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| Key issues in diagnosing and treating acute aortic syndromes: results from the metropolitan area of Bologna network Problemi di diagnosi e terapia delle sindromi aortiche acute: Risultati della rete assistenziale dell'area metropolitana di Bologna | |
| Vagnarelli;Fabio <1981> | |
| 出版年 | 2015 |
| 学位授予单位 | Alma Mater Studiorum - Università di Bologna |
| 英文摘要 | Background: Survival of patients with Acute Aortic Syndrome (AAS) may relate to the speed of diagnosis. Diagnostic delay is exacerbated by non classical presentations such as myocardial ischemia or acute heart failure (AHF). However little is known about clinical implications and pathophysiological mechanisms of Troponin T elevation and AHF in AAS. Methods and Results: Data were collected from a prospective metropolitan AAS registry (398 patients diagnosed between 2000 and 2013). Troponin T values (either standard or high sensitivity assay, HS) were available in 248 patients (60%) of the registry population; the overall frequency of troponin positivity was 28% (ranging from 16% to 54%, using standard or HS assay respectively, p = 0.001). Troponin positivity was associated with a twofold increased risk of long in-hospital diagnostic time (OR 1.92, 95% CI 1.05-3.52, p = 0.03), but not with in-hospital mortality. The combination of positive troponin and ACS-like ECG abnormalities resulted in a significantly increased risk of inappropriate therapy due to a misdiagnosis of ACS (OR 2.48, 95% CI 1.12-5.54, p = 0.02). Patients with AHF were identified by the presence of dyspnea as presentation symptom or radiological signs of pulmonary congestion or cardiogenic shock. The overall frequency of AHF was 28 % (32% type A vs. 20% type B AAS, p = 0.01). AHF was due to a variety of pathophysiological mechanisms including cardiac tamponade (26%), aortic regurgitation (25%), myocardial ischemia (17%), hypertensive crisis (10%). AHF was associated with increased surgical delay and with increased risk of in-hospital death (adjusted OR 1.97 95% CI1.13-3.37,p=0.01). Conclusions: Troponin positivity (particularly HS) was a frequent finding in AAS. Abnormal troponin values were strongly associated with ACS-like ECG findings, in-hospital diagnostic delay, and inappropriate therapy. AHF was associated with increased surgical delay and was an independent predictor of in-hospital mortality. |
| 语种 | 英语 |
| URL | http://amsdottorato.unibo.it/6891 |
| 来源机构 | Università di Bologna |
| 资源类型 | 学位论文 |
| 条目标识符 | http://119.78.100.177/qdio/handle/2XILL650/249422 |
| 推荐引用方式 GB/T 7714 | Vagnarelli;Fabio <1981>. Key issues in diagnosing and treating acute aortic syndromes: results from the metropolitan area of Bologna network Problemi di diagnosi e terapia delle sindromi aortiche acute: Risultati della rete assistenziale dell'area metropolitana di Bologna[D]. Alma Mater Studiorum - Università di Bologna,2015. |
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