Characteristics of Inter-Arm Difference in Blood Pressure in Acute Aortic Dissection
Background: An inter-arm difference in blood pressure (IADBP) is characteristic of acute aortic dissection (AAD), but the importance of which arm exhibits lower blood pressure (BP) and the mechanism underlying IADBP are not well understood. Methods: We identified consecutive patients with chest and/...
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| Veröffentlicht in: | Journal of Nippon Medical School 2021/10/25, Vol.88(5), pp.467-474 |
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| creator | Sasamoto, Nozomi Akutsu, Koichi Yamamoto, Takeshi Otsuka, Toshiaki Sangen, Hideto Hayashi, Hiroshi Murata, Hiroshige Miyachi, Hideki Hosokawa, Yusuke Tara, Shuhei Tokita, Yukichi Miyata, Satoshi Morota, Tetsuro Nitta, Takashi Shimizu, Wataru |
| description | Background: An inter-arm difference in blood pressure (IADBP) is characteristic of acute aortic dissection (AAD), but the importance of which arm exhibits lower blood pressure (BP) and the mechanism underlying IADBP are not well understood. Methods: We identified consecutive patients with chest and/or back pain and suspected acute cardiovascular disease whose BP had been measured in both arms. We retrospectively compared the characteristics of such patients with AAD (n=93) to those without AAD (non-AAD group, n=122). Additionally, we separately compared patients with type A AAD (TAAD group, n=58) or type B AAD (TBAD group, n=35) to the non-AAD group. The characteristics analyzed were patient background and IADBP-related factors, including systolic BP (SBP) in the right arm (R) and left arm (L), and R-L or L-R as IADBP. Computed tomography (CT) findings of AD extending to the brachiocephalic artery (BCA) and/or left subclavian artery (LSCA) were examined in patients with an IADBP. Results: In a comparison of the TAAD group and non-AAD group, the prevalences of R 15 mm Hg (19% vs. 8%, p=0.047), L-R >20 mm Hg (14% vs. 4%, p=0.029) were higher in the TAAD group. Multivariate analysis showed that L-R >15 mm Hg with R 20 mm Hg all had TAAD, and all aortic dissection extended to the BCA just before the right common carotid artery on CT. Conclusions: IADBP was characterized by R |
| doi_str_mv | 10.1272/jnms.JNMS.2021_88-605 |
| format | Article |
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Methods: We identified consecutive patients with chest and/or back pain and suspected acute cardiovascular disease whose BP had been measured in both arms. We retrospectively compared the characteristics of such patients with AAD (n=93) to those without AAD (non-AAD group, n=122). Additionally, we separately compared patients with type A AAD (TAAD group, n=58) or type B AAD (TBAD group, n=35) to the non-AAD group. The characteristics analyzed were patient background and IADBP-related factors, including systolic BP (SBP) in the right arm (R) and left arm (L), and R-L or L-R as IADBP. Computed tomography (CT) findings of AD extending to the brachiocephalic artery (BCA) and/or left subclavian artery (LSCA) were examined in patients with an IADBP. Results: In a comparison of the TAAD group and non-AAD group, the prevalences of R <130 mm Hg (38% vs. 19%, p=0.009), L-R >15 mm Hg (19% vs. 8%, p=0.047), L-R >20 mm Hg (14% vs. 4%, p=0.029) were higher in the TAAD group. Multivariate analysis showed that L-R >15 mm Hg with R <130 mm Hg was independently associated with TAAD (OR 25.97, 95% CI 2.45-275.67, p=0.007). However, IADBP-related factors were not associated with TBAD. AAD patients with L-R >20 mm Hg all had TAAD, and all aortic dissection extended to the BCA just before the right common carotid artery on CT. Conclusions: IADBP was characterized by R<L with low R in TAAD but was not associated with TBAD.</description><identifier>ISSN: 1345-4676</identifier><identifier>EISSN: 1347-3409</identifier><identifier>DOI: 10.1272/jnms.JNMS.2021_88-605</identifier><identifier>PMID: 33692296</identifier><language>eng</language><publisher>Japan: The Medical Association of Nippon Medical School</publisher><subject>Acute Disease ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting - diagnostic imaging ; aortic dissection ; Blood Pressure - physiology ; characteristics ; Female ; Humans ; inter-arm difference in blood pressure ; Male ; Middle Aged ; Pulse ; pulse deficit ; Retrospective Studies ; stanford type A ; Tomography, X-Ray Computed</subject><ispartof>Journal of Nippon Medical School, 2021/10/25, Vol.88(5), pp.467-474</ispartof><rights>2021 by the Medical Association of Nippon Medical School</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c624t-fffa22be6db8be203688071c82035ca7c31c6a4ed446907c68a3be16bb968ed63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1883,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33692296$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sasamoto, Nozomi</creatorcontrib><creatorcontrib>Akutsu, Koichi</creatorcontrib><creatorcontrib>Yamamoto, Takeshi</creatorcontrib><creatorcontrib>Otsuka, Toshiaki</creatorcontrib><creatorcontrib>Sangen, Hideto</creatorcontrib><creatorcontrib>Hayashi, Hiroshi</creatorcontrib><creatorcontrib>Murata, Hiroshige</creatorcontrib><creatorcontrib>Miyachi, Hideki</creatorcontrib><creatorcontrib>Hosokawa, Yusuke</creatorcontrib><creatorcontrib>Tara, Shuhei</creatorcontrib><creatorcontrib>Tokita, Yukichi</creatorcontrib><creatorcontrib>Miyata, Satoshi</creatorcontrib><creatorcontrib>Morota, Tetsuro</creatorcontrib><creatorcontrib>Nitta, Takashi</creatorcontrib><creatorcontrib>Shimizu, Wataru</creatorcontrib><creatorcontrib>Department of Cardiovascular Medicine</creatorcontrib><creatorcontrib>Nippon Medical School</creatorcontrib><creatorcontrib>Center for Clinical Research</creatorcontrib><creatorcontrib>Teikyo University Graduate School of Public Healt</creatorcontrib><creatorcontrib>Division of Cardiovascular Intensive Care</creatorcontrib><creatorcontrib>Department of Hygiene and Public Health</creatorcontrib><creatorcontrib>Department of Cardiovascular Surgery</creatorcontrib><creatorcontrib>Nippon Medical School Hospital</creatorcontrib><title>Characteristics of Inter-Arm Difference in Blood Pressure in Acute Aortic Dissection</title><title>Journal of Nippon Medical School</title><addtitle>J Nippon Med Sch</addtitle><description>Background: An inter-arm difference in blood pressure (IADBP) is characteristic of acute aortic dissection (AAD), but the importance of which arm exhibits lower blood pressure (BP) and the mechanism underlying IADBP are not well understood. Methods: We identified consecutive patients with chest and/or back pain and suspected acute cardiovascular disease whose BP had been measured in both arms. We retrospectively compared the characteristics of such patients with AAD (n=93) to those without AAD (non-AAD group, n=122). Additionally, we separately compared patients with type A AAD (TAAD group, n=58) or type B AAD (TBAD group, n=35) to the non-AAD group. The characteristics analyzed were patient background and IADBP-related factors, including systolic BP (SBP) in the right arm (R) and left arm (L), and R-L or L-R as IADBP. Computed tomography (CT) findings of AD extending to the brachiocephalic artery (BCA) and/or left subclavian artery (LSCA) were examined in patients with an IADBP. Results: In a comparison of the TAAD group and non-AAD group, the prevalences of R <130 mm Hg (38% vs. 19%, p=0.009), L-R >15 mm Hg (19% vs. 8%, p=0.047), L-R >20 mm Hg (14% vs. 4%, p=0.029) were higher in the TAAD group. Multivariate analysis showed that L-R >15 mm Hg with R <130 mm Hg was independently associated with TAAD (OR 25.97, 95% CI 2.45-275.67, p=0.007). However, IADBP-related factors were not associated with TBAD. AAD patients with L-R >20 mm Hg all had TAAD, and all aortic dissection extended to the BCA just before the right common carotid artery on CT. Conclusions: IADBP was characterized by R<L with low R in TAAD but was not associated with TBAD.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aneurysm, Dissecting - diagnostic imaging</subject><subject>aortic dissection</subject><subject>Blood Pressure - physiology</subject><subject>characteristics</subject><subject>Female</subject><subject>Humans</subject><subject>inter-arm difference in blood pressure</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pulse</subject><subject>pulse deficit</subject><subject>Retrospective Studies</subject><subject>stanford type A</subject><subject>Tomography, X-Ray Computed</subject><issn>1345-4676</issn><issn>1347-3409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUcuO1DAQtBCIXRY-AZQjlwx-xXGOwwDLwvKQWM6W43TAUWIvdiLE39OZDHPg0m7b1dVd1YQ8Z3THeM1fDWHKuw-fP33bccqZ0bpUtHpALpmQdSkkbR4e86qUqlYX5EnOA6VCVJV6TC6EUA3njbokd4efNlk3Q_J59i4XsS9uAl7LfZqKN77vIUFwUPhQvB5j7IqvCXJe0vFl75YZin1MWIrgnMHNPoan5FFvxwzPTucV-f7u7d3hfXn75frmsL8tneJyLvu-t5y3oLpWt8CpUFrTmjmNaeVs7QRzykropFQNrZ3SVrTAVNs2SkOnxBV5ufHep_hrgTybyWcH42gDxCUbXqFkzRVnCK02qEsx5wS9uU9-sumPYdSshprVULMaak6GGjQU616cWiztBN256p-DCLjeAPjrnR1jGH0AM8QlBdRu3G82xJX6yEopSqwMxaYUF4OhlqJB4Y1Epo8b05Bn-wPOrezq7gjbgDhWtYb_Bz2jHO7TQBB_ARTApHA</recordid><startdate>20211025</startdate><enddate>20211025</enddate><creator>Sasamoto, Nozomi</creator><creator>Akutsu, Koichi</creator><creator>Yamamoto, Takeshi</creator><creator>Otsuka, Toshiaki</creator><creator>Sangen, Hideto</creator><creator>Hayashi, Hiroshi</creator><creator>Murata, Hiroshige</creator><creator>Miyachi, Hideki</creator><creator>Hosokawa, Yusuke</creator><creator>Tara, Shuhei</creator><creator>Tokita, Yukichi</creator><creator>Miyata, Satoshi</creator><creator>Morota, Tetsuro</creator><creator>Nitta, Takashi</creator><creator>Shimizu, Wataru</creator><general>The Medical Association of Nippon Medical School</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20211025</creationdate><title>Characteristics of Inter-Arm Difference in Blood Pressure in Acute Aortic Dissection</title><author>Sasamoto, Nozomi ; Akutsu, Koichi ; Yamamoto, Takeshi ; Otsuka, Toshiaki ; Sangen, Hideto ; Hayashi, Hiroshi ; Murata, Hiroshige ; Miyachi, Hideki ; Hosokawa, Yusuke ; Tara, Shuhei ; Tokita, Yukichi ; Miyata, Satoshi ; Morota, Tetsuro ; Nitta, Takashi ; Shimizu, Wataru</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c624t-fffa22be6db8be203688071c82035ca7c31c6a4ed446907c68a3be16bb968ed63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aneurysm, Dissecting - diagnostic imaging</topic><topic>aortic dissection</topic><topic>Blood Pressure - physiology</topic><topic>characteristics</topic><topic>Female</topic><topic>Humans</topic><topic>inter-arm difference in blood pressure</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pulse</topic><topic>pulse deficit</topic><topic>Retrospective Studies</topic><topic>stanford type A</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sasamoto, Nozomi</creatorcontrib><creatorcontrib>Akutsu, Koichi</creatorcontrib><creatorcontrib>Yamamoto, Takeshi</creatorcontrib><creatorcontrib>Otsuka, Toshiaki</creatorcontrib><creatorcontrib>Sangen, Hideto</creatorcontrib><creatorcontrib>Hayashi, Hiroshi</creatorcontrib><creatorcontrib>Murata, Hiroshige</creatorcontrib><creatorcontrib>Miyachi, Hideki</creatorcontrib><creatorcontrib>Hosokawa, Yusuke</creatorcontrib><creatorcontrib>Tara, Shuhei</creatorcontrib><creatorcontrib>Tokita, Yukichi</creatorcontrib><creatorcontrib>Miyata, Satoshi</creatorcontrib><creatorcontrib>Morota, Tetsuro</creatorcontrib><creatorcontrib>Nitta, Takashi</creatorcontrib><creatorcontrib>Shimizu, Wataru</creatorcontrib><creatorcontrib>Department of Cardiovascular Medicine</creatorcontrib><creatorcontrib>Nippon Medical School</creatorcontrib><creatorcontrib>Center for Clinical Research</creatorcontrib><creatorcontrib>Teikyo University Graduate School of Public Healt</creatorcontrib><creatorcontrib>Division of Cardiovascular Intensive Care</creatorcontrib><creatorcontrib>Department of Hygiene and Public Health</creatorcontrib><creatorcontrib>Department of Cardiovascular Surgery</creatorcontrib><creatorcontrib>Nippon Medical School Hospital</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of Nippon Medical School</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sasamoto, Nozomi</au><au>Akutsu, Koichi</au><au>Yamamoto, Takeshi</au><au>Otsuka, Toshiaki</au><au>Sangen, Hideto</au><au>Hayashi, Hiroshi</au><au>Murata, Hiroshige</au><au>Miyachi, Hideki</au><au>Hosokawa, Yusuke</au><au>Tara, Shuhei</au><au>Tokita, Yukichi</au><au>Miyata, Satoshi</au><au>Morota, Tetsuro</au><au>Nitta, Takashi</au><au>Shimizu, Wataru</au><aucorp>Department of Cardiovascular Medicine</aucorp><aucorp>Nippon Medical School</aucorp><aucorp>Center for Clinical Research</aucorp><aucorp>Teikyo University Graduate School of Public Healt</aucorp><aucorp>Division of Cardiovascular Intensive Care</aucorp><aucorp>Department of Hygiene and Public Health</aucorp><aucorp>Department of Cardiovascular Surgery</aucorp><aucorp>Nippon Medical School Hospital</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characteristics of Inter-Arm Difference in Blood Pressure in Acute Aortic Dissection</atitle><jtitle>Journal of Nippon Medical School</jtitle><addtitle>J Nippon Med Sch</addtitle><date>2021-10-25</date><risdate>2021</risdate><volume>88</volume><issue>5</issue><spage>467</spage><epage>474</epage><pages>467-474</pages><artnum>JNMS.2021_88-605</artnum><issn>1345-4676</issn><eissn>1347-3409</eissn><abstract>Background: An inter-arm difference in blood pressure (IADBP) is characteristic of acute aortic dissection (AAD), but the importance of which arm exhibits lower blood pressure (BP) and the mechanism underlying IADBP are not well understood. Methods: We identified consecutive patients with chest and/or back pain and suspected acute cardiovascular disease whose BP had been measured in both arms. We retrospectively compared the characteristics of such patients with AAD (n=93) to those without AAD (non-AAD group, n=122). Additionally, we separately compared patients with type A AAD (TAAD group, n=58) or type B AAD (TBAD group, n=35) to the non-AAD group. The characteristics analyzed were patient background and IADBP-related factors, including systolic BP (SBP) in the right arm (R) and left arm (L), and R-L or L-R as IADBP. Computed tomography (CT) findings of AD extending to the brachiocephalic artery (BCA) and/or left subclavian artery (LSCA) were examined in patients with an IADBP. Results: In a comparison of the TAAD group and non-AAD group, the prevalences of R <130 mm Hg (38% vs. 19%, p=0.009), L-R >15 mm Hg (19% vs. 8%, p=0.047), L-R >20 mm Hg (14% vs. 4%, p=0.029) were higher in the TAAD group. Multivariate analysis showed that L-R >15 mm Hg with R <130 mm Hg was independently associated with TAAD (OR 25.97, 95% CI 2.45-275.67, p=0.007). However, IADBP-related factors were not associated with TBAD. AAD patients with L-R >20 mm Hg all had TAAD, and all aortic dissection extended to the BCA just before the right common carotid artery on CT. Conclusions: IADBP was characterized by R<L with low R in TAAD but was not associated with TBAD.</abstract><cop>Japan</cop><pub>The Medical Association of Nippon Medical School</pub><pmid>33692296</pmid><doi>10.1272/jnms.JNMS.2021_88-605</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of Nippon Medical School, 2021/10/25, Vol.88(5), pp.467-474 |
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| language | eng |
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| source | MEDLINE; J-STAGE (Japan Science & Technology Information Aggregator, Electronic) Freely Available Titles - Japanese |
| subjects | Acute Disease Aged Aged, 80 and over Aneurysm, Dissecting - diagnostic imaging aortic dissection Blood Pressure - physiology characteristics Female Humans inter-arm difference in blood pressure Male Middle Aged Pulse pulse deficit Retrospective Studies stanford type A Tomography, X-Ray Computed |
| title | Characteristics of Inter-Arm Difference in Blood Pressure in Acute Aortic Dissection |
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