Yeh Hsin-Tzu, Lu Sz-Wei, Cheng Tzu-Heng, Lu Jian-Xun, Hsiao Chien-Han, Yen Chieh-Ching
Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
Department of Emergency Medicine, Tri-Service General Hospital SongShan Branch, National Defense Medical Center, Taipei, Taiwan; Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
Biomed J. 2024 May 10;48(2):100747. doi: 10.1016/j.bj.2024.100747.
Transthoracic echocardiography (TTE) is currently recognized as the potential first-line imaging test for patients with suspected acute type A aortic syndrome (AAAS). Direct TTE sign for detecting AAAS is positive if there is an intimal flap separating two aortic lumens or aortic wall thickening seen in the ascending aorta. Indirect TTE sign indicates high-risk features of AAAS, such as aortic root dilatation, pericardial effusion, and aortic regurgitation. Our aim is to summarize the existing clinical evidence regarding the diagnostic accuracy of TTE and to evaluate its potential role in the management of patients with suspected AAAS.
We included prospective or retrospective diagnostic cohort studies, written in any language, that specifically focused on using TTE to diagnose AAAS from databases such as PubMed, EMBASE, MEDLINE, and the Cochrane Library. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) , and hierarchical summary receiver-operating characteristic (HSROC) curve were calculated for TTE in diagnosing AAAS. We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria.
Ten studies (2886 patients) were included in the meta-analysis. The pooled sensitivity and specificity of direct TTE signs were 58% (95% CI, 38-76%) and 94% (95% CI, 89-97%). For any TTE signs, the pooled sensitivity and specificity were 91% (95% CI, 85-94%) and 74% (95% CI, 61-84%). The diagnostic accuracy of direct TTE signs was significantly higher than that of any TTE signs, as measured by the area under the HSROC curve [0.95 (95% CI, 0.92-0.96) vs. 0.87 (95% CI, 0.84-0.90)] in four studies.
Our study suggests that TTE could serve as the initial imaging test for patients with suspected AAAS. Given its high specificity, the presence of direct TTE signs may indicate AAAS, whereas the absence of any TTE signs, combined with low clinical suspicion, could suggest a lower likelihood of AAAS.
经胸超声心动图（TTE）目前被认为是疑似急性A型主动脉综合征（AAAS）患者潜在的一线影像学检查。如果在升主动脉中看到有内膜瓣将两个主动脉腔分开或主动脉壁增厚，则检测AAAS的直接TTE征象为阳性。间接TTE征象提示AAAS的高危特征，如主动脉根部扩张、心包积液和主动脉瓣反流。我们的目的是总结关于TTE诊断准确性的现有临床证据，并评估其在疑似AAAS患者管理中的潜在作用。
我们纳入了以任何语言撰写的前瞻性或回顾性诊断队列研究，这些研究专门聚焦于使用TTE从PubMed、EMBASE、MEDLINE和Cochrane图书馆等数据库中诊断AAAS。计算了TTE诊断AAAS的合并敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）和分层汇总接受者操作特征（HSROC）曲线。我们应用了诊断准确性质量评估（QUADAS - 2）工具和推荐分级、评估、制定与评价（GRADE）质量评估标准。
荟萃分析纳入了10项研究（2886例患者）。直接TTE征象的合并敏感性和特异性分别为58%（95%CI，38 - 76%）和94%（95%CI，89 - 97%）。对于任何TTE征象，合并敏感性和特异性分别为91%（95%CI，85 - 94%）和74%（95%CI，61 - 84%）。在四项研究中，通过HSROC曲线下面积测量，直接TTE征象的诊断准确性显著高于任何TTE征象[0.95（95%CI，0.92 - 0.96）对0.87（95%CI，0.84 - 0.90）]。
我们的研究表明，TTE可作为疑似AAAS患者的初始影像学检查。鉴于其高特异性，直接TTE征象的存在可能提示AAAS，而任何TTE征象的缺失，再加上临床怀疑程度低，则可能提示AAAS的可能性较低。
