Co esponding au ho : Nadia Mohammed Awaji.
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
T ans ho acic echoca diog aphy uses o diagnose p oximal ao ic dissec ions in he
eme gency depa men : A sys ema ic e iew
Nadia Mohammed Awaji 1, *, Nadia Ali Alha i i 2 and Haja Alhussain Almezhe 3
1 Saudi Boa d eme gency medicine Senio Regis a , Eme gency Depa men , Khamis Mushai gene al hospi al, Khamis
Mushai , Saudi A abia.
2 Eme gency medicine depa men , A med Fo ced Hospi al Sou he n Region, Khamis Mushai , Saudi A abia.
3 Eme gency medicine depa men , Asee cen al hospi al, Abha, Saudi A abia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2258-2263
Publica ion his o y: Recei ed on 04 Ap il 2025; e ised on 11 May 2025; accep ed on 13 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1882
Abs ac
Acu e ype A ao ic dissec ion is among he mos dange ous ca dio ascula eme gencies. Ou goals we e o ga he he
mos up- o-da e clinical da a on TTE's diagnos ic es accu acy and assess i s po en ial applica ion in he ea men o
indi iduals wi h p obable AD. This s udy ollowed he PRISMA guideline. S udies ha employed TTE o examine ype A
o ascending dissec ion in people, whe he andomized o non- andomized, we e included because hey me a clea
e e ence s anda d. We sea ched, Embase, Scopus, MEDLINE, and Web o Science, he sea ch was conduc ed wi hou
ega d o language and includes s udies published be ween 2014 and 2024. We ound ha pa ien s wi h suspec ed ype
A AD can be iaged quickly using TTE as a i s -line me hod. I p o ides eme gency physicians wi h i al in o ma ion
o assis hem make decisions abou whe he o ans e pa ien s o specialized ins i u ions o p oceed swi ly o
ad anced ao ic imaging p ocedu es. TTE canno be used as a s and-alone es o ule in and ule ou ype A AD, e en
when i is used in conjunc ion wi h he AD isk sco e classi ica ion. P elimina y indings indica e ha TTE can apidly
p o ide c i ical diagnos ic in o ma ion in pa ien s p esen ing wi h shock o hypo ension, bu mo e ho ough
in es iga ion is equi ed.
Keywo ds: T ans ho acic Echoca diog aphy; Diagnose P oximal Ao ic Dissec ions; Eme gency Depa men
1. In oduc ion
One o he mos se ious ca dio ascula eme gencies is acu e ype A ao ic dissec ion (AD) [1,2]. Howe e , non-speci ic
symp oms migh make diagnosis di icul . Ce ain ao ic imaging echniques a e necessa y o an accu a e and ho ough
depic ion o ao ic ana omy and p oblems. Tools like as compu ed omog aphy (CT), magne ic esonance imaging (MRI),
ans ho acic echoca diog am (TTE), and ansesophageal echoca diog aphy a e essen ial in his p ocess. The se e i y
o he pa ien 's illness, he a ailabili y o an imaging modali y a he ins i u ion, and he p esence o a skilled imaging
specialis may all in luence he choice o modali y. Because o i s widesp ead use and speedy p oduc ion o high-
esolu ion, c isp 3D pic u es, CT scanne s a e he go- o op ion o assessing possible ao ic p oblems and ascula
ea men s, pa icula ly in eme gency si ua ions [3].
As a bedside diagnos ic solu ion, TTE p o ides mobili y and high a ailabili y. TTE is ecommended as he ini ial imaging
es o pa ien s suspec ed o ha ing AD by he Eu opean Ca diology Socie y and he Eu opean Echoca diog aphy
Associa ion. This is especially ad ised when a pa ien 's AD Risk Sco e indica es a low likelihood o AD [4]. Con i ma o y
imaging is necessa y o pa ien s wi h posi i e D-dime es indings because o hei high sensi i i y and lack o
speci ici y [5]. TTE has gained popula i y as a sc eening me hod because o i s accessibili y, non-in asi eness, and lack
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2258-2263
2259
o adia ion [6]. To help iden i y di ec and indi ec indica ions o AD, TTE makes i possible o see he ho acic ao a,
pe ica dium, and ca diac al es [7]. I he ascending ao a exhibi s ao ic wall hickening (diame e mo e han 5 mm)
o an in imal lap sepa a ing wo ao ic lumens, he di ec TTE sign is posi i e. An echoca diog aphic inding ha
indica es high- isk cha ac e is ics o consequences o AD, such as pe ica dial e usion o ca diac amponade, ao ic
egu gi a ion, o dila a ion o he ho acic ao ic oo (diame e mo e han 4 cm), is known as an indi ec TTE sign [8].
We aimed o compile he mos ecen clinical da a on he diagnos ic es accu acy o TTE and e alua e i s po en ial use
in ea ing pa ien s wi h suspec ed AD.
Figu e 1 PRISMA conso cha o s udies selec ion
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2258-2263
2260
2. Me hod
We conduc ed a comp ehensi e analysis o esea ch compa ing TTE's e ec i eness in e alua ing ype A AD. The
P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses (PRISMA) s a emen was adhe ed o in his
in es iga ion. We included s udies wi h a well-de ined e e ence s anda d ha used TTE o in es iga e ype A o
ascending dissec ion in humans, whe he andomized o non- andomized. S udies ha we e p ospec i e o
e ospec i e we e accep able. Animal expe imen s, e iews, c i icism, and case epo s we e no included.
The ollowing sea ch keywo ds we e used in a sys ema ic sea ch ac oss Embase, Scopus, MEDLINE, and Web o Science:
echoca diog aphy, sonog aphy, ul asound, ype A ao ic disec ion, p oximal, ascending. S udies published be ween
2014 and 2024 we e included in he sea ch, wi h no language cons ain s.
Based on he p e iously men ioned c i e ia, wo w i e s independen ly e iewed and chose pape s; di e ences we e
se led by consensus wi h a hi d au ho . Following sc eening, s udies ound in a ious da abases we e de-duplica ed.
The whole ex o he a icles ha made i beyond he i s sc eening was examined (Fig 1). Resul s om he e e ence
s anda d we e used o de e mine ou comes in cases when only incomple e in o ma ion was a ailable. Da ase s we e
os ensibly g ouped acco ding o sonog aphic esul s based on he p esen a ion o indings in he included esea ch. The
popula ion, s udy design, s udy goal, key indings, conclusion, and e e ence s anda d we e all e ie ed.
3. Resul
We included 5 a icles in his sys ema ic e iew (Fig 1), he a icles assessed he use o TTE in de ec ion o acu e AD in
eme gency depa men , au ho s used CT, CT angiog aphy and au opsy as e e ence s anda ds es s when compa e TTE
o o he modali ies. Hui e al. (2022) epo ed ha 33.0% o he pa ien s had a ype A AD diagnosis. The sensi i i y and
speci ici y o Type A AD we e 43.0% and 97.0%, espec i ely, when di ec TTE signals we e p esen , and 97.0% and
78.0%, espec i ely, when any TTE indica ion was p esen . The addi i e ad an age o TTE was g ea es in hose wi h a
low clinical isk o Type A AD. When he e we e no di ec symp oms o TTE and he isk sco e was less han 1, he
sensi i i y o he Type A AD ule-ou was 98.4%. When compa ed o CT angiog aphy, eme gency physician TTE showed
a sensi i i y o 86.4% and a speci ici y o 100.0% (Wang e al., 2020). The doo - o-diagnosis ime o he TTE g oup was
10.5 minu es, while i was 79.0 minu es o he con ol g oup. The doo - o-CT angiog aphy, examina ion, and doo - o-
a ge ed- ea men imings did no di e be ween he TTE and con ol g oups. The TTE g oup had a 4.2% in-hospi al
dea h a e and a 25.0% 3-mon h pos -discha ge mo ali y a e, compa ed o 9.1% and 20.8% o he con ol g oup. Main
cha ac e is ics o he included s udies we e p esen ed in (Table 1).
Acco ding o Sobczyk e al. s udy he e is no app eciable di e ences be ween CT and TTE in e ms o diagnosing
p oximal AD. Pa ien s wi h ao ic al e abno mali ies we e mo e likely o ha e a composi e ansplan , whe eas pa ien s
wi h no mal ao ic al e images we e mo e likely o ecei e al e spa ing su ge y (50.8%). Acco ding o he R-
Spea man s a is ics, he e is a s ong posi i e co ela ion be ween he maximum diame e o he ascending ao a as
assessed by TTE and CT, as well as be ween TTE and in aope a i e measu emen .
Table 1 s udy design, aim and main indings o he includes s udies
Ci a ion
S udy design
S udy aim
Main indings
Naze ian
e al.,
2014 [9]
Mul icen e
p ospec i e
To assess he diagnos ic
e icacy o TTE conduc ed
by eme gency doc o s in
suspec ed ype A AD, bo h
by i sel and in conjunc ion
wi h he AD de ec ion isk
sco e.
The sensi i i y o diagnosing ype A AD was 88%
when any TTE indica ion o AD was de ec ed.
Diagnos ic sensi i i y was aised o 96% in he
p esence o any FOCUS indica ion o an AD de ec ion
isk sco e g ea e han 0. Di ec FOCUS sign
iden i ica ion showed a 94% speci ici y, whe eas
di ec TTE sign de ec ion combined wi h an ADD isk
sco e > 1 had a 98% speci ici y.
Hui e al.,
2022 [10]
Re ospec i e
obse a ional
s udy
To assess TTE's
e ec i eness in ype A AD
sc eening in indi iduals
who ha e had an ST-
segmen aised myoca dial
in a c ion.
33.0% we e diagnosed wi h ype A AD. Fo Type A AD,
he sensi i i y and speci ici y we e 43.0% and 97.0%,
espec i ely, o he p esence o di ec TTE signals
and 97.0% and 78.0%, espec i ely, o he p esence
o any TTE sign. In indi iduals wi h a low clinical
likelihood o Type A AD, he addi i e bene i o TTE
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2258-2263
2261
was mos no iceable. The sensi i i y o he Type A AD
ule-ou was 98.4% when he isk sco e was ≤1 and
he e we e no di ec TTE symp oms.
Wang e
al., 2020
[6]
Single cen e
p ospec i e
To in es iga e how
eme gency physicians' use
o TTE a ec s AD pa ien s'
diagnosis, ca e, and sa e y in
eme gency si ua ions.
In he TTE g oup, eme gency physician TTE had a
sensi i i y o 86.4% and a speci ici y o 100.0% when
compa ed o CT angiog aphy. The TTE g oup's doo -
o-diagnosis ime was 10.5 minu es, whe eas he
con ol g oup's was 79.0 minu es. The e we e no
di e ences be ween he TTE and con ol g oups in he
doo - o-CT angiog aphy, examina ion, o doo - o-
a ge ed- ea men imes. The TTE g oup saw an in-
hospi al dea h a e o 4.2% and a 3-mon h pos -
discha ge mo ali y a e o 25.0%, while he con ol
g oup expe ienced a es o 9.1% and 20.8%.
Tokuda e
al., 2018
[11]
Single cen e
e ospec i e
To e alua e he p edic i e
alues o AD ma ke s in
s oke o ansien ischemic
a ack pa ien s.
Pa ien s wi h AD had subs an ially g ea e ini ial D-
dime concen a ions, sys olic blood p essu e
la e ali y, and mo e o en pe ica dial e usion on
echoca diog aphy and common ca o id a e y
dissec ion on TTE han pa ien s wi hou AD. AD on
TTE has adequa e sensi i i y and seems o be he mos
disease-speci ic esul .
Sobczyk e
al., 2015
[12]
Compa a i e
s udy
The pu pose o he s udy
was o de e mine i TTE is
mo e accu a e han CT in
diagnosing acu e ype A AD.
The e we e no disce nible di e ences be ween CT
and TTE in e ms o de ec ing p oximal AD, acco ding
o s a is ical analysis. A composi e g a was he
p e e ed me hod o indi iduals wi h anomalies o
he ao ic al e, whe eas he al e spa ing su ge y
was mo e likely o be pe o med on pa ien s wi h
no mal ao ic al e images (50,88%). The maximal
diame e o he ascending ao a as de e mined by TTE
and CT, as well as TTE and in aope a i e
measu emen , ha e a high posi i e connec ion,
acco ding o he R-Spea man s a is ics.
4. Discussion
The pu pose o his s udy was o assess TTE's abili y o diagnose p oximal AD by iden i ying ce ain sonog aphic
ea u es. We ound ha , gi en i s low likelihood a io, s ong diagnos ic odds a io, low sensi i i y, and low numbe
needed o ea , he sys ema ic e alua ion o each sonog aphic cha ac e is ic may help educe suspicion o p oximal
AD. The iden i ica ion o a speci ic g oup combined wi h nega i e ul asound esul s a e he me hodical e alua ion o
any sonog aphic ea u e can e ec i ely and con iden ly ule ou p oximal AD.
In con as o Naze ian e al. [9] indings o eme gency doc o s pe o med TTE, which showed sensi i i y o 88% and
speci ici y o 96%, Wang e al. [6] s udy e ealed ha he sensi i i y o TTE o ype A AD was 90.9% and he speci ici y
was 100%. The disc epancy sugges s ha specialized aining and expe ise ha e a signi ican impac on he es 's
sensi i i y and speci ici y. A longe aining pe iod and a mo e uni o m pic u e ga he ing p ocedu e may also help o
enhance he ou come. Fo he i s 48 hou s, he pa ien dea h a e o ype A AD ises by 1% o 2% e e y hou [13].
The e o e, o his kind o pa ien , educing he diagnos ic ime is essen ial. In Wang e al.'s s udy, he eme gency doc o s
pe o med TTE examina ion was conduc ed concu en ly wi h he pa ien 's s anda d diagnos ic and he apeu ic
p ocedu es, and i did no leng hen hose imes. This ex a e alua ion had no e ec on he he apeu ic plan because he
a ending physician on du y was blinded o he es esul s.
TTE has so a demons a ed a ying deg ees o sensi i i y and speci ici y o he iden i ica ion o ypical ype A AD
when conduc ed by expe ienced ca diologis s in a ious clinical si ua ions [7,14]. The sensi i i y o di ec sonog aphic
signs o AD was signi ican ly highe in a s udy by Cecconi and colleagues [7] e alua ing he diagnos ic pe o mance o
TTE pe o med by skilled ca diologis s wi h ex ensi e expe ience in 270 pa ien s wi h suspec ed ype A AD in he
in ensi e ca e uni o eme gency depa men . This sugges s ha speci ic aining and expe ience in TTE signi ican ly
a ec he sensi i i y o his echnique [7].
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2262
TTE canno , howe e , be u ilized as a s and-alone es o ule in o ule ou ype A AD in all indi iduals, as demons a ed
by ea lie esea ch. Fo example, in Naze ian e al. [9] coho , i he decision o send pa ien s o immedia e su ge y had
been based solely on he de ec ion o a "no mal TTE," six po en ially li e-sa ing ope a ions would ha e been missed,
and 14 inapp op ia e in e en ions would ha e been gene a ed i he decision had been based on he diagnosis o
in imal lap/in amu al hema oma a TTE examina ion. Ad anced ao ic imaging in es iga ions like CT angiog aphy,
TEE, o MRI mus be used o compa e he poo accu acy o TTE wi h 95–100% sensi i i y and 94–100% speci ici y [15–
17].
Lis o abb e ia ions
• TTE, T ans ho acic echoca diog aphy
• AD, Ao ic dissec ion
• MRI, magne ic esonance imaging
• CT, compu ed omog aphy
• PRISMA, P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses
5. Conclusion
TTE can be used as a quick i s -line ool o iage pa ien s wi h suspec ed ype A AD. I gi es eme gency physicians
c ucial in o ma ion o help decide whe he o mo e quickly o ad anced ao ic imaging es s o o ans e pa ien s o
specialized acili ies. E en when pe o med in conjunc ion wi h he AD isk sco e ca ego iza ion, TTE canno be u ilized
as a s and-alone es o ule in and ule ou ype A AD. Al hough mo e ex ensi e esea ch is necessa y, p elimina y
esul s show ha TTE can quickly gi e i al diagnos ic in o ma ion in pa ien s p esen ing wi h shock o hypo ension.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
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