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Diagnostic Performance of Focused Cardiac Ultrasound Performed by Emergency Physicians for the Assessment of Ascending Aorta Dilation and Aneurysm
Author(s) -
Nazerian Peiman,
Vanni Simone,
Morello Fulvio,
Castelli Matteo,
Ottaviani Maddalena,
Casula Claudia,
Petrioli Alessandra,
Bartolucci Maurizio,
Grifoni Stefano
Publication year - 2015
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12650
Subject(s) - medicine , ascending aorta , radiology , aorta , aneurysm , confidence interval , emergency department , prospective cohort study , computed tomography angiography , angiography , nuclear medicine , cardiology , psychiatry
Objectives The diagnostic performance of transthoracic focused cardiac ultrasound (Fo CUS ) performed by emergency physicians ( EP ) to estimate ascending aorta dimensions in the acute setting has not been prospectively studied. The diagnostic accuracy and the interobserver variability of EP ‐performed Fo CUS were investigated to estimate thoracic aortic dilation and aneurysm compared with the results of computed tomography angiography ( CTA ). Methods This was a prospective single‐center cohort study of a convenience sample of patients who underwent CTA in the emergency department for suspected aortic pathology. Fo CUS was performed before CTA , and the maximum ascending aorta diameter evaluated in parasternal long‐axis view. Aorta diameter < 40 mm by visual estimation or by diameter measurement was considered normal. Measurements were recorded in all patients with aorta diameter ≥ 40 mm. Diagnostic accuracy of Fo CUS for detection of aortic dilation (diameter ≥ 40 mm) and aneurysm (diameter ≥ 45 mm) were calculated considering the CTA result as reference standard. In a subgroup of patients, a second EP ‐sonographer performed Fo CUS to evaluate interobserver agreement for the diagnosis of ascending aorta dilation. Results A total of 140 patients were enrolled in the study. Ascending aorta dilation and aneurysm were detected with Fo CUS in 50 (35.7%) and in 27 (17.8%) patients, respectively. Sensitivity and specificity of Fo CUS were 78.6% (95% confidence interval [ CI ] = 65.6% to 88.4%) and 92.9% (95% CI = 85.1% to 97.3%), respectively, for ascending aorta dilation and 64.7% (95% CI = 46.5% to 80.2%) and 95.3% (95% CI = 89.3% to 98.4%), respectively, for ascending aorta aneurysm. Interobserver agreement of Fo CUS was k = 0.82. Conclusions Fo CUS performed by EP is specific for ascending aorta dilation and aneurysm when compared to CTA and appears a reproducible technique.