{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:37:12Z","timestamp":1790012232711,"version":"4.0.1"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,11,7]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Contradictions between management modalities of type A acute aortic dissection (TAAAD) and ST\u2010elevation\u2013myocardial infarction (STEMI) may result in clinical catastrophe. Therefore, we aimed to explore which 2\u2010dimensional echocardiography (2DE) findings are optimal for differentiating TAAAD from STEMI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This study included 340 patients with STEMI and 340 patients with TAAAD who underwent 2DE in the emergency department between 2012 and 2021. The proximal ascending aorta (PAA) diameter and other echocardiographic parameters were analyzed. PAA diameters were measured at 4 levels in the parasternal view: Valsalva, the sinotubular junction (STJ), the PAA at 1 cm above the STJ, and the PAA at 2\u2009cm above the STJ. Receiver\u2010operating characteristic curve analysis showed that Valsalva, STJ, PAA at 1 cm above the STJ, and PAA at 2\u2009cm above the STJ were significant predictors of TAAAD (areas under the curve: 0.777, 0.924, 0.965, and 0.975, respectively;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) with the respective cutoff values of 39.4, 38.5, 39.8, and 41.2\u2009mm. Multivariable analysis suggested that all 2DE parameters were significant predictors of TAAAD. Among the 2DE parameters examined, the incorporation of PAA at 2\u2009cm above the STJ to clinical indicators exhibited the most significant diagnostic capability (C\u2010statistics, 0.97; net reclassification improvement, 1.81; integrated discrimination improvement, 0.61). When only TAAAD with coronary malperfusion and STEMI were analyzed, the diagnostic utility of PAA at 1 cm above the STJ was evident (C\u2010statistics, 0.99; net reclassification improvement, 1.79; integrated discrimination improvement, 0.67), with PAA at 2\u2009cm above the STJ ranking second in diagnostic significance (C\u2010statistics, 0.99; net reclassification improvement, 1.12; integrated discrimination improvement, 0.66).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">PAA measurements were the most beneficial for diagnosing TAAAD in all 2DE findings and TAAAD from STEMI.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.029506","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T10:28:45Z","timestamp":1697624925000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST\u2010Segment\u2013Elevation Myocardial Infarction"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0477-0323","authenticated-orcid":false,"given":"Jin","family":"Kirigaya","sequence":"first","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4810-3570","authenticated-orcid":false,"given":"Noriaki","family":"Iwahashi","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3496-1953","authenticated-orcid":false,"given":"Takeru","family":"Abe","sequence":"additional","affiliation":[{"name":"Advanced Critical Care and Emergency Center Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3243-4028","authenticated-orcid":false,"given":"Masaomi","family":"Gohbara","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4214-2886","authenticated-orcid":false,"given":"Yohei","family":"Hanajima","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8265-8710","authenticated-orcid":false,"given":"Mutsuo","family":"Horii","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7151-2167","authenticated-orcid":false,"given":"Kozo","family":"Okada","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Matsuzawa","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8641-3759","authenticated-orcid":false,"given":"Shota","family":"Yasuda","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8990-6344","authenticated-orcid":false,"given":"Masami","family":"Kosuge","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2506-6706","authenticated-orcid":false,"given":"Toshiaki","family":"Ebina","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Advanced Critical Care and Emergency Center Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8469-2870","authenticated-orcid":false,"given":"Keiji","family":"Uchida","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0660-5372","authenticated-orcid":false,"given":"Kouichi","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1543-1183","authenticated-orcid":false,"given":"Kiyoshi","family":"Hibi","sequence":"additional","affiliation":[{"name":"Division of Cardiology Yokohama City University Medical Center Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001029"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000558"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.10.055"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jeq056"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu281"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz207"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2021-211390"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001106"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-131-1-199907060-00010"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra022643"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy462"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.988568"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.11.009"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2987"},{"key":"e_1_3_1_16_3","doi-asserted-by":"publisher","unstructured":"doi: 10.1002\/sim.2987","DOI":"10.1002\/sim.2987"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(01)00341-9"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-014-1080-9"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15223"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.4414\/smw.2017.14489"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.949131"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2022.3305"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.72.986"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-018-1014-y"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew053"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.28.1.47"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7808"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmn051"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.11.015"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.029506","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:17:11Z","timestamp":1715602631000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.029506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,7]]},"references-count":29,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2023,11,7]]}},"alternative-id":["10.1161\/JAHA.123.029506"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.029506","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,7]]},"assertion":[{"value":"2023-01-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e029506"}}