Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection

Nazerian, Peiman; Morello, Fulvio; Vanni, Simone; Bono, Alessia; Castelli, Matteo; Forno, Daniela; Gigli, Chiara; Soardo, Flavia; Carbone, Federica; Lupia, Enrico; Grifoni, Stefano

doi:10.1016/j.ijcard.2014.04.257

Cited by 70 publications

(92 citation statements)

References 34 publications

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“…Five studies met all eligibility criteria. [16][17][18][19][20] The characteristics of these studies and the participants enrolled are outlined in Tables 2 and 3. In addition to the information presented in Tables 2 and 3, some specific points need to be highlighted.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection

Asha

Miers

2015

Annals of Emergency Medicine

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Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection

Asha

Miers

2015

Annals of Emergency Medicine

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“…Although the risk score system has a high sensitivity of 95.7% for the detection of AAD (6), its specificity is much lower (39.8%) (7). In recent years, numerous researchers have attempted to seek several novel methods for the early identification of AAD (6)(7)(8)(9)(10)(11)(12)(13)(14). For instance, the combined use of the ADD risk score and D-dimer was studied as part of the current diagnostic work-up of patients with AAD (13,14).…”

Section: Introductionmentioning

confidence: 99%

Values of aortic dissection detection risk score combined with ascending aorta diameter >40 mm for the early identification of type A acute aortic dissection

Wang

et al. 2018

J. Thorac. Dis.

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Background: Type A acute aortic dissection (A-AAD), involving the ascending aorta, is a life-threatening disease. To detect A-AAD early and rapidly in patients with acute chest pain, especially in patients with acute myocardial infarction (AMI) secondary to A-AAD, we investigated values of combined use of the risk score and the ascending aorta diameter >40 mm for the early identification of A-AAD.Methods: Our study retrospectively encompassed 239 patients with acute chest pain on admission to our hospital between July 2010 and December 2016. The risk score was calculated according to the aortic dissection detection (ADD) risk score system, and the ascending aorta diameter was accurately obtained from the transthoracic echocardiography (TTE). Results: A risk score ≥1 had an excellent sensitivity of 94.9% and a fair negative predictive value (NPV) of 77.8%, with a poor specificity of 8.7% and a positive predictive value (PPV) of 33.5% for the diagnosis of A-AAD. A risk score ≥2 had an excellent specificity of 91.3% and a fair NPV of 73.1%, whereas it had a lower sensitivity of 30.8% and a PPV of 63.2%. A risk score ≥1, combined with an ascending aorta diameter >40 mm, had a sensitivity, a specificity, a PPV, and an NPV of 84.6%, 87.6%, 76.7%, and 92.2%for the diagnosis of A-AAD, respectively. The combined use of a risk score ≥2 and an ascending aorta diameter >40 mm had an excellent specificity of 98.1% and a PPV of 86.4%, a fair NPV of 72.8%, and a poor sensitivity of 24.4% for the detection of A-AAD. Moreover, the omission diagnostic rate for A-AAD was significantly decreased from 33.3% to 7.4% using a risk score ≥1 combined with an ascending aorta diameter >40 mm in patients with AMI secondary to A-AAD. Conclusions: The combined use of an ADD risk score ≥1 and an ascending aorta diameter >40 mm was highly indicative of A-AAD in patients presenting with acute chest pain, especially in patients with AMI secondary to A-AAD, which urgently needed computed tomography angiography (CTA) or magnetic resonance imaging (MRI) to confirm the diagnosis of A-AAD.Keywords: Aortic dissection detection risk score (AAD risk score); ascending aorta diameter; type A acute aortic dissection (A-AAD); acute myocardial infarction (AMI); portable transthoracic echocardiography (portable TTE)

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“…In case of discordant diagnosis, the final diagnosis was adjudicated by (SG). 17 According to guidelines, the following diagnoses were considered as acute aortic syndromes: Stanford type A and type B AD, aortic intramural hematoma, and penetrating aortic ulcer. 16 …”

Section: Study Protocolmentioning

confidence: 99%

Diagnostic Performance of Focused Cardiac Ultrasound Performed by Emergency Physicians for the Assessment of Ascending Aorta Dilation and Aneurysm

Nazerian

Vanni

Morello

et al. 2015

Academic Emergency Medicine

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Objectives: The diagnostic performance of transthoracic focused cardiac ultrasound (FoCUS) performed by emergency physicians (EP) to estimate ascending aorta dimensions in the acute setting has not been prospectively studied. The diagnostic accuracy and the interobserver variability of EP-performed FoCUS were investigated to estimate thoracic aortic dilation and aneurysm compared with the results of computed tomography angiography (CTA).Methods: This was a prospective single-center cohort study of a convenience sample of patients who underwent CTA in the emergency department for suspected aortic pathology. FoCUS was performed before CTA, and the maximum ascending aorta diameter evaluated in parasternal long-axis view. Aorta diameter < 40 mm by visual estimation or by diameter measurement was considered normal. Measurements were recorded in all patients with aorta diameter ≥ 40 mm. Diagnostic accuracy of FoCUS for detection of aortic dilation (diameter ≥ 40 mm) and aneurysm (diameter ≥ 45 mm) were calculated considering the CTA result as reference standard. In a subgroup of patients, a second EP-sonographer performed FoCUS to evaluate interobserver agreement for the diagnosis of ascending aorta dilation.Results: A total of 140 patients were enrolled in the study. Ascending aorta dilation and aneurysm were detected with FoCUS in 50 (35.7%) and in 27 (17.8%) patients, respectively. Sensitivity and specificity of FoCUS were 78.6% (95% confidence interval [CI] = 65.6% to 88.4%) and 92.9% (95% CI = 85.1% to 97.3%), respectively, for ascending aorta dilation and 64.7% (95% CI = 46.5% to 80.2%) and 95.3% (95% CI = 89.3% to 98.4%), respectively, for ascending aorta aneurysm. Interobserver agreement of FoCUS was k = 0.82. Conclusions:FoCUS performed by EP is specific for ascending aorta dilation and aneurysm when compared to CTA and appears a reproducible technique. ACADEMIC EMERGENCY MEDICINE 2015;22:536-541 © 2015 by the Society for Academic Emergency Medicine A cute aortic dissection (AD) involving the ascending aorta (Stanford type A AD) has a mortality of over 50% in the first 48 hours and accounts for twice as many deaths as attributed to ruptured abdominal aneurysms.1,2 One of the risk factors for type A AD is ascending aorta aneurysm.3-5 Thus, its early identification is paramount to reduce morbidity and mortality. Formal transthoracic echocardiography performed by cardiologists allows accurate measurement of the proximal ascending aorta. 6 The accuracy of ultrasonography (US) performed by emergency physicians (EPs) for the diagnosis of abdominal aortic aneurysm is excellent, and the utility of transthoracic focused cardiac ultrasound (FoCUS) to diagnose peri-

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Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection

Cited by 70 publications

References 34 publications

A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection

A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection

Values of aortic dissection detection risk score combined with ascending aorta diameter >40 mm for the early identification of type A acute aortic dissection

Diagnostic Performance of Focused Cardiac Ultrasound Performed by Emergency Physicians for the Assessment of Ascending Aorta Dilation and Aneurysm

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