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Performance of different scan protocols of fetal echocardiography in the diagnosis of fetal congenital heart disease: a systematic review and meta-analysis.

Li Y, Hua Y, Fang J, Wang C, Qiao L, Wan C, Mu D, Zhou K - PLoS ONE (2013)

Bottom Line: We use results from 81 studies in 63 articles to analyze the pooled accuracy.Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00.But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.

ABSTRACT

Objective: The rapid progress in fetal echocardiography has lead to early detection of congenital heart diseases. Increasing evidences have shown that prenatal diagnosis could be life saving in certain cases. However, there is no agreement on which protocol is most adaptive diagnostic one. Thus, we use meta-analysis to conduct a pooled performance test on 5 diagnostic protocols.

Methods: We searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials and WHO clinical trails registry center to identify relevant studies up to August, 2012. We performed meta-analysis in a fixed/random-effect model using Meta-disc 1.4. We used STATA 11.0 to estimate the publication bias and SPSS 17.0 to evaluate variance.

Results: We use results from 81 studies in 63 articles to analyze the pooled accuracy. The overall performance of pooled sensitivities of spatiotemporal image correlation (STIC), extend cardiac echography examination (ECEE) and 4 chambers view + outflow tract view + 3 vessels and trachea view (4 CV+OTV+3 VTV) were around 0.90, which was significant higher than that of 4 chambers view + outflow tract view or 3 vessels and trachea view (4 CV+OTV/3 VTV) and 4 chambers view (4 CV). Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00. The area under the summary receiver operating characteristic curves value of STIC, ECEE, 4 CV+OTV+3 VTV, 4 CV+OTV/3 VTV and 4 CV were 0.9700, 0.9971, 0.9983, 0.9929 and 0.9928 respectively.

Conclusion: These results suggest a great diagnostic potential for fetal echocardiography detection as a reliable method of fetal congenital heart disease. But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.

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Related in: MedlinePlus

Flow diagram of study selection process.
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pone-0065484-g001: Flow diagram of study selection process.

Mentions: A total of 519 citations were retrieved by the method aforementioned. After reading titles and abstracts, 428 citations were excluded according to the selection criteria, and identified the initially 91 articles. Among them, 39 articles were excluded by reading the completed articles [9], [25]–[62], in which 17 articles were unable to construct 2×2 table, 13 articles were not about diagnostic tests, 4 articles focused special echocardiography use for diagnosis, 2 articles only provided technique successful rate, 1 article didn’t focus on CHDs, 1 article was a repeated sample and 1 article was a review. Then, 11 articles were added through manual retrospective research after reading related publications [53], [57], [61], [63]–[70]. At last 63 articles with 81 diagnostic test studies for fetal CHD diagnosis were enrolled into this meta-analysis [11], [17], [63]–[123] (Figure 1). Among these 81 researches, 8 studies were about STIC, 24 studies were about ECEE, 9 studies were about 4 CV+OTV+3 VTV, 13 studies were about 4 CV+OTV or 4 CV+3 VTV and 24 studies were about 4 CV. Moreover, 16 articles contained 2 studies for such accuracy evaluation [71], [74], [76]–[79], [83], [87]–[89], [100], [101], [106], [113], [116], [119], and 1 article contained 3 studies of such accuracy evaluation [68]. The basic characteristics of included studies were showed in Table 1.


Performance of different scan protocols of fetal echocardiography in the diagnosis of fetal congenital heart disease: a systematic review and meta-analysis.

Li Y, Hua Y, Fang J, Wang C, Qiao L, Wan C, Mu D, Zhou K - PLoS ONE (2013)

Flow diagram of study selection process.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672155&req=5

pone-0065484-g001: Flow diagram of study selection process.
Mentions: A total of 519 citations were retrieved by the method aforementioned. After reading titles and abstracts, 428 citations were excluded according to the selection criteria, and identified the initially 91 articles. Among them, 39 articles were excluded by reading the completed articles [9], [25]–[62], in which 17 articles were unable to construct 2×2 table, 13 articles were not about diagnostic tests, 4 articles focused special echocardiography use for diagnosis, 2 articles only provided technique successful rate, 1 article didn’t focus on CHDs, 1 article was a repeated sample and 1 article was a review. Then, 11 articles were added through manual retrospective research after reading related publications [53], [57], [61], [63]–[70]. At last 63 articles with 81 diagnostic test studies for fetal CHD diagnosis were enrolled into this meta-analysis [11], [17], [63]–[123] (Figure 1). Among these 81 researches, 8 studies were about STIC, 24 studies were about ECEE, 9 studies were about 4 CV+OTV+3 VTV, 13 studies were about 4 CV+OTV or 4 CV+3 VTV and 24 studies were about 4 CV. Moreover, 16 articles contained 2 studies for such accuracy evaluation [71], [74], [76]–[79], [83], [87]–[89], [100], [101], [106], [113], [116], [119], and 1 article contained 3 studies of such accuracy evaluation [68]. The basic characteristics of included studies were showed in Table 1.

Bottom Line: We use results from 81 studies in 63 articles to analyze the pooled accuracy.Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00.But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.

ABSTRACT

Objective: The rapid progress in fetal echocardiography has lead to early detection of congenital heart diseases. Increasing evidences have shown that prenatal diagnosis could be life saving in certain cases. However, there is no agreement on which protocol is most adaptive diagnostic one. Thus, we use meta-analysis to conduct a pooled performance test on 5 diagnostic protocols.

Methods: We searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials and WHO clinical trails registry center to identify relevant studies up to August, 2012. We performed meta-analysis in a fixed/random-effect model using Meta-disc 1.4. We used STATA 11.0 to estimate the publication bias and SPSS 17.0 to evaluate variance.

Results: We use results from 81 studies in 63 articles to analyze the pooled accuracy. The overall performance of pooled sensitivities of spatiotemporal image correlation (STIC), extend cardiac echography examination (ECEE) and 4 chambers view + outflow tract view + 3 vessels and trachea view (4 CV+OTV+3 VTV) were around 0.90, which was significant higher than that of 4 chambers view + outflow tract view or 3 vessels and trachea view (4 CV+OTV/3 VTV) and 4 chambers view (4 CV). Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00. The area under the summary receiver operating characteristic curves value of STIC, ECEE, 4 CV+OTV+3 VTV, 4 CV+OTV/3 VTV and 4 CV were 0.9700, 0.9971, 0.9983, 0.9929 and 0.9928 respectively.

Conclusion: These results suggest a great diagnostic potential for fetal echocardiography detection as a reliable method of fetal congenital heart disease. But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.

Show MeSH
Related in: MedlinePlus