Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, 44195, USA.
Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
J Cardiovasc Comput Tomogr. 2021 Jul-Aug;15(4):313-321. doi: 10.1016/j.jcct.2020.11.008. Epub 2020 Nov 30.
To compare the diagnostic accuracy of transesophageal echocardiography (TEE) and cardiac computed tomography (CCT) in diagnosing infective endocarditis (IE).
TEE is a mainstay imaging modality for IE, while the use of CCT is becoming increasingly prevalent. Data directly comparing the diagnostic performance of these two imaging modalities for IE are limited.
We conducted a systematic review and meta-analysis of published literature in Embase, PubMed and Cochrane databases through October 1, 2020 for studies comparing diagnostic performance of CCT and TEE for the diagnosis of IE in the same patient populations. A meta-analysis of diagnostic accuracy was performed using the bivariate model based on studies that used surgical pathology as a reference standard for defining endocarditis. From a total of 10 studies included in the meta-analysis, a total of 872 patients were evaluated.
The pooled sensitivities and specificities of TEE for detecting vegetations were 96% and 83% respectively, whereas for CCT, they were 85% and 84%, respectively. In the prosthetic valve sub-group, the pooled sensitivities and specificities of TEE for detecting vegetations were 89% and 74% respectively, whereas for CCT, they were 78% and 94%, with CCT being more specific than TEE (p < 0.05). The pooled sensitivities and specificities of TEE for detecting periannular complications were 70% and 96% respectively, whereas for CCT, they were 88% and 93%, respectively. CCT showed a trend (p = 0.06) towards higher sensitivity than TEE for detection of periannular complications. The pooled sensitivities and specificities of TEE for detecting leaflet perforation were 79% and 93% respectively, whereas for CCT, they were 48% and 93% respectively, with TEE being more sensitive (p < 0.05). The two modalities also showed comparable diagnostic performance for detecting fistulae, paravalvular leaks and prosthetic valve dehiscence.
In a contemporary comparative meta-analysis, TEE and CCT demonstrated both good diagnostic accuracy for detecting valvular involvement and complications of IE. TEE performed better for detecting leaflet defects, whereas CCT performed better in cases of prosthetic valve involvement, and showed a trend towards improved detection of periannular complications. Appropriate, complementary use of both TEE and CCT in a multimodality imaging approach in clinical practice may achieve the highest diagnostic performance.
比较经食管超声心动图（TEE）和心脏计算机断层扫描（CCT）诊断感染性心内膜炎（IE）的准确性。
TEE 是 IE 的主要影像学检查方法，而 CCT 的应用越来越普遍。直接比较这两种影像学方法诊断 IE 的诊断性能的数据有限。
我们通过 Embase、PubMed 和 Cochrane 数据库对截至 2020 年 10 月 1 日发表的文献进行了系统评价和荟萃分析，以比较 CCT 和 TEE 在同一患者人群中诊断 IE 的诊断性能。使用基于以手术病理学为 IE 定义标准的研究的双变量模型对诊断准确性进行荟萃分析。在荟萃分析中，共纳入了 10 项研究，共评估了 872 例患者。
TEE 检测赘生物的汇总敏感性和特异性分别为 96%和 83%，而 CCT 分别为 85%和 84%。在人工瓣膜亚组中，TEE 检测赘生物的汇总敏感性和特异性分别为 89%和 74%，而 CCT 分别为 78%和 94%，CCT 的特异性优于 TEE（p<0.05）。TEE 检测瓣周并发症的汇总敏感性和特异性分别为 70%和 96%，而 CCT 分别为 88%和 93%。CCT 检测瓣周并发症的敏感性（p=0.06）有高于 TEE 的趋势。TEE 检测瓣叶穿孔的汇总敏感性和特异性分别为 79%和 93%，而 CCT 分别为 48%和 93%，TEE 的敏感性更高（p<0.05）。两种方法在检测瘘管、瓣周漏和人工瓣膜瓣裂方面也具有相似的诊断性能。
在一项当代比较荟萃分析中，TEE 和 CCT 均显示出良好的诊断准确性，可用于检测 IE 的瓣膜受累和并发症。TEE 在检测瓣叶缺陷方面表现更好，而 CCT 在人工瓣膜受累方面表现更好，且在检测瓣周并发症方面有提高的趋势。在临床实践中，采用 TEE 和 CCT 相结合的多模态成像方法，可以获得最高的诊断性能。
