Correlation of echocardiographic myocardial deformation variables and vascular Doppler ultrasound variables in the classification of Type-Entry-Malperfusion (TEM) for aortic dissection.

BACKGROUND

Aortic dissection is a severe and life-threatening condition that may involve both myocardial and vascular dysfunction. Conventional imaging parameters are limited in detecting subtle myocardial or vascular alterations associated with malperfusion. The aim of this study was to correlate echocardiographic myocardial deformation and vascular Doppler parameters with the Type-Entry-Malperfusion (TEM) classification in aortic dissection.

METHODS

This cross-sectional study included 114 patients with acute aortic dissection (mean age 56.6±11.8 years). Transesophageal echocardiography (TEE) and transthoracic echocardiography with speckle-tracking analysis were performed to evaluate conventional and myocardial deformation variables. Doppler ultrasound was used to assess descending aortic compliance.

RESULTS

Most patients (100%) presented type A dissection, predominantly with rupture in the ascending aorta (E1) or aortic arch (E2). Conventional echocardiographic parameters showed weak correlation with malperfusion categories (M0-M3). In contrast, global longitudinal strain (GLS) strongly correlated with myocardial malperfusion, particularly in E1/M1 (r=0.8333, P<0.0001), E1/M1 with bicuspid aortic valve (r=0.8872, P<0.0001), and E2/M2 (r=0.9018, P<0.0001). Myocardial biomarkers creatine kinase-MB (CK-MB) (r=0.8797, P<0.0001) and cardiac troponin I (cTnI) (r=0.6659, P<0.0001) also correlated with GLS. Doppler-derived pulsatility index (PI) correlated with smooth muscle myosin heavy chain (smMHC; r=0.8793, P<0.0001) and soluble elastin fragments (sELAF; r=0.7623, P<0.0001), indicating reduced vascular compliance.

CONCLUSIONS

Integration of GLS and PI parameters with the TEM classification provides additional quantitative insight into myocardial and vascular injury in aortic dissection, supporting their potential prognostic value in surgical outcomes.