Hesami Mina, Denkewicz Ryan, Boivin Zachary, Bhalodkar Sonali, Li Jia Jian, Moore Christopher
Department of Emergency Medicine, Yale University, New Haven, CT, USA.
Department of Emergency Medicine, Yale University, New Haven, CT, USA.
Am J Emerg Med. 2025 Sep;95:89-94. doi: 10.1016/j.ajem.2025.05.039. Epub 2025 May 22.
Thoracic aortic dissection (TAD) is a life-threatening condition with a mortality rate of 1-2 % per hour, highlighting the importance of prompt diagnosis. Thoracic aortic aneurysm (TAA) is associated with TAD and can be detected by point-of-care ultrasound (POCUS). We sought to evaluate the diagnostic accuracy of POCUS in detecting TAA and the prevalence of TAD in patients with TAA by POCUS. We hypothesized that a dilated aortic root on POCUS would be strongly associated with TAA and TAD.
Patients with a dilated aortic root measurement of ≥4.5 cm on transthoracic cardiac POCUS between 2013 and 2023 who received either chest CT or cardiology echocardiogram (c-echo) were retrospectively selected by querying a POCUS database (QpathE) from three EDs in our system. Comprehensive demographic, clinical, and imaging data were retrieved from electronic medical records. For both CT and c-echo, aortic measurements of ≥4 cm were considered aneurysmal, using the largest reported measurement. If both CT and c-echo were performed, the largest CT measure was used. We also investigated how many patients with TAA also had TAD. Statistical analysis was performed using IBM SPSS version 29.
Our cohort included 304 patients with TAA (≥4.5 cm) on POCUS, with a median age of 67.5 years (IQR:58-80) of which 247 (81.3 %) were male. 227 (74.6 %) had CT performed, and 77 (25.3 %) had a c-echo without CT. There was a significant positive correlation between POCUS measurements and those of CT and c-echo (r = 0.62, p < 0.001). Comparing the measurements on POCUS with those derived from our ground truths, the mean difference for the Bland-Altman plot was 0.13 cm (95 % confidence interval; -0.71 to 0.97), with the average POCUS measure being slightly higher. Overall, the positive predictive value (PPV) of POCUS for TAA was 96 % (95 % CI, 93.8 %-98 %). TAD was present in 45 (15.4 %) of patients with TAA.
Although POCUS measurement tended to be slightly higher than that of CT or c-echo on average, it demonstrated a high accuracy and predictive value for TAA. More than one in seven patients with TAA on POCUS had TAD. Our results underscore the efficacy of POCUS for the prompt detection of thoracic aortic aneurysm and dissection.
胸主动脉夹层（TAD）是一种危及生命的疾病，死亡率为每小时1%-2%，这凸显了及时诊断的重要性。胸主动脉瘤（TAA）与TAD相关，可通过床旁超声（POCUS）检测到。我们旨在评估POCUS检测TAA的诊断准确性以及通过POCUS检测TAA患者中TAD的患病率。我们假设POCUS上主动脉根部扩张与TAA和TAD密切相关。
通过查询我们系统中三个急诊科的POCUS数据库（QpathE），回顾性选择2013年至2023年间经胸心脏POCUS测量主动脉根部直径≥4.5 cm且接受胸部CT或心脏超声心动图（c-回声）检查的患者。从电子病历中检索全面的人口统计学、临床和影像学数据。对于CT和c-回声检查，报告的最大测量值≥4 cm被视为动脉瘤。如果同时进行了CT和c-回声检查，则使用最大的CT测量值。我们还调查了有多少TAA患者同时患有TAD。使用IBM SPSS 29版进行统计分析。
我们的队列包括304例POCUS检查显示TAA（≥4.5 cm）的患者，中位年龄为67.5岁（四分位间距：58-80岁），其中247例（81.3%）为男性。227例（74.6%）进行了CT检查，77例（25.3%）进行了c-回声检查但未进行CT检查。POCUS测量值与CT和c-回声测量值之间存在显著正相关（r = 0.62，p < 0.001）。将POCUS测量值与我们的真实测量值进行比较，Bland-Altman图的平均差异为0.13 cm（95%置信区间；-0.71至0.97），POCUS的平均测量值略高。总体而言，POCUS对TAA的阳性预测值（PPV）为96%（95% CI，93.8%-98%）。45例（15.4%）TAA患者存在TAD。
尽管POCUS测量值平均往往略高于CT或c-回声测量值，但它对TAA具有较高的准确性和预测价值。POCUS检查显示TAA的患者中，七分之一以上患有TAD。我们结果强调了POCUS在快速检测胸主动脉瘤和夹层方面的有效性。
