The role of transthoracic echocardiography in the diagnosis and management of acute type A aortic syndrome

Cecconi, Moreno; Chirillo, Fabio; Costantini, Carlo; Iacobone, G; Lopez, Ercole; Zanoli, Raffaele; Gili, A. Bernat; Moretti, Stefano; Manfrin, Marcello; Münch, Christopher; Torracca, Lucia; Perna, Gian Piero

doi:10.1016/j.ahj.2011.09.022

Cited by 60 publications

(37 citation statements)

References 23 publications

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“…Transthoracic echocardiography may also a useful imaging modality for the diagnosis of acute aortic syndromes. Some have reported it to be beneficial for screening [31] but it should not be used as the sole screening imaging technique [32]. …”

Section: Discussionmentioning

confidence: 99%

Early recognition of acute thoracic aortic dissection and aneurysm

et al. 2013

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BackgroundThoracic aortic dissection (TAD) and aneurysm (TAA) are rare but catastrophic. Prompt recognition of TAD/TAA and differentiation from acute coronary syndrome (ACS) is difficult yet crucial. Earlier identification of TAA/TAD based upon routine emergency department screening is necessary.MethodsA retrospective analysis of patients that presented with acute thoracic complaints to the ED from January 2007 through June 2012 was performed. Cases of TAA/TAD were compared to an equal number of controls which consisted of patients with the diagnosis of ACS. Demographics, physical findings, EKG, and the results of laboratory and radiological imaging were compared. P-value of > 0.05 was considered statistically significant.ResultsIn total, 136 patients were identified with TAA/TAD, 0.36% of patients that presented with chest complaints. Compared to ACS patients, TAA/TAD group was older (68.9 vs. 63.2 years), less likely to be diabetic (13% vs 32%), less likely to complain of chest pain (47% vs 85%) and head and neck pain (4% vs 17%). The pain for the TAA/TAD group was less likely characterized as tight/heavy in nature (5% vs 37%). TAA/TAD patients were also less likely to experience shortness of breath (42% vs. 51%), palpitations (2% vs 9%) and dizziness (2% vs 13%) and had a greater incidence of focal lower extremity neurological deficits (6% vs 1%), bradycardia (15% vs. 5%) and tachypnea (53% vs. 22%). On multivariate analysis, increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction were independent predictors of ACS.ConclusionsIncreasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction can be used to differentiate acute coronary syndromes from thoracic aortic dissections/aneurysms.

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Section: Discussionmentioning

confidence: 99%

Early recognition of acute thoracic aortic dissection and aneurysm

et al. 2013

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“…However, because of new transducers with improved resolution, harmonic imaging, and contrast enhancement, the sensitivity of TTE has improved to approximately 85% on the basis of recent data from Cecconi et al 145 and Evangelista et al 146 Therefore, TTE may be of some use as the initial imaging modality, especially in the emergency room ( Figure 27). In addition, TTE provides assessment of left ventricular contractility, pericardial effusion, aortic valve function, right ventricular size and function, and pulmonary artery pressure, which may facilitate the diagnosis of chest pain due to myocardial ischemia and/or infarction, pulmonary embolism, or pericardial disease and may identify dissection complications such as aortic regurgitation (AR) in an early fashion.…”

Section: Echocardiography (Tte and Tee)mentioning

confidence: 96%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

541

434

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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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The role of transthoracic echocardiography in the diagnosis and management of acute type A aortic syndrome

Cited by 60 publications

References 23 publications

Early recognition of acute thoracic aortic dissection and aneurysm

Early recognition of acute thoracic aortic dissection and aneurysm

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

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

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