Wang Di, Wang Zhi-Yan, Wang Ju-Fang, Zhang Li-Li, Zhu Ju-Mo, Yuan Zhong-Xiang, Wang Yi
Department of Cardiology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China.
Department of Cardiac Ultrasound, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China.
J Thorac Dis. 2018 Mar;10(3):1815-1824. doi: 10.21037/jtd.2018.02.42.
Type A acute aortic dissection (A-AAD), involving the ascending aorta, is a life-threatening disease. To detect A-AAD early and rapidly in patients with acute chest pain, especially in patients with acute myocardial infarction (AMI) secondary to A-AAD, we investigated values of combined use of the risk score and the ascending aorta diameter >40 mm for the early identification of A-AAD.
Our study retrospectively encompassed 239 patients with acute chest pain on admission to our hospital between July 2010 and December 2016. The risk score was calculated according to the aortic dissection detection (ADD) risk score system, and the ascending aorta diameter was accurately obtained from the transthoracic echocardiography (TTE).
A risk score ≥1 had an excellent sensitivity of 94.9% and a fair negative predictive value (NPV) of 77.8%, with a poor specificity of 8.7% and a positive predictive value (PPV) of 33.5% for the diagnosis of A-AAD. A risk score ≥2 had an excellent specificity of 91.3% and a fair NPV of 73.1%, whereas it had a lower sensitivity of 30.8% and a PPV of 63.2%. A risk score ≥1, combined with an ascending aorta diameter >40 mm, had a sensitivity, a specificity, a PPV, and an NPV of 84.6%, 87.6%, 76.7%, and 92.2% for the diagnosis of A-AAD, respectively. The combined use of a risk score ≥2 and an ascending aorta diameter >40 mm had an excellent specificity of 98.1% and a PPV of 86.4%, a fair NPV of 72.8%, and a poor sensitivity of 24.4% for the detection of A-AAD. Moreover, the omission diagnostic rate for A-AAD was significantly decreased from 33.3% to 7.4% using a risk score ≥1 combined with an ascending aorta diameter >40 mm in patients with AMI secondary to A-AAD.
The combined use of an ADD risk score ≥1 and an ascending aorta diameter >40 mm was highly indicative of A-AAD in patients presenting with acute chest pain, especially in patients with AMI secondary to A-AAD, which urgently needed computed tomography angiography (CTA) or magnetic resonance imaging (MRI) to confirm the diagnosis of A-AAD.
累及升主动脉的A型急性主动脉夹层（A-AAD）是一种危及生命的疾病。为了在急性胸痛患者中早期快速检测出A-AAD，尤其是在继发于A-AAD的急性心肌梗死（AMI）患者中，我们研究了风险评分与升主动脉直径>40 mm联合使用对早期识别A-AAD的价值。
我们的研究回顾性纳入了2010年7月至2016年12月期间我院收治的239例急性胸痛患者。根据主动脉夹层检测（ADD）风险评分系统计算风险评分，并通过经胸超声心动图（TTE）准确获取升主动脉直径。
风险评分≥1对A-AAD诊断的敏感性极佳，为94.9%，阴性预测值（NPV）尚可，为77.8%，特异性较差，为8.7%，阳性预测值（PPV）为33.5%。风险评分≥2的特异性极佳，为91.3%，NPV尚可，为73.1%，而敏感性较低，为30.8%，PPV为63.2%。风险评分≥1联合升主动脉直径>40 mm对A-AAD诊断的敏感性、特异性、PPV和NPV分别为84.6%、87.6%、76.7%和92.2%。风险评分≥2联合升主动脉直径>40 mm检测A-AAD的特异性极佳，为98.1%，PPV为86.4%，NPV尚可，为72.8%，敏感性较差，为24.4%。此外，在继发于A-AAD的AMI患者中，使用风险评分≥1联合升主动脉直径>40 mm，A-AAD的漏诊率从33.3%显著降至7.4%。
ADD风险评分≥1联合升主动脉直径>40 mm对急性胸痛患者，尤其是继发于A-AAD的AMI患者中的A-AAD具有高度指示性，这类患者急需计算机断层扫描血管造影（CTA）或磁共振成像（MRI）来确诊A-AAD。
