用于先天性心脏病诊断的胎儿超声心动图：一项荟萃分析、效能分析和缺失数据分析。

Fetal echocardiography for congenital heart disease diagnosis: a meta-analysis, power analysis and missing data analysis.

作者信息

Liu Hong, Zhou Jie, Feng Qiao-Ling, Gu Hai-Tao, Wan Gang, Zhang Huo-Ming, Xie Yong-Jun, Li Xiao-Song

机构信息

Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, PR China Collaborative Group of Congenital Heart Disease, Department of Pediatric Cardiology, Jiangsu Women's and Children's Health of Nanjing Medical University, PR China Research Institute of Heart, Lung and Blood Vessel Diseases, Jiangsu Provincial Academy of Clinical Medicine, PR China.

Study Group of Echocardiography, Department of Sonographic Diagnostic Medicine, First Affiliated Hospital of Nanjing Medical University, PR China.

出版信息

Eur J Prev Cardiol. 2015 Dec;22(12):1531-47. doi: 10.1177/2047487314551547. Epub 2014 Sep 25.

DOI:10.1177/2047487314551547

PMID:25258423

Abstract

BACKGROUND

Prenatal ultrasonography is the most widely available diagnostic test for fetal congenital heart disease (CHD), but the factors influencing its diagnostic accuracy remain uncertain despite extensive research. The aim of the present study was to evaluate the potential role of demographic, clinical and ultrasonographic characteristics on diagnostic yields for detecting CHD.

METHODS

A systematic search of PubMed, ISI Web of Science, SinoMed, and the Cochrane Library was performed to identify studies assessing the accuracy of prenatal ultrasound in the detection of CHD. A random effects model was used to generate pooled sensitivity and specificity in addition to summary receiver operating characteristic (SROC) curves.

RESULTS

Overall, prenatal ultrasound in the detection of CHD had a moderate sensitivity of 68.1% (95% CI 59.6-75.5) and a favorable specificity of 99.9% (99.7-99.9). Risk level and gestation age were independent predictors of diagnostic performance for detecting CHD (p = 0.004 vs. p = 0.002, respectively). The pooled sensitivities significantly increased to varying extents with the following echocardiographic views: 48.7% (34.8-67.2) for four-chamber view (4CV); 58.0% (40.3-73.9) for a combination of 4CV and outflow tract views (OTV); 73.5% (59.2-84.1) for combination of 4CV, OTV and three vessels and trachea view (3VTV); 77.1% (62.0-87.5) for extensive cardiac echocardiography examination (ECEE); and 89.6% (81.0-94.6) for spatiotemporal image correlation (STIC).

CONCLUSIONS

Prenatal ultrasound is a powerful tool for the diagnosis of CHD; however, a single ultrasonographic regime is not definitive on its own and must be interpreted in the context of demographic and clinical characteristics.

摘要

背景

产前超声检查是胎儿先天性心脏病（CHD）最广泛应用的诊断检查方法，但尽管进行了广泛研究，影响其诊断准确性的因素仍不明确。本研究的目的是评估人口统计学、临床和超声特征对CHD诊断率的潜在作用。

方法

对PubMed、ISI科学网、中国生物医学文献数据库和考克兰图书馆进行系统检索，以确定评估产前超声检测CHD准确性的研究。除了汇总接受者操作特征（SROC）曲线外，还使用随机效应模型生成合并敏感性和特异性。

结果

总体而言，产前超声检测CHD的敏感性为68.1%（95%CI 59.6 - 75.5），处于中等水平，特异性为99.9%（99.7 - 99.9），表现良好。风险水平和孕周是检测CHD诊断性能的独立预测因素（分别为p = 0.004和p = 0.002）。随着以下超声心动图视图的使用，合并敏感性有不同程度的显著提高：四腔心视图（4CV）为48.7%（34.8 - 67.2）；4CV和流出道视图（OTV）联合为58.0%（40.3 - 73.9）；4CV、OTV和三血管及气管视图（3VTV）联合为73.5%（59.2 - 84.1）；广泛心脏超声心动图检查（ECEE）为77.1%（62.0 - 87.5）；时空图像相关（STIC）为89.6%（81.0 - 94.6）。