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Diagnosis of acute aortic syndromes

Imaging and beyond

Diagnose des akuten Aortensyndroms

Bildgebung und mehr

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Abstract

Acute aortic syndromes are fatal medical conditions including classic acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Given the nonspecific symptoms and signs, a high clinical index of suspicion followed by an imaging study, namely transesophageal echocardiography, computed tomography, and magnetic resonance imaging (sensitivity 98–100% and specificity 95–100%), is a conditio sine qua non for prompt diagnosis of acute aortic syndromes. This article provides an overview of established and emerging approaches for the assessment of acute aortic syndromes, with focus on imaging and biomarkers. In this regard, D-dimer levels (cut-off: 500 ng/ml) may be useful to rule out aortic dissection, if used within the first 24 h after symptom onset.

Zusammenfassung

Das akute Aortensyndrom ist eine letale Erkrankung und umfasst beispielsweise die klassische akute Aortendissektion, das intramurale Hämatom und das penetrierende atherosklerotische Ulkus. Angesichts der unspezifischen Symptome sind bei starkem klinischem Verdacht bildgebende Untersuchungen, also transösophageale Echokardiographie, Computertomographie und Magnetresonanztomographie (Sensitivität: 98–100%, Spezifität: 95–100%), eine Conditio sine qua non für die zügige Diagnose eines akuten Aortensyndroms. In der vorliegenden Übersichtsarbeit wird ein Überblick über etablierte und neue Ansätze zur Beurteilung des akuten Aortensyndroms gegeben, dabei liegt der Schwerpunkt auf Bildgebung und Biomarkern. Diesbezüglich ist möglicherweise die Bestimmung des D-Dimer-Spiegels (Grenzwert: 500 ng/ml) zum Ausschluss einer Aortendissektion hilfreich, wenn sie innerhalb der ersten 24 h nach Symptombeginn durchgeführt wird.

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References

  1. Hiratzka LF, Bakris GL, Beckman JA et al (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121:e266–e369

    Article  PubMed  Google Scholar 

  2. Erbel R, Alfonso F, Boileau C et al (2001) Diagnosis and management of aortic dissection. Eur Heart J 22:1642–1681

    Article  PubMed  CAS  Google Scholar 

  3. Booher AM, Eagle KA, Bossone E (2011) Acute aortic syndromes. Herz 36:480–487

    Article  PubMed  CAS  Google Scholar 

  4. Hagan PG, Nienaber CA, Isselbacher EM et al (2000) The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 283:897–903

    Article  PubMed  CAS  Google Scholar 

  5. Rogers AM, Hermann LK, Booher AM et al (2011) Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. Circulation 123:2213–2218

    Article  PubMed  Google Scholar 

  6. Harris KM, Strauss CE, Eagle KA et al (2011) Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD). Circulation 124:1911–1918

    Article  PubMed  Google Scholar 

  7. Shiga T, Wajima Z, Apfel CC et al (2006) Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med 166:1350–1356

    Article  PubMed  Google Scholar 

  8. Nienaber CA, Kodolitsch Y von, Nicolas V et al (1993) The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 328:1–9

    Article  PubMed  CAS  Google Scholar 

  9. Moore AG, Eagle KA, Bruckman D et al (2002) Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol 89:1235–1238

    Article  PubMed  Google Scholar 

  10. Evangelista A, Flachskampf FA, Erbel R et al (2010) Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 11:645–658

    Article  PubMed  Google Scholar 

  11. Bireley WR II, Diniz LO, Groves EM et al (2007) Orthogonal measurement of thoracic aorta luminal diameter using ECG-gated high-resolution contrast-enhanced MR angiography. J Magn Reson Imaging 26:1480–1485

    Article  PubMed  Google Scholar 

  12. Mendoza DD, Kochar M, Devereux RB et al (2011) Impact of image analysis methodology on diagnostic and surgical classification of patients with thoracic aortic aneurysms. Ann Thorac Surg 92:904–912

    Article  PubMed  Google Scholar 

  13. Schernthaner MB, Edelhauser G, Berzaczy D et al (2010) Perceptibility and quantification of in-stent stenosis with six peripheral arterial stent types in vitro: comparison of 16-MDCT angiography, 64-MDCT angiography, and MR angiography. AJR Am J Roentgenol 194:1346–1351

    Article  PubMed  Google Scholar 

  14. Morita S, Masukawa A, Suzuki K et al (2011) Unenhanced MR angiography: techniques and clinical applications in patients with chronic kidney disease. Radiographics 31:E13–E33

    Article  PubMed  Google Scholar 

  15. Blanke P, Bulla S, Baumann T et al (2010) Thoracic aorta: prospective electrocardiographically triggered CT angiography with dual-source CT–feasibility, image quality, and dose reduction. Radiology 255:207–217

    Article  PubMed  Google Scholar 

  16. Evangelista A, Dominguez R, Sebastia C et al (2003) Long-term follow-up of aortic intramural hematoma: predictors of outcome. Circulation 108:583–589

    Article  PubMed  Google Scholar 

  17. Park GM, Ahn JM, Kim DH et al (2011) Distal aortic intramural hematoma: clinical importance of focal contrast enhancement on CT images. Radiology 259:100–108

    Article  PubMed  Google Scholar 

  18. Wu MT, Wang YC, Huang YL et al (2011) Intramural blood pools accompanying aortic intramural hematoma: CT appearance and natural course. Radiology 258:705–713

    Article  PubMed  Google Scholar 

  19. Srichai MB, Junor C, Rodriguez LL et al (2006) Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am Heart J 152:75–84

    Article  PubMed  Google Scholar 

  20. Weinsaft JW, Kim HW, Shah DJ et al (2008) Detection of left ventricular thrombus by delayed-enhancement cardiovascular magnetic resonance prevalence and markers in patients with systolic dysfunction. J Am Coll Cardiol 52:148–157

    Article  PubMed  Google Scholar 

  21. Kumar A, Green JD, Sykes JM et al (2011) Detection and quantification of myocardial reperfusion hemorrhage using T2*-weighted CMR. JACC Cardiovasc Imaging 4:1274–1283

    Article  PubMed  Google Scholar 

  22. Yucel EK, Steinberg FL, Egglin TK et al (1990) Penetrating aortic ulcers: diagnosis with MR imaging. Radiology 177:779–781

    PubMed  CAS  Google Scholar 

  23. Demarco JK, Ota H, Underhill HR et al (2010) MR carotid plaque imaging and contrast-enhanced MR angiography identifies lesions associated with recent ipsilateral thromboembolic symptoms: an in vivo study at 3T. AJNR Am J Neuroradiol 31:1395–1402

    Article  PubMed  CAS  Google Scholar 

  24. Min JK, Edwardes M, Lin FY et al (2011) Relationship of coronary artery plaque composition to coronary artery stenosis severity: results from the prospective multicenter ACCURACY trial. Atherosclerosis 219:573–578

    Article  PubMed  CAS  Google Scholar 

  25. Suzuki T, Katoh H, Watanabe M et al (1996) Novel biochemical diagnostic method for aortic dissection. Results of a prospective study using an immunoassay of smooth muscle myosin heavy chain. Circulation 93:1244–1249

    Article  PubMed  CAS  Google Scholar 

  26. Suzuki T, Katoh H, Tsuchio Y et al (2000) Diagnostic implications of elevated levels of smooth-muscle myosin heavy-chain protein in acute aortic dissection. The smooth muscle myosin heavy chain study. Ann Intern Med 133:537–541

    Article  PubMed  CAS  Google Scholar 

  27. Suzuki T, Katoh H, Kurabayashi M et al (1997) Biochemical diagnosis of aortic dissection by raised concentrations of creatine kinase BB-isozyme. Lancet 350:784–785

    Article  PubMed  CAS  Google Scholar 

  28. Suzuki T, Distante A, Zizza A et al (2008) Preliminary experience with the smooth muscle troponin-like protein, calponin, as a novel biomarker for diagnosing acute aortic dissection. Eur Heart J 29:1439–1445

    Article  PubMed  CAS  Google Scholar 

  29. Shinohara T, Suzuki K, Okada M et al (2003) Soluble elastin fragments in serum are elevated in acute aortic dissection. Arterioscler Thromb Vasc Biol 23:1839–1844

    Article  PubMed  CAS  Google Scholar 

  30. Makita S, Ohira A, Tachieda R et al (2000) Behavior of C-reactive protein levels in medically treated aortic dissection and intramural hematoma. Am J Cardiol 86:242–244

    Article  PubMed  CAS  Google Scholar 

  31. Sangiorgi G, Trimarchi S, Mauriello A et al (2006) Plasma levels of metalloproteinases-9 and -2 in the acute and subacute phases of type A and type B aortic dissection. J Cardiovasc Med 7:307–315

    Article  Google Scholar 

  32. Matt P, Schoenhoff F, Habashi J et al (2009) Circulating transforming growth factor-beta in Marfan syndrome. Circulation 120:526–532

    Article  PubMed  CAS  Google Scholar 

  33. Suzuki T, Trimarchi S, Sawaki D et al (2011) Circulating transforming growth factor-beta levels in acute aortic dissection. J Am Coll Cardiol 58:775

    Article  PubMed  Google Scholar 

  34. Shimony A, Filion KB, Mottillo S et al (2011) Meta-analysis of usefulness of D-dimer to diagnose acute aortic dissection. Am J Cardiol 107:1227–1234

    Article  PubMed  CAS  Google Scholar 

  35. Suzuki T, Distante A, Zizza A et al (2009) Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation 119:2702–2707

    Article  PubMed  Google Scholar 

  36. Sbarouni E, Georgiadou P, Marathias A et al (2007) D-dimer and BNP levels in acute aortic dissection. Int J Cardiol 122:170–172

    Article  PubMed  Google Scholar 

  37. Ohlmann P, Faure A, Morel O et al (2006) Diagnostic and prognostic value of circulating D-dimers in patients with acute aortic dissection. Crit Care Med 34:1358–1364

    Article  PubMed  Google Scholar 

  38. Hazui H, Fukumoto H, Negoro N et al (2005) Simple and useful tests for discriminating between acute aortic dissection of the ascending aorta and acute myocardial infarction in the emergency setting. Circ J 69:677–682

    Article  PubMed  Google Scholar 

  39. Akutsu K, Sato N, Yamamoto T et al (2005) A rapid bedside D-dimer assay (cardiac D-dimer) for screening of clinically suspected acute aortic dissection. Circ J 69:397–403

    Article  PubMed  Google Scholar 

  40. Eggebrecht H, Naber CK, Bruch C et al (2004) Value of plasma fibrin D-dimers for detection of acute aortic dissection. J Am Coll Cardiol 44:804–809

    Article  PubMed  CAS  Google Scholar 

  41. Weber T, Hogler S, Auer J et al (2003) D-dimer in acute aortic dissection. Chest 123:1375–1378

    Article  PubMed  Google Scholar 

  42. Tsai TT, Nienaber CA, Eagle KA (2005) Acute aortic syndromes. 112: 3802–3813

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Acknowledgments

All authors participated in the writing of this manuscript and are responsible for its content. Eduardo Bossone assumes responsibility for the integrity of all contents of this manuscript.

Sources of funding

This work was supported by the National Institutes of Health (NIIH/NHLBI US Federal Government Contract N-01-HV-68199 [National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions]; JWW, KAE) (K23 HL102249-01; JWW).

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Heart Department, University of Salerno, Salern, Italy

    E. Bossone M.D., Ph.D., FESC, FCCP, FACC

  2. Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    E. Bossone M.D., Ph.D., FESC, FCCP, FACC

  3. Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    T. Suzuki

  4. University of Michigan Cardiovascular Center, Ann Arbor, MI, USA

    K.A. Eagle

  5. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    J.W. Weinsaft

Authors
  1. E. Bossone M.D., Ph.D., FESC, FCCP, FACC
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  2. T. Suzuki
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  3. K.A. Eagle
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  4. J.W. Weinsaft
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Corresponding author

Correspondence to E. Bossone M.D., Ph.D., FESC, FCCP, FACC.

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Bossone, E., Suzuki, T., Eagle, K. et al. Diagnosis of acute aortic syndromes. Herz 38, 269–276 (2013). https://doi.org/10.1007/s00059-012-3710-1

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