Blood Pressure Discrepancy and Pulse Differential in Patients Undergoing CT Angiography for Suspected Acute Aortic Dissection

Author(s): Lucas Stefanelli, Courtney Abbott, Michael Sloan, Angus Hartery

Purpose: To determine if blood pressure discrepancy between arms, pulse pressure, or other patient characteristics are more common in patients diagnosed with acute aortic dissection than those without, as confirmed on computed tomography angiography.

Methods: A retrospective chart review was conducted for patients who had undergone CTA for possible acute aortic dissection in Newfoundland and Labrador from 2012-2019. Each CTA-positive participant was sex, age (+/- 2 years), and technology-matched with CTA-negative controls.

Results: 61 participants met all inclusion criteria. Blood pressure discrepancy was not significant between acute aortic dissection types or between genders, with no impact on mortality rates. Pulse pressure was significantly higher in Stanford Type B aortic dissection (STB) than Stanford Type A Aortic Dissections (STA). Lower pulse pressures had lower mortality rates for STB respondents only. Abdominal pain was more frequent in STB than STA. Females with abdominal pain or back pain had increased mortality rates. Syncope was more common in STA than STB. Males with syncope had increased mortality rates. STA males had significantly increased mortality, while STB males had decreased mortality across all time points.

Conclusion: This was the first study to compare blood pressure differentials and pulse pressures together in conjunction with age-, sex- , and technology-matched controls, and the first to break these findings down further by AAD type and sex. Our findings demonstrate previously unidentified symptom- and sex-specific factors which could be invaluable in initial assessment and triage.