Diagnostic performance of focused cardiac ultrasound performed by emergency physicians for the assessment of ascending aorta dilatation and aneurysm

Background

The diagnostic performance of transthoracic focus cardiac ultrasound (FoCUS) performed by emergency physician (EP) to estimate ascending aorta dimensions in the acute setting is not known.

Objective

We investigate the accuracy and the intervariability of EP-performed FoCUS to estimate thoracic aortic dilation and aneurysm compared with computed tomography angiography (CTA) as the reference standard.

Patients and methods

This was a prospective single-centre cohort study of a convenience sample of patients that underwent CTA in the emergency department for suspected aortic pathology. FOCUS was performed before CTA and the maximum ascending aorta diameter measured in parasternal long-axis view. Diagnostic accuracy of FOCUS for detection of aortic dilation (diameter ≥40 mm) and aneurysm (diameter ≥45 mm) were calculated considering CTA as reference standard. In a subgroup of patients, a second EP-sonographer performed FoCUS to evaluate interobserver agreement for the diagnosis of ascending aorta dilation.

Results

140 patients were enrolled in the study. Ascending aorta dilation and aneurysm were detected at FoCUS in 50 (35.7%) and in 27 (17.8%) respectively. Sensitivity and specificity of FOCUS for ascending aorta dilation were 78.6% (95% CI 65.6-88.4) and 93.9% (95% CI 85.1-97.3) respectively and for ascending aorta aneurysm were 64.7% (95% CI 46.5-80.2) and 95.3% (95% CI 89.3-98.4) respectively. Inter-observer agreement of FoCUS was k = 0.82.

Conclusions

FoCUS performed by EP showed a good specificity and suboptimal sensitivity for ascending aorta dilation and aneurysm when compared to CTA and appears as a highly reproducible technique.