Proximal ascending aorta measurements most beneficial for distinguishing TAAAD from STEMI

In a critical breakthrough for emergency medicine, researchers have identified key echocardiography markers that can help distinguish Type A acute aortic dissection (TAAAD) from ST‐elevation–myocardial infarction (STEMI). The findings were published in Journal of the American Heart Association.

This study examined 340 patients with STEMI and 340 patients with TAAAD who had undergone 2D echocardiography in the emergency department over the past decade. The study focused on echocardiographic parameters, particularly the diameter of the proximal ascending aorta (PAA) and its various segments.

The researchers found that the PAA diameter at different levels in the parasternal view, including the Valsalva, the sinotubular junction (STJ), PAA at 1 cm above the STJ, and PAA at 2 cm above the STJ, were significant predictors of TAAAD. These findings were supported by Receiver‐operating characteristic curve analysis, which indicated high diagnostic accuracy (with areas under the curve ranging from 0.777 to 0.975) for each of these parameters.

Multivariable analysis reinforced the significance of these 2DE parameters in predicting TAAAD. The study's standout discovery was the diagnostic capability of measuring PAA at 2 cm above the STJ, which, when incorporated with clinical indicators, showed the most significant diagnostic potential.

When the study considered only patients with TAAAD experiencing coronary malperfusion and those with STEMI, the diagnostic utility of PAA at 1 cm above the STJ became evident. These findings, with high C-statistics and improved reclassification and discrimination metrics, underline the practical significance of this measurement.

The importance of accurately distinguishing TAAAD from STEMI cannot be overstated. Treatment modalities and management for these two conditions differ significantly, and misdiagnosis can lead to dire consequences. Aortic dissection requires immediate surgical intervention, while myocardial infarction, although also an emergency, is managed differently.

These findings provide a significant advancement in the field of emergency medicine, helping healthcare providers swiftly and accurately differentiate between these life-threatening conditions. The results highlight the significance of PAA measurements, particularly at various levels above the STJ, as a crucial tool for clinicians in making this critical differentiation.

Source:

Kirigaya, J., Iwahashi, N., Abe, T., Gohbara, M., Hanajima, Y., Horii, M., Ebina, T., Takeuchi, I., Uchida, K., & Hibi, K. (2023). Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST‐Segment–Elevation Myocardial Infarction. In Journal of the American Heart Association. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/jaha.123.029506