Abstract 2680: Tight Heart Rate Control Reduces Secondary Adverse Events in Patients with Type B Acute Aortic Dissection
Background: Although type B aortic dissection (AD) has been treated with beta-blocker to lower the arterial blood pressure (BP), there has been little evidences about reduction in heart rate (HR). We assessed whether tight HR control improved the outcome of medical treatment in patients with AD.
Methods and Results: From 1997 to 2005, consecutive 223 patients with AD medically treated and controlled to lower BP under 120 mmHg were enrolled. Based on the average HR at 3, 5, and 7 days after the onset, patients were divided to tight HR (<60 bpm) control group (39 patients; mean HR of 56 .8bpm) and conventional HR (equal or more than 60 bpm) control group (184 patients; mean HR of 71.6 bpm). We compared the frequency of aortic events including aortic rupture, recurrent dissection, and aortic expansion of more than 5mm, and surgical requirement between two groups. During a median follow-up of 33.3 months, aortic rupture, recurrent dissection, pathological aortic expansion, and aortic surgery occurred in 3, 14, 43, and 30 patients respectively. Reductions in aortic events and surgical requirement were observed in tight HR control group (10.3% and 2.6%) compared to conventional HR control group (28.3% and 15.8%) (Odds ratio: 0.29 and 0.14. C.I.:0.10 to 0.90 and 0.02 to 1.07, p<0.01.). Kaplan-Meier curves of aortic event and surgical requirement free rates were shown in figure 1 and 2⇓.
Conclusions: The present study demonstrated that tight heart rate control improved the outcome of medical treatment in patients with AD.