Comparison between transthoracic echocardiography and transoesophageal echocardiography in the diagnosis of acute aortic dissection from an emergency perspective. A systematic review and meta-analysis
Comparison between transthoracic echocardiography and transoesophageal echocardiography in the diagnosis of acute aortic dissection from an emergency perspective. A systematic review and meta-analysis
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BackgroundAcute aortic dissection (AAD) is a life-threatening medical condition with high early fatality.Therefore, a prompt and precise diagnosis, which can be achieved through invasive and non-invasive techniques is vital.Echocardiography, unlike MRI and CT, is accessible in emergency units and bedside-compatible.
The recommended echocardiographic techniques for AAD Comb are transthoracic and transoesophageal echocardiography (TTE and TOE).Therefore, our review compares their diagnostic roles in AAD.MethodsStudies relevant to our topic were attained through a database search and manual scrutiny of references lists of articles obtained from the electronic databases.
The Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) has been used for quality assessment.All quantitative analyses were performed using either STATA 16 or Comprehensive Meta-Analyst software.ResultsThe search strategy yielded 1,798 articles, of which only 11 were eligible for inclusion.
Our subgroup analysis showed that conventional TTE had a sensitivity and specificity of 85.35% and 84.51% for the diagnosis of Stanford type A AAD and was 45.
89% sensitive and 87.05% Rear Camera specific for the diagnosis of type B AAD.However, the subgroup analysis shows that contrast-enhancement of TTE results in a sensitivity and specificity of 93.
30% and 97.60% for diagnosis of type A AAD, and 83.60% and 94.
50% for diagnosis of type B AAD, respectively.On the other hand, conventional TOE was 93.64% sensitive and 95.
50% specific for the diagnosis of type A AAD, 99.80% sensitive and 99.87% specific for the diagnosis of type B AAD.
Moreover, our analyses show that TTE has pooled false negative and positive rates of 28.6% and 18.6%, while TOE has shown false negative and positive rates of 2.
4% and 4.3%, respectively.ConclusionTOE is the more favorable diagnostic tool for AAD diagnosis than TTE.
However, it cannot be used as a stand-alone diagnostic tool since misdiagnosis cases are being reported.Contrast-enhanced TTE can also diagnose AAD since it provides similar results to conventional TOE.