Evaluation of Lateral-Flow Assay for Rapid Detection of Influenza Virus

Background. Influenza virus mainly causes acute respiratory infections in humans. However, the diagnosis of influenza is not accurate based on clinical evidence, as the symptoms of flu are similar to other respiratory virus. The lateral-flow assay is a rapid method to detect influenza virus. But the effectiveness of the technique in detecting flu viruses is unclear. Hence, a meta-analysis would be performed to evaluate the accuracy of LFA in detecting influenza virus. Methods. Relevant literature was searched out in PubMed, Embase, Web of Science, and Cochrane Library databases with the keywords “lateral flow assay” and “flu virus”. By Meta-DiSc software, pooled sensitivity, pooled specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), summary receiver operating characteristic curve (SROC), and area under the curve (AUC) can be calculated. Results. This meta-analysis contains 13 studies and 24 data. The pooled sensitivity and specificity of the influenza virus detected by LFA were 0.84 (95% CI: 0.82-0.86) and 0.97 (95% CI: 0.97-0.98), respectively. The pooled values of PLR, NLR, DOR, and SROC were 32.68 (17.16-62.24), 0.17 (0.13-0.24), 334.07 (144.27-773.53), and 0.9877. No publication bias was found. Conclusions. LFA exhibited high sensitivity and specificity in diagnosing influenza virus. It is a valuable alternative method which can diagnose influenza virus quickly. However, more evidence is required to confirm whether LFA is comparable to traditional methods for detecting the virus.

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Diagnostic accuracy of Xpert Xpress Flu/RSV for detection of Influenza and Respiratory syncytial virus: systematic review and meta-analysis

10.21203/rs.2.17887/v1 ◽

2019 ◽

Author(s):

Xu-Guang Guo ◽

Ye-Ling Liu ◽

Tian-Ao Xie ◽

Geng-Ling Lin ◽

Qin-Rong Lin ◽

...

Keyword(s):

Influenza Virus ◽

Respiratory Syncytial Virus ◽

Publication Bias ◽

Likelihood Ratio ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Cochrane Library ◽

Original Research ◽

Syncytial Virus

Abstract Background: Xpert Xpress Flu/RSV assay is a fast and automated real-time nucleic acid amplification method, recently approved by the USA, Europe and China for detection and differentiation of influenza (Flu) A, Flu B and RSV virus from nasopharyngeal swabs. Nevertheless, there are still no systematic reviews and meta-analysis on the accuracy of identification of influenza virus by The Xpert Xpress Flu/RSV assay. The aim of this meta-analysis was to verify the accuracy of Xpert Xpress Flu/RSV for detecting Flu and RSV.Materials and Methods: The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched using the following keywords: Xpert Xpress Flu/RSV, Flu and RSV up to April 2019. Four researchers screened and extracted documents according to inclusion and exclusion criteria. The quality of original research was assessed using the QUADAS-2 guidelines. Meta-DiSc 1.4 software was used to analyze the sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic ratio (DOR), and Summary receiver operating characteristic curves (SROC). Deek’s funnel plot asymmetry test was used to evaluate the publication bias by Stata 12.0.Results: Nine studies with 22 fourfold tables were included in this meta-analysis. The sensitivity of Xpert Xpress Flu/RSV for detection of Flu A, Flu B, and RSV was 0.96, 0.98, 0.98; the specificity was 0.97, 0.99, 0.99; +LR was 80.65, 163.74, 237.35; -LR was 0.02 , 0.03, 0.05；DOR was 4806.90, 6266.78, 5254.41, respectively. AUC was all over 0.9. In addition, no publication bias for FluA, Flu B, and RSV was found. Conclusions: Compared to the traditional PCR approach, Xpert Xpress Flu/RSV resulted as a valuable method for Flu and RSV diagnosis in the clinic, offering high sensitivity and specificity. Nonetheless, further research is necessary to determine whether Xpert Xpress Flu/RSV can be used as a clinical diagnostic standard for the identification of Flu and RSV. Keywords: Xpert Xpress Flu/RSV; influenza virus; respiratory syncytial virus; PCR

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Diagnostic and Prognostic Role of miR-192 in Different Cancers: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2021/8851035 ◽

2021 ◽

Vol 2021 ◽

pp. 1-14

Author(s):

Lili Wang ◽

Yuhan Liu ◽

Chen Lyu ◽

Alexander Buchner ◽

Heike Pohla

Keyword(s):

Systematic Review ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Cochrane Library ◽

Eligibility Criteria ◽

Potential Biomarker

Introduction. It has been shown that miR-192 is abnormally expressed in a variety of cancer types and participates in different kinds of signaling pathways. The role of miR-192 in the diagnosis and prognosis of cancer has not been verified. This article is aimed at exploring the diagnostic and prognostic value of miR-192 through a systematic review and meta-analysis. Methods. A systematic search was performed through PubMed, Embase, Web of Science, and Cochrane Library databases up to June 16, 2020. A total of 16 studies were enrolled in the meta-analyses, of which 11 articles were used for diagnostic meta-analysis and 5 articles were used for prognostic meta-analysis. The values of sensitivity and specificity using miR-192 expression as a diagnostic tool were pooled in the diagnostic meta-analysis. The hazard ratios (HRs) of overall survival (OS) with 95 confidence intervals (CIs) were extracted from the studies, and pooled HRs were evaluated in the prognostic meta-analysis. Eleven studies including 667 cancer patients and 514 controls met the eligibility criteria for the diagnostic meta-analysis. Five studies including 166 patients with high miR-192 expression and 236 patients with low miR-192 expression met the eligibility criteria for the prognostic meta-analysis. Results. The overall diagnostic accuracy was as follows: sensitivity 0.79 ( 95 % CI = 0.75 -0.82), specificity 0.74 ( 95 % CI = 0.64 -0.82), positive likelihood ratio 3.03 ( 95 % CI = 2.11 -4.34), negative likelihood ratio 0.29 ( 95 % CI = 0.23 -0.37), diagnostic odds ratio 10.50 ( 95 % CI = 5.89 -18.73), and area under the curve ratio (AUC) 0.82 ( 95 % CI = 0.78 -0.85). The overall prognostic analysis showed that high expression of miR-192 in patients was associated with positive survival ( HR = 0.62 , 95 % CI : 0.41 -0.93, p = 0.020 ). Conclusion. Our results revealed that miR-192 was a potential biomarker with good sensitivity and specificity in cancers. Moreover, highly expressed miR-192 predicted a good prognosis for patients.

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Diagnostic Performance of Ultrasonography in Patients With Pneumonia: An Updated Comparative Systematic Review and Meta-analysis

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479321992348 ◽

2021 ◽

pp. 875647932199234

Author(s):

Sharareh Sanei Sistani ◽

Fateme Parooie

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Diagnostic Method ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Cost Effective ◽

Study Data ◽

Cochrane Library ◽

Methodologic Quality

Objectives: A chest radiograph (CXR) is still the preferred diagnostic method when pneumonia is suspected, although the sensitivity is relatively low. The aim of this study was to compare the diagnostic sensitivity, specificity, and accuracy of ultrasonography (US) for the diagnosis of community-acquired pneumonia (CAP), compared with CXR. Materials and Methods: A principled search was conducted to identify original English articles using PubMed, EMBASE, Web of Science, Scopus, and the Cochrane library, with the end date of October 2020. A combination of keywords, such as “ultrasound” or “ultrasonography,” “pneumonia,” “sensitivity,” and “specificity,” was used. Methodologic quality was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 criteria. Statistical analysis was completed on the resulting study data. Results: The search produced 16 eligible articles that reported on 2040 patients. The overall pooled sensitivity for US and CXR, to diagnose pneumonia, was 0.96 and 0.65, respectively. The overall pooled specificity for US and CXR was 0.85 and 0.81, respectively. The overall pooled positive likelihood ratio for US and CXR was 9.74 and 3.67, respectively. The negative likelihood ratio for US and CXR was 0.05 and 0.42, respectively. In addition, summary receiver operative characteristics areas under the curve were 0.98 for US and 0.77 for CXR. Conclusion: This review demonstrated that lung US is a useful technique for the diagnosis of pneumonia. This diagnostic method can be used by emergency physicians with high accuracy, sensitivity, and specificity. Among an elderly population, this diagnostic method may be a better choice than CXR. The rapid performance of lung US may facilitate a quick, cost-effective, and safe diagnosis of this potentially fatal disease.

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The value of glycosylated hemoglobin in the diagnosis of diabetic retinopathy: a systematic review and Meta-analysis

BMC Endocrine Disorders ◽

10.1186/s12902-021-00737-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bo Zhang ◽

Bingjie Zhang ◽

Zhulin Zhou ◽

Yutong Guo ◽

Dan Wang

Keyword(s):

Diabetic Retinopathy ◽

Likelihood Ratio ◽

Roc Curve ◽

Meta Analysis ◽

Glycosylated Hemoglobin ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Biomedical Literature ◽

Cochrane Library ◽

Clinical Value

AbstractObjectiveGlycosylated hemoglobin (HbA1c) has obvious clinical value in the diagnosis of diabetes, but the conclusions on the diagnostic value of diabetic retinopathy (DR) are not consistent. This study aims to comprehensively evaluate the accuracy of glycosylated hemoglobin in the diagnosis of diabetic retinopathy through the meta-analysis of diagnostic tests.MethodsCochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), China Wanfang Database, Chinese Biomedical Literature Database (CBM) were searched until November, 2020. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the quality of the included studies. The pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR) and areas under the receiver operating characteristic (ROC) curve were calculated by Stata 15.0 software.ResultsAfter screening, 18 high-quality papers were included. The results of meta-analysis showed that the combined DOR = 18.19 (95% CI: 10.99–30.11), the sensitivity= 0.81 (95% CI): 0.75 ~ 0.87), specificity = 0.81 (95%CI: 0.72 ~ 0.87), +LR = 4.2 (95%CI: 2.95 ~ 6.00), −LR = 0.23 (95%CI: 0.17 ~ 0.31), and the area under the Summary ROC curve was 0.88 (95%CI: 0.85 ~ 0.90).ConclusionThe overall accuracy of HbA1cC forin diagnosing diabetic retinopathy is good. As it is more stable than blood sugar and is not affected by meals, it may be a suitable indicator for diabetic retinopathy.

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Pooled analysis of T2 Candida for rapid diagnosis of candidiasis

BMC Infectious Diseases ◽

10.1186/s12879-019-4419-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Dong-Lan Tang ◽

Xiao Chen ◽

Chang-Guo Zhu ◽

Zhong-wei Li ◽

Yong Xia ◽

...

Keyword(s):

Likelihood Ratio ◽

Web Of Science ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Pooled Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Research Subjects

Abstract Background The present meta-analysis examined the diagnostic accuracy of T2 Candida for candidiasis. Methods The literature databases, such as PubMed, Embase, DVIO, Cochrane library, Web of Science, and CNKI, were searched on T2 Candida detection. Results A total of 8 articles, comprising of 2717 research subjects, were included in the study. The pooled sensitivity and specificity were 0.91 (95% confidence interval (CI): 0.88–0.94) and 0.94 95% CI: 0.93–0.95), respectively. The pooled positive likelihood ratio and negative likelihood ratio was 10.16 (95% CI: 2.75–37.50) and 0.08 (95% CI: 0.02–0.35), respectively. The combined diagnostic odds ratio is 133.65 95% CI: 17.21–1037.73), and the AUC of SROC is 0.9702 [(SE = 0.0235), Q* = 0.9201(SE = 0.0381)]. Conclusions The current evidence supported that T2 Candida has high accuracy and sensitivity and is of major clinical significance in the diagnosis of Candida infection.

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Evaluation of GeneXpert vanA/vanB in the early diagnosis of vancomycin-resistant enterococci infection

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009869 ◽

2021 ◽

Vol 15 (11) ◽

pp. e0009869

Author(s):

Zhuo-Lei Li ◽

Qi-Bing Luo ◽

Shan-Shan Xiao ◽

Ze-Hong Lin ◽

Ye-Ling Liu ◽

...

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Characteristic Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Clinical Problem ◽

Diagnostic Odds Ratio ◽

Cochrane Library ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant

Purpose Vancomycin-resistant enterococci infection is a worrying worldwide clinical problem. To evaluate the accuracy of GeneXpert vanA/vanB in the diagnosis of VRE, we conducted a systematic review in the study. Methods Experimental data were extracted from publications until May 03 2021 related to the diagnostic accuracy of GeneXpert vanA/vanB for VRE in PubMed, Embase, Web of Science and the Cochrane Library. The accuracy of GeneXpert vanA/vanB for VRE was evaluated using summary receiver to operate characteristic curve, pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. Results 8 publications were divided into 3 groups according to two golden standard references, vanA and vanB group, vanA group, vanB group, including 6 researches, 5 researches and 5 researches, respectively. The pooled sensitivity and specificity of group vanA and vanB were 0.96 (95% CI, 0.93–0.98) and 0.90 (95% CI, 0.88–0.91) respectively. The DOR was 440.77 (95% CI, 37.92–5123.55). The pooled sensitivity and specificity of group vanA were 0.86 (95% CI, 0.81–0.90) and 0.99 (95% CI, 0.99–0.99) respectively, and those of group vanB were 0.85 (95% CI, 0.63–0.97) and 0.82 (95% CI, 0.80–0.83) respectively. Conclusion GeneXpert vanA/vanB can diagnose VRE with high-accuracy and shows greater accuracy in diagnosing vanA.

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Systematic Review and Meta-Analysis of the Utility of Circular RNAs as Biomarkers of Hepatocellular Carcinoma

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/1684039 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 2

Author(s):

Qingqin Hao ◽

Yadi Han ◽

Wei Xia ◽

Qinghui Wang ◽

Huizhong Qian

Keyword(s):

Likelihood Ratio ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Clinicopathological Characteristics ◽

Cochrane Library ◽

Circular Rnas ◽

Clinical Value ◽

Sensitivity Specificity

Emerging studies have reported circRNAs were dysregulated in HCC. However, the clinical value of these circRNAs remains to be clarified. Herein, we aimed to comprehensively explore their association with the diagnosis, prognosis, and clinicopathological characteristics of HCC. PubMed, EMBASE, Web of Science, and Cochrane Library databases were comprehensively searched for eligible studies up to October 30, 2018. The diagnostic effect was evaluated by the pooled sensitivity, specificity, and other indexes. The pooled hazard ratio (HR) for overall survival (OS) and recurrence free survival (RFS) was calculated to assess the prognostic value. Ten studies on diagnosis, 12 on prognosis, and 23 on clinicopathology were identified from the databases. A total of 11 upregulated and 11 downregulated circRNAs showed an association with clinicopathological features of HCC. For the diagnosis analyses, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of circRNAs for HCC were 0.74 (95%CI: 0.65-0.82) and 0.76 (95%CI: 0.70-0.81), 3.1 (95%CI: 2.5-3.8), 0.34 (95%CI: 0.25-0.47), and 9 (95%CI: 6-14), respectively. The area under SROC curve (AUC) was 0.81 (95% CI: 0.78–0.84), indicating moderate diagnostic accuracy. In stratified analyses, the diagnostic performance of circRNAs varied based on the source of control and specimen type. For the prognosis analyses, increased expression of upregulated circRNAs was associated with worse OS (HR: 3.67, 95%: 2.07-6.48), while high expression of downregulated circRNAs was associated with better OS (HR: 0.38, 95%: 0.30-0.48). In conclusion, this study reveals that circRNAs may serve as promising diagnostic and prognostic biomarkers for HCC. However, further investigations are still required to explore the clinical value of circRNAs.

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Diagnostic Accuracy of Epithelial Membrane Antigen for Malignant Effusions: A Meta-Analysis

The International Journal of Biological Markers ◽

10.5301/jbm.5000181 ◽

2016 ◽

Vol 31 (1) ◽

pp. 11-16 ◽

Cited By ~ 1

Author(s):

Wentao Lin ◽

Xiaoxue Liu ◽

Ying Cen

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Odds Ratio ◽

Epithelial Membrane Antigen ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Diagnostic Potential ◽

Malignant Effusions

Background and Objectives Body cavity fluid examination sometimes presents a diagnostic challenge in cytology practice. This meta-analysis was undertaken to comprehensively assess the diagnostic potential of epithelial membrane antigen (EMA) in malignant effusions. Materials and Methods All relevant original articles about EMA in the diagnosis of malignant effusions published up to July 1, 2014 were retrieved. The overall sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristic (SROC) curve were pooled to evaluate the diagnostic value of EMA for malignant effusions using the Meta-Disc 1.4 and STATA 12.0 statistical software. Results Eleven studies met the inclusion criteria for the meta-analysis and the summary estimates for EMA in the diagnosis of malignant effusions were as follows: sensitivity 0.9 (95% CI 0.83-0.87), specificity 0.87 (95% CI 0.96-0.99), positive likelihood ratio 5.8 (95% CI 15.59-36.37), negative likelihood ratio 0.15 (95% CI 0.07-0.20) and diagnostic odds ratio 52.63 (95% CI 20.91-132.49). The SROC curve indicated that the maximum joint sensitivity and specificity (Q-value) was 0.88; the area under the curve was 0.94. Conclusion The present meta-analysis indicated that EMA may be a useful diagnostic tool with good sensitivity and specificity for differentiating malignant effusions from benign effusions.

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Reliability of circulating fibrinogen in the diagnosis of prosthesis-related infections: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02171-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xingyang Zhu ◽

Haitao Zhang ◽

Xiaobo Sun ◽

Yijin Li ◽

Jiahao Li ◽

...

Keyword(s):

Likelihood Ratio ◽

Meta Analysis ◽

Joint Infection ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Small Sample ◽

Cochrane Library ◽

Sensitivity Specificity

Abstract Background Fibrinogen (FIB) has recently been used as a biomarker to diagnose periprosthetic joint infection (PJI), but its reliability is still questionable. The aim of this study was to investigate the accuracy of FIB in the diagnosis of PJI after joint replacement. Methods We searched for literatures published in PubMed, EMBASE, and the Cochrane Library from the time of database inception to September 2020 and screened the studies according to the inclusion criteria. Then, we calculated the diagnostic parameters of FIB, including the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), area under the curve (AUC), and diagnostic odds ratio (DOR). In addition, we implemented subgroup analyses to identify the sources of heterogeneity. Results Seven studies including 1341 patients were selected in our meta-analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR of FIB for PJI diagnosis were 0.78 (95% confidence interval [CI], 0.73–0.82), 0.83 (95% CI, 0.81–0.86), 4.60 (95% CI, 3.30–6.42), 0.24 (95% CI, 0.18–0.34), and 20.13 (95% CI, 14.80–27.36), respectively, while the AUC was 0.896. Conclusion The present study indicated that FIB was a reliable detection method and might be introduced into the diagnostic criteria for PJI. However, more robust studies are still needed to confirm the current findings, because most of the included studies were retrospective and had small sample sizes.

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Comparison of methods for the diagnosis of patent foramen ovale in patients with cryptogenic cerebral ischemia: a meta-analysis

10.22541/au.161626571.12319626/v1 ◽

2021 ◽

Author(s):

Xiaoxuan Guo ◽

Xiaojuan Wang ◽

Lu Zhang ◽

Yan Zhang ◽

Rui Peng ◽

...

Keyword(s):

Cerebral Ischemia ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Transthoracic Echocardiography ◽

Patent Foramen Ovale ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Receiver Operating Curve ◽

Foramen Ovale

Background: Foramen ovale is a residual cavity in the developing heart in the fetus. At present, the standard methods for the diagnosis of PFO-right-to-left-shunting (PFO-RLS) include transesophageal echocardiography (TEE), contrast-transcranial Doppler echocardiography (C-TCD), and contrast-transthoracic echocardiography (C-TTE), each of them having its advantages and disadvantages.However, there are no data allowing the comparison of these three methods. Methods: We systematically reviewed all published studies on patients with cryptogenic cerebral ischemia. The sensitivity, specificity, and other indexes of C-TCD and C-TTE in the diagnosis of PFO-RLS were calculated using the Stata 16.0 software. The area under the summary receiver operating curve（SROC) was calculated. Results: Twenty-five 25 controlled studies involving a total of 2282 patients were analyzed. There was considerable heterogeneity between C-TCD and C-TTE sensitivity and specificity among the studies. The combined sensitivity and specificity of C-TCD and C-TTE were 0.95 (95%CI, 0.93-0.97) and 0.86(95%CI, 0.78-0.91), and 0.88 (95%CI, 0.69-0.96) and 0.99 (95%CI, 0.67-1.00). The positive likelihood ratio and negative likelihood ratio of C-TCD and C-TTE were 6.81 (95%CI, 4.42-10.48) and 0.05 (95%CI, 0.03-0.08), and 82.31(95%CI, 2.03-3341.00) and 0.12 (95%CI, 0.04-0.34). The areas under the SROC for C-TCD and C-TTE were 0.97 (95%CI, 0.95–0.98) and 0.98 (95%CI, 0.96–0.99), respectively, and were not significantly different by the Z test (z=-0.17, p=0.86). Conclusion: C-TCD and C-TTE have advantages in diagnosing PFO-RTL. The combination of C-TCD and C-TTE improves the detection rate and reduces the misdiagnosis rate. Key words: patent foramen ovale, cryptogenic cerebral ischemia, contrast-transthoracic echocardiography, contrast-transthoracic echocardiography

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