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Echocardiography versus computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta-analysis

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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.

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Authors and Affiliations

  1. Institute of Life Sciences, Scuola Superiore Sant’Anna and Cardiology Division, University Hospital of Pisa, Piazza Martiri della Libertà 33, 56124, Pisa, Italy

    Alberto Aimo & Michele Emdin

  2. Cardiology Division, University Hospital of Pisa, Pisa, Italy

    Alberto Aimo

  3. Emergency Department, Hippokrateio General Hospital of Athens, Athens, Greece

    Eleni Kollia

  4. Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece

    Georgios Ntritsos

  5. Department of Informatics and Telecommunications, School of Informatics and Telecommunications, University of Ioannina, Arta, Greece

    Georgios Ntritsos

  6. Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Andrea Barison & Michele Emdin

  7. School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital Campus, London, UK

    Pier-Giorgio Masci & Georgios Georgiopoulos

  8. Department of Cardiovascular Medicine, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano, 20089, Milan, IT, Italy

    Stefano Figliozzi

  9. Department of Radiology, Humanitas Clinical and Research Center – IRCCS, via Manzoni 56, Rozzano, 20089, Milan, IT, Italy

    Stefano Figliozzi

  10. First Department of Cardiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece

    Dimitrios Klettas

  11. Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece

    Kimon Stamatelopoulos, Dimitrios Delialis & Georgios Georgiopoulos

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  1. Alberto Aimo
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Correspondence to Alberto Aimo.

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G.G. was supported by a research fellowship from the European Association of Cardiovascular Imaging; the other Authors have no conflict of interest to disclose.

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Aimo, A., Kollia, E., Ntritsos, G. et al. Echocardiography versus computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta-analysis. Clin Res Cardiol 110, 1697–1703 (2021). https://doi.org/10.1007/s00392-020-01741-7

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  • DOI: https://doi.org/10.1007/s00392-020-01741-7

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