Vol.:(0123456789)
1 3
Heart and Vessels
https://doi.org/10.1007/s00380-018-1199-0
ORIGINAL ARTICLE
Predictors of oxygenation impairment in medical treatment for type B
acute aortic dissection
Yusuke Kashiwagi
1
· Kimiaki Komukai
1
· Kenichiro Suzuki
1
· Yuhei Oi
1
· Mitsutoshi Tominaga
1
· Kotaro Nakata
1
·
Satoru Miyanaga
1
· Tetsuya Ishikawa
1
· Kosuke Minai
2
· Tomohisa Nagoshi
2
· Michihiro Yoshimura
2
Received: 24 February 2018 / Accepted: 1 June 2018
© Springer Japan KK, part of Springer Nature 2018
Abstract
Lung oxygenation impairment often occurs in patients with type B acute aortic dissection (AAD), necessitating mechani-
cal ventilation. Patients receiving mechanical ventilation are at risk of complications, so a low-oxygen condition requiring
mechanical ventilation should be avoided. We explored the predictors of oxygenation impairment. We enrolled 46 patients
with type B AAD who had been medically treated and underwent computed tomography. Blood was sampled to measure
markers of inflammation, such as the C-reactive protein (CRP) levels and white blood cell count. The arterial partial pressure
of oxygen/fraction of inspired oxygen ratio (PaO
2
/FiO
2
) was calculated to quantify the severity of respiratory failure. Spear-
man’s rank correlation analysis revealed that the minimum PaO
2
/FiO
2
ratio was significantly correlated with gender, age, and
current smoker, and the peak CRP, body temperature, and D-dimer values. A multivariate regression analysis revealed that
younger age, male sex, and the peak CRP level were significant predictors of the minimum PaO
2
/FiO
2
ratio (P = 0.01, 0.035
and 0.005, respectively). A covariance structure analysis showed that a younger age and the peak CRP level were significant
predictors of oxygenation impairment in type B AAD. Oxygenation impairment in type B AAD is correlated with younger
age and a higher peak CRP level. This will enable the identification of patients whose respiratory condition is susceptible to
worsening and help prevent mechanical ventilation, leading to the provision of appropriate therapy.
Keywords Acute aortic dissection · Oxygenation impairment · Vascular permeability · Inflammation · Pulmonary
connective tissue
Introduction
Patients with type B acute aortic dissection (AAD) have a bet-
ter prognosis than those with type A AAD, and they are ini-
tially managed with medical therapy, such as antihypertensive
treatment. However, some type B AAD patients suffer from
lung oxygenation impairment, which necessitates mechanical
ventilation. Patients receiving mechanical ventilation are at
risk of certain complications, such as ventilator-associated
pneumonia (VAP) and ventilator-associated lung injury
(VILI) [1–3]. VAP causes substantial morbidity by increasing
the duration of mechanical ventilation and intensive-care unit
(ICU) stay [4, 5]. It is, therefore, important to avoid low-oxy-
gen conditions that necessitate mechanical ventilation.
Previous studies have shown that oxygenation impair-
ment is associated with a systemic inflammatory reaction
and the degree of aortic injury [6–9]. However, in patients
with aortic dissection, the inflammatory marker levels peak
several days after the onset and are, therefore, inadequate for
predicting oxygenation impairment at the time of admission.
The aim of this study was to identify other clinical risk
factors associated with oxygenation impairment in patients
with type B AAD at the early stage of hospitalization.
Methods
Between December 2010 and May 2017, 67 patients diag-
nosed with type B AAD were admitted to our institution.
We excluded patients who were admitted more than 24 h
* Yusuke Kashiwagi
y-kashiwa@jikei.ac.jp
1
Division of Cardiology, Department of Internal Medicine,
The Jikei University School of Medicine, Kashiwa Hospital,
163-1 Kashiwashita, Kashiwa, Chiba 277-8567, Japan
2
Division of Cardiology, Department of Internal Medicine,
The Jikei University School of Medicine, Tokyo, Japan
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