Journal of cardiology · 2026
Echocardiographic features and prognostic implications in acute type A intramural hematoma and classic aortic dissection.
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Kirigaya Jin, Iwahashi Noriaki, Yoshii Tomohiro, Hattori Kyoko, Matsushita Kensuke, Gohbara Masaomi, Okada Kozo, Cho Tomoki, Yasuda Shota, Kosuge Masami, Ebina Toshiaki, Uchida Keiji, Sugano Teruyasu, Hibi Kiyoshi
Аннотация
BACKGROUND: Echocardiography is a first-line modality for evaluating type A acute aortic dissection (TAAAD). However, the diagnostic and prognostic implications of echocardiographic findings may differ between acute type A intramural hematoma (ATAIMH) and classic type A aortic dissection (CAAAD). This study aimed to compare echocardiographic characteristics between ATAIMH and CAAAD and to evaluate their prognostic value for in-hospital mortality, stratified by surgical treatment.
METHODS: This retrospective single-center study included 434 patients with TAAAD (156 ATAIMH, 278 CAAAD) who underwent admission echocardiography. Findings assessed included direct signs (flap or hematoma), pericardial effusion, tamponade, aortic regurgitation, thoracic aortic enlargement (≥4 cm), and left ventricular wall motion abnormality (LVWMA). Prognostic value was evaluated stratified by surgical treatment (central repair vs. non-operative).
RESULTS: Direct signs were less common in ATAIMH than CAAAD (39.1% vs. 66.6%, p < 0.001). Thoracic aortic enlargement ≥4 cm was similarly frequent (94.2% in both). ATAIMH showed more pericardial effusion but less aortic regurgitation than CAAAD. In multivariable analysis, tamponade predicted in-hospital mortality in the overall cohort, ATAIMH, and CAAAD; however, this lost significance in CAAAD after adjustment for central repair. Pericardial effusion was prognostic in the overall cohort and CAAAD, but not ATAIMH. LVWMA was not predictive in ATAIMH but remained significant in CAAAD, even after adjustment for central repair.
CONCLUSIONS: Thoracic aortic enlargement was the most consistent diagnostic marker, suggesting this finding as a diagnostic priority, whereas direct signs were less frequent in ATAIMH, highlighting diagnostic challenges. Although no single echocardiographic parameter consistently predicted outcomes across all disease subtypes, pericardial effusion, tamponade, and LVWMA should be regarded as dynamic indicators readily assessed by echocardiography.
METHODS: This retrospective single-center study included 434 patients with TAAAD (156 ATAIMH, 278 CAAAD) who underwent admission echocardiography. Findings assessed included direct signs (flap or hematoma), pericardial effusion, tamponade, aortic regurgitation, thoracic aortic enlargement (≥4 cm), and left ventricular wall motion abnormality (LVWMA). Prognostic value was evaluated stratified by surgical treatment (central repair vs. non-operative).
RESULTS: Direct signs were less common in ATAIMH than CAAAD (39.1% vs. 66.6%, p < 0.001). Thoracic aortic enlargement ≥4 cm was similarly frequent (94.2% in both). ATAIMH showed more pericardial effusion but less aortic regurgitation than CAAAD. In multivariable analysis, tamponade predicted in-hospital mortality in the overall cohort, ATAIMH, and CAAAD; however, this lost significance in CAAAD after adjustment for central repair. Pericardial effusion was prognostic in the overall cohort and CAAAD, but not ATAIMH. LVWMA was not predictive in ATAIMH but remained significant in CAAAD, even after adjustment for central repair.
CONCLUSIONS: Thoracic aortic enlargement was the most consistent diagnostic marker, suggesting this finding as a diagnostic priority, whereas direct signs were less frequent in ATAIMH, highlighting diagnostic challenges. Although no single echocardiographic parameter consistently predicted outcomes across all disease subtypes, pericardial effusion, tamponade, and LVWMA should be regarded as dynamic indicators readily assessed by echocardiography.