose of the Study:
- To investigate the frequency of ECG findings in AAOD patients.
- To determine the prognostic value of ECG findings on hospital and follow-up mortality.
- To examine the relationship between ECG findings, coronary involvement, and troponin levels.
Main Methods:
- Retrospective analysis of ECGs from AAOD patients (March 2004 - March 2015).
- Evaluation of ECG findings, hospital mortality, and long-term mortality.
- Assessment of coronary involvement and troponin levels.
Main Results:
- Acute ischemic changes were present in 38.0% of patients; T inversion was most common (38.6%).
- ST elevation in lead aVR predicted higher hospital death (OR 5.30), and QRS duration >120 ms predicted long-term mortality (HR 2.45).
- Acute ECG changes were not associated with increased troponin or coronary lesions.
Conclusions:
- Acute ischemic ECG changes are frequent in AAOD, with a normal ECG being uncommon.
- Specific ECG markers, ST elevation in aVR and prolonged QRS duration, are significant predictors of mortality in AAOD.
- ECG findings in AAOD are not directly linked to coronary artery disease or myocardial injury markers.
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.
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