左心耳封堵术后心脏CT与经食管超声心动图的比较：一项系统评价和荟萃分析
Cardiac CT Versus Transesophageal Echocardiography Following Left Atrial Appendage Closure: A Systematic Review and Meta-Analysis.
作者信息
Tan Bryan E-Xin, Baqai Faiz, Padilla Fernando, Nimri Nadeem, Cheung Jim W, Kottam Anupama, Medina Hector M
机构信息
Section of Cardiology, Department of Medicine (B.E.T., N.N., A.K.), Baylor College of Medicine, Houston, TX.
Section of General Internal Medicine, Department of Medicine (F.B., F.P.), Baylor College of Medicine, Houston, TX.
出版信息
Circ Cardiovasc Imaging. 2025 Aug;18(8):e018151. doi: 10.1161/CIRCIMAGING.125.018151. Epub 2025 Jun 27.
BACKGROUND
In the landmark WATCHMAN trials, transesophageal echocardiography (TEE) was used to evaluate peri-device leak (PDL) and device-related thrombus (DRT) after percutaneous left atrial appendage closure (LAAC). We aimed to investigate the diagnostic utility of cardiac computed tomography angiography (CCTA) compared with TEE for post-LAAC device surveillance.
METHODS
We conducted a literature search of 5 electronic databases to identify studies that included patients who underwent both CCTA and TEE after LAAC. We performed a meta-analysis by pooling outcomes for residual leak (left atrial appendage patency), any PDL, large PDL (>5 mm), and DRT.
RESULTS
We included 17 cohort studies with 1313 patients who underwent both CCTA and TEE after LAAC. CCTA was associated with higher odds of detecting residual leak (58.8% versus 34.6%, odds ratio, 2.26 [95% CI, 1.48-3.44], =0.0002; =73%; 15 studies, 975 patients; moderate certainty) and any PDL (51.6% versus 35.5%, odds ratio, 1.59 [95% CI, 1.01-2.51], =0.04; =73%; 12 studies, 870 patients; moderate certainty) when compared with TEE. There were no significant differences in the detection rates of large PDL (>5 mm) between CCTA and TEE (2.8% versus 0.8%, odds ratio, 3.12 [95% CI, 0.73-13.36], =0.13; =0%; 5 studies, 338 patients; moderate certainty). The incidence of DRT was low (1.7%), and the detection rate did not differ between the 2 modalities (1.7% versus 1.7%, odds ratio, 1.0 [95% CI, 0.41-2.42], =1.0; =0%; 6 studies, 584 patients; high-certainty).
CONCLUSIONS
Following LAAC, CCTA had higher odds of detecting residual leak and any PDL compared with TEE, whereas there were no significant differences in the detection of large PDL (> 5mm) and DRT between the 2 modalities. The findings of this meta-analysis should provide reassurance to patients and clinicians who prefer CCTA over TEE after LAAC. While DRT and left atrial appendage patency with visible PDL are known to be associated with thromboembolism, the clinical significance of left atrial appendage patency without visible PDL is uncertain and warrants further investigation.
REGISTRATION
URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42024578802.
背景
在具有里程碑意义的WATCHMAN试验中，经食管超声心动图（TEE）被用于评估经皮左心耳封堵术（LAAC）后器械周围渗漏（PDL）和器械相关血栓（DRT）。我们旨在研究心脏计算机断层扫描血管造影（CCTA）与TEE相比在LAAC术后器械监测中的诊断效用。
方法
我们对5个电子数据库进行文献检索，以识别纳入了LAAC术后同时接受CCTA和TEE检查患者的研究。我们通过汇总残余渗漏（左心耳通畅情况）、任何PDL、大的PDL（>5mm）和DRT的结果进行荟萃分析。
结果
我们纳入了17项队列研究，共1313例LAAC术后同时接受CCTA和TEE检查的患者。与TEE相比，CCTA检测到残余渗漏的几率更高（58.8%对34.6%，优势比为2.26 [95%CI，1.48 - 3.44]，P = 0.0002；I² = 73%；15项研究，975例患者；中等确定性）以及任何PDL的几率更高（51.6%对35.5%，优势比为1.59 [95%CI，1.01 - 2.51]，P = 0.04；I² = 73%；12项研究，870例患者；中等确定性）。CCTA和TEE在大的PDL（>5mm）检测率上无显著差异（2.8%对0.8%，优势比为3.12 [95%CI，0.73 - 13.36]，P = 0.13；I² = 0%；5项研究，338例患者；中等确定性）。DRT的发生率较低（1.7%），两种检查方式在DRT检测率上无差异（1.7%对1.7%，优势比为1.0 [95%CI，0.41 - 2.42]，P = 1.0；I² = 0%；6项研究，584例患者；高确定性）。
结论
LAAC术后，与TEE相比，CCTA检测到残余渗漏和任何PDL的几率更高，而在大的PDL（>5mm）和DRT的检测上两种检查方式无显著差异。这项荟萃分析的结果应能让LAAC术后更倾向于CCTA而非TEE的患者和临床医生放心。虽然已知DRT和可见PDL的左心耳通畅情况与血栓栓塞有关，但无可见PDL的左心耳通畅情况的临床意义尚不确定，值得进一步研究。
注册
网址：https://www.crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42024578802。
Zotero 插件