Echocardiography versus computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a
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REVIEW
Echocardiography versus computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta‑analysis Alberto Aimo1,2 · Eleni Kollia3 · Georgios Ntritsos4,5 · Andrea Barison6 · Pier‑Giorgio Masci7 · Stefano Figliozzi8,9 · Dimitrios Klettas10 · Kimon Stamatelopoulos11 · Dimitrios Delialis11 · Michele Emdin1,6 · Georgios Georgiopoulos7,11 Received: 20 July 2020 / Accepted: 3 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Accurate and reproducible diagnostic techniques are essential to detect left-sided cardiac thrombi [either in the left ventricle (LV) or in the left atrial appendage (LAA)] and to guide the onset and duration of antithrombotic treatment while minimizing the risk for thromboembolic and hemorrhagic events. Methods We conducted a systematic review and meta-analysis aiming to compare the diagnostic performance of transthoracic echocardiography (TTE) vs. cardiac magnetic resonance (CMR) for the detection of LV thrombi, and transesophageal echocardiography (TEE) vs. computed tomography (CT) for the detection of LAA thrombi. Results Six studies were included in the first meta-analysis (TTE vs. CMR for LV thrombosis). Pooled sensitivity and specificity values were 62% [95% confidence interval (CI), 37–81%] and 97% (95% CI, 94–99%). The shape of the hierarchical summary receiver operating characteristic (HSROC) curve and the area under the curve (AUC) of 0.96 suggested a high accuracy. Ten studies were included in the second meta-analysis (CT versus TEE for LAA thrombosis). The pooled values of sensitivity and specificity were 97% (95% CI, 77–100%) and 94% (95% CI, 87–98%). The pooled diagnostic odds ratio (DOR) was 500 (95% CI, 52–4810), and the pooled likelihood ratios (LR + and LR−) were 17% (95% CI, 7–40%) and 3% (95% CI, 0–28%). The shape of the HSROC curve and 0.99 AUC suggested a high accuracy of CT vs. TEE. Conclusions TTE is a fair alternative to DE-CMR for the identification of LV thrombi, while CT has a good accuracy compared to TEE for the detection of LAA thrombosis. PROSPERO registration CRD42020185842. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01741-7) contains supplementary material, which is available to authorized users. * Alberto Aimo [email protected]; [email protected] 1
7
School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital Campus, London, UK
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Department of Cardiovascular Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano, 20089 Milan, IT, Italy
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Department of Radiology, Humanitas Clinical and Research Center – IRCCS, via Manzoni 56, Rozzano, 20089 Milan, IT, Italy
Institute of Life Sciences, Scuola Superiore Sant’Anna and Cardiology Division, University Hospital of Pisa, Piazza Martiri della Libertà 33, 56124 Pisa, Italy
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Cardiology Division, University Hospital of Pisa, Pisa, Italy
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Emergen
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