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2020, Número 3

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Med Crit 2020; 34 (3)


Ultrasonido Doppler con contraste para el diagnóstico de cortocircuito de derecha a izquierda: revisión sistemática y metaanálisis

González TMF, Cerón DUW, Villagrana MSA

Idioma: Español
Referencias bibliográficas: 43
Paginas: 184-193
Archivo PDF: 398.98 Kb.


RESUMEN

Introducción: La comunicación de derecha a izquierda (CDI) se produce principalmente con lesiones intracardiacas, como el foramen oval permeable (FOP) y, en menor medida, a través de malformaciones arteriovenosas pulmonares (MAVP). Desde el informe inicial de Gramiak y colaboradores, la ecocardiografía con contraste ha sido el método de elección para identificar CDI, siendo el ecocardiograma transesofágico con contraste (ETE-c) actualmente el método diagnóstico ideal para CDI.
Material y métodos: Se realizó una revisión sistemática con el objetivo de conocer el rendimiento diagnóstico del ultrasonido Doppler contrastado (UD-c) en sus diferentes variantes (transcraneal, vertebral y carotídeo) en comparación con el ETE-c para el diagnóstico de CDI; la revisión se realizó en las bases de datos EBSCO, Elsevier, KoreaMed, Lilacs, PubMed/Medline, OVID/Cochrane Library, Scielo, SCOPUS, Web of Science y EMBASE.
Resultados: Se obtuvieron 33 publicaciones que cumplían con los criterios de inclusión, aportando 36 estudios con 3,099 participantes (edad promedio de 47.1 años; 53% masculinos). De éstos, sólo se incluía un estudio sobre UD-c vertebral y un estudio sobre UD-c carotídeo, por lo que no se pudo realizar análisis estadístico de estas 2 pruebas diagnósticas. El UD-c Transcraneal fue reportado en 34 estudios, incluyendo 2,964 participantes (edad promedio de 46.8 años; 52% masculinos). Para el conjunto de estudios, se calculó una sensibilidad de 95% (IC 95% de 0.93-0.97) y especificidad de 95% (IC de 95% de 0.89-0.98); se calcularon además likelihood ratio (+) de 8.93 (IC de 95% de 7.17-11.0), un likelihood ratio (-) de 0.08 (IC de 95% de 0.05-0.12) y, al elaborar el nomograma de Bayes, infiriendo una probabilidad pretest de 30% (prevalencia de CDI en la población general), se calculó una probabilidad postest para su respectivo likelihood ratio (+) de 79% (IC 0.75-0.82), y una probabilidad postest para su respectivo likelihood (-) de 3% (IC 0.02-0.05).
Conclusiones: El UD-c transcraneal es una prueba con un excelente rendimiento diagnóstico al compararse contra el ETE-c, cuenta con la desventaja de no permitir diferenciar el tipo de comunicación (intracardiaca o pulmonar). No existe suficiente evidencia para recomendar el uso de UD-c vertebral o carotídeo para el diagnóstico de CDI; sin embargo, la evidencia actual orienta hacia una superioridad del UD-c transcraneal sobre éstos.


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