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Pasteur-Rousseau A, Souibri K, Fouassier D, Mehier B, Wong T, Paul JF. [Benefits and drawbacks of CT scan as a triple rule-out exam in acute chest pain to exclude acute coronary syndrome, pulmonary embolism and aortic dissection]. Ann Cardiol Angeiol (Paris) 2023; 72:101641. [PMID: 37703710 DOI: 10.1016/j.ancard.2023.101641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 09/15/2023]
Abstract
Chest pain is one of the major causes for admission in the Emergency Room in most countries and one of the principal reasons for urgent consultation with a cardiologist or a general practitioner. After clinical examination and initial biological measurements, substantial patients require further explorations. CT scan allows the search for pulmonary embolism in the early stage of pulmonary arteries iodine contrast exploration. During the same exam at the systemic arterial phase, the search for aortic dissection or coronary artery disease is possible while exploring the later contrast in the aortic artery. This triple rule-out exam allows correct diagnosis in case of acute chest pain with suspected pulmonary embolism, aortic dissection and other acute aortic syndromes or acute coronary syndrome. But X-rays are substantially increased as well as iodine contrast agent quantity while exam quality is globally decreased. Artificial intelligence may play an important role in the development of this protocol.
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Affiliation(s)
- Adrien Pasteur-Rousseau
- Institut Cœur Paris Centre, 31 rue du Petit Musc, 75004 Paris, France; Clinique Turin, 5 rue de Turin, 75008 Paris, France; Clinique du Parc Monceau, 21 rue du Chazelles, 75017 Paris, France; Clinique de l'Alma, 166 Rue de l'Université, 75007 Paris, France; Clinique Floréal, 40 Rue Floréal, 93170 Bagnolet, France; Centre de Santé Cap Horn, 55 rue Gaston Lauriau, 93100 Montreuil, France.
| | - Karam Souibri
- Institut Cœur Paris Centre, 31 rue du Petit Musc, 75004 Paris, France; Clinique Turin, 5 rue de Turin, 75008 Paris, France.
| | - David Fouassier
- Centre Hospitalier Universitaire Hôtel-Dieu, 1 Parvis Notre-Dame - Pl. Jean-Paul II, 75004 Paris, France.
| | - Benjamin Mehier
- Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France.
| | - Tatiana Wong
- Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France.
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Sun P, Li Z, Guo W, Moreira P. Evidence on the need for early identification of asymptomatic true abdominal aortic aneurysm in pregnancy: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231173789. [PMID: 37745087 PMCID: PMC10515510 DOI: 10.1177/2050313x231173789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/18/2023] [Indexed: 09/26/2023] Open
Abstract
Pregnant women are more likely to face cardiovascular disease than non-pregnant women. However, abdominal aortic aneurysm is an extremely rare complication of pregnancy. Abdominal aortic aneurysms in pregnancy are difficult to identify in the early stage and are often diagnosed only when the symptoms have manifested. We report the case of a multiparous 35-year-old patient with a history of abnormal ascending aorta and ruled-out Marfan syndrome by genetic testing. After a multidisciplinary medical team evaluation, she delivered a live baby by cesarean section at 37 weeks of gestation, and the abdominal aortic aneurysm was repaired simultaneously. This case offers evidence-based recommendations for obstetricians to carry out preventive imaging examination for pregnant women with similar risk factors and provide successful experience in prenatal examination for similar diseases.
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Affiliation(s)
- Ping Sun
- Department of Obstetrics and Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhaoqi Li
- Department of Obstetrics and Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Guo
- Department of Obstetrics and Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Paulo Moreira
- International Healthcare Management Research and Development Center, Shandong Provincial Qianfoshan Hospital, Jinan, China
- Atlantica Instituto Universitario, Gestao em Saude, Oeiras, Portugal
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Kuipers AL, Carr JJ, Terry JG, Nair S, Barinas-Mitchell E, Wheeler V, Zmuda JM, Miljkovic I. Aortic Area as an Indicator of Subclinical Cardiovascular Disease. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2203100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim:
Outward arterial remodeling occurs early in cardiovascular disease (CVD) and, as such, measuring arterial dimension may be an early indicator of subclinical disease.
Objective:
The objective of our study was to measure area at three aortic locations: The ascending thoracic (ASC), the descending thoracic (DSC), and the abdominal (ABD), and to test for association with traditional CVD risk factors and subclinical CVD throughout the body.
Methods:
We measured ASC, DSC, and ABD using computed tomography (CT) in 408 African ancestry men aged 50-89 years. We assessed prevalent CVD risk factors via participant interview and clinical exam, and subclinical CVD, including carotid atherosclerosis through B-mode carotid ultrasound, vascular calcification via chest and abdominal CT, and arterial stiffness via pulse-wave velocity (PWV).
Results:
As expected, all aortic areas were in correlation with each other (r=0.39-0.63, all p<0.0001) and associated with greater age, greater body size, and hypertension (p≤0.01 for all). After adjustment for traditional CVD risk factors, ASC was positively associated with carotid atherosclerosis (p<0.01). A greater area at each location was associated with greater PWV (p<0.03 for all), with the DSC region showing the most significant association.
Conclusion:
This is the first study to test the association of aortic area measured at multiple points with subclinical CVD. We found that combined CT assessment of ascending and descending aortic area may indicate a high risk of prevalent subclinical CVD elsewhere in the body independent of age, body size, and blood pressure.
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Gallego-Colon E, Yosefy C, Cherniavsky E, Osherov A, Khalameizer V, Piltz X, Pery M, Bruoha S, Jafari J. Correction to: Isolated ascending aorta dilatation is associated with increased risk of abdominal aortic aneurysm. J Cardiothorac Surg 2021; 16:168. [PMID: 34103050 PMCID: PMC8188711 DOI: 10.1186/s13019-021-01553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Enrique Gallego-Colon
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel.
| | - Chaim Yosefy
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Evgenia Cherniavsky
- Department of Medical Imaging, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Azriel Osherov
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Vladimir Khalameizer
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Xavier Piltz
- Department of Medical Imaging, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Marina Pery
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Sharon Bruoha
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Jamal Jafari
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
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