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Diagnostic Value of Advanced Imaging Modalities for the Detection and Differentiation of Prosthetic Valve Obstruction A Systematic Review and Meta-Analysis

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Author(s)
Jin Young KimYoung Joo SuhKyunghwa HanYoung Jin KimByoung Wook Choi
Keimyung Author(s)
Kim, Jin Young
Department
Dept. of Internal Medicine (내과학)
Journal Title
JACC: Cardiovascular Imaging
Issued Date
2019
Volume
12
Issue
11 Pt 1
Keyword
multidetector-row computed tomographypannusprosthetic valve obstructionthrombustransesophageal echocardiographytransthoracic echocardiography
Abstract
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.
Keimyung Author(s)(Kor)
김진영
Publisher
School of Medicine (의과대학)
Citation
Jin Young Kim et al. (2019). Diagnostic Value of Advanced Imaging Modalities for the Detection and Differentiation of Prosthetic Valve Obstruction A Systematic Review and Meta-Analysis. JACC: Cardiovascular Imaging, 12(11 Pt 1). doi: 10.1016/j.jcmg.2018.11.033
Type
Article
ISSN
1936-878X
Source
https://www.sciencedirect.com/science/article/pii/S1936878X19300944?via%3Dihub
DOI
10.1016/j.jcmg.2018.11.033
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41932
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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