title: Fetal echocardiography for congenital heart disease diagnosis: a meta-analysis, power analysis and missing data analysis.
abstract: BACKGROUND
  Prenatal ultrasonography is the most widely available diagnostic test for fetal congenital heart disease (CHD), but the factors influencing its diagnostic accuracy remain uncertain despite extensive research. The aim of the present study was to evaluate the potential role of demographic, clinical and ultrasonographic characteristics on diagnostic yields for detecting CHD.
  
  
  METHODS
  A systematic search of PubMed, ISI Web of Science, SinoMed, and the Cochrane Library was performed to identify studies assessing the accuracy of prenatal ultrasound in the detection of CHD. A random effects model was used to generate pooled sensitivity and specificity in addition to summary receiver operating characteristic (SROC) curves.
  
  
  RESULTS
  Overall, prenatal ultrasound in the detection of CHD had a moderate sensitivity of 68.1% (95% CI 59.6-75.5) and a favorable specificity of 99.9% (99.7-99.9). Risk level and gestation age were independent predictors of diagnostic performance for detecting CHD (p = 0.004 vs. p = 0.002, respectively). The pooled sensitivities significantly increased to varying extents with the following echocardiographic views: 48.7% (34.8-67.2) for four-chamber view (4CV); 58.0% (40.3-73.9) for a combination of 4CV and outflow tract views (OTV); 73.5% (59.2-84.1) for combination of 4CV, OTV and three vessels and trachea view (3VTV); 77.1% (62.0-87.5) for extensive cardiac echocardiography examination (ECEE); and 89.6% (81.0-94.6) for spatiotemporal image correlation (STIC).
  
  
  CONCLUSIONS
  Prenatal ultrasound is a powerful tool for the diagnosis of CHD; however, a single ultrasonographic regime is not definitive on its own and must be interpreted in the context of demographic and clinical characteristics.
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, PR China Collaborative Group of Congenital Heart Disease, Department of Pediatric Cardiology, Jiangsu Women's and Children's Health of Nanjing Medical University, PR China Research Institute of Heart, Lung and Blood Vessel Diseases, Jiangsu Provincial Academy of Clinical Medicine, PR China.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Study Group of Echocardiography, Department of Sonographic Diagnostic Medicine, First Affiliated Hospital of Nanjing Medical University, PR China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Key Laboratory of Diagnostic Medicine of Education Ministry, Institute of Laboratory Medicine, Chongqing Medical University, PR China.
authors.forename: Qiao-Ling
authors.initials: QL
authors.lastname: Feng
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, PR China Collaborative Group of Congenital Heart Disease, Department of Pediatric Cardiology, Jiangsu Women's and Children's Health of Nanjing Medical University, PR China Research Institute of Heart, Lung and Blood Vessel Diseases, Jiangsu Provincial Academy of Clinical Medicine, PR China dr.htgu@hotmail.com.
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Gu
authors.affiliation: Department of Radiology, General Clinical Center for Radiation Oncology, Affiliated Cancer Hospital of Guangxi Medical University, PR China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wan
authors.affiliation: Institute of Fluid Measurement and Simulation, Department of Mechanics, College of Metrology & Measurement Engineering, China Jiliang University, PR China.
authors.forename: Huo-Ming
authors.initials: HM
authors.lastname: Zhang
authors.affiliation: National Experimental Center for Medical Simulation of China, Laboratory of Anthropotomy & Histo-Embryology, School of Basic Medical Sciences, Chengdu Medical College, PR China.
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Xie
authors.affiliation: Department of Health Statistics, National Center for Chinese Clinical Trial Register, School of Public Health, Sichuan University Western China School of Medicine, PR China.
authors.forename: Xiao-Song
authors.initials: XS
authors.lastname: Li
mesh_terms: D019540:Area Under Curve; D004452:Echocardiography; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: Heart defect; congenital; echocardiography; fetus; pediatrics