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

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.

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