Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 Apr;50(4):643-50.e1.
doi: 10.1016/j.jemermed.2015.12.002. Epub 2016 Jan 29.

Evaluation of the Aortic Arch from the Suprasternal Notch View Using Focused Cardiac Ultrasound

Karen A Kinnaman  1 , Heidi H Kimberly  2 , Emanuele Pivetta  3 , Elke Platz  2 , Avni Chudgar  4 , Alexander Adduci  4 , Michael B Stone  2 , Joshua S Rempell  2
Affiliations
Observational Study

Evaluation of the Aortic Arch from the Suprasternal Notch View Using Focused Cardiac Ultrasound

Karen A Kinnaman et al. J Emerg Med. 2016 Apr.

Abstract

Background: The suprasternal notch view (SSNV) is an additional echocardiographic view not routinely used by emergency physicians (EPs) performing focused cardiac ultrasound (FOCUS).

Objective: This pilot study determined the ease and self-perceived accuracy of the SSNV as performed by EPs. Additionally, we assessed the accuracy of FOCUS including the SSNV in thoracic aortic measurements compared to chest CT angiography (CTA).

Methods: This was a prospective, observational, pilot study of adult patients undergoing chest CTA. Thoracic aortic measurements were recorded at the sinus of Valsalva, sinotubular junction, and ascending aorta at its widest diameter in the parasternal long axis (PSL) view and SSNV. EPs rated ease of acquisition and self-perceived accuracy of thoracic aorta measurements. Two blinded radiologists performed thoracic aortic CTA measurements at predefined locations corresponding to the ultrasound measurements.

Results: Of the 79 patients (median age 57 years) enrolled, the SSNV was obtained in 97% of cases. EPs rated the ease of obtaining the SSNV as "easy" in 64.5% of cases and "very difficult" in 7.6% of cases. The mean difference between ultrasound (FOCUS plus SSNV) and CTA measurements were 1.2 mm (95% limits of agreement -2.9 to 5.3) at the sinus of Valsalva, 1.0 mm (95% limits of agreement -5.5 to 3.6 mm) at the sinotubular junction, 0.8 mm (95% limits of agreement -6.2 to 4.6 mm) at the proximal ascending aorta, and 0.6 mm (95% limits of agreement -2.8 to 4.0) at the aortic arch.

Conclusions: Our findings suggest that the SSNV is an easily attainable and accurate view of the thoracic aorta that can be obtained by EPs in the majority of ED patients.

Keywords: aorta; cardiac; ultrasound.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Suprasternal notch view probe positioning.
Figure 2
Figure 2
(A) Parasternal long axis view with sites of measurement. (B) Suprasternal notch view (SSNV) with sites of measurement. 1 = sinus of Valsava; 2 = sinotubular junction; 3 = ascending aorta. AA = aortic arch; AO = ascending aorta; D = widest diameter of aortic arch measurement; LA = left atrium; LV = left ventricle; RV = right ventricle.
Figure 3
Figure 3
Study flow chart. SSNV = suprasternal notch view; CTA = computed tomography angiography; FOCUS = focused cardiac ultrasound; EP = emergency physician; US = ultrasound; OSH = outside hospital.
Figure 4
Figure 4
Survey results on ease of obtaining parasternal long axis (PSL) view and suprasternal notch view (SSNV) images (unable to obtain, very difficult to obtain, moderately difficult to obtain, easy to obtain).
Figure 5
Figure 5
Bland-Altman plots of ultrasound vs. computed tomography angiography (CTA) measurements. The difference between ultrasonography and CTA measurements (mm) is plotted against the mean ultrasound and CTA measurements. The horizontal line represents the mean difference at each location and the bold lines the 95% limits of agreement. TTE = transthoracic echocardiography.
See this image and copyright information in PMC

References

    1. Perkins AM, Liteplo A, Noble VE, et al. Ultrasound diagnosis of type A aortic dissection. J Emerg Med. 2010;38:490–3. - PubMed
    1. Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010;23:1225–30. - PubMed
    1. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) Eur Heart J. 2014;35:2873–926. - PubMed
    1. Gardin JM, Adams DB, Douglas PS, et al. Recommendations for a standardized report for adult transthoracic echocardiography: a report from the American Society of Echocardiography’s Nomenclature and Standards Committee and Task Force for a Standardized Echocardiography Report. J Am Soc Echocardiogr. 2002;15:275–90. - PubMed
    1. Taylor RA, Olivia I, Van Tonder R, et al. Point-of-care focused cardiac ultrasound for the assessment of thoracic aortic dimensions, dilation, and aneurysmal disease. Acad Emerg Med. 2012;19:244–7. - PubMed

Publication types

LinkOut - more resources