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超声心动图筛查腹主动脉瘤的效果。

Effectiveness of screening for abdominal aortic aneurysm during echocardiography.

机构信息

Department of Cardiology, Dupuytren University Hospital, Limoges, France; INSERM U1094, Tropical Neuroepidemiology, Limoges University, Limoges, France.

Department of Cardiology, Rangueil University Hospital, Toulouse, France.

出版信息

Am J Cardiol. 2014 Oct 1;114(7):1100-4. doi: 10.1016/j.amjcard.2014.07.024. Epub 2014 Jul 18.

Abstract

Screening patients with abdominal aortic aneurysm (AAA) is associated with reduced AAA-related mortality, but population screening is poorly implemented. Opportunistic screening during imaging for other indications might be efficient. Single-center series reported AAA rates of 0.8% to 6.5% in patients undergoing transthoracic echocardiography (TTE), with disparities due to selection bias. In this first multicenter study, we aimed to assess the feasibility and criteria for screening AAA during TTE in real-life practice. During a week of May 2011, 79 centers participated in a nationwide survey. All patients aged ≥65 years requiring TTE for any indication were eligible, except for those with operated abdominal aorta. We defined AAA by an anteroposterior diameter of the infrarenal aorta≥30 mm. Of 1,382 consecutive patients, abdominal aorta imaging was feasible in 96.7%, with a median delay of 1.7 minutes (>3 minutes in 3.6% of cases). We found AAA in 50 patients (3.7%). Unknown AAA (2.7%) was more frequent in men than women (3.7% vs 1.3%, respectively, p=0.007) and increased by age at 2.2%, 2.5%, and 5.8% in age bands of 65 to 74, 75 to 84, and 85+ years, respectively. None of the female participants aged <75 years had AAA. Smoking status and family history of AAA were significantly more frequent among patients with AAA. The ascending aorta was larger in those with AAA (36.2±4.7 vs 34.0±5.2 mm, p=0.006), and bicuspid aortic valve and/or major aortic regurgitation were also more frequent (8% vs 2.6%, p=0.017). In conclusion, rapid AAA screening during TTE is feasible and should be limited to men ≥65 years and women≥75 years.

摘要

对腹主动脉瘤(AAA)患者进行筛查与降低 AAA 相关死亡率相关,但人群筛查实施情况不佳。在进行其他影像学检查时进行机会性筛查可能会更有效。单中心系列研究报告称,在接受经胸超声心动图(TTE)检查的患者中,AAA 的发生率为 0.8%至 6.5%,存在因选择偏倚导致的差异。在这项首次多中心研究中,我们旨在评估在真实临床实践中通过 TTE 筛查 AAA 的可行性和标准。在 2011 年 5 月的一周内,79 个中心参与了一项全国性调查。所有因任何原因需要进行 TTE 检查的年龄≥65 岁的患者均符合条件,除外已行腹部主动脉手术的患者。我们将肾下主动脉的前后直径≥30mm 定义为 AAA。在 1382 例连续患者中,96.7%的患者可进行腹部主动脉成像,中位延迟时间为 1.7 分钟(3.6%的患者延迟时间超过 3 分钟)。我们发现 50 例患者存在 AAA(3.7%)。在男性中,未知的 AAA(2.7%)比女性(1.3%)更为常见(分别为 3.7%和 1.3%,p=0.007),且随着年龄的增加而增加,在年龄为 65 至 74 岁、75 至 84 岁和 85 岁以上的患者中,分别增加 2.2%、2.5%和 5.8%。在所有年龄<75 岁的女性患者中均未发现 AAA。患有 AAA 的患者中,吸烟状况和 AAA 家族史更为常见。在患有 AAA 的患者中,升主动脉更大(36.2±4.7 比 34.0±5.2mm,p=0.006),且二叶式主动脉瓣和/或主动脉瓣大量反流更为常见(8%比 2.6%,p=0.017)。总之,在 TTE 期间快速筛查 AAA 是可行的,应仅限于年龄≥65 岁的男性和年龄≥75 岁的女性。

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