Photo Credit: Pitchayanan Kongkaew
The following is a summary of “Bedside-focused transthoracic echocardiography in acute atraumatic thoracic aortic syndrome: a systematic review and meta-analysis of diagnostic accuracy,” published in the December 2024 issue of Emergency Medicine by Mani et al.
Researchers conducted a retrospective study to evaluate the diagnostic accuracy of bedside-focused transthoracic echocardiography (TTE) for adults with acute atraumatic thoracic aortic syndrome.
They reviewed publications describing bedside-focused TTE used in adults with suspected atraumatic thoracic aortic syndrome in emergency care settings. Studies were identified through keyword and MeSH searches in databases and grey literature, with abstracts screened and selected by 2 independent reviewers.
The results showed that 16 studies spanning 6 decades were included in the meta-analysis (n = 4,569 participants). The prevalence of type A thoracic aortic dissection was 11% (range 1.4–45.7%), and type B dissection was 7% (range 1.8–30.55%). Pooled sensitivity and specificity for type A dissection, based on direct TTE visualization of an intimal flap, were 89% [95% CI, 82–94%] and 92% (95% CI, 88–95%), respectively. For type B dissection, pooled sensitivity was 65% (95% CI, 45–80%), and specificity was 100% (95% CI, 0.69–100%). Indirect TTE signs showed pooled sensitivities and specificities of 64% (5.2–98.2%) and 94% (92–96.1%) for aortic valve regurgitation, 92% (54–99.2%) and 87% (62–97%) for thoracic aortic aneurysm, and 39% (33.8–45%) and 94% (92–95%) for pericardial effusion.
Investigators concluded the bedside-focused TTE demonstrated high specificity for type A and B aortic dissections, moderate to high sensitivity for type A dissection but poor for type B, with unclear diagnostic accuracy for intramural hematoma and penetrating aortic ulcer.
