Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
JACC Cardiovasc Imaging. 2019 Nov;12(11 Pt 1):2182-2192. doi: 10.1016/j.jcmg.2018.11.033. Epub 2019 Feb 13.
This meta-analysis investigated the diagnostic values of transthoracic echocardiography (TTE), 2-dimensional (2D) and 3-dimensional (3D) transesophageal echocardiography (TEE), and multidetector-row computed tomography (MDCT) in patients with suspected mechanical prosthetic valve obstruction (PVO) for detecting subprosthetic mass and differentiating its causes.
Diagnostic values of advanced imaging modalities, such as MDCT and TEE, for the detection and differentiation of PVO have not been investigated.
PubMed and EMBASE were systematically searched for studies that evaluated PVO using imaging modalities. The modified Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate study quality. Pooled sensitivity of each modality for PVO detection and pooled diagnostic accuracy of TEE and MDCT for differentiating the causes of PVO were analyzed. Study heterogeneity was also assessed.
Seventeen studies (229 patients) that used at least 1 index tool among TTE, TEE, or MDCT were included. For detecting a subprosthetic mass that caused PVO, 3D TEE and MDCT showed a higher sensitivity of 81% (95% confidence interval [CI]: 40% to 95%) and 88% (95% CI: 81% to 93%), respectively, compared with TTE (20%; 95% CI: 7% to 47%) and 2D TEE (68%; 95% CI: 46% to 84%). Pooled sensitivity and specificity for diagnosing thrombus as a cause of PVO was 75% (95% CI: 54% to 88%) and 75% (95% CI: 40% to 93%), respectively, for TEE and 45% (95% CI: 16% to 77%) and 90% (95% CI: 77% to 96%), respectively, for MDCT. Pooled sensitivity for diagnosing pannus as a cause of PVO was 62% (95% CI: 46% to 76%) for TEE and 85% (95% CI: 70% to 93%) for MDCT.
This meta-analysis suggested that MDCT and 3D TEE have higher sensitivity than do TTE and 2D TEE, and can be reliable imaging modalities for detecting a subprosthetic mass that causes PVO. Moreover, MDCT can more accurately differentiate the cause of PVO than does TEE.
本荟萃分析旨在研究经胸超声心动图（TTE）、二维（2D）和三维（3D）经食管超声心动图（TEE）以及多排螺旋计算机断层扫描（MDCT）在疑似机械人工心脏瓣膜梗阻（PVO）患者中的诊断价值，以检测瓣下赘生物并鉴别其病因。
尚未研究 MDCT 和 TEE 等先进影像学方法在检测和鉴别 PVO 中的诊断价值。
系统检索了评估使用影像学方法诊断 PVO 的研究，检索了 PubMed 和 EMBASE 数据库。使用改良的诊断准确性研究质量评估工具（QUADAS-2）对研究质量进行评估。分析每种方法检测 PVO 瓣下赘生物的敏感性汇总值，以及 TEE 和 MDCT 鉴别 PVO 病因的汇总诊断准确性。还评估了研究的异质性。
纳入了 17 项研究（229 名患者），这些研究使用了 TTE、TEE 或 MDCT 中的至少 1 种指标工具。对于检测导致 PVO 的瓣下赘生物，3D TEE 和 MDCT 的敏感性分别为 81%（95%置信区间[CI]：40%至 95%）和 88%（95% CI：81%至 93%），高于 TTE（20%；95% CI：7%至 47%）和 2D TEE（68%；95% CI：46%至 84%）。TEE 诊断血栓为 PVO 病因的敏感性和特异性汇总值分别为 75%（95% CI：54%至 88%）和 75%（95% CI：40%至 93%），MDCT 则分别为 45%（95% CI：16%至 77%）和 90%（95% CI：77%至 96%）。TEE 诊断 PVO 病因是假性瘤的敏感性为 62%（95% CI：46%至 76%），MDCT 为 85%（95% CI：70%至 93%）。
本荟萃分析表明，MDCT 和 3D TEE 的敏感性高于 TTE 和 2D TEE，可作为检测导致 PVO 的瓣下赘生物的可靠影像学方法。此外，MDCT 比 TEE 更能准确地鉴别 PVO 的病因。
