A systematic review and meta-analysis comparing cardiac CT angiography with transesophageal echocardiography in planning left atrial appendage closure
10.3969/j.issn.1004-8812.2023.12.008
- VernacularTitle:比较心脏CT血管造影与经食管超声心动图术前评估左心耳封堵术的Meta分析
- Author:
Jia-Qi LI
1
;
Jing-Chao LU
;
Ya-Qiong JIN
;
Meng-Xiao WANG
;
Jie ZHANG
;
Ke-Ke WANG
;
Fan LIU
Author Information
1. 050000 河北石家庄,河北医科大学第二医院心内科
- Keywords:
Cardiac CT angiography;
Transesophageal echocardiography;
Left atrial appendage closure;
Atrial fibrillation
- From:
Chinese Journal of Interventional Cardiology
2023;31(12):935-945
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically evaluate the differences in preoperative planning for left atrial appendage closure(LAAC)using cardiac CT angiography(CCTA)and transesophageal echocardiography(TEE).Methods Relevant studies comparing CCTA and TEE for preoperative assessment of LAAC published from the inception of each database to July 18,2023,were searched in PubMed,EMBASE,the Cochrane Library,CNKI,Wanfang,and CBM database.Meta-analysis was performed using RevMan 5.4 and Stata 15.1.Results A total of 21 studies with 2 137 patients were included.Compared to TEE,preoperative CCTA measurement of the left atrial appendage(LAA)showed a larger maximum diameter(MD 2.27 mm,95％CI 1.70-2.83,P＜0.001)and higher accuracy in predicting occlusion device(RR 1.67,95％CI 1.39-2.01,P＜0.001).Subgroup analysis based on whether 3D reconstruction was performed and occlusion device type showed similar results.There was no statistically significant difference in the surgical success rate(RR 1.03,95％CI 0.98-1.08,P=0.230)between the two imaging methods.Additionally,preoperative 3D reconstruction based on CCTA resulted in fewer occlusion devices used(MID-0.29,95％CI-0.53--0.04,P=0.020),less contrast agent usage(MD-4.48 ml,95％CI-7.40—-1.56,P=0.003),shorter operative time(MD-14.98 min,95％CI-17.79—-12.17,P＜0.001),and a lower rate of postoperative residual leakage(RR 0.59,95％CI 0.36-0.99,P=0.040).Conclusions Compared to TEE,preoperative CCTA for LAAC improves the accuracy of occlusion device prediction.3D reconstruction based on CCTA reduces the occlusion devices used and the usage of contrast agents,shortens the operative time,improves surgical efficiency,and is associated with a lower rate of postoperative residual leakage.Therefore,CCTA has more advantages in preoperative planning for LAAC.
