Diagnostic performance of focused cardiac ultrasound performed by emergency physicians for the assessment of ascending aorta dilatation and aneurysm

Abstract BackgroundThe relationship between malnutrition and ascending aorta dilatation (AAD) is still unclear. Therefore, the aim of this study was to examine the association of exposure to the Chinese famine during early life with AAD in adulthood.MethodsWe investigated data of 2598 adults born between 1952 and 1964 from Guangdong, China. All enrolled subjects were divided into five groups: no exposed, fetal exposed, early, mid and late childhood exposed. AAD was assessed by cardiac ultrasound. Multivariate logistic regression and interaction tests were used to estimate the odds ratio (OR) and confidence interval (CI) between famine exposure and AAD.ResultsThere were 2598 (943 male, mean age 59.1 ± 3.65 years) participants were enrolled, among them consist of 270 (10.4%) subjects with AAD. Compared with no exposed group, the adjusted ORs for AAD widening from fetal-exposed, early, mid to late childhood exposed were 1.374 (95% CI: 0.794, 2.364, P = 0.251), 1.976 (95% CI: 1.243, 3.181, P = 0.004), 1.929 (95% CI: 1.237, 3.058, P = 0.004) and 2.227 (95% CI: 1.433, 3.524, P < 0.001), respectively. Stratified analysis showed that the effect of famine exposure on AAD was more pronounced in female, smokers, BMI ≥ 24 kg/m2 and hypertensive patients.ConclusionsWe observed that exposure to famine during early life was an independent risk factor for AAD in adulthood; this effect was not modified by gender, BMI, smoking, hypertension and diabetes.Yu-qing HUANG and Lin LIU are equally to this paper.

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The relationship between famine exposure during early life and ascending aorta dilatation in adults

British Journal Of Nutrition ◽

10.1017/s0007114521001161 ◽

2021 ◽

pp. 1-29

Author(s):

Yu-qing Huang ◽

Lin Liu ◽

Kenneth Lo ◽

Yu-ling Yu ◽

Chao-lei Chen ◽

...

Keyword(s):

Early Life ◽

Chinese Population ◽

Ascending Aorta ◽

Late Childhood ◽

Cardiac Ultrasound ◽

Multivariate Logistic Regression ◽

Fetal Period ◽

Famine Exposure ◽

Aorta Dilatation ◽

The Relationship

Abstract Background and aims: The relationship between exposure to famine in early life and the risk of ascending aorta dilatation (AAD) in adulthood is still unclear, therefore we aimed to examine the association in a Chinese population. Methods and results: We investigated the data of 2,598 adults that were born between 1,952 and 1,964 in Guangdong, China. All enrolled subjects were categorized into five groups: not exposed to famine, exposed during fetal period, and exposed during early, mid or late childhood. AAD was assessed by cardiac ultrasound. Multivariate logistic regression and interaction tests were performed to estimate the odds ratio (OR) and confidence interval (CI) on the association between famine exposure and AAD. There were 2,598 (943 male, mean age 58.3 ± 3.68 years) participants were enrolled, and 270 (10.4%) subjects with AAD. We found that famine exposure (OR=2.266, 95% CI: 1.477, 3.477, P=0.013) associated with elevated AAD after adjusting for multiple confounders. In addition, compared with the non-exposure group, the adjusted ORs for famine exposure during fetal period, early, mid or late childhood were 1.374 (95% CI: 0.794, 2.364, P=0.251), 1.976 (95% CI: 1.243, 3.181, P=0.004), 1.929 (95% CI: 1.237, 3.058, P=0.004) and 2.227 (95% CI: 1.433, 3.524, P<0.001), respectively. Subgroup analysis showed that the effect of famine exposure on the association with AAD was more pronounced in female, current smokers, people with BMI ≥24 kg/m2 and hypertensive patients. Conclusion: We observed that exposure to famine during early life was linked to AAD in adulthood.

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Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American Society of Echocardiography and American College of Emergency Physicians

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2010.10.005 ◽

2010 ◽

Vol 23 (12) ◽

pp. 1225-1230 ◽

Cited By ~ 410

Author(s):

Arthur J. Labovitz ◽

Vicki E. Noble ◽

Michelle Bierig ◽

Steven A. Goldstein ◽

Robert Jones ◽

...

Keyword(s):

Consensus Statement ◽

Cardiac Ultrasound ◽

Emergency Physicians ◽

Focused Cardiac Ultrasound ◽

American Society

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Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians

BMC Medical Education ◽

10.1186/1472-6920-14-25 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 25

Author(s):

Heloisa A Gaspar ◽

Samira S Morhy ◽

Alessandro C Lianza ◽

Werther B de Carvalho ◽

Jose L Andrade ◽

...

Keyword(s):

Cardiac Ultrasound ◽

Emergency Physicians ◽

Training Course ◽

Focused Cardiac Ultrasound

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Correction to: Isolated ascending aorta dilatation is associated with increased risk of abdominal aortic aneurysm

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01553-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Enrique Gallego-Colon ◽

Chaim Yosefy ◽

Evgenia Cherniavsky ◽

Azriel Osherov ◽

Vladimir Khalameizer ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Ascending Aorta ◽

Abdominal Aortic ◽

Increased Risk ◽

Aorta Dilatation

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One clot after another in COVID-19 patient: diagnostic utility of handheld echocardiogram

Oxford Medical Case Reports ◽

10.1093/omcr/omaa141 ◽

2021 ◽

Vol 2021 (2) ◽

Author(s):

Gini Priyadharshini Jeyashanmugaraja ◽

Evgeny Shloknik ◽

Deborah Tosin Akanya ◽

Kristin Stawiarski ◽

Christopher Winterbottom ◽

...

Keyword(s):

Right Ventricular ◽

Care Setting ◽

Pressure Overload ◽

Massive Pulmonary Embolism ◽

Cardiac Ultrasound ◽

Ventricular Dilation ◽

Severe Respiratory Distress ◽

Systemic Thrombolysis ◽

Focused Cardiac Ultrasound ◽

Right Ventricular Dilation

ABSTRACT A 63-year-old woman was admitted with severe respiratory distress requiring mechanical ventilation and shock requiring vasopressor support. She was found to have COVID-19 pneumonia. Focused cardiac ultrasound performed for evaluation of shock was significant for right ventricular dilation and dysfunction with signs of right ventricular pressure overload. Given worsening shock and hypoxemia systemic thrombolysis was administered for presumed massive pulmonary embolism with remarkable improvement of hemodynamics and respiratory failure. In next 24 h patient’s neurologic status deteriorated to the point of unresponsiveness. Emergent computed tomography showed multiple ischemic infarcts concerning for embolic etiology. Focused cardiac ultrasound with agitated saline showed large right to left shunt due to a patent foramen ovale. This was confirmed by transesophageal echocardiogram, 5 months later. This case highlights strengths of focused cardiac ultrasound in critical care setting and in patients with COVID-19 when access to other imaging modalities can be limited.

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