De Simone R, Haberbosch W, Iarussi D, Iacono A
Istituto Medico-Chirurgico di Cardiologia, I Facoltà di Medicina, Università degli Studi, Napoli.
Cardiologia. 1990 May;35(5):387-90.
The diagnosis of acute aortic pathology is decisive for the prognosis of the patient, since an effective surgical and medical therapy can improve the high rate of mortality due to this pathology. Conventional transthoracic echocardiography (TTE) fails to detect abnormalities of the descending thoracic aorta. Aim of this study was the evaluation of the actual usefulness of transesophageal echocardiography (TEE) in the diagnosis of aneurysm (AN) and/or dissection (DISS) of the aorta. Fifty-six consecutive patients with clinical suspicion of AN or DISS underwent TEE. Of these, 24 (42.8%) did not show any abnormality, while 32 (57.2%) had a severe pathology of the aorta requiring angiography (ANG) or cardiac surgery (SURG). All the patients underwent computed tomography scanning examinations (CT) even if TEE did not show any abnormality. The diagnoses obtained by TTE, TEE and CT were compared with those obtained by reference methods (ANG and/or SURG). Non-dissecting aorta aneurysms were detected in 11 patients; dissecting aorta aneurysms were found in 21 patients; 5 patients showed an isolated aortic dissection (without aneurysm). The sensitivity of TTE for detecting pathology of the aorta resulted very low (56.3%) when compared to TEE (96.8%) and CT (90.6%). The specificity for diagnosing aortic pathology was for TTE 63.1%, for TEE 96.0% and CT 88.8%; the accuracy of TTE resulted 75.0%, TEE 98.2% and CT 94.6%; the predictive value of TTE was 85.7%, TEE 96.8% and CT 93.5%. In conclusion, TEE provides a reliable non-invasive diagnosis of AN and/or DISS superior to TTE and CT; it may be considered the method of choice to detect acute aorta pathology.
急性主动脉病变的诊断对患者的预后起着决定性作用，因为有效的手术和药物治疗可以改善因该病变导致的高死亡率。传统经胸超声心动图（TTE）无法检测胸降主动脉的异常情况。本研究的目的是评估经食管超声心动图（TEE）在诊断主动脉瘤（AN）和/或主动脉夹层（DISS）方面的实际效用。连续56例临床怀疑患有AN或DISS的患者接受了TEE检查。其中，24例（42.8%）未显示任何异常，而32例（57.2%）患有严重的主动脉病变，需要进行血管造影（ANG）或心脏手术（SURG）。即使TEE未显示任何异常，所有患者均接受了计算机断层扫描检查（CT）。将TTE、TEE和CT获得的诊断结果与参考方法（ANG和/或SURG）获得的诊断结果进行比较。11例患者检测到非夹层主动脉瘤；21例患者发现夹层主动脉瘤；5例患者显示孤立性主动脉夹层（无动脉瘤）。与TEE（96.8%）和CT（90.6%）相比，TTE检测主动脉病变的敏感性非常低（56.3%）。TTE诊断主动脉病变的特异性为63.1%，TEE为96.0%，CT为88.8%；TTE的准确性为75.0%，TEE为98.2%，CT为94.6%；TTE的预测值为85.7%，TEE为96.8%，CT为93.5%。总之，TEE对AN和/或DISS提供了一种可靠的非侵入性诊断，优于TTE和CT；它可被视为检测急性主动脉病变的首选方法。
