Type of publication:

Conference abstract

Author(s):

*Doherty J.; *Ellis C.; *Lee E.;

Citation:

Echo Research and Practice. Conference: British Society of Echocardiography annual meeting 2023. Newport . 11(Supplement 1) (no pagination), 2024. Date of Publication: 01 Jul 2024.

Abstract:

Background: In 2020 the BSE updated the methods and reference values for assessing the proximal ascending aorta (PAA). It is important to quantify how implementing these methods alter the rate of 'dilated' PAAs identified by echocardiography, and how this will impact the wider service and patient pathway. Purpose(s): To compare the rate of dilated PAAs detected by the current BSE methods, and two other methods of assessing the PAA in our patient population. Method(s): All transthoracic echocardiograms where the PAA was measured between January 2018 and December 2019 were included. Studies with incomplete demographics or bicuspid aortic valves were excluded. The PAA was indexed to height (Method 1), body surface area (BSA) (Method 2) and height2.7 (Method 3), compared to the corresponding normal reference values and classified as 'dilated' or 'nondilated' accordingly. The rate of 'dilated' proximal ascending aortas were compared using Chi-squared test. Result(s): 11,828 studies were identified. 2189 were removed due to incomplete patient demographics and 27 with bicuspid aortic valves. 2710 studies were removed as Method 2 does not provide reference values for patients < 45 and Method 3 > 80 years old. 6902 studies were included in the analysis. Method 1 classified significantly more PAAs as 'dilated' (31%, AUC = 0.930) compared to Method 2 (10%, AUC = 0.841) and 3 (3%, AUC = 0.921) (X2(1, N = 6902) = 2435.8, p < 0.001). Figure 1 (abstract ABS004) A comparison of number of Proximal Ascending Aortas classified as dilated using three different methods of normalising and assessing the proximal ascending aorta to body size; Method 1-height and sex, Method 2-body surface area, age and sex and Method 3-height2.7, age and sex.*Significantly different from Method 1 (p < 0.001).**Significantly different to Method 2 (p < 0.001) Figure 2 (abstract ABS004) Receiver Operating Characteristic (ROC) curves of three methods for assessing the size of the proximal ascending aorta (PAA) on echocardiography; BSE recommended methods using height and sex (Method 1, green), body surface area, age and sex (Method 2, red) and height2.7, age and sex (Method 3, blue). Sensitivity and 1-specificty values for each method at the PAA diameter of 4 cm is plotted. Of the 6902 studies, 306 PAAs were > 4 cm. Method 1 classified all PAAs > 4 cm and 1885 < 4 cm as dilated; Method 2 classified 111 PAAs > 4 cm and 82 < 4 cm as dilated; and Method 3 classified 203 PAAs > 4 cm and 476 < 4 cm as dilated. Conclusion(s): Adopting the 2020 BSE recommended methods significantly increase the detection rate of dilated PAAs in our patient population. This will impact subsequent downstream testing, affecting resource planning and patient journey.

DOI: 10.1186/s44156-024-00053-0

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