Background: We have recently demonstrated that muscle sympathetic nerve activity and normetanephrine levels are transiently increased for several days immediately after acute type B aortic dissection. We now report other markers of sympathetic activation, natriuresis and inflammation over the same time frame.
Methods: In 13 patients with known acute type B aortic dissection (median age 71 years, CI 29-89), we undertook serial measurements of catecholamine metabolites including: normetanephrine , metanephrine , and their second messenger cyclic adenosine monophosphate; renin and aldosterone; N terminal- pro-brain natriuretic peptide (NT-proBNP), and its second messenger cyclic guanosine monophosphate; C-type natriuretic peptide; the inflammatory growth differentiation factor GDF-15; the stress hormone copeptin; mid-regional- proadrenomedullin; and the marker of cardiac muscle damage Troponin T. Venous sampling times were: on admission; then 12 hours, 24 hours; one week and six weeks later. Serial measurements were also undertaken in 12 controls (median age 61 years CI 25-86) who presented with chest pain.
Results: During the first week after dissection, normetanephrine levels were increased: 617- 792 pmol/L versus 425-489 in controls (ANOVA p=0.01). There was also a simultaneous increase in NT-proBNP levels: 49-93 pmol/L versus 14-21 (ANOVA p=0.07) and GDF-15 levels 1507-2873 pg/ml versus 1146-1448 (ANOVA p=0.01) over the same period.
Conclusion: The increase in normetanephrine levels during the week after type B dissection confirms sympathetic nerve activity as a likely mechanism for hypertension in these patients. This surge of sympathetic activity may be partially antagonised by a simultaneous increase in NT-proBNP which is possibly triggered by acute inflammation and oxidative stress caused by the dissection.
- 9926864977701891
- Rapid responses of catecholamines, natriuretic peptides and inflammatory markers to acute type B Aortic Dissection (NOMAD Study)
- Eric T.A. LimDavid JardineChristopher J. PembertonChristopher FramptonRichard TroughtonAdib Khanafer
- Surgery and Critical Care (UOC); Medicine (UOC)
- JVS-vascular science, 100422
- Elsevier
- 30/04/2026
- Obex Medical Limited, Auckland, New Zealand
- Copyright © The Author(s) 2026. This work was first published in JVS-Vascular Science (Elsevier). This is an open access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial use, distribution and reproduction in any medium, provided the original work is properly attributed to the creator(s) and the source, is not altered, transformed, or built upon in any way, and a link to the Creative Commons license is provided.
- English
- Journal article