Bryan E-Xin Tan, Faiz Baqai, Fernando Padilla, Nadeem Nimri, Jim W Cheung, Anupama Kottam, Hector M Medina
{"title":"左心耳关闭后心脏CT与经食管超声心动图：系统回顾和荟萃分析。","authors":"Bryan E-Xin Tan, Faiz Baqai, Fernando Padilla, Nadeem Nimri, Jim W Cheung, Anupama Kottam, Hector M Medina","doi":"10.1161/CIRCIMAGING.125.018151","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In the landmark WATCHMAN trials, transesophageal echocardiography (TEE) was used to evaluate peri-device leak (PDL) and device-related thrombus (DRT) after percutaneous left atrial appendage closure (LAAC). We aimed to investigate the diagnostic utility of cardiac computed tomography angiography (CCTA) compared with TEE for post-LAAC device surveillance.</p><p><strong>Methods: </strong>We conducted a literature search of 5 electronic databases to identify studies that included patients who underwent both CCTA and TEE after LAAC. We performed a meta-analysis by pooling outcomes for residual leak (left atrial appendage patency), any PDL, large PDL (>5 mm), and DRT.</p><p><strong>Results: </strong>We included 17 cohort studies with 1313 patients who underwent both CCTA and TEE after LAAC. CCTA was associated with higher odds of detecting residual leak (58.8% versus 34.6%, odds ratio, 2.26 [95% CI, 1.48-3.44], <i>P</i>=0.0002; <i>I</i><sup>2</sup>=73%; 15 studies, 975 patients; moderate certainty) and any PDL (51.6% versus 35.5%, odds ratio, 1.59 [95% CI, 1.01-2.51], <i>P</i>=0.04; <i>I</i><sup>2</sup>=73%; 12 studies, 870 patients; moderate certainty) when compared with TEE. There were no significant differences in the detection rates of large PDL (>5 mm) between CCTA and TEE (2.8% versus 0.8%, odds ratio, 3.12 [95% CI, 0.73-13.36], <i>P</i>=0.13; <i>I</i><sup>2</sup>=0%; 5 studies, 338 patients; moderate certainty). The incidence of DRT was low (1.7%), and the detection rate did not differ between the 2 modalities (1.7% versus 1.7%, odds ratio, 1.0 [95% CI, 0.41-2.42], <i>P</i>=1.0; <i>I</i><sup>2</sup>=0%; 6 studies, 584 patients; high-certainty).</p><p><strong>Conclusions: </strong>Following LAAC, CCTA had higher odds of detecting residual leak and any PDL compared with TEE, whereas there were no significant differences in the detection of large PDL and DRT between the 2 modalities. The findings of this meta-analysis should provide reassurance to patients and clinicians who prefer CCTA over TEE after LAAC. While DRT and left atrial appendage patency with visible PDL are known to be associated with thromboembolism, the clinical significance of left atrial appendage patency without visible PDL is uncertain and warrants further investigation.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42024578802.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018151"},"PeriodicalIF":6.5000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cardiac CT Versus Transesophageal Echocardiography Following Left Atrial Appendage Closure: A Systemic Review and Meta-Analysis.\",\"authors\":\"Bryan E-Xin Tan, Faiz Baqai, Fernando Padilla, Nadeem Nimri, Jim W Cheung, Anupama Kottam, Hector M Medina\",\"doi\":\"10.1161/CIRCIMAGING.125.018151\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In the landmark WATCHMAN trials, transesophageal echocardiography (TEE) was used to evaluate peri-device leak (PDL) and device-related thrombus (DRT) after percutaneous left atrial appendage closure (LAAC). We aimed to investigate the diagnostic utility of cardiac computed tomography angiography (CCTA) compared with TEE for post-LAAC device surveillance.</p><p><strong>Methods: </strong>We conducted a literature search of 5 electronic databases to identify studies that included patients who underwent both CCTA and TEE after LAAC. We performed a meta-analysis by pooling outcomes for residual leak (left atrial appendage patency), any PDL, large PDL (>5 mm), and DRT.</p><p><strong>Results: </strong>We included 17 cohort studies with 1313 patients who underwent both CCTA and TEE after LAAC. CCTA was associated with higher odds of detecting residual leak (58.8% versus 34.6%, odds ratio, 2.26 [95% CI, 1.48-3.44], <i>P</i>=0.0002; <i>I</i><sup>2</sup>=73%; 15 studies, 975 patients; moderate certainty) and any PDL (51.6% versus 35.5%, odds ratio, 1.59 [95% CI, 1.01-2.51], <i>P</i>=0.04; <i>I</i><sup>2</sup>=73%; 12 studies, 870 patients; moderate certainty) when compared with TEE. There were no significant differences in the detection rates of large PDL (>5 mm) between CCTA and TEE (2.8% versus 0.8%, odds ratio, 3.12 [95% CI, 0.73-13.36], <i>P</i>=0.13; <i>I</i><sup>2</sup>=0%; 5 studies, 338 patients; moderate certainty). The incidence of DRT was low (1.7%), and the detection rate did not differ between the 2 modalities (1.7% versus 1.7%, odds ratio, 1.0 [95% CI, 0.41-2.42], <i>P</i>=1.0; <i>I</i><sup>2</sup>=0%; 6 studies, 584 patients; high-certainty).</p><p><strong>Conclusions: </strong>Following LAAC, CCTA had higher odds of detecting residual leak and any PDL compared with TEE, whereas there were no significant differences in the detection of large PDL and DRT between the 2 modalities. The findings of this meta-analysis should provide reassurance to patients and clinicians who prefer CCTA over TEE after LAAC. While DRT and left atrial appendage patency with visible PDL are known to be associated with thromboembolism, the clinical significance of left atrial appendage patency without visible PDL is uncertain and warrants further investigation.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42024578802.</p>\",\"PeriodicalId\":10202,\"journal\":{\"name\":\"Circulation: Cardiovascular Imaging\",\"volume\":\" \",\"pages\":\"e018151\"},\"PeriodicalIF\":6.5000,\"publicationDate\":\"2025-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCIMAGING.125.018151\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCIMAGING.125.018151","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Cardiac CT Versus Transesophageal Echocardiography Following Left Atrial Appendage Closure: A Systemic Review and Meta-Analysis.
Background: In the landmark WATCHMAN trials, transesophageal echocardiography (TEE) was used to evaluate peri-device leak (PDL) and device-related thrombus (DRT) after percutaneous left atrial appendage closure (LAAC). We aimed to investigate the diagnostic utility of cardiac computed tomography angiography (CCTA) compared with TEE for post-LAAC device surveillance.
Methods: We conducted a literature search of 5 electronic databases to identify studies that included patients who underwent both CCTA and TEE after LAAC. We performed a meta-analysis by pooling outcomes for residual leak (left atrial appendage patency), any PDL, large PDL (>5 mm), and DRT.
Results: We included 17 cohort studies with 1313 patients who underwent both CCTA and TEE after LAAC. CCTA was associated with higher odds of detecting residual leak (58.8% versus 34.6%, odds ratio, 2.26 [95% CI, 1.48-3.44], P=0.0002; I2=73%; 15 studies, 975 patients; moderate certainty) and any PDL (51.6% versus 35.5%, odds ratio, 1.59 [95% CI, 1.01-2.51], P=0.04; I2=73%; 12 studies, 870 patients; moderate certainty) when compared with TEE. There were no significant differences in the detection rates of large PDL (>5 mm) between CCTA and TEE (2.8% versus 0.8%, odds ratio, 3.12 [95% CI, 0.73-13.36], P=0.13; I2=0%; 5 studies, 338 patients; moderate certainty). The incidence of DRT was low (1.7%), and the detection rate did not differ between the 2 modalities (1.7% versus 1.7%, odds ratio, 1.0 [95% CI, 0.41-2.42], P=1.0; I2=0%; 6 studies, 584 patients; high-certainty).
Conclusions: Following LAAC, CCTA had higher odds of detecting residual leak and any PDL compared with TEE, whereas there were no significant differences in the detection of large PDL and DRT between the 2 modalities. The findings of this meta-analysis should provide reassurance to patients and clinicians who prefer CCTA over TEE after LAAC. While DRT and left atrial appendage patency with visible PDL are known to be associated with thromboembolism, the clinical significance of left atrial appendage patency without visible PDL is uncertain and warrants further investigation.
期刊介绍：
Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others.
Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.
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