Wouter W Jansen Klomp1, Linda M Peelen2, Sander J Spanjersberg3, George J Brandon Bravo Bruinsma4, Fellery de Lange5, Arnoud W J van't Hof6, Karel G M Moons2. 1. Department of Cardiology, Isala, Dokter van Heesweg 2, Zwolle 8025AB, The Netherlands Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands w.w.jansen.klomp@isala.nl. 2. Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Department of (Thoracic) Anaesthesia and Intensive Care, Isala, Zwolle, The Netherlands. 4. Department of Cardiothoracic Surgery, Isala, Zwolle, The Netherlands. 5. Departments of Cardiac Anesthesia and Intensive Care, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden 8934 AD, The Netherlands. 6. Department of Cardiology, Isala, Dokter van Heesweg 2, Zwolle 8025AB, The Netherlands.
Abstract
AIMS: Accurate visualization of the distal ascending aorta (DAA) can guide the surgical management and hence prevent dislodgment of atherogenic emboli during cardiac surgery. Conventional transoesophageal echocardiography (TEE) has a poor sensitivity; modified TEE was previously shown to accurately visualize atherosclerosis of the DAA. We studied the added value of modified TEE beyond the patient history and TEE screening. METHODS AND RESULTS: Included were 421 patients from a previous diagnostic study, which compared the diagnosis of severe atherosclerosis with modified TEE and epiaortic ultrasound (EUS; reference test). We fitted three models, which predicted presence of atherosclerosis Grade ≥3 of the DAA. Model 1 included preoperative patient characteristics; in Model 2 conventional TEE was added; Model 3 additionally included modified TEE results. For each model, the area under the receiver-operating curve (AUC), the 'net reclassification improvement' (NRI) and the 'integrated discrimination improvement' (IDI) were determined. Missing data were imputed. The AUCs of Models 1, 2, and 3 were 0.73 (95% CI: 0.68-0.78), 0.80 (95% CI: 0.76-0.85), and 0.93 (95% CI: 0.90-0.96), respectively. Comparing Model 3 with Model 2, the AUC was significantly higher (P < 0.001), the NRI was 0.60 (95% CI: 0.54-0.66; P < 0.001), and the IDI was 0.30 (95% CI: 0.28-0.32; P < 0.001), indicating that visualization of the DAA with modified TEE significantly improved reclassification. CONCLUSION: Visualization of atherosclerosis of the DAA with modified TEE provided information beyond patient history and conventional TEE screening, which resulted in an improved diagnosis of atherosclerosis. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Accurate visualization of the distal ascending aorta (DAA) can guide the surgical management and hence prevent dislodgment of atherogenic emboli during cardiac surgery. Conventional transoesophageal echocardiography (TEE) has a poor sensitivity; modified TEE was previously shown to accurately visualize atherosclerosis of the DAA. We studied the added value of modified TEE beyond the patient history and TEE screening. METHODS AND RESULTS: Included were 421 patients from a previous diagnostic study, which compared the diagnosis of severe atherosclerosis with modified TEE and epiaortic ultrasound (EUS; reference test). We fitted three models, which predicted presence of atherosclerosis Grade ≥3 of the DAA. Model 1 included preoperative patient characteristics; in Model 2 conventional TEE was added; Model 3 additionally included modified TEE results. For each model, the area under the receiver-operating curve (AUC), the 'net reclassification improvement' (NRI) and the 'integrated discrimination improvement' (IDI) were determined. Missing data were imputed. The AUCs of Models 1, 2, and 3 were 0.73 (95% CI: 0.68-0.78), 0.80 (95% CI: 0.76-0.85), and 0.93 (95% CI: 0.90-0.96), respectively. Comparing Model 3 with Model 2, the AUC was significantly higher (P < 0.001), the NRI was 0.60 (95% CI: 0.54-0.66; P < 0.001), and the IDI was 0.30 (95% CI: 0.28-0.32; P < 0.001), indicating that visualization of the DAA with modified TEE significantly improved reclassification. CONCLUSION: Visualization of atherosclerosis of the DAA with modified TEE provided information beyond patient history and conventional TEE screening, which resulted in an improved diagnosis of atherosclerosis. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Wouter W Jansen Klomp; George J Brandon Bravo Bruinsma; Arnoud W van 't Hof; Jan G Grandjean; Arno P Nierich Journal: Int J Vasc Med Date: 2016-02-04
Authors: Wouter W Jansen Klomp; Linda M Peelen; George J Brandon Bravo Bruinsma; Arnoud W J Van't Hof; Jan G Grandjean; Arno P Nierich Journal: Cardiovasc Ultrasound Date: 2016-08-03 Impact factor: 2.062
Authors: Wouter W Jansen Klomp; Carl G M Moons; Arno P Nierich; George J Brandon Bravo Bruinsma; Arnoud W J Van't Hof; Jan G Grandjean; Linda M Peelen Journal: Int J Vasc Med Date: 2017-09-11