Anomalous Aortic Origin of Coronary Arteries in the Young
Autor: | J. René Herlong, Peter C. Frommelt, Richard Lorber, Susan McIntyre, William M. DeCampli, Shubhika Srivastava, Marshall L. Jacobs, William G. Williams, Eugene H. Blackstone, Ira A. Parness, Luc Mertens, Travis J. Wilder |
---|---|
Rok vydání: | 2015 |
Předmět: |
medicine.medical_specialty
business.industry medicine.disease Sudden death Surgical planning Coronary arteries Cohen's kappa medicine.anatomical_structure Radiology Nuclear Medicine and imaging Great arteries Predictive value of tests Anomalous aortic origin of a coronary artery Operative report Medicine Radiology Nuclear Medicine and imaging Radiology Cardiology and Cardiovascular Medicine business |
Zdroj: | JACC: Cardiovascular Imaging. 8:1239-1249 |
ISSN: | 1936-878X |
Popis: | Objectives This study sought to compare findings from institutional echocardiographic reports with imaging core laboratory (ICL) review of corresponding echocardiographic images and operative reports in 159 patients with anomalous aortic origin of a coronary artery (AAOCA). The study also sought to develop a “best practice” protocol for imaging and interpreting images in establishing the diagnosis of AAOCA. Background AAOCA is associated with sudden death in the young. Underlying anatomic risk factors that can cause ischemia-related events include coronary arterial ostial stenosis, intramural course of the proximal coronary within the aortic wall, interarterial course, and potential compression between the great arteries. Consistent protocols for diagnosing and evaluating these features are lacking, potentially precluding the ability to risk stratify patients based on evidence and plan surgical strategy. Methods For a prescribed set of anatomic AAOCA features, percentages of missing data in institutional echocardiographic reports were calculated. For each feature, agreement among institutional echocardiographic reports, ICL review of images, and surgical reports was evaluated using the weighted kappa statistic. An echocardiographic imaging protocol was developed heuristically to reduce differences between institutional reports and ICL review. Results A total of 13%, 33%, and 62% of echocardiograms were missing images enabling diagnosis of intra-arterial course, proximal intramural course, and high ostial takeoff, respectively. There was poor agreement between institutional reports and ICL review for diagnosis of origin of coronary artery, interarterial course, intramural course, and acute angle takeoff (kappa = 0.74, 0.11, –0.03, 0.13, respectively). Surgical findings were also significantly different from those of reports, and to a lesser extent ICL reviews. The resulting protocol contains technical recommendations for imaging each of these features. Conclusions Poor agreement between institutional reports and ICL review for AAOCA suggests need for an imaging protocol to permit evidence-based risk stratification and surgical planning. Even then, delineation of echocardiographic details in AAOCA will remain imperfect. |
Databáze: | OpenAIRE |
Externí odkaz: |