PDF(Pubmed)
Abstract：
Type A acute aortic syndrome (urgent AAS, UAAS) has a low incidence and high mortality rate; however, it is often missed or diagnosed late. Our aim was to create a new tool for distinguishing UAAS by using multiple modalities to select patients for CT aortography. This study included 75 patients with UAAS, 77 with acute coronary syndrome (ACS), and 81 with heart failure (HF) who received urgent treatment after propensity matching. Specific symptoms, past medical history, mediastinal width, region of interest (ROI) ratio in the lung base/apex, D-dimers, and troponin I were investigated to differentiate UAAS from ACS and HF. The most significant variables were selected to create a new scoring system. The UAAS score exhibited a performance AUC of 0.982. A simple UAAS score >1, excluding ROI ratios in lung base/apex, showed an AUC of 0.977, a sensitivity of 96%, and specificity of 92.41%. The results were validated using an external data set of 292 patients (simple UAAS score > 1: AUC of 0.966, sensitivity 93.33%, and specificity 95.36%). The simple UAAS score may be a valuable tool for suspecting UAAS and may reduce the likelihood of misdiagnosis or performing unnecessary CT aortography.
摘要：
A型急性主动脉综合征（紧急AAS，UAAS）发病率低，死亡率高；然而，它经常被错过或晚期诊断。我们的目标是通过使用多种方式选择患者进行CT主动脉造影来创建一种区分UAAS的新工具。这项研究包括75例UAAS患者，77例急性冠脉综合征（ACS），和81名心力衰竭（HF）患者在倾向匹配后接受紧急治疗。具体症状,既往病史,纵隔宽度,肺基部/心尖的感兴趣区域（ROI）比率，D-二聚体,和肌钙蛋白I进行了研究，以区分UAAS与ACS和HF。选择最重要的变量来创建新的评分系统。UAAS评分表现出0.982的表现AUC。简单的UAAS评分>1，不包括肺基部/心尖的ROI比率，显示AUC为0.977，灵敏度为96%，特异性为92.41%。使用292例患者的外部数据集验证结果（简单UAAS评分>1：AUC为0.966，灵敏度为93.33％，和特异性95.36%）。简单的UAAS评分可能是怀疑UAAS的有价值的工具，并且可以减少误诊或执行不必要的CT主动脉造影的可能性。
