Author + information
- Nick Huynh,
- Sarah Thordsen,
- Shannon Mackey-Bojack,
- Taylor Thomas,
- Emily Duncanson,
- Darlington Nwaudo,
- Ross Garberich and
- Kevin Harris
Background: Aortic dissection (AD) is characterized by diverse clinical manifestations and as a result, diagnosis is often delayed or not recognized until autopsy. Despite significant advances in imaging and the knowledge from clinical registries such as IRAD, the diagnosis is often still missed. Given low autopsy rates, little is known about the pathologic findings in the contemporary era.
Methods: The Jesse E. Edwards Registry of Cardiovascular (CV) Disease database was queried for cardiac specimens from autopsies with AD as a diagnosis. Two autopsy cohorts were compared; early (1956 – 1992 and current (1993 – 2015).
Results: From 1956 to 2015, 338 patients (167 early, 171 current) with AD were included (mean age: 60; 62% male). The AD was 86% type A and 14% type B. 62% of cases were under medical care at time of death (61% early, 62% current, p=NS). Of those under medical care, 63% were not diagnosed prior to death (64% early, 62% current, p= NS).
An intimal tear was identified in the ascending aorta in the majority (68%) followed by descending (14%), root (9.5%) and arch (7%). Extra-aortic rupture occurred in 70%, most frequently in the ascending aorta (58%); followed by the descending aorta (17%). 51% had hemopericardium. Coronary ischemia (11%) and AI (4%) were the most frequent causes of death in those without rupture. Healed dissections that didn't contribute to death and were clinically silent were found in 7%. Cystic medial necrosis was identified in 46%. Risks for dissection did not differ between time intervals and include: bicuspid valve (14%), connective tissue disease (9%), aortitis (5%) and prior CV surgery (38%). Coexistent coronary artery disease was present in 72% of patients. LVH was present in the 84% with a mean myocardial weight of 606 gm.
Conclusions: Although diagnostic techniques have significantly improved over the time interval of this study, AD is not detected clinically and is first identified at autopsy in 62% of cases under medical care in the current era. AD death is related to rupture of the ascending aorta in 70%. Risks for dissection including prior CV surgery, bicuspid valve and connective tissue disease remain similar in both time periods.
Moderated Poster Contributions
Vascular Medicine Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 4:00 p.m.-4:10 p.m.
Session Title: Advancing Our Understanding of Aortic Disease
Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease
Presentation Number: 1267M-05
- 2017 American College of Cardiology Foundation