Journal article
Integration of transthoracic focused cardiac ultrasound in the diagnostic algorithm for suspected acute aortic syndromes.
- Nazerian P Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy.
- Mueller C Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital of Basel, Petersgraben 4, Basel, Switzerland.
- Vanni S Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy.
- Soeiro AM Emergency Care Unit, Heart Institute, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 44 - Cerqueira César, São Paulo, Brazil.
- Leidel BA Department of Emergency Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin, Germany.
- Cerini G Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy.
- Lupia E Department of Emergency Medicine, S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, Torino, Italy.
- Palazzo A Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy.
- Grifoni S Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy.
- Morello F Department of Emergency Medicine, S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, Torino, Italy.
- 2019-06-22
Published in:
- European heart journal. - 2019
Aortic dissection
Aortic syndrome
Diagnosis
Echocardiography
Ultrasound
Acute Disease
Aged
Aged, 80 and over
Algorithms
Aneurysm, Dissecting
Aorta
Diagnosis, Differential
Echocardiography
Europe
Female
Fibrin Fibrinogen Degradation Products
Follow-Up Studies
Humans
Male
Middle Aged
Prospective Studies
Risk Assessment
Sensitivity and Specificity
Syndrome
Triage
English
AIMS
The diagnosis of acute aortic syndromes (AASs) is challenging and requires integrated strategies. Transthoracic focused cardiac ultrasound (FoCUS) is endorsed by guidelines as a first-line/triage tool allowing rapid bedside assessment of the aorta. However, the performance of FoCUS in the European Society of Cardiology-recommended workup of AASs awaits validation.
METHODS AND RESULTS
This was a prespecified subanalysis of the ADvISED multicentre prospective study. Patients with suspected AAS underwent FoCUS for detection of direct/indirect signs of AAS. Clinical probability assessment was performed with the aortic dissection detection risk score (ADD-RS). Case adjudication was based on advanced imaging, surgery, autopsy, or 14-day follow-up. An AAS was diagnosed in 146 (17.4%) of 839 patients. Presence of direct FoCUS signs had a sensitivity and specificity of 45.2% [95% confidence interval (CI) 37-53.6%] and 97.4% (95% CI 95.9-98.4%), while presence of any FoCUS sign had a sensitivity and specificity of 89% (95% CI 82.8-93.6%) and 74.5% (95% CI 71-77.7%) for AAS. The additive value of FoCUS was most evident within low clinical probability (ADD-RS ≤1). Herein, direct FoCUS signs were identified in 40 (4.8%) patients (P < 0.001), including 29 with AAS. ADD-RS ≤1 plus negative FoCUS for AAS rule-out had a sensitivity of 93.8% (95% CI 88.6-97.1%) and a failure rate of 1.9% (95% CI 0.9-3.6%). Addition of negative D-dimer led to a failure rate of 0% (95% CI 0-1.2%).
CONCLUSION
FoCUS has additive value in the workup of AASs. Direct FoCUS signs can rapidly identify patients requiring advanced imaging despite low clinical probability. In integrated bundles, negative FoCUS is useful for rule-out of AASs.
The diagnosis of acute aortic syndromes (AASs) is challenging and requires integrated strategies. Transthoracic focused cardiac ultrasound (FoCUS) is endorsed by guidelines as a first-line/triage tool allowing rapid bedside assessment of the aorta. However, the performance of FoCUS in the European Society of Cardiology-recommended workup of AASs awaits validation.
METHODS AND RESULTS
This was a prespecified subanalysis of the ADvISED multicentre prospective study. Patients with suspected AAS underwent FoCUS for detection of direct/indirect signs of AAS. Clinical probability assessment was performed with the aortic dissection detection risk score (ADD-RS). Case adjudication was based on advanced imaging, surgery, autopsy, or 14-day follow-up. An AAS was diagnosed in 146 (17.4%) of 839 patients. Presence of direct FoCUS signs had a sensitivity and specificity of 45.2% [95% confidence interval (CI) 37-53.6%] and 97.4% (95% CI 95.9-98.4%), while presence of any FoCUS sign had a sensitivity and specificity of 89% (95% CI 82.8-93.6%) and 74.5% (95% CI 71-77.7%) for AAS. The additive value of FoCUS was most evident within low clinical probability (ADD-RS ≤1). Herein, direct FoCUS signs were identified in 40 (4.8%) patients (P < 0.001), including 29 with AAS. ADD-RS ≤1 plus negative FoCUS for AAS rule-out had a sensitivity of 93.8% (95% CI 88.6-97.1%) and a failure rate of 1.9% (95% CI 0.9-3.6%). Addition of negative D-dimer led to a failure rate of 0% (95% CI 0-1.2%).
CONCLUSION
FoCUS has additive value in the workup of AASs. Direct FoCUS signs can rapidly identify patients requiring advanced imaging despite low clinical probability. In integrated bundles, negative FoCUS is useful for rule-out of AASs.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1093/eurheartj/ehz207
- PMID 31226214
- Persistent URL
- https://roar.hep-bejune.ch/global/documents/206929
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