Diagnostic Value Of Emergency Bedside Immediate Transthoracic Echocardiography Combined With Serum Markers For Type A Acute Aortic Syndrome

Objective:(1)To investigate the early independent diagnostic efficacy and combined diagnostic efficacy of each sign of emergency bedside immediate transthoracic echocardiography(TTE)for type A acute aortic syndrome(AAS),respectively.(2)To analyze serum concentrations of matrix metalloproteinase-9(MMP-9),transforming growth factor-?(TGF-?)and acidic calponin in patients with AAS.To investigate their feasibility as early diagnostic markers for type A AAS and to search for the best diagnostic combination of serum markers with TTE signs.Methods:(1)One hundred and seventy-nine patients'clinical data and TTE signs were collected.?2 tests were used to compare the clinical and TTE characteristics between type A AAS and non type A AAS groups,and receiver operating characteristic curve(ROC)analysis was established to evaluate the efficacy of TTE for early diagnosis of type A AAS.(2)Serum MMP-9,TGF-?,and acidic calponin levels were measured by enzyme-linked immunosorbent assay(ELISA).T-test was used to compare the differences in serum levels among different groups,while the optimal combination way of the above serum markers combined with TTE signs for early diagnosis was established by ROC curve.Results:(1)Type A AAS was finally confirmed in 49 of 179 suspected patients.The sign of internal diameter broadening of the ascending aorta was the most easily detectable sign of TTE,and its AUC could reach 76.9%,with a cutoff value of 39.5 mm.The TTE signs are ranked in order of diagnostic sensitivity;Widened internal diameter of ascending aorta(77.6%);aortic regurgitation(63.3%);pericardial effusion(16.3%);direct signs(10.2%).Order of specificity from highest to lowest is:Direct signs(97.7%);pericardial effusion(90.8%);widened ascending aortic internal diameter(68.5%);aortic regurgitation(67.7%).(2)The parallel combination of direct signs of TTE+widened internal diameter of the ascending aorta showed high diagnostic accuracy(70.9%);However,the sensitivity of sequence combined diagnosis performed for each TTE sign was low(4.1%);The diagnostic sensitivity of either TTE sign in critically suspected patients with hypotension/shock can reach 100%and specificity 60%,while the specificity of positive TTE direct signs can reach 100%.(3)Acidic calponin(t=8.56,P<0.05)and TGF-?(t=8.55,P<0.05)levels were significantly different between groups.MMP-9 levels in type A AAS group were not significantly different from those in type B AAS(P=0.32)or PE group(P=0.90).(4)The highest AUC of 0.963 was observed in the combination of internal diameter of the ascending aorta+TGF-?+acidic calponin,with a sensitivity and specificity of 95.92%and 95.23%,respectively.Conclusion:(1)Bedside TTE,as an independent examination method,showed screening value for the early diagnosis of type A AAS.However,its sensitivity is multifactorial,and still needs to be combined with other diagnostic indicators to improve the overall diagnostic accuracy(2)Bedside TTE signs especially direct signs showed a higher diagnostic efficacy in critically ill patients with hypotension/shock.(3)The type A AAS related serum markers MMP-9,TGF-? and acidic calponin are valuable for its early diagnosis efficacy.(4)Internal diameter of the ascending aorta combined with acidic calponin showed high value for early bedside diagnosis of type A AAS.