Department of Cardiology Cardiovascular Center Beijing Friendship Hospital Beijing China.
Department of Internal Medicine Medical Health Center Beijing Friendship Hospital Beijing China.
J Am Heart Assoc. 2021 Dec 7;10(23):e022505. doi: 10.1161/JAHA.121.022505. Epub 2021 Nov 19.
Background Transesophageal echocardiography (TEE) has been considered the gold standard for left atrial appendage (LAA) thrombus detection. Nevertheless, TEE may sometimes induce discomfort and cause complications. Cardiac computed tomography has been studied extensively for LAA thrombus detection. We performed this systemic review and meta-analysis to assess the diagnostic accuracy of cardiac computed tomography for LAA thrombus detection compared with TEE. Methods and Results A systemic search was conducted in the PubMed, Embase, and Cochrane Library databases from January 1977 to February 2021. Studies performed for assessment diagnostic accuracy of cardiac computed tomography on LAA thrombus compared with TEE were included. Summary sensitivity, specificity, and posterior probability of LAA thrombus was calculated by using bivariate random-effects model. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used for the quality assessment. A total of 27 studies involving 6960 patients were included in our study. The summary sensitivity of early imaging studies was 0.95 (95% CI, 0.79-0.99), and the specificity was 0.89 (95% CI, 0.85-0.92). The positive posterior probability was 19.11%, and the negative posterior probability was 0.16%. The summary sensitivity of delayed imaging studies was 0.98 (95% CI, 0.92-1.00), and the specificity was 1.00 (95% CI, 0.98-1.00). The positive posterior probability was 95.76%, and the negative posterior probability was 0.12%. The delayed imaging method significantly improved the specificity (1.00 versus 0.89; <0.05) and positive posterior probability (95.76% versus 19.11%; <0.05). Conclusions Cardiac computed tomography with a delayed imaging is a reliable alternative to TEE. It may save the patient and health care from an excess TEE. Registration URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42021236352.
经食管超声心动图（TEE）一直被认为是检测左心耳（LAA）血栓的金标准。然而，TEE 有时会引起不适并导致并发症。心脏计算机断层扫描（CT）已广泛用于 LAA 血栓的检测。我们进行了这项系统评价和荟萃分析，以评估心脏 CT 检测 LAA 血栓与 TEE 的诊断准确性。
系统检索了 1977 年 1 月至 2021 年 2 月期间的 PubMed、Embase 和 Cochrane 图书馆数据库。纳入了评估心脏 CT 检测 LAA 血栓与 TEE 的诊断准确性的研究。使用双变量随机效应模型计算 LAA 血栓的汇总敏感性、特异性和后验概率。使用诊断准确性研究质量评估工具（QUADAS-2）进行质量评估。本研究共纳入 27 项研究，涉及 6960 例患者。早期成像研究的汇总敏感性为 0.95（95%CI，0.79-0.99），特异性为 0.89（95%CI，0.85-0.92）。阳性后验概率为 19.11%，阴性后验概率为 0.16%。延迟成像研究的汇总敏感性为 0.98（95%CI，0.92-1.00），特异性为 1.00（95%CI，0.98-1.00）。阳性后验概率为 95.76%，阴性后验概率为 0.12%。延迟成像方法显著提高了特异性（1.00 与 0.89；<0.05）和阳性后验概率（95.76%与 19.11%；<0.05）。
心脏 CT 延迟成像可作为 TEE 的可靠替代方法。它可以使患者和医疗保健人员免受过多 TEE 的影响。
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