目的 通过系统评价与Meta分析评估心脏磁共振(cardiac magnetic resonance,CMR)对心房纤颤(atrial fibrillation,AF)患者左心房/左心耳(left atrial/left atrial appendage,LA/LAA)血栓的诊断价值,并分析不同的成像序列下所形成的诊断效能之间的差异.材料与方法 从PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方和维普数据库查找关于经食道超声心动图(transesophageal echocardiography,TEE)或外科病理活检的方法检测AF患者LA/LAA结构内是否存在血栓的研究,同时比较CMR成像与其诊断效能上的差异,检索的时间为2000年至2022年.将这些文献分为四个类别:(1)CMR电影(cine-cardiac magnetic resonance,cine-CMR)成像;(2)对比增强磁共振血管造影(contrast enhanced magnetic resonance angiography,CE-MRA);(3)对比增强CMR(contrast enhanced CMR,CE-CMR)成像;(4)CMR.分别进行统计分析,提取相关的临床数据,利用Stata 17.0、Review Manager5.3及Meta-DiSc 1.4等专业数据分析应用软件对患者的医疗记录进行详细统计,并进一步对合并敏感度、特异度、阳性似然比、阴性似然比及诊断比值比的具体数值进行运算,最后绘制了受试者工作特征曲线,同时对曲线下面积(area under the curve,AUC)进行计算得出诊断效能大小.结果 共纳入11篇文献,包含868例患者.Meta分析结果显示,各成像方式的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比、AUC值如下:cine-CMR分别为92％、93％、12.8、0.08、154、0.93;CE-MRA分别为 91％、100％、476.4、0.09、5 044、0.99;CE-CMR分别为 96％、100％、247.5、0.04、6 656、1.00;CMR分别为99％、99％、95.1、0.01、7 357、1.00.结论 CMR对AF患者LA/LAA血栓的诊断具备较高的诊断效能.
Value of cardiac magnetic resonance in the diagnosis of left atrial/left atrial appendage thrombosis in patients with atrial fibrillation:A systematic review and Meta-analysis
Objective:To assess the accuracy of cardiac magnetic resonance(CMR)in evaluating left atrial/left atrial appendage(LA/LAA)thrombus in patients with atrial fibrillation(AF)and to analyze the difference in diagnostic accuracy of a number of imaging sequences.Materials and Methods:Between 2000 and 2022,a systematic search was carried out across multiple databases such as PubMed,Web of Science,Embase,the Cochrane Library,China National Knowledge Infrastructure,VIP databases,Wangfang date bases to compare the effectiveness of CMR with transesophageal echocardiogram(TEE)or surgical pathology in detecting LA/LAA thrombus.The literature was divided into four categories:(1)cine-cardiac magnetic resonance(cine-CMR);(2)contrast enhanced magnetic resonance angiography(CE-MRA);(3)contrast enhanced-cardiac magnetic resonance(CE-CMR);(4)CMR.Statistical analysis was then performed separately to extract relevant clinical data.Extracting pertinent clinical records,the analysis and calculation of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,receiver operating characteristic,and area under the curve(AUC)were conducted using Stata17.0,Review Manager 5.3,and Meta-DiSc 1.4.Results:The evaluation encompassed a total of 868 patients across eleven publications.Cine-CMR exhibits a pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,and AUC of 92％,93％,12.8,0.08,154,0.93,respectively;CE-MRA demonstrates values of 91％,100％,476.4,0.09,5 044,0.99,respectively;CE-CMR demonstrates values of 96％,100％,247.5,0.04,6 656,1.00,respectively;and CMR demonstrates values of 99％,99％,95.1,0.01,7 357,1.00,respectively.Conclusions:CMR has been shown to be a favorable diagnostic method for the detecting and evaluating LA/LAA thrombus,in individuals diagnosed with atrial fibrillation.
万方数据
维普
