Doppler da artéria oftálmica no diagnóstico da pré-eclâmpsia: uma revisão sistemática e metanálise

Abstract

Objective: To evaluate the accuracy of different parameters of the ophthalmic artery Doppler (OAD) in the diagnosis of preeclampsia (PE). Methods: MEDLINE, EMBASE, Bireme, Lilacs, Web of Science, Cochrane Library, Scopus, and the gray literature were systematically searched to identify relevant articles related to the diagnosis of PE using OAD. Studies were eligible for inclusion if they included pregnant women aged 18 to 45 years with singleton pregnancies without or with risk factors for PE. Study quality was assessed with the QUADAS-2 tool. To investigate the mean difference in OAD values, peak systolic velocity (PSV), end-diastolic velocity (EDV), second systolic velocity peak (P2), resistance index (RI), pulsatility index (PI), and peak ratio (PR), between PE cases (overall and according to severity) and controls, random-effects meta-analyses were conducted for each Doppler parameter, with overall PE, mild and severe PE subgroups. Diagnostic performance and heterogeneity were evaluated with summary receiver-operating characteristics curves (sROC) and 95% confidence regions, obtained with bivariate models. Results: Of 734 articles identified, 14 (1.6%) met inclusion criteria, involving a total of 1,425 pregnant women. Eight studies stratified the results in mild and severe or late and early PE. Despite a high heterogeneity between studies, PR and P2 had better diagnostic performance than the other indexes, with the PR of AUsROC at 0.885, the sensitivity of 84%, and specificity of 92%, with a low false- positive rate of 0.08 and the P2 with AUsROC of 0.926, the sensitivity of 85% and specificity of 88%. RI, PI, and EDV showed good performance and consistency across studies, but lower AUsROC of 0.833, 0.794, and 0.772, respectively. The PSV was highly variable and had little diagnostic utility. Conclusion: Ophthalmic artery Doppler is a complementary tool with good performance for diagnosis of overall and severe preeclampsia, with high and best sensitivity and specificity when using PR and P2 parameters.