Aortic Annular Sizing Using Novel Software in Three-Dimensional Transesophageal Echocardiography for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Figures

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  Figure 1. PRISMA flow diagram of the study selection process. 3D-TEE = Three-dimensional transesophageal echocardiography, n = Number of literatures, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-analyses.

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  Figure 2. Quality assessment of included studies. Risk of bias and applicability of concerns domains are presented as percentages based on modified Quality Assessment of Diagnostic Accuracy Studies-2 tool. Each bar shows percentage of studies with high (red), unclear (yellow), and low (green) risks of bias and applicability of concerns.

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  Figure 3. Forest plots of correlation between 3D-TEE and MDCT for annular sizing parameters. (a) Aortic annular area; (b) Aortic annular perimeter; (c) Annular area-derived diameter; (d) Annular perimeter-derived diameter; (e) Annular maximum diameter; (f) Annular minimum diameter. 3D-TEE = Three-dimensional transesophageal echocardiography, MDCT = Multidetector computed tomography, CI = Confidence interval, COR = Correlation coefficient.

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  Figure 4. Funnel plots to detect publication bias of correlation between 3D-TEE and MDCT. Bias and p values of asymmetry derived from Egger’s test are shown for annular sizing parameters. (a) Aortic annular area (bias = −1.40, p = 0.67); (b) Aortic annular perimeter (bias = 0.15, p = 0.97); (c) Annular area-derived diameter (bias = 0.11, p = 0.99); (d) Annular perimeter-derived diameter (bias = 0.92, p = 0.92); (e) Annular maximum diameter (bias = −16.67, p = 0.34); (f) Annular minimum diameter (bias = 10.36, p = 0.69). 3D-TEE = Three-dimensional transesophageal echocardiography, MDCT = Multidetector computed tomography.

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  Figure 5. Forest plots of mean differences between 3D-TEE and MDCT for annular sizing parameters. p values derived from the pooled mean difference of each parameters are shown. (a) Aortic annular area (p = 0.011); (b) Aortic annular perimeter (p < 0.0001); (c) Annular area-derived diameter (p = 0.40); (d) Annular perimeter-derived diameter (p = 0.12); (e) Annular maximum diameter (p = 0.012); (f) Annular minimum diameter (p = 0.18). 3D-TEE = Three-dimensional transesophageal echocardiography (Experimental), MDCT = Multidetector computed tomography (Control), CI = Confidence interval, MD = Mean difference, SD = Standard deviation.

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  Figure 6. Funnel plots to detect publication bias of mean difference between 3D-TEE and MDCT. Bias and p values of asymmetry derived from Egger’s test are shown for annular sizing parameters. (a) Aortic annular area (bias = 1.72, p = 0.56); (b) Aortic annular perimeter (bias = 0.45, p = 0.84); (c) Annular area-derived diameter (Unable to test); (d) Annular perimeter-derived diameter (Unable to test); (e) Annular maximum diameter (bias = 4.62, p = 0.80); (f) Annular minimum diameter (bias = −0.03, p = 0.98). 3D-TEE = Three-dimensional transesophageal echocardiography, MDCT = Multidetector computed tomography.