-Original-

Characteristics of Inter-Arm Difference in Blood Pressure in Acute Aortic Dissection

Nozomi Sasamoto^1,2, Koichi Akutsu^1,2, Takeshi Yamamoto², Toshiaki Otsuka^3,4, Hideto Sangen², Hiroshi Hayashi^1,2, Hiroshige Murata^1,2, Hideki Miyachi^1,2, Yusuke Hosokawa², Shuhei Tara², Yukichi Tokita^1,2, Satoshi Miyata⁵, Tetsuro Morota⁶, Takashi Nitta⁶ and Wataru Shimizu^1,2

¹Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
²Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo, Japan
³Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
⁴Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
⁵Teikyo University Graduate School of Public Healt, Tokyo, Japan
⁶Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan

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.

J Nippon Med Sch 2021; 88: 467-474

Keywords
aortic dissection, inter-arm difference in blood pressure, pulse deficit, characteristics, stanford type A

Correspondence to
Koichi Akutsu, MD, Division of Intensive and Cardiovascular Care Unit, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
koichi-a@nms.ac.jp

Received, October 27, 2020
Accepted, December 23, 2020