Multidetector computed tomography for detecting left atrial/left atrial appendage thrombus: a meta‐analysis. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Zou, H.; Zhang, Y.; Tong, J.; Liu, Z.
• Is Part Of: Internal medicine journal. Volume 45:Issue 10(2015)
• Page Start: 1044
• Page End: 1053
• Publication Date: 2015-10
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12862
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12862-sec-0001" sec-type="section"> <title>Background</title> <p>The diagnostic accuracy of multidetector computed tomography (MDCT) in the detection of left atrial/left atrial appendage (LA/LAA) thrombus had been tested in many studies; however, the results are controversial.</p> </sec> <sec id="imj12862-sec-1001" sec-type="section"> <title>Aim</title> <p>The aim of the present study was to evaluate synthetically the diagnostic accuracy of MDCT in LA/LAA thrombus.</p> </sec> <sec id="imj12862-sec-0002" sec-type="section"> <title>Methods</title> <p>PubMed and Embase were searched for published prospective studies which compared computed tomography with transoesophageal echocardiography (TEE) in detecting LA/LAA thrombus prior to March 2014. Descriptive and quantitative information was extracted and MetaDiSc 1.4 was used to perform a meta‐analysis.</p> </sec> <sec id="imj12862-sec-2001" sec-type="section"> <title>Results</title> <p>Fifteen prospective clinical controlled trials with 2540 patients fulfilled the inclusion criteria. The pooled sensitivities (SEN): 0.957; pooled specificities (SPE): 0.917; pooled positive likelihood ratio (PLR): 22.017; pooled negative likelihood ratio (NLR): 0.060; pooled diagnostic odds ratio (DOR): 437.43; the area under the curve (AUC): 0.9883; Q*‐value: 0.9544. However, in the abovementioned indexes, the heterogeneities were statistically significant between studies (<italic>P</italic> < 0.05, inconsistency index (I<sup>2</sup>) > 50%). In a sub‐analysis of studies in which delayed imaging, electrocardiogram (ECG) gating and heart rate control were performed, not only the diagnostic accuracy, but also the heterogeneities were significantly improved (pooled SEN 0.991; pooled SPE 0.989; pooled PLR 60.768; pooled NLR 0.034; pooled DOR 2561.7; AUC 0.9972; Q*‐value 0.9806; all the indexes' <italic>P</italic>‐value were greater than 0.05 and the I<sup>2</sup> were 0%, except for SPE, I<sup>2</sup> = 54.6%).</p> </sec> <sec id="imj12862-sec-0003" sec-type="section"> <title>Conclusion</title> <p>For patients with TEE intolerance or contraindications, MDCT may be an alternative method, especially when the delayed imaging, ECG gating and heart rate control were performed.</p> </sec> </abstract>