Cardiac CT angiography detected significantly more cardiac thrombi (6.3%) compared to transesophageal echocardiography (4.9%) in patients with ischemic stroke.
Meta-Analysis (n=1,568)
Does cardiac CT angiography improve the detection of cardiac thrombi compared to echocardiography in patients with ischemic stroke?
Cardiac CT angiography demonstrates a higher diagnostic yield than transesophageal echocardiography for detecting cardiac thrombi in ischemic stroke patients, suggesting it is a promising alternative imaging modality.
Tasa de eventos absoluta: 6.3% vs 4.9%
valor p: p=<0.001
BACKGROUND AND PURPOSE: Cardiac thrombi are an important cause of embolic stroke. We studied the diagnostic yield and diagnostic accuracy of cardiac CT angiography (CTA) compared to echocardiography for detection of cardiac thrombi in ischemic stroke patients. METHODS: We performed a systematic review and meta-analysis of the literature on cardiac CTA versus echocardiography for detection of cardiac thrombi in ischemic stroke patients. We included studies (N ≥ 20) in which both cardiac CTA (index test) and echocardiography (reference test) were performed and data on cardiac thrombi were reported. Results were stratified for type of echocardiography: transesophageal (TEE) vs transthoracic (TTE). RESULTS: Out of 1530 studies, 14 were included (all single center cohort studies), with data on 1568 patients. Mean age varied between 52 and 69 years per study and 66% were men. Reported time intervals ranged from 0 to 21 days between stroke and first test, and from 0 to 199 days between tests. In ten studies that compared CTA to TEE, CTA detected cardiac thrombi in 87/1385 (6.3%) patients versus 68/1385 (4.9%) on TEE (p < 0.001). In four studies comparing CTA to TTE, CTA detected thrombi in 23/183 (12.5%) patients versus 12/183 (6.6%) on TTE (p = 0.010). Pooled sensitivity and specificity of CTA versus TEE were 86.0% (95% CI 65.6-95.2) and 97.4% (95% CI 95.0-98.7), respectively. CONCLUSIONS: CTA may be a promising alternative to echocardiography for detection of cardiac thrombi in patients with ischemic stroke, especially now that CTA is standard care for patient selection for endovascular treatment. However, studies were too heterogeneous and of insufficient methodological quality to draw firm conclusions. Large, prospective studies on this topic are warranted.
Groeneveld et al. (Thu,) conducted a meta-analysis in Ischemic stroke or transient ischemic attack (n=1,568). Cardiac CT angiography (CTA) vs. Transesophageal echocardiography (TEE) was evaluated on Diagnostic yield (proportion of patients with a cardiac thrombus) (p=<0.001). Cardiac CT angiography detected significantly more cardiac thrombi (6.3%) compared to transesophageal echocardiography (4.9%) in patients with ischemic stroke.