Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina, 45110 Ioannina, Greece.
Rev Cardiovasc Med. 2021 Dec 22;22(4):1513-1521. doi: 10.31083/j.rcm2204155.
Transthoracic echocardiography (TTE) and Cardiac Magnetic Resonance (CMR) have complementary roles in the severity grading of mitral regurgitation (MR). Our objective was to systematically review the correlation of MR severity as assessed by TTE and CMR. We searched MEDLINE and Cochrane Library for original series published between January 1st, 2000 and March 23rd, 2020. We used Cohen's kappa coefficient to measure agreement between modalities. We plotted a hierarchical summary receiver operator characteristic (HSROC) curve and estimated the area under the curve (AUC) to assess the concordance between the two imaging modalities for the detection of severe MR. We identified 858 studies, of which 65 underwent full-text assessment and 8 were included in the meta-analysis. A total of 718 patients were included (425 males, 59%) in the final analysis. There was significant heterogeneity in the methods used and considerable variation in kappa coefficient, ranging from 0.10 to 0.48. Seven out of eight studies provided the necessary data to plot HSROC curves and calculate the AUC. The AUC for detecting severe MR was 0.83 (95% CI 0.80 to 0.86), whereas the AUC for detecting moderate to severe MR was 0.83 (95% CI 0.79 to 0.86). The agreement between TTE and CMR in MR severity evaluation is modest across the entire spectrum of severity grading. However, when focusing on patients with at least moderate MR the concordance between TTE and CMR is very good. Further prospective studies comparing hard clinical endpoints based on the CMR and TTE assessment of MR severity are needed.
经胸超声心动图（TTE）和心脏磁共振（CMR）在二尖瓣反流（MR）严重程度分级中具有互补作用。我们的目的是系统地回顾 TTE 和 CMR 评估的 MR 严重程度之间的相关性。我们在 MEDLINE 和 Cochrane 图书馆中搜索了 2000 年 1 月 1 日至 2020 年 3 月 23 日之间发表的原始系列。我们使用 Cohen 的 kappa 系数来衡量两种模式之间的一致性。我们绘制了分层综合接收者操作特征（HSROC）曲线，并估计了曲线下面积（AUC），以评估两种成像方式在检测严重 MR 方面的一致性。我们确定了 858 项研究，其中 65 项进行了全文评估，8 项纳入了荟萃分析。最终分析共纳入 718 名患者（男性 425 名，占 59%）。在使用的方法和 kappa 系数方面存在显著的异质性，范围从 0.10 到 0.48。八项研究中的七项提供了绘制 HSROC 曲线和计算 AUC 的必要数据。检测严重 MR 的 AUC 为 0.83（95%CI 0.80 至 0.86），而检测中度至重度 MR 的 AUC 为 0.83（95%CI 0.79 至 0.86）。TTE 和 CMR 在整个严重程度分级范围内评估 MR 严重程度的一致性适中。然而，当关注至少中度 MR 的患者时，TTE 和 CMR 之间的一致性非常好。需要进一步的前瞻性研究，比较基于 CMR 和 TTE 评估的 MR 严重程度的硬临床终点。
