Abstract Body:
Background: Ischemic stroke, a leading cause of mortality, necessitates understanding its mechanism for effective prevention. Echocardiography is an accepted standard in stroke evaluation. Transesophageal echocardiography (TEE) being the gold standard for left atrial thrombus detection, its invasiveness, operator skill dependence, and limited availability in some centers prompt exploration of alternatives, such as cardiac computer tomography (CCT).
Objective: To provide an updated systematic review and meta-analysis assessing the ability of CCT in the detection of intracardiac thrombus as compared to echocardiography.
Methods: We searched four databases up to September 8^th, 2023, adhering to PRISMA guidelines. The risk of bias was assessed using the QUADAS-2 tool and employed random-effects meta-analysis to calculate different diagnostic metrics.
Results: The meta-analysis on CCT versus echocardiography for intracardiac thrombus detection, comprising 43 studies, 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, non-gated 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 ratios estimates.
Conclusions: CCT demonstrates high sensitivity, specificity, and diagnostic odds ratios in detecting intracardiac thrombus compared to traditional echocardiography. Large scale studies are warranted to further evaluateCCT as a promising alternative for identifying intracardiac thrombus.