Department of Cardiology, Isala, Dokter van Heesweg 2, Zwolle 8025AB, The Netherlands Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2014 Jun;15(6):623-30. doi: 10.1093/ehjci/jet257. Epub 2013 Dec 26.
Accurate visualization of the distal ascending aorta (DAA) can guide the surgical management and hence prevent dislodgment of atherogenic emboli during cardiac surgery. Conventional transoesophageal echocardiography (TEE) has a poor sensitivity; modified TEE was previously shown to accurately visualize atherosclerosis of the DAA. We studied the added value of modified TEE beyond the patient history and TEE screening.
Included were 421 patients from a previous diagnostic study, which compared the diagnosis of severe atherosclerosis with modified TEE and epiaortic ultrasound (EUS; reference test). We fitted three models, which predicted presence of atherosclerosis Grade ≥3 of the DAA. Model 1 included preoperative patient characteristics; in Model 2 conventional TEE was added; Model 3 additionally included modified TEE results. For each model, the area under the receiver-operating curve (AUC), the 'net reclassification improvement' (NRI) and the 'integrated discrimination improvement' (IDI) were determined. Missing data were imputed. The AUCs of Models 1, 2, and 3 were 0.73 (95% CI: 0.68-0.78), 0.80 (95% CI: 0.76-0.85), and 0.93 (95% CI: 0.90-0.96), respectively. Comparing Model 3 with Model 2, the AUC was significantly higher (P < 0.001), the NRI was 0.60 (95% CI: 0.54-0.66; P < 0.001), and the IDI was 0.30 (95% CI: 0.28-0.32; P < 0.001), indicating that visualization of the DAA with modified TEE significantly improved reclassification.
Visualization of atherosclerosis of the DAA with modified TEE provided information beyond patient history and conventional TEE screening, which resulted in an improved diagnosis of atherosclerosis.
准确显示升主动脉远端（DAA）可指导手术管理，从而防止心脏手术期间动脉粥样硬化栓子的移位。传统经食管超声心动图（TEE）的敏感性较差；先前的研究表明，改良 TEE 可准确显示 DAA 的动脉粥样硬化。我们研究了改良 TEE 在患者病史和 TEE 筛查之外的附加价值。
本研究纳入了来自先前诊断研究的 421 例患者，该研究比较了改良 TEE 和主动脉外超声（EUS；参考测试）对严重动脉粥样硬化的诊断。我们拟合了三个模型，用于预测 DAA 动脉粥样硬化≥3 级的存在。模型 1 包括术前患者特征；模型 2 中加入了传统 TEE；模型 3 还包括改良 TEE 结果。对于每个模型，计算了接受者操作特征曲线（ROC）下的面积（AUC）、“净重新分类改善”（NRI）和“综合鉴别改善”（IDI）。缺失数据采用插补法进行处理。模型 1、2 和 3 的 AUC 分别为 0.73（95%可信区间：0.68-0.78）、0.80（95%可信区间：0.76-0.85）和 0.93（95%可信区间：0.90-0.96）。与模型 2 相比，模型 3 的 AUC 显著更高（P<0.001），NRI 为 0.60（95%可信区间：0.54-0.66；P<0.001），IDI 为 0.30（95%可信区间：0.28-0.32；P<0.001），表明改良 TEE 显示 DAA 动脉粥样硬化可提供超出患者病史和传统 TEE 筛查的信息，从而改善了动脉粥样硬化的诊断。
改良 TEE 显示 DAA 动脉粥样硬化可提供患者病史和传统 TEE 筛查之外的信息，从而改善动脉粥样硬化的诊断。
