Nazerian Peiman, Vanni Simone, Morello Fulvio, Castelli Matteo, Ottaviani Maddalena, Casula Claudia, Petrioli Alessandra, Bartolucci Maurizio, Grifoni Stefano
Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
Department of Emergency Medicine, A.O.U. Città della Salute e della Scienza-Molinette Hospital, Torino, Italy.
Acad Emerg Med. 2015 May;22(5):536-41. doi: 10.1111/acem.12650. Epub 2015 Apr 21.
The diagnostic performance of transthoracic focused cardiac ultrasound (FoCUS) performed by emergency physicians (EP) to estimate ascending aorta dimensions in the acute setting has not been prospectively studied. The diagnostic accuracy and the interobserver variability of EP-performed FoCUS were investigated to estimate thoracic aortic dilation and aneurysm compared with the results of computed tomography angiography (CTA).
This was a prospective single-center cohort study of a convenience sample of patients who underwent CTA in the emergency department for suspected aortic pathology. FoCUS was performed before CTA, and the maximum ascending aorta diameter evaluated in parasternal long-axis view. Aorta diameter < 40 mm by visual estimation or by diameter measurement was considered normal. Measurements were recorded in all patients with aorta diameter ≥ 40 mm. Diagnostic accuracy of FoCUS for detection of aortic dilation (diameter ≥ 40 mm) and aneurysm (diameter ≥ 45 mm) were calculated considering the CTA result as reference standard. In a subgroup of patients, a second EP-sonographer performed FoCUS to evaluate interobserver agreement for the diagnosis of ascending aorta dilation.
A total of 140 patients were enrolled in the study. Ascending aorta dilation and aneurysm were detected with FoCUS in 50 (35.7%) and in 27 (17.8%) patients, respectively. Sensitivity and specificity of FoCUS were 78.6% (95% confidence interval [CI] = 65.6% to 88.4%) and 92.9% (95% CI = 85.1% to 97.3%), respectively, for ascending aorta dilation and 64.7% (95% CI = 46.5% to 80.2%) and 95.3% (95% CI = 89.3% to 98.4%), respectively, for ascending aorta aneurysm. Interobserver agreement of FoCUS was k = 0.82.
FoCUS performed by EP is specific for ascending aorta dilation and aneurysm when compared to CTA and appears a reproducible technique.
急诊医师（EP）在急性情况下经胸心脏聚焦超声（FoCUS）评估升主动脉内径的诊断性能尚未得到前瞻性研究。本研究旨在调查急诊医师进行的FoCUS在估计胸主动脉扩张和动脉瘤方面的诊断准确性及观察者间的变异性，并与计算机断层血管造影（CTA）结果进行比较。
这是一项前瞻性单中心队列研究，对因疑似主动脉病变在急诊科接受CTA检查的便利样本患者进行研究。在CTA检查前进行FoCUS，在胸骨旁长轴视图中评估升主动脉的最大直径。通过视觉估计或直径测量，升主动脉直径<40mm被认为是正常的。对所有升主动脉直径≥40mm的患者进行测量记录。以CTA结果作为参考标准，计算FoCUS检测主动脉扩张（直径≥40mm）和动脉瘤（直径≥45mm）的诊断准确性。在一组患者中，由另一位急诊超声医师进行FoCUS，以评估观察者间对升主动脉扩张诊断的一致性。
共有140名患者纳入本研究。通过FoCUS分别在50名（35.7%）和27名（17.8%）患者中检测到升主动脉扩张和动脉瘤。对于升主动脉扩张，FoCUS的敏感性和特异性分别为78.6%（95%置信区间[CI]=65.6%至88.4%）和92.9%（95%CI=85.1%至97.3%）；对于升主动脉动脉瘤，敏感性和特异性分别为64.7%（95%CI=46.5%至80.2%）和95.3%（95%CI=89.3%至98.4%）。FoCUS的观察者间一致性为k=0.82。
与CTA相比，急诊医师进行的FoCUS对升主动脉扩张和动脉瘤具有特异性，且似乎是一种可重复的技术。
