Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial Infarction
Background Contradictions between management modalities of type A acute aortic dissection (TAAAD) and ST‐elevation–myocardial infarction (STEMI) may result in clinical catastrophe. Therefore, we aimed to explore which 2‐dimensional echocardiography (2DE) findings are optimal for differentiating TAAA...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.029506 |
| _version_ | 1797400641745715200 |
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| author | Jin Kirigaya Noriaki Iwahashi Takeru Abe Masaomi Gohbara Yohei Hanajima Mutsuo Horii Kozo Okada Yasushi Matsuzawa Shota Yasuda Masami Kosuge Toshiaki Ebina Ichiro Takeuchi Keiji Uchida Kouichi Tamura Kiyoshi Hibi |
| author_facet | Jin Kirigaya Noriaki Iwahashi Takeru Abe Masaomi Gohbara Yohei Hanajima Mutsuo Horii Kozo Okada Yasushi Matsuzawa Shota Yasuda Masami Kosuge Toshiaki Ebina Ichiro Takeuchi Keiji Uchida Kouichi Tamura Kiyoshi Hibi |
| author_sort | Jin Kirigaya |
| collection | DOAJ |
| description | Background Contradictions between management modalities of type A acute aortic dissection (TAAAD) and ST‐elevation–myocardial infarction (STEMI) may result in clinical catastrophe. Therefore, we aimed to explore which 2‐dimensional echocardiography (2DE) findings are optimal for differentiating TAAAD from STEMI. Methods and Results This study included 340 patients with STEMI and 340 patients with TAAAD who underwent 2DE in the emergency department between 2012 and 2021. The proximal ascending aorta (PAA) diameter and other echocardiographic parameters were analyzed. PAA diameters were measured at 4 levels in the parasternal view: Valsalva, the sinotubular junction (STJ), the PAA at 1 cm above the STJ, and the PAA at 2 cm above the STJ. Receiver‐operating characteristic curve analysis showed that Valsalva, STJ, PAA at 1 cm above the STJ, and PAA at 2 cm above the STJ were significant predictors of TAAAD (areas under the curve: 0.777, 0.924, 0.965, and 0.975, respectively; P<0.001) with the respective cutoff values of 39.4, 38.5, 39.8, and 41.2 mm. Multivariable analysis suggested that all 2DE parameters were significant predictors of TAAAD. Among the 2DE parameters examined, the incorporation of PAA at 2 cm above the STJ to clinical indicators exhibited the most significant diagnostic capability (C‐statistics, 0.97; net reclassification improvement, 1.81; integrated discrimination improvement, 0.61). When only TAAAD with coronary malperfusion and STEMI were analyzed, the diagnostic utility of PAA at 1 cm above the STJ was evident (C‐statistics, 0.99; net reclassification improvement, 1.79; integrated discrimination improvement, 0.67), with PAA at 2 cm above the STJ ranking second in diagnostic significance (C‐statistics, 0.99; net reclassification improvement, 1.12; integrated discrimination improvement, 0.66). Conclusions PAA measurements were the most beneficial for diagnosing TAAAD in all 2DE findings and TAAAD from STEMI. |
| first_indexed | 2024-03-09T01:58:29Z |
| format | Article |
| id | doaj.art-320cc2e43f8e4018800cc367bc9ebff5 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-09T01:58:29Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-320cc2e43f8e4018800cc367bc9ebff52023-12-08T11:09:10ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-11-01122110.1161/JAHA.123.029506Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial InfarctionJin Kirigaya0Noriaki Iwahashi1Takeru Abe2Masaomi Gohbara3Yohei Hanajima4Mutsuo Horii5Kozo Okada6Yasushi Matsuzawa7Shota Yasuda8Masami Kosuge9Toshiaki Ebina10Ichiro Takeuchi11Keiji Uchida12Kouichi Tamura13Kiyoshi Hibi14Division of Cardiology Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanAdvanced Critical Care and Emergency Center Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanAdvanced Critical Care and Emergency Center Yokohama City University Medical Center Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanDepartment of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama JapanDivision of Cardiology Yokohama City University Medical Center Yokohama JapanBackground Contradictions between management modalities of type A acute aortic dissection (TAAAD) and ST‐elevation–myocardial infarction (STEMI) may result in clinical catastrophe. Therefore, we aimed to explore which 2‐dimensional echocardiography (2DE) findings are optimal for differentiating TAAAD from STEMI. Methods and Results This study included 340 patients with STEMI and 340 patients with TAAAD who underwent 2DE in the emergency department between 2012 and 2021. The proximal ascending aorta (PAA) diameter and other echocardiographic parameters were analyzed. PAA diameters were measured at 4 levels in the parasternal view: Valsalva, the sinotubular junction (STJ), the PAA at 1 cm above the STJ, and the PAA at 2 cm above the STJ. Receiver‐operating characteristic curve analysis showed that Valsalva, STJ, PAA at 1 cm above the STJ, and PAA at 2 cm above the STJ were significant predictors of TAAAD (areas under the curve: 0.777, 0.924, 0.965, and 0.975, respectively; P<0.001) with the respective cutoff values of 39.4, 38.5, 39.8, and 41.2 mm. Multivariable analysis suggested that all 2DE parameters were significant predictors of TAAAD. Among the 2DE parameters examined, the incorporation of PAA at 2 cm above the STJ to clinical indicators exhibited the most significant diagnostic capability (C‐statistics, 0.97; net reclassification improvement, 1.81; integrated discrimination improvement, 0.61). When only TAAAD with coronary malperfusion and STEMI were analyzed, the diagnostic utility of PAA at 1 cm above the STJ was evident (C‐statistics, 0.99; net reclassification improvement, 1.79; integrated discrimination improvement, 0.67), with PAA at 2 cm above the STJ ranking second in diagnostic significance (C‐statistics, 0.99; net reclassification improvement, 1.12; integrated discrimination improvement, 0.66). Conclusions PAA measurements were the most beneficial for diagnosing TAAAD in all 2DE findings and TAAAD from STEMI.https://www.ahajournals.org/doi/10.1161/JAHA.123.029506aortic dissectionechocardiographyemergency department |
| spellingShingle | Jin Kirigaya Noriaki Iwahashi Takeru Abe Masaomi Gohbara Yohei Hanajima Mutsuo Horii Kozo Okada Yasushi Matsuzawa Shota Yasuda Masami Kosuge Toshiaki Ebina Ichiro Takeuchi Keiji Uchida Kouichi Tamura Kiyoshi Hibi Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic dissection echocardiography emergency department |
| title | Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial Infarction |
| title_full | Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial Infarction |
| title_fullStr | Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial Infarction |
| title_full_unstemmed | Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial Infarction |
| title_short | Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial Infarction |
| title_sort | clinical usefulness of echocardiographic measurement of proximal aortic diameter in early differentiation between type a acute aortic dissection and st segment elevation myocardial infarction |
| topic | aortic dissection echocardiography emergency department |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.029506 |
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