Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2021 Jul 1;150:114-116. doi: 10.1016/j.amjcard.2021.03.041. Epub 2021 May 18.
We have noticed, in caring for thousands of patients with ascending aortic aneurysm (AscAA), that the "thumb palm test" is often positive (with the thumb crossing beyond the edge of the palm). It is not known how accurate this test may be. We conducted the thumb-palm test in 305 patients undergoing cardiac surgery with intra-operative transesophageal echocardiography (TEE) for a variety of disorders: ascending aneurysm in 59 (19.4%) and non-AscAA disease in 246 (80.6%) (including CABG, valve repair, and descending aortic aneurysm). The TEE provided a precise ascending aortic diameter. The thumb palm test gave us a discrete, binary positive or negative result. We calculated the accuracy (sensitivity and specificity) of the thumb palm test in determining presence or absence of AscAA (defined as ascending aortic diameter > 3.8cm). Maximal ascending aortic diameters ranged from 2.0 to 6.6 cm (mean 3.48). 93 patients (30.6%) were classified as having an AscAA and 212 (69.4%) as not having an AscAA. 10 patients (3.3%) had a positive thumb-palm test and 295 patients (96.7%) did not. Sensitivity of the test (proportion of diseased patients correctly classified) was low (7.5%), but specificity (proportion of non-diseased patients correctly classified) was very high (98.5%). This study supports the utility of the thumb-palm test in evaluation for ascending thoracic aortic aneurysm. That is to say, a positive test implies a substantial likelihood of harboring an ascending aortic aneurysm. A negative test does not exclude an aneurysm. In other words, the majority of aneurysm patients do not manifest a positive thumb-palm sign, but patients who do have a positive sign have a very high likelihood of harboring an ascending aneurysm. We suggest that the thumb-palm test be part of the standard physical examination, especially in patients with suspicion of ascending aortic aneurysm (e.g. those with a positive family history).
我们在护理数千例升主动脉瘤（AscAA）患者时注意到，“拇指掌测试”通常为阳性（拇指越过手掌边缘）。目前尚不清楚该测试的准确性如何。我们对 305 例接受心脏手术的患者进行了拇指掌测试，这些患者因各种疾病接受了术中经食管超声心动图（TEE）检查：升主动脉瘤 59 例（19.4%），非升主动脉瘤疾病 246 例（80.6%）（包括 CABG、瓣膜修复和降主动脉瘤）。TEE 提供了精确的升主动脉直径。拇指掌测试为我们提供了一个离散的、二进制的阳性或阴性结果。我们计算了拇指掌测试在确定是否存在 AscAA 中的准确性（灵敏度和特异性）（定义为升主动脉直径>3.8cm）。升主动脉最大直径范围为 2.0 至 6.6cm（平均 3.48cm）。93 例（30.6%）患者被归类为患有 AscAA，212 例（69.4%）患者未患有 AscAA。10 例（3.3%）患者拇指掌测试阳性，295 例（96.7%）患者拇指掌测试阴性。该测试的灵敏度（患病患者正确分类的比例）较低（7.5%），但特异性（非患病患者正确分类的比例）非常高（98.5%）。这项研究支持拇指掌测试在评估升主动脉胸动脉瘤中的效用。也就是说，阳性测试意味着很有可能存在升主动脉瘤。阴性测试并不能排除动脉瘤。换句话说，大多数动脉瘤患者没有表现出阳性的拇指掌征，但出现阳性征的患者极有可能存在升主动脉瘤。我们建议将拇指掌测试作为标准体检的一部分，特别是在怀疑升主动脉瘤的患者中（例如，有阳性家族史的患者）。
