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Echocardiographic screening for the anomalous aortic origin of coronary arteries
Francesco Bianco1,2, Massimo Colaneri2, Valentina Bucciarelli3,2
1Department of Neuroscience, Imaging and Clinical Sciences, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Abruzzo, Italy dr.francescobianco@gmail.com.
Insights
A new echocardiographic method improves the diagnosis of anomalous aortic origin of coronary arteries (AAOCA) in young adults and athletes. This standardized approach offers higher sensitivity and increased detection rates for this rare condition.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Technology
Background:
- Anomalous aortic origin of coronary arteries (AAOCA) is a congenital heart defect that can lead to serious cardiovascular events.
- Early and accurate diagnosis is crucial for managing AAOCA, especially in young individuals and athletes who may be at higher risk.
- Traditional echocardiographic methods have limitations in detecting AAOCA.
Purpose of the Study:
- To evaluate the diagnostic performance of a standardized echocardiographic approach for identifying anomalous aortic origin of coronary arteries (AAOCA).
- To assess the clinical profiles and outcomes of young adults and athletes diagnosed with AAOCA.
- To compare the sensitivity of the new standardized method with traditional echocardiographic evaluations.
Main Methods:
- A prospective screening of 5998 outpatients (age ≥ 16 years) using four specific echocardiographic windows was conducted between 2015-2019.
- Coronary CT angiography was used to confirm AAOCA diagnoses in patients with suspicious echocardiograms.
- Two independent physicians retrospectively reviewed echocardiographic images for performance analysis, with 300 coronary CT scans available.
Main Results:
- A total of 47 cases of AAOCA were diagnosed, with an overall prevalence of 0.0078%.
- The diagnostic rate of AAOCA showed a significant increment over the 5-year study period.
- The standardized echocardiographic approach demonstrated higher sensitivity (93%) compared to traditional short-axis evaluation (83%), with good interobserver agreement.
Conclusions:
- A standardized echocardiographic approach significantly increases the detection rate of anomalous aortic origin of coronary arteries (AAOCA).
- This method exhibits superior sensitivity compared to traditional echocardiographic assessments.
- Implementing this protocol can enhance the diagnosis of AAOCA in young adults and athletes, potentially improving patient outcomes.
Aims:
We sought to determine the diagnostic performance, clinical profiles and outcomes of anomalous aortic origin of coronary arteries (AAOCA) using a standardised echocardiographic approach in young adults and athletes.
Methods:
In 2015-2019, we screened 5998 outpatients (age 16 years (Q1-Q3: 11, 36)), referred for routine echocardiography, using four specific echocardiographic windows: parasternal short/long axis and apical 4/5-chambers view. Coronary CT confirmed AAOCA. For the performance analysis, 300 coronary-CT scans were available; two independent and double-blinded physicians retrospectively reviewed echocardiographic images.
Results:
A total of 47 AAOCA was diagnosed; the overall prevalence was 0.0078%. Over 5 years, we found a significant increment of AAOCA diagnostic rate (P for trend=0.002). Syncope (n=17/47) and palpitations (n=6/47) were prevalent symptoms. All patients suspended sports activity at the diagnosis. Twenty-seven patients underwent surgery, while 20 underwent a conservative medical treatment. All patients are alive at a median follow-up of 3±1.6 years; only surgical repairs restarted their activity. Our method showed better sensitivity than traditional short-axis evaluation: 93% vs 83%, p=0.0030 (AUC 0.96 (95% CI 0.92, 0.99) and AUC 0.89 (95% CI 0.83, 0.95), respectively), with a good interobserver agreement (95%, k=0.83, p<0.001).
Conclusions:
The application of a standardised echocardiographic approach for AAOCA detection led to a significantly increased rate of identified anomalies. This approach demonstrated higher sensitivity than the traditional echocardiographic assessment. Implementing this protocol in clinical practice may help improve the AAOCA diagnosis in young adults and athletes.
Trial Registration Number:
NCT04224090.
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