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CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis
BACKGROUND AND PURPOSE: Cardiac thrombi are an important cause of embolic stroke. We studied the diagnostic yield and diagnostic accuracy of cardiac CT angiography (CTA) compared to echocardiography for detection of cardiac thrombi in ischemic stroke patients. METHODS: We performed a systematic revi...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293690/ https://www.ncbi.nlm.nih.gov/pubmed/32140869 http://dx.doi.org/10.1007/s00415-020-09766-8 |
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author | Groeneveld, Nina-Suzanne Guglielmi, Valeria Leeflang, Mariska M. G. Matthijs Boekholdt, S. Nils Planken, R. Roos, Yvo B. W. E. M. Majoie, Charles B. L. M. Coutinho, Jonathan M. |
author_facet | Groeneveld, Nina-Suzanne Guglielmi, Valeria Leeflang, Mariska M. G. Matthijs Boekholdt, S. Nils Planken, R. Roos, Yvo B. W. E. M. Majoie, Charles B. L. M. Coutinho, Jonathan M. |
author_sort | Groeneveld, Nina-Suzanne |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Cardiac thrombi are an important cause of embolic stroke. We studied the diagnostic yield and diagnostic accuracy of cardiac CT angiography (CTA) compared to echocardiography for detection of cardiac thrombi in ischemic stroke patients. METHODS: We performed a systematic review and meta-analysis of the literature on cardiac CTA versus echocardiography for detection of cardiac thrombi in ischemic stroke patients. We included studies (N ≥ 20) in which both cardiac CTA (index test) and echocardiography (reference test) were performed and data on cardiac thrombi were reported. Results were stratified for type of echocardiography: transesophageal (TEE) vs transthoracic (TTE). RESULTS: Out of 1530 studies, 14 were included (all single center cohort studies), with data on 1568 patients. Mean age varied between 52 and 69 years per study and 66% were men. Reported time intervals ranged from 0 to 21 days between stroke and first test, and from 0 to 199 days between tests. In ten studies that compared CTA to TEE, CTA detected cardiac thrombi in 87/1385 (6.3%) patients versus 68/1385 (4.9%) on TEE (p < 0.001). In four studies comparing CTA to TTE, CTA detected thrombi in 23/183 (12.5%) patients versus 12/183 (6.6%) on TTE (p = 0.010). Pooled sensitivity and specificity of CTA versus TEE were 86.0% (95% CI 65.6–95.2) and 97.4% (95% CI 95.0–98.7), respectively. CONCLUSIONS: CTA may be a promising alternative to echocardiography for detection of cardiac thrombi in patients with ischemic stroke, especially now that CTA is standard care for patient selection for endovascular treatment. However, studies were too heterogeneous and of insufficient methodological quality to draw firm conclusions. Large, prospective studies on this topic are warranted. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-09766-8) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7293690 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-72936902020-06-16 CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis Groeneveld, Nina-Suzanne Guglielmi, Valeria Leeflang, Mariska M. G. Matthijs Boekholdt, S. Nils Planken, R. Roos, Yvo B. W. E. M. Majoie, Charles B. L. M. Coutinho, Jonathan M. J Neurol Original Communication BACKGROUND AND PURPOSE: Cardiac thrombi are an important cause of embolic stroke. We studied the diagnostic yield and diagnostic accuracy of cardiac CT angiography (CTA) compared to echocardiography for detection of cardiac thrombi in ischemic stroke patients. METHODS: We performed a systematic review and meta-analysis of the literature on cardiac CTA versus echocardiography for detection of cardiac thrombi in ischemic stroke patients. We included studies (N ≥ 20) in which both cardiac CTA (index test) and echocardiography (reference test) were performed and data on cardiac thrombi were reported. Results were stratified for type of echocardiography: transesophageal (TEE) vs transthoracic (TTE). RESULTS: Out of 1530 studies, 14 were included (all single center cohort studies), with data on 1568 patients. Mean age varied between 52 and 69 years per study and 66% were men. Reported time intervals ranged from 0 to 21 days between stroke and first test, and from 0 to 199 days between tests. In ten studies that compared CTA to TEE, CTA detected cardiac thrombi in 87/1385 (6.3%) patients versus 68/1385 (4.9%) on TEE (p < 0.001). In four studies comparing CTA to TTE, CTA detected thrombi in 23/183 (12.5%) patients versus 12/183 (6.6%) on TTE (p = 0.010). Pooled sensitivity and specificity of CTA versus TEE were 86.0% (95% CI 65.6–95.2) and 97.4% (95% CI 95.0–98.7), respectively. CONCLUSIONS: CTA may be a promising alternative to echocardiography for detection of cardiac thrombi in patients with ischemic stroke, especially now that CTA is standard care for patient selection for endovascular treatment. However, studies were too heterogeneous and of insufficient methodological quality to draw firm conclusions. Large, prospective studies on this topic are warranted. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-09766-8) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-03-05 2020 /pmc/articles/PMC7293690/ /pubmed/32140869 http://dx.doi.org/10.1007/s00415-020-09766-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Communication Groeneveld, Nina-Suzanne Guglielmi, Valeria Leeflang, Mariska M. G. Matthijs Boekholdt, S. Nils Planken, R. Roos, Yvo B. W. E. M. Majoie, Charles B. L. M. Coutinho, Jonathan M. CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis |
title | CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis |
title_full | CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis |
title_fullStr | CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis |
title_full_unstemmed | CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis |
title_short | CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis |
title_sort | ct angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis |
topic | Original Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293690/ https://www.ncbi.nlm.nih.gov/pubmed/32140869 http://dx.doi.org/10.1007/s00415-020-09766-8 |
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