Accuracy of Transcranial Doppler for the Diagnosis of Intracardiac Right-to-Left Shunt A Bivariate Meta-Analysis of Prospective Studies
Accuracy of Transcranial Doppler for the Diagnosis of Intracardiac Right-to-Left Shunt A Bivariate Meta-Analysis of Prospective Studies
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DOI：
10.1016/j.jcmg.2013.12.011
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发表时间：
2014-03-01
影响因子：
14
通讯作者：
Tobis, Jonathan M.
中科院分区：
文献类型：
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作者：
Mojadidi, M. Khalid;Roberts, Scott C.;Tobis, Jonathan M.
目的：本meta分析的目的是确定经颅多普勒（TCD）与经食管超声心动图（TEE）作为参考的准确性。右至左分流（RLS）通常通过卵圆孔未闭（PFO），与偏头痛、隐源性卒中和低氧血症有关。随着对PFO主题的观察性研究和临床试验的出现，有必要准确诊断患有这些疾病的PFO患者，以及那些正在考虑经导管关闭的患者。虽然TEE气泡研究是目前诊断PFO的标准参考，但TCD气泡研究可能是一种更好的替代测试，因为它具有高灵敏度和特异性，无创性和低成本。方法对Medline、Cochrane图书馆和Embase进行系统回顾，寻找所有使用TCD与TEE作为参考评估心内RLS的前瞻性研究；在所有的研究中，这两项测试都是用造影剂和刺激RLS的手法进行的。结果共有27项研究（29组比较），1968例患者（平均年龄47.8±5.7岁，男性占51%）符合纳入标准。TCD的加权平均敏感性和特异性分别为97%和93%。正似然比为13.51，负似然比为0.04。使用10个微泡作为TCD阳性研究的栓塞截止点时，TCD比使用1个微泡作为截止点时具有更高的特异性（p = 0.04）；然而，敏感性没有显著变化（p = 0.29）。结论TCD是一种可靠、无创的检查方法，诊断准确性高，是一种检测RLS的有效方法。TCD可作为卒中检查的一部分，也可用于考虑关闭PFO的患者。如果需要精确的解剖知识，那么TEE可以在安排患者进行经导管PFO闭合之前获得。(C) 2014年由美国心脏病学会基金会发布
OBJECTIVES The aim of this meta-analysis was to determine the accuracy of transcranial Doppler (TCD) compared with transesophageal echocardiography (TEE) as the reference.BACKGROUND Right-to-left shunting (RLS), usually through a patent foramen ovale (PFO), has been associated with migraine, cryptogenic stroke, and hypoxemia. With emerging observational studies and clinical trials on the subject of PFO, there is a need for accurate diagnosis of PFO in patients with these conditions, and those being considered for transcatheter closure. Although a TEE bubble study is the current standard reference for diagnosing PFO, the TCD bubble study may be a preferable alternative test for RLS because of its high sensitivity and specificity, noninvasive nature, and low cost.METHODS A systematic review of Medline, the Cochrane Library, and Embase was done to look for all the prospective studies assessing intracardiac RLS using TCD compared with TEE as the reference; both tests were performed with a contrast agent and a maneuver to provoke RLS in all studies.RESULTS A total of 27 studies (29 comparisons) with 1,968 patients (mean age 47.8 +/- 5.7 years; 51% male) fulfilled the inclusion criteria. The weighted mean sensitivity and specificity for TCD were 97% and 93%, respectively. Likewise, the positive and negative likelihood ratios were 13.51 and 0.04, respectively. When 10 microbubbles was used as the embolic cutoff for a positive TCD study, TCD produced a higher specificity compared with when 1 microbubble was used as the cutoff (p = 0.04); there was, however, no significant change in sensitivity (p = 0.29).CONCLUSIONS TCD is a reliable, noninvasive test with excellent diagnostic accuracies, making it a proficient test for detecting RLS. TCD can be used as a part of the stroke workup and for patients being considered for PFO closure. If knowledge of the precise anatomy is required, then TEE can be obtained before scheduling a patient for transcatheter PFO closure. (C) 2014 by the American College of Cardiology Foundation