A relevant extracardiac domain for echocardiography.
Editor: We agree with the conclusions of Earnshaw et al. (1) that
stresses again the usefulness of population screening for abdominal aortic
aneurysm (AAA) as recently demonstrated by the MASS study (2). We would
like to add another possible and cost effective way to discover silent AAA
by extending the domain for echocardiography.
Indeed AAA shares with hypertensive (H) and coronary (CAD) patients common
risk factors (male sex, age, smoke, hypercholesterolemia) and most of the
recognized H and CAD patients undergo echocardiography but, according to
the 2003 ACC/AHA/ASE guidelines update for echocardiography (3), only the
thoracic aorta is considered. The additional evaluation of the abdominal
aorta from the celiac trunk to the bifurcation of the iliac arteries would
increase the diagnostic yield of echocardiography.
In order to test the feasibility of our proposal we looked for the
presence of AAA (a transverse diameter >30 mm was needed) in 100 H and
100 IHD patients, (age 67± 11 yrs (SD), 61 % males), consecutively studied
in our echocardiography laboratory. A 2.5 MHz probe was utilized on a 2000
Hewlett Packard echocardiograph, avoiding purposely the use of a dedicated
ultrasound probe for the abdomen. We detected in 6 % of H and in 9 % of
IHD patients the presence of AAA; an inadequate resolution was present in
1 % of the subjects. The measurements were than compared and found all
consistent with those obtained with a dedicated (4.5 Hz) probe for
abdominal echo scan. Of relevance, all AAA patients were clinically
silent. A rapid maneuver is therefore at hand during a routine
echocardiographic examination to unhide a potentially lethal AAA.
1) Earnshaw JJ, Shaw E, Whyman MR, Poskitt KR, Heather BP. Screening for
abdominal aortic aneurysms in men. BMJ 2004; 328: 1122-1124.
2) Ashton HA, Buxton MJ, Day NE et al. The Multicentre Aneurysm Screening
Study (MASS) into the effect of abdominal aortic aneurysm screening on
mortality in men: a randomised controlled trial. Lancet 2002; 360:1531-9.
3) Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003
Guideline Update for the Clinical Application of Echocardiography: Summary
Article: A Report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to
Update the 1997 Guidelines for the Clinical Application of
Echocardiography). Circulation 2003;108: 1146-1162.
Competing interests: No competing interests