即时超声检查主动脉根部扩张与主动脉瘤及夹层的关系

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine Pub Date : 2025-05-22 DOI:10.1016/j.ajem.2025.05.039

Mina Hesami MD, Ryan Denkewicz MD, Zachary Boivin MD, Sonali Bhalodkar MD, Jia Jian Li MD, Christopher Moore MD

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引用次数: 0

摘要

目的胸主动脉夹层（TAD）是一种危及生命的疾病，死亡率为每小时1 - 2%，突出了及时诊断的重要性。胸主动脉瘤（TAA）与TAD相关，可通过即时超声（POCUS）检测。我们试图评估POCUS检测TAA的诊断准确性以及POCUS在TAA患者中TAD的患病率。我们假设POCUS的主动脉根部扩张与TAA和TAD密切相关。方法回顾性选择2013年至2023年间经胸心脏POCUS主动脉根部扩张测量≥4.5 cm且接受胸部CT或心脏科超声心动图（c-echo）检查的患者，通过查询本系统3个急诊室的POCUS数据库（QpathE）进行选择。从电子病历中检索了全面的人口统计、临床和影像学数据。对于CT和c-echo，≥4cm的主动脉测量值被认为是动脉瘤，使用最大的测量值。如果同时进行CT和c-echo，则使用最大的CT测量。我们还调查了有多少TAA患者同时患有TAD。采用IBM SPSS version 29进行统计分析。结果我们的队列包括304例POCUS TAA（≥4.5 cm）患者，中位年龄为67.5岁（IQR: 58-80），其中247例（81.3%）为男性。227例（74.6%）行CT检查，77例（25.3%）未行CT检查。POCUS与CT、c-echo有显著正相关(r = 0.62, p <；0.001)。将POCUS测量值与我们的基础事实值进行比较，Bland-Altman图的平均差异为0.13 cm(95%置信区间；−0.71 ~ 0.97)，平均POCUS测量值略高。总体而言，POCUS对TAA的阳性预测值（PPV）为96% （95% CI, 93.8% - 98%）。TAA患者中有45例（15.4%）存在TAD。结论虽然POCUS测量的平均值略高于CT或c-echo，但对TAA具有较高的准确性和预测价值。在POCUS上，超过七分之一的TAA患者患有TAD。我们的结果强调POCUS在及时发现胸主动脉瘤和夹层方面的有效性。

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Association of dilated aortic root on point-of-care ultrasound with aortic aneurysm and dissection

Objectives

Thoracic aortic dissection (TAD) is a life-threatening condition with a mortality rate of 1–2 % per hour, highlighting the importance of prompt diagnosis. Thoracic aortic aneurysm (TAA) is associated with TAD and can be detected by point-of-care ultrasound (POCUS). We sought to evaluate the diagnostic accuracy of POCUS in detecting TAA and the prevalence of TAD in patients with TAA by POCUS. We hypothesized that a dilated aortic root on POCUS would be strongly associated with TAA and TAD.

Methods

Patients with a dilated aortic root measurement of ≥4.5 cm on transthoracic cardiac POCUS between 2013 and 2023 who received either chest CT or cardiology echocardiogram (c-echo) were retrospectively selected by querying a POCUS database (QpathE) from three EDs in our system. Comprehensive demographic, clinical, and imaging data were retrieved from electronic medical records. For both CT and c-echo, aortic measurements of ≥4 cm were considered aneurysmal, using the largest reported measurement. If both CT and c-echo were performed, the largest CT measure was used. We also investigated how many patients with TAA also had TAD. Statistical analysis was performed using IBM SPSS version 29.

Results

Our cohort included 304 patients with TAA (≥4.5 cm) on POCUS, with a median age of 67.5 years (IQR:58–80) of which 247 (81.3 %) were male. 227 (74.6 %) had CT performed, and 77 (25.3 %) had a c-echo without CT. There was a significant positive correlation between POCUS measurements and those of CT and c-echo (r = 0.62, p < 0.001). Comparing the measurements on POCUS with those derived from our ground truths, the mean difference for the Bland-Altman plot was 0.13 cm (95 % confidence interval; −0.71 to 0.97), with the average POCUS measure being slightly higher. Overall, the positive predictive value (PPV) of POCUS for TAA was 96 % (95 % CI, 93.8 %–98 %). TAD was present in 45 (15.4 %) of patients with TAA.

Conclusion

Although POCUS measurement tended to be slightly higher than that of CT or c-echo on average, it demonstrated a high accuracy and predictive value for TAA. More than one in seven patients with TAA on POCUS had TAD. Our results underscore the efficacy of POCUS for the prompt detection of thoracic aortic aneurysm and dissection.

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来源期刊

American Journal of Emergency Medicine 医学-急救医学

CiteScore

6.00

自引率

5.60%

发文量

730

审稿时长

42 days

期刊介绍： A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.