Key result
Echo screening for AAOCA proves feasible but yields lower detection rates than CT.
Why the study?
Anomalous aortic origin of coronary arteries is the second most common cause of sudden cardiac death in athletes, motivating an analysis of the feasibility and detection rate of echocardiography.
Is echocardiography feasible and accurate for detecting anomalous aortic origin of coronary arteries in children and athletes?
Systematic Review (n=33,592)
Is echocardiography feasible and accurate for detecting anomalous aortic origin of coronary arteries in children and athletes?
Echocardiography is a feasible and accurate screening tool for anomalous aortic origin of coronary arteries in athletes and children, though standardization of views and definitions is needed to improve sensitivity.
Echocardiography remains feasible for AAOCA screening but detects fewer cases than CT; extends systematic evidence while underscoring need for standardized protocols.
Anomalous aortic origin of coronary arteries (AAOCA) represents a rare congenital heart disease. However, this disease is the second most common cause of sudden cardiac death in apparently healthy athletes. The aim of this systematic review is to analyze the feasibility and the detection rate of AAOCA by echocardiography in children and adults. A literature search was performed within the National Library of Medicine using the following keywords: coronary artery origin anomalies and echocardiography; then, the search was redefined by adding the keywords: athletes, children, and high take-off. Nine echocardiographic studies investigating AAOCA and a total of 33,592 children and adults (age range: 12-49 years) were included in this review. Of these, 6599 were athletes (12-49 years). All studies demonstrated a high feasibility and accuracy of echocardiography for the evaluation of coronary arteries origin as well as their proximal tracts. However, some limitations exist: the incidence of AAOCA varied from 0.09% to 0.39% (up to 0.76%) and was lower than described in computed tomography series (0.3-1.8%). Furthermore, echocardiographic views for the evaluation of AAOCA and the definition of "minor" defects (e.g., high take-off coronary arteries) have not been standardized. An echocardiographic protocol to diagnose the high take-off of coronary arteries is proposed in this article. In conclusion, the screening of AAOCA by echocardiography is feasible and accurate when appropriate examinations are performed; however, specific acoustic windows and definitions of defects other than AAOCA need to be standardized to improve sensitivity and specificity.
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Cantinotti et al. (2021) conducted a systematic review in Anomalous aortic origin of coronary arteries (AAOCA) (n=33,592). Echocardiography vs. Computed tomography was evaluated on Feasibility and detection rate of AAOCA. Echocardiographic screening for anomalous aortic origin of coronary arteries is feasible, but yielded a lower detection rate (0.09-0.76%) compared to computed tomography series (0.3-1.8%).
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