Hoff, Emily

Background: Little is known about the relationship between Type A Acute Aortic Dissection (TAAAD) and pulse pressure (PP), defined as the difference between systolic and diastolic blood pressure. This study explores the association between PP and presentation, complications and outcomes of TAAAD patients. Methods: PP at hospital presentation was used to divide 1,960 non-iatrogenic TAAAD patients into quartiles: narrowed (≤39 mmHg; n=430), normal (40-56 mmHg; n=554), mildly elevated (57-75 mmHg; n=490) and markedly elevated (≥76 mmHg; n=486). Variables relating to index presentation and in-hospital outcomes were analyzed. Results: TAAAD patients (patients) in the narrowed PP quartiles were more frequently older and Caucasian while patients with markedly elevated PPs tended to be male and have a history of hypertension. Patients who demonstrated abdominal vessel involvement more commonly demonstrated elevated PPs whereas patients with narrowed PPs were more likely to have periaortic hematoma and/or pericardial effusion. Narrowed PPs were also correlated with higher incidences of hypotension, cardiac tamponade and mortality. TAAAD patients who were managed with endovascular and hybrid procedures and those with renal failure tended to have elevated PPs. No difference in aortic regurgitation at presentation was noted between groups. Conclusions: TAAAD patients in the middle two PP quartiles had better in-hospital outcomes than patients in the outer quartiles. Patients with narrowed PPs experienced more cardiac complications, particularly cardiac tamponade, while those with elevated PPs were more likely to have abdominal aortic involvement. Presenting PP offers a clue to different manifestations of AAD that may facilitate initial triage and care.