Alberto Aimo1,2, Eleni Kollia3, Georgios Ntritsos4,5, Andrea Barison6, Pier-Giorgio Masci7, Stefano Figliozzi8,9, Dimitrios Klettas10, Kimon Stamatelopoulos11, Dimitrios Delialis11, Michele Emdin12,6, Georgios Georgiopoulos7,11. 1. Institute of Life Sciences, Scuola Superiore Sant'Anna and Cardiology Division, University Hospital of Pisa, Piazza Martiri della Libertà 33, 56124, Pisa, Italy. a.aimo@santannapisa.it. 2. Cardiology Division, University Hospital of Pisa, Pisa, Italy. a.aimo@santannapisa.it. 3. Emergency Department, Hippokrateio General Hospital of Athens, Athens, Greece. 4. Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. 5. Department of Informatics and Telecommunications, School of Informatics and Telecommunications, University of Ioannina, Arta, Greece. 6. Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy. 7. School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital Campus, London, UK. 8. Department of Cardiovascular Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano, 20089, Milan, IT, Italy. 9. Department of Radiology, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano, 20089, Milan, IT, Italy. 10. First Department of Cardiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece. 11. Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece. 12. Institute of Life Sciences, Scuola Superiore Sant'Anna and Cardiology Division, University Hospital of Pisa, Piazza Martiri della Libertà 33, 56124, Pisa, Italy.
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.
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.
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