Wong Sophia, Spina Roberto, Toemoe Sianne, Dhital Kumud
Prince of Wales Clinical School, Sydney, Australia
Department of Cardiology, St Vincent's Hospital, Sydney, Australia.
Interact Cardiovasc Thorac Surg. 2016 Apr;22(4):480-6. doi: 10.1093/icvts/ivv362. Epub 2015 Dec 30.
A best evidence topic was written according to a structured protocol. The question addressed was: is cardiac magnetic resonance (CMR) imaging as accurate as echocardiography in the assessment of aortic valve stenosis? Altogether 239 papers were found using the reported search. Only 12 demonstrated the best evidence to answer the clinical question. Nine of these 12 papers found CMR to correlate well with transthoracic echocardiography (TTE) or transoesophageal echocardiography (TOE) in the evaluation of aortic valve stenosis. When aortic valve areas were measured with cardiac tomography (CT) or cardiac catheterization (CC), four papers found CMR to be more accurate than TTE. Eight of 12 papers found CMR to have excellent reliability and reproducibility, as demonstrated by the low inter- and intraobserver variability. Four papers did not estimate intra- or interobserver variability. One paper noted a sensitivity and specificity of 96 and 100%, respectively, when using CMR to detect severe aortic stenosis (AS) that had been diagnosed during CC. A second paper noted a lower sensitivity and specificity of 78 and 89%, respectively, but this was still better than the sensitivities and specificities found when using TOE or TTE to detect severe AS, as noted on CC. We conclude that current evidence finds echocardiography and CMR to be equally reliable in assessing aortic stenosis. CMR has better inter- and intraobserver reliability and demonstrates an advantage over echocardiography in the detection of severe AS with greater specificity and sensitivity. The final choice, however, is as likely to be influenced by the availability of magnetic resonance imaging and expertise in interpreting the results as by accuracy and reliability.
根据结构化方案撰写了一个最佳证据主题。所探讨的问题是：在评估主动脉瓣狭窄方面，心脏磁共振成像（CMR）是否与超声心动图一样准确？通过报告的检索共找到239篇论文。其中只有12篇展示了回答该临床问题的最佳证据。这12篇论文中有9篇发现CMR在评估主动脉瓣狭窄时与经胸超声心动图（TTE）或经食管超声心动图（TOE）相关性良好。当用心脏断层扫描（CT）或心导管检查（CC）测量主动脉瓣面积时，4篇论文发现CMR比TTE更准确。12篇论文中有8篇发现CMR具有出色的可靠性和可重复性，观察者间和观察者内的变异性较低证明了这一点。4篇论文未评估观察者内或观察者间的变异性。一篇论文指出，使用CMR检测在CC期间已诊断出的严重主动脉狭窄（AS）时，敏感性和特异性分别为96%和100%。第二篇论文指出敏感性和特异性分别较低，为78%和89%，但这仍优于使用TOE或TTE检测CC上所指出的严重AS时的敏感性和特异性。我们得出结论，目前的证据表明超声心动图和CMR在评估主动脉狭窄方面同样可靠。CMR在观察者间和观察者内具有更好的可靠性，并且在检测严重AS方面比超声心动图具有优势，特异性和敏感性更高。然而，最终的选择可能同样受到磁共振成像的可用性以及解读结果的专业知识的影响，就如同受到准确性和可靠性的影响一样。
