Added value of modified transoesophageal echocardiography in the diagnosis of atherosclerosis of the distal ascending aorta in cardiac surgery patients. (26th December 2013)

• Record Type: Journal Article
• Authors: Jansen Klomp, Wouter W.; Peelen, Linda M.; Spanjersberg, Sander J.; Brandon Bravo Bruinsma, George J.; Lange, Fellery de; van't Hof, Arnoud W.J.; Moons, Karel G.M.
• Is Part Of: European heart journal. Volume 15:Number 6(2014:Jun.)
• Page Start: 623
• Page End: 630
• Publication Date: 2013-12-26
• Subjects: Atherosclerosis -- Cardiac surgery -- Diagnostic Testing -- Transoesophageal echocardiography; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jet257
• Languages: English
• ISSNs: 2047-2404

Abstract

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.