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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

 Jin Young Kim  ;  Young Joo Suh  ;  Kyunghwa Han  ;  Young Jin Kim  ;  Byoung Wook Choi 
 JACC-CARDIOVASCULAR IMAGING, Vol.12(11 Pt 1) : 2182-2192, 2019 
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Issue Date
multidetector-row computed tomography ; pannus ; prosthetic valve obstruction ; thrombus ; transesophageal echocardiography ; transthoracic echocardiography
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.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
5. Research Institutes (연구소) > Others (기타) > 1. Journal Papers
Yonsei Authors
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Suh, Young Joo(서영주) ORCID logo https://orcid.org/0000-0002-2078-5832
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Han, Kyung Hwa(한경화)
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