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Predictive value of heart rate in patients with acute type A aortic dissection: a retrospective cohort study

Yong Zhou1, Qipeng Luo2, Xiaoxiao Guo3

  • 1Anaesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China.

BMJ Open
|November 12, 2021
PubMed

Insights

Elevated heart rate (HR) is a significant predictor of mortality in patients with acute type A aortic dissection (ATAAD) after total aortic arch replacement with frozen elephant trunk (TAR+FET). A heart rate over 80 bpm is independently linked to increased long-term mortality.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Diseases

Background:

  • Heart rate (HR) is a known mortality risk factor in cardiovascular diseases.
  • Clinical data on HR's prognostic value in acute type A aortic dissection (ATAAD) is limited.
  • Total aortic arch replacement with frozen elephant trunk (TAR+FET) is a key intervention for ATAAD.

Purpose of the Study:

  • To assess the association between HR and long-term mortality in ATAAD patients.
  • To establish HR criteria for predicting prognosis in ATAAD patients undergoing TAR+FET.

Main Methods:

  • Retrospective cohort study of 707 consecutive ATAAD patients.
  • Patients underwent TAR+FET between 2009 and 2015.
  • Follow-up for a median of 29 months to evaluate 30-day and long-term mortality.

Main Results:

  • Multivariate analysis identified HR, age, renal insufficiency, ejection fraction, bypass time, and blood loss as significant mortality predictors.
  • A hinge point for increased long-term mortality was observed at 80 beats/min (bpm).
  • HR >80 bpm was associated with a nearly threefold higher long-term mortality risk compared to HR ≤80 bpm.

Conclusions:

  • HR is a potent predictor of long-term mortality in ATAAD patients treated with TAR+FET.
  • An HR exceeding 80 bpm is independently associated with elevated long-term mortality in this patient cohort.
Abstract

Keywords:
anaesthesia in cardiologyvalvular heart diseasevascular medicine

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