Dear Editor,
We have carefully read the research literature of Wang Dalong and others on “dexamethasone can reduce the inflammatory response and thus reduce the myocardial injury in Stanford type A aortic dissection patients”11. Wang D, Lin Q, Du M, Zheng G, Xu W, Zhang H, et al. Protective effect of dexmedetomidine on perioperative myocardial injury in patients with Stanford type-A aortic dissection. Rev Assoc Med Bras (1992). 2020;66(12):1638-44. https://doi.org/10.1590/1806-9282.66.12.1638
https://doi.org/10.1590/1806-9282.66.12....
. This study compared the heart rate, mean arterial pressure at different time points, serum creatine kinase MB, cardiac troponin I, C-reactive protein, and tumor necrosis factor-α between the dexamethasone group and the control group, and proposed that “dexamethasone treatment can reduce perioperative myocardial injury in patients with Stanford type A aortic dissection and its mechanism may be related to resistance to inflammatory response and oxidative stress.” As a clinician in the emergency department, this study has a high reference value for our clinical work. However, we still have several problems to discuss with the channel.
First of all, we know that Stanford’s classification of aortic dissection is a rough classification. In recent years, many scholars have proposed a variety of subtype schemes for Stanford type A aortic dissection based on their clinical experience, anatomical location, prognosis, and other factors22. Zhu Y, Lingala B, Baiocchi M, Tao JJ, Toro Arana V, Khoo JW, et al. Type A aortic dissection-experience over 5 decades: JACC historical breakthroughs in perspective. J Am Coll Cardiol. 2020;76(14):1703-13. https://doi.org/10.1016/j.jacc.2020.07.061
https://doi.org/10.1016/j.jacc.2020.07.0...
,33. Kuroyanagi S, Higashiue S, Komooka M, Furuya O, Hiramatsu N, Kojima S, et al. Treatment Strategy for Stanford Type A Acute Aortic Dissection. Kyobu Geka. 2020;73(8):563-71. PMID: 32879281. We hope that this study will further show the general demographic characteristics of the selected cases, as well as the specific anatomical location of Stanford type A aortic dissection and other individual case characteristics, so as to further judge the clinical application scope and value of this study.
Second, the prognostic indicators of Stanford type A aortic dissection patients, such as survival time follow-up, incidence of complications, and postoperative physical recovery, are the key results that directly reflect the effect of dexamethasone in the perioperative period. We hope that the follow-up research of this study can fully show.
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Funding: none.
REFERENCES
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1Wang D, Lin Q, Du M, Zheng G, Xu W, Zhang H, et al. Protective effect of dexmedetomidine on perioperative myocardial injury in patients with Stanford type-A aortic dissection. Rev Assoc Med Bras (1992). 2020;66(12):1638-44. https://doi.org/10.1590/1806-9282.66.12.1638
» https://doi.org/10.1590/1806-9282.66.12.1638 -
2Zhu Y, Lingala B, Baiocchi M, Tao JJ, Toro Arana V, Khoo JW, et al. Type A aortic dissection-experience over 5 decades: JACC historical breakthroughs in perspective. J Am Coll Cardiol. 2020;76(14):1703-13. https://doi.org/10.1016/j.jacc.2020.07.061
» https://doi.org/10.1016/j.jacc.2020.07.061 -
3Kuroyanagi S, Higashiue S, Komooka M, Furuya O, Hiramatsu N, Kojima S, et al. Treatment Strategy for Stanford Type A Acute Aortic Dissection. Kyobu Geka. 2020;73(8):563-71. PMID: 32879281
Publication Dates
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Publication in this collection
22 Oct 2021 -
Date of issue
July 2021
History
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Received
04 May 2021 -
Accepted
23 May 2021