Point-of-Care Focused Cardiac Ultrasound in Assessing the Thoracic Aorta

Study Overview
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Brief Summary
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The purpose of this prospective study is to compare point-of-care focused cardiac ultrasound (FOCUS) to thoracic computed tomographic angiography (CTA) in the measurement of ascending aortic dimensions. We hypothesize that FOCUS will demonstrate good agreement with CTA in the measurement of ascending aortic dimensions and accurately detect dilation and aneurysmal disease.

Detailed Description
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Nonspecific chest pain is frequently encountered in the emergency department. Accounting for over 13,000 deaths annually, aortic aneurysmal disease is a potential cause of chest pain.There are multiple diagnostic imaging modalities in practice to interrogate the thoracic aorta, with the most common being computed tomographic angiography (CTA), trans-thoracic echocardiography (TTE) and trans-esophageal echocardiography (TEE), each with its own advantages and limitations. In the ED setting, point-of-care (POC) focused cardiac ultrasound (FOCUS) is increasingly being used as an adjunct to the emergency physician's (EP) workup of undifferentiated chest pain. Based on prior retrospective data FOCUS and CTA appear to have good agreement. This studies aims to confirm these findings through prospective evaluation Specific Aims Aim 1: To prospectively compare Point of Care (POC) Focused Cardiac Ultrasound (FOCUS) to thoracic computed tomographic angiography (CTA) in the measurement of ascending aortic dimensions. Maximal diameter measurements of the ascending thoracic aorta by FOCUS will be compared to CTA. Bland Altman plots with 95% limits of agreement will be used to determine clinical and statistical significance. Hypothesis: 95% limits of agreement between FOCUS and CTA will be within +/- 5 mm. Aim 2: To determine the diagnostic accuracy of Point-of-Care Focused Cardiac Ultrasound for the detection of thoracic aortic dilation and aneurysm with computed tomographic angiography as the reference standard Sensitivity, Specificity and Accuracy of FOCUS will be computed with CTA as the reference standard.

Official Title
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A Prospective Study on Point-of-Care Focused Cardiac Ultrasound in Assessing for Thoracic Aortic Dimensions, Dilation, and Aneurysm in Correlation With CT Angiogram in Suspected Cases of Pathology

Conditions
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Aortic Aneurysm, Thoracic, Aortic Dissection

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients aged 18 years and older presenting to the ED for whom a thoracic CTA has been ordered. Exclusion Criteria: Refusal of verbal consent for ultrasound. Inability to obtain informed written consent for data collection from either the patient or the patients decision-making surrogate

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximal diameter measurements of the proximal ascending aorta by CTA and FOCUS | Maximal diameter measurements of the ascending thoracic aorta by FOCUS will be compared to CTA. Bland Altman plots with 95% limits of agreement will be used to determine clinical and statistical significance. | during emergency department visit (estimated average 3-6 hours) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to Emergency Department Disposition | Time until an admission or discharge order is placed within the electronic medical record | estimated time frame 3-6 hours | 
| Number and percent probabilities of differential diagnosis | Number and percent probabilities of differential diagnosis will be obtained before and after ultrasound to calculate the informational content provided by the ultrasound and perform additional uncertainty analyses | (estimated time frame 0 -3 hours) | 
| Time to diagnostic imaging | Time when diagnostic imaging is performed | estimated time frame 0-6 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ultrasound, point-of-care, echocardiography, Aortic dissection, Aortic dilation, Aortic Aneurysm