title: Diagnostic performance of echocardiography for the detection of acute cardiac allograft rejection: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Many studies have addressed the diagnostic performance of echocardiography to evaluate acute cardiac allograft rejection compared with endomyocardial biopsy. But the existence of heterogeneity limited its clinical application. Thus, we conducted 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 were examined by two independent reviews. We conducted meta-analysis by using Meta-DiSc 1.4 software. An assessment tool of QUADAS-2 was applied to evaluate the risk of bias and applicability of the studies.
  
  
  RESULTS
  Thirty studies met the inclusion criteria of meta-analysis. The four parameters of pressure half time, isovolumic relaxation time, index of myocardial performance and late diastolic mitral annular motion velocity were included in the meta-analysis, with a pooled diagnostic odds ratio of 10.43, 6.89, 15.95 and 5.68 respectively, and the area under the summary receiver operating characteristic curves value of 0.829, 0.599, 0.871 and 0.685 respectively.
  
  
  CONCLUSIONS
  The meta-analysis and systematic review demonstrate that no single parameter of echocardiography showed a reliable diagnostic performance for acute cardiac allograft rejection. A result of echocardiography for ACAR should be comprehensively considered by physicians in the context of clinical presentations and imaging feature.
authors.affiliation: Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.affiliation: Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
authors.forename: Xudong
authors.initials: X
authors.lastname: Pan
authors.affiliation: Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
authors.forename: Lizhong
authors.initials: L
authors.lastname: Sun
mesh_terms: D019540:Area Under Curve; D004452:Echocardiography / Q000379:methods* / Q000592:standards*; D006084:Graft Rejection / Q000175:diagnosis*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016017:Odds Ratio; D012372:ROC Curve
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