Shoko Yamaguchi1, Hironori Murakami2, Tomoko Kudo1, Chiharu Otokozawa1, Shunsuke Sasaki2, Satoshi Yuda3, Masanori Nojima4. 1. Department of Clinical Laboratory Medicine, Teine Keijinkai Hospital, 1-12, Maeda, Teine-ku, Sapporo, 006-8555, Japan. 2. Division of Cardiology, Cardiovascular Center, Teine Keijinkai Hospital, 1-12, Maeda, Teine-ku, Sapporo, 006-8555, Japan. 3. Division of Cardiology, Cardiovascular Center, Teine Keijinkai Hospital, 1-12, Maeda, Teine-ku, Sapporo, 006-8555, Japan. yuda410902@gmail.com. 4. Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, 4-6-1 Shiroganedai, Minato-ku, Tokyo, 108-8639, Japan.
Abstract
BACKGROUND: Transthoracic echocardiography (TTE) is not recommended as the first-line diagnostic modality for Stanford type B aortic dissection (type-B AD). PURPOSES: The aims of this study were to evaluate the usefulness and factors influencing for the diagnosis of type-B AD using the transthoracic echocardiographic paravertebral approach (PVA). METHODS: We compared the image acquisition rate of descending thoracic aorta (DTA) and the diagnostic rate of type-B AD using TTE versus PVA. Both tests were compared with type-B AD, which was diagnosed by enhanced computed tomography (CT), as the reference standard. We also analyzed the factors influencing adequate image acquisition and the diagnosis of type-B AD using the PVA. The length between the dorsal thoracic surface and the DTA (TDAL) and thickness of lung on the TDAL line (LTh) were measured on the CT images. RESULTS: No significant difference was found between the image acquisition rate of the DTA between the PVA and the TTE (70.1 vs. 64.2%, p = 0.56), while the diagnostic rate of type-B AD using the PVA was significantly greater than when using the TTE (56.7 vs. 26.9%, p < 0.001). Furthermore, when adequate images of DTA were obtained using the PVA, 80.9% of the patients were diagnosed with type-B AD. A multivariate analysis demonstrated that a lower LTh (p = 0.001) and the existence of a pleural effusion (p = 0.03) significantly influenced the diagnosis of type-B AD using the PVA. CONCLUSIONS: The PVA might be a useful method for diagnosis of type-B AD, when adequate images of the DTA are obtained.
BACKGROUND: Transthoracic echocardiography (TTE) is not recommended as the first-line diagnostic modality for Stanford type B aortic dissection (type-B AD). PURPOSES: The aims of this study were to evaluate the usefulness and factors influencing for the diagnosis of type-B AD using the transthoracic echocardiographic paravertebral approach (PVA). METHODS: We compared the image acquisition rate of descending thoracic aorta (DTA) and the diagnostic rate of type-B AD using TTE versus PVA. Both tests were compared with type-B AD, which was diagnosed by enhanced computed tomography (CT), as the reference standard. We also analyzed the factors influencing adequate image acquisition and the diagnosis of type-B AD using the PVA. The length between the dorsal thoracic surface and the DTA (TDAL) and thickness of lung on the TDAL line (LTh) were measured on the CT images. RESULTS: No significant difference was found between the image acquisition rate of the DTA between the PVA and the TTE (70.1 vs. 64.2%, p = 0.56), while the diagnostic rate of type-B AD using the PVA was significantly greater than when using the TTE (56.7 vs. 26.9%, p < 0.001). Furthermore, when adequate images of DTA were obtained using the PVA, 80.9% of the patients were diagnosed with type-B AD. A multivariate analysis demonstrated that a lower LTh (p = 0.001) and the existence of a pleural effusion (p = 0.03) significantly influenced the diagnosis of type-B AD using the PVA. CONCLUSIONS: The PVA might be a useful method for diagnosis of type-B AD, when adequate images of the DTA are obtained.
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