Author + information
- Received June 6, 2018
- Revision received November 19, 2018
- Accepted November 28, 2018
- Published online February 13, 2019.
- Jin Young Kim, MDa,
- Young Joo Suh, MD, PhDb,∗ (, )
- Kyunghwa Han, PhDb,
- Young Jin Kim, MD, PhDb and
- Byoung Wook Choi, MD, PhDb
- aDepartment of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
- bDepartment of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Young Joo Suh, Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
Objectives This meta-analysis investigated the diagnostic values of transthoracic echocardiography (TTE), 2-dimensional (2D) and 3-dimensional (3D) transesophageal echocardiography (TEE), and multidetector-row computed tomography (MDCT) in patients with suspected mechanical prosthetic valve obstruction (PVO) for detecting subprosthetic mass and differentiating its causes.
Background Diagnostic values of advanced imaging modalities, such as MDCT and TEE, for the detection and differentiation of PVO have not been investigated.
Methods PubMed and EMBASE were systematically searched for studies that evaluated PVO using imaging modalities. The modified Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate study quality. Pooled sensitivity of each modality for PVO detection and pooled diagnostic accuracy of TEE and MDCT for differentiating the causes of PVO were analyzed. Study heterogeneity was also assessed.
Results Seventeen studies (229 patients) that used at least 1 index tool among TTE, TEE, or MDCT were included. For detecting a subprosthetic mass that caused PVO, 3D TEE and MDCT showed a higher sensitivity of 81% (95% confidence interval [CI]: 40% to 95%) and 88% (95% CI: 81% to 93%), respectively, compared with TTE (20%; 95% CI: 7% to 47%) and 2D TEE (68%; 95% CI: 46% to 84%). Pooled sensitivity and specificity for diagnosing thrombus as a cause of PVO was 75% (95% CI: 54% to 88%) and 75% (95% CI: 40% to 93%), respectively, for TEE and 45% (95% CI: 16% to 77%) and 90% (95% CI: 77% to 96%), respectively, for MDCT. Pooled sensitivity for diagnosing pannus as a cause of PVO was 62% (95% CI: 46% to 76%) for TEE and 85% (95% CI: 70% to 93%) for MDCT.
Conclusions This meta-analysis suggested that MDCT and 3D TEE have higher sensitivity than do TTE and 2D TEE, and can be reliable imaging modalities for detecting a subprosthetic mass that causes PVO. Moreover, MDCT can more accurately differentiate the cause of PVO than does TEE.
- multidetector-row computed tomography
- prosthetic valve obstruction
- transesophageal echocardiography
- transthoracic echocardiography
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 6, 2018.
- Revision received November 19, 2018.
- Accepted November 28, 2018.
- 2019 American College of Cardiology Foundation
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