BACKGROUND AND OBJECTIVES Ischemic stroke, a leading cause of mortality, necessitates understanding its mechanism for effective prevention. Echocardiography, especially transesophageal echocardiography (TEE), is the gold standard for detection of cardiac sources of stroke including left atrial thrombus, although its invasiveness, operator skill dependence, and limited availability in some centers prompt exploration of alternatives, such as cardiac CT (CCT). We conducted a systematic review and meta-analysis assessing the ability of CCT in the detection of intracardiac thrombus compared with echocardiography. METHODS We searched 4 databases up through September 8, 2023. Major search terms included a combination of the terms "echocardiograph," "CT," "TEE," "imaging," "stroke," "undetermined," and "cryptogenic." The current systematic literature review of the English language literature was reported in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. We assessed risk of bias using the QUADAS-2 tool and used random-effects meta-analysis to calculate different diagnostic metrics. RESULTS The meta-analysis investigating CCT vs echocardiography for intracardiac thrombus detection yielded a total of 43 studies of 9,552 patients. Risk-of-bias assessment revealed a predominantly low risk of bias in the flow and timing, index test, and patient selection domains and a predominantly unclear risk of bias in the reference standard domain. The analysis revealed an overall sensitivity of 98.38% (95% CI 89.2-99.78) and specificity of 96.0% (95% CI 92.55-97.88). Subgroup analyses demonstrated that delayed-phase, electrocardiogram-gated CCT had the highest sensitivity (100%; 95% CI 0-100) while early-phase, nongated CCT exhibited a sensitivity of 94.31% (95% CI 28.58-99.85). The diagnostic odds ratio was 98.59 (95% CI 44.05-220.69). Heterogeneity was observed, particularly in specificity and diagnostic odds ratio estimates. DISCUSSION CCT demonstrates high sensitivity, specificity, and diagnostic odds ratios in detecting intracardiac thrombus compared with traditional echocardiography. Limitations include the lack of randomized controlled studies, and other cardioembolic sources of stroke such as valvular disease, cardiac function, and aortic arch disease were not examined in our analysis. Large-scale studies are warranted to further evaluate CCT as a promising alternative for identifying intracardiac thrombus and other sources of cardioembolic stroke.

中文翻译：

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心脏 CT 与超声心动图检测缺血性中风心内血栓：43 项研究的系统回顾和荟萃分析。


背景和目标 缺血性中风是死亡的主要原因，有必要了解其机制以进行有效预防。超声心动图，特别是经食管超声心动图 (TEE)，是检测中风心脏来源（包括左心房血栓）的金标准，尽管其侵入性、操作员技能依赖以及某些中心的可用性有限促使人们探索替代方案，例如心脏 CT (CCT) ）。我们进行了系统回顾和荟萃分析，评估了 CCT 与超声心动图相比检测心内血栓的能力。方法 我们检索了截至 2023 年 9 月 8 日的 4 个数据库。主要搜索术语包括术语“超声心动图”、“CT”、“TEE”、“成像”、“中风”、“未确定”和“隐源性”的组合。目前对英语文献的系统文献综述是按照系统综述和荟萃分析报告指南的首选报告项目进行报告的。我们使用 QUADAS-2 工具评估偏倚风险，并使用随机效应荟萃分析来计算不同的诊断指标。结果 研究 CCT 与超声心动图检测心内血栓的荟萃分析共得出 43 项研究，涉及 9,552 名患者。偏倚风险评估显示，流程和时间、指标测试和患者选择领域的偏倚风险显着较低，而参考标准领域的偏倚风险显着不明确。分析显示总体敏感性为 98.38% (95% CI 89.2-99.78)，特异性为 96.0% (95% CI 92.55-97.88)。 亚组分析表明，延迟相、心电图门控 CCT 的敏感性最高（100%；95% CI 0-100），而早期、非门控 CCT 的敏感性为 94.31%（95% CI 28.58-99.85）。诊断优势比为 98.59 (95% CI 44.05-220.69)。观察到异质性，特别是在特异性和诊断比值比估计方面。讨论 与传统超声心动图相比，CCT 在检测心内血栓方面表现出较高的敏感性、特异性和诊断比值比。局限性包括缺乏随机对照研究，并且我们的分析中没有检查其他心源性卒中来源，例如瓣膜疾病、心脏功能和主动脉弓疾病。有必要进行大规模研究来进一步评估 CCT 作为识别心内血栓和其他心源性卒中来源的有前景的替代方案。