Division of Perioperative Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Br J Anaesth. 2010 Aug;105(2):131-8. doi: 10.1093/bja/aeq122. Epub 2010 Jun 10.
Epiaortic ultrasound scanning (EUS) is regarded as the reference standard for detecting atherosclerosis in the ascending aorta (AA). Combined with appropriate surgical modifications, EUS use can significantly reduce the incidence of postoperative stroke when detecting severe AA atherosclerosis. A recently introduced modification of conventional transoesophageal echocardiography (TOE), known as the A-View method, has proven capable of inspecting the distal AA. The objective of this study was to quantify the diagnostic accuracy of modified TOE in assessing atherosclerosis of the distal AA.
After approval by the institutional medical ethical committee and after obtaining written informed consent, 465 consecutive patients above 65 yr old, undergoing elective cardiac surgery with a median sternotomy, were included. The study followed a cross-sectional diagnostic design. All consecutive patients underwent modified TOE followed by EUS (reference standard) to assess the severity of distal AA atherosclerosis. We constructed contingency tables to compare the presence (and severity) of atherosclerosis, detected by the two techniques.
The positive predictive value of modified TOE for the detection of clinically significant atherosclerosis was 67%, and the negative predictive value was 97%. The sensitivity was 95% and the specificity was 79%. One patient suffered a pulmonary haemorrhage, although he recovered without further sequelae. We did not observe any clinical significant haemodynamic or ventilatory effects.
The high negative predictive value and sensitivity show that modified TOE yields adequate diagnostic accuracy for excluding clinically relevant aorta atherosclerosis without significant cardiopulmonary side-effects, provided that the A-View catheter is introduced carefully.
主动脉外膜超声扫描（EUS）被认为是检测升主动脉（AA）动脉粥样硬化的参考标准。结合适当的手术修改，EUS 的使用可以显著降低检测到严重 AA 动脉粥样硬化时术后中风的发生率。一种新引入的常规经食管超声心动图（TOE）的修改方法，称为 A-View 方法，已被证明能够检查远端 AA。本研究的目的是定量评估改良 TOE 检测远端 AA 动脉粥样硬化的诊断准确性。
在获得机构医学伦理委员会的批准并获得书面知情同意后，纳入 465 名年龄在 65 岁以上、接受正中胸骨切开术择期心脏手术的连续患者。该研究采用了横断面诊断设计。所有连续患者均接受改良 TOE 检查，然后进行 EUS（参考标准）检查，以评估远端 AA 动脉粥样硬化的严重程度。我们构建了列联表来比较两种技术检测到的远端 AA 动脉粥样硬化的存在（和严重程度）。
改良 TOE 检测临床显著动脉粥样硬化的阳性预测值为 67%，阴性预测值为 97%。敏感性为 95%，特异性为 79%。一名患者发生了肺出血，但他没有进一步的后遗症而康复。我们没有观察到任何临床显著的血流动力学或通气影响。
高阴性预测值和敏感性表明，改良 TOE 在排除临床相关主动脉粥样硬化方面具有足够的诊断准确性，而不会产生显著的心肺副作用，前提是小心引入 A-View 导管。
