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. 2015 Mar;7(3):252-63.
doi: 10.3978/j.issn.2072-1439.2015.01.27.

Diagnostic performance of cardiac magnetic resonance for the detection of acute cardiac allograft rejection: a systematic review and meta-analysis

Wei Lu  1 , Jun Zheng  1 , Xu-Dong Pan  1 , Ming-Duo Zhang  1 , Tie-Yuan Zhu  1 , Bin Li  1 , Li-Zhong Sun  1
Affiliations

Diagnostic performance of cardiac magnetic resonance for the detection of acute cardiac allograft rejection: a systematic review and meta-analysis

Wei Lu et al. J Thorac Dis. 2015 Mar.

Abstract

Background: Several studies have addressed the diagnostic accuracy of cardiac magnetic resonance (CMR) to assess acute cardiac allograft rejection (ACAR) compared with endomyocardial biopsy (EMB). But the methodological heterogeneity limited the clinical application of CMR. Accordingly, we have sought a comprehensive, systematic literature review and meta-analysis for the purpose.

Methods: Studies prior to September 1, 2014 identified by Medline/PubMed, EMBASE and Cochrance search and citation tracking were examined by two independent reviewers. A study was included if a CMR was used as a diagnostic test for the detection of ACAR.

Results: Of the seven articles met the inclusion criteria. Only four studies using T2 relaxation time as a CMR parameter could be pooled results, because the number of studies using other parameters was less than three. By using DerSimonian-Laird random effects model, meta-analysis demonstrated a pooled sensitivity of 90% [95% confidence interval (CI), 79% to 97%], a pooled specificity of 83% (95% CI, 78% to 88%), and a pooled diagnostic odds ratio (DOR) of 61.66 (95% CI, 18.09 to 210.10).

Conclusions: CMR seems to have a high sensitivity and moderate specificity in the diagnosis of ACAR. However, as a result of CMR for diagnostic ACAR should be comprehensively considered by physicians and imaging experts in the context of clinical presentations and imaging feature. Further investigations are still required to test different parameters and study condition.

Keywords: Magnetic resonance imaging; graft rejection; heart transplantation (HTX).

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Figures

Figure 1
Figure 1
Flow diagram of literature search. CAV, cardiac allograft vasculopathy; se/sp, sensitivity/specificity.
Figure 2
Figure 2
Forest plot of sensitivity and specificity for T2 relaxation time. CI, confidence interval.
Figure 3
Figure 3
Forest plot of positive likelihood ratio and negative likelihood ratio for T2 relaxation time. LR, likelihood ratio.
Figure 4
Figure 4
Forest plot of diagnostic odds ratio for T2 relaxation time. OR, odds ratio.
Figure 5
Figure 5
Summary receiver operator characteristic (SROC) of T2 relaxation time shows a symmetric curve with an AUC (area under the curve) of 0.955, Q index value of 0.897 and standard error of 0.026.
Figure S1
Figure S1
Assessment of methodological quality according to QUADAS-2.
Figure S2
Figure S2
Summary of methodological quality according to QUADAS-2.
See this image and copyright information in PMC

References

    1. Patel JK, Kobashigawa JA. Should we be doing routine biopsy after heart transplantation in a new era of anti-rejection? Curr Opin Cardiol 2006;21:127-31. - PubMed
    1. Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult heart transplant report--2010. J Heart Lung Transplant 2010;29:1089-103. - PubMed
    1. Deckers JW, Hare JM, Baughman KL. Complications of transvenous right ventricular endomyocardial biopsy in adult patients with cardiomyopathy: a seven-year survey of 546 consecutive diagnostic procedures in a tertiary referral center. J Am Coll Cardiol 1992;19:43-7. - PubMed
    1. Hosenpud JD. Complications of endomyocardial biopsy. In: Karson J, Morton MS. eds. Complications of Cardiac Catheterization and Angiography. Prevention and Management. Mt Kisco: Futura, 1989:135-54.
    1. Felker GM, Hu W, Hare JM, et al. The spectrum of dilated cardiomyopathy. The Johns Hopkins experience with 1,278 patients. Medicine (Baltimore) 1999;78:270-83. - PubMed