Atrial thrombi detection prior to pulmonary vein isolation: Diagnostic accuracy of cardiac computed tomography versus transesophageal echocardiography

Munir, Sohaib; Chang, Justues H.; Salahudeen, Shafeequr; Baranchuk, Adrián; Morris, Cheryl; O’Reilly, Michael; Pal, Raveen

doi:10.5603/cj.a2015.0017

Cited by 5 publications

(10 citation statements)

References 21 publications

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“…Echocardiography, primarily TEE, has been studied and used in patients undergoing pulmonary vein isolation to assess for thrombus before instrumenting the left atrium. 54 Intracardiac echocardiography can also be useful in detecting atrial thrombus and is commonly used during the procedure by the electrophysiologist to assist in monitoring and guidance of the pulmonary vein isolation procedure. 55 TTE has been reported to be useful in assessing return of LA function after pulmonary vein isolation, 56 while TEE can be useful in identifying pulmonary vein stenosis after the procedure.…”

Section: Echocardiographic Evaluation Of the Left Atrium And Laamentioning

confidence: 99%

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism

Sarić

Armour

Arnaout

et al. 2016

Journal of the American Society of Echocardiography

313

235

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Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.

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Section: Echocardiographic Evaluation Of the Left Atrium And Laamentioning

confidence: 99%

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism

Sarić

Armour

Arnaout

et al. 2016

Journal of the American Society of Echocardiography

313

235

View full text Add to dashboard Cite

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“…Then, by browsing the title, abstract and full text, 62 papers were selected from the 1716 papers, and further excluded literature such as unrigorous research design, imperfect outcome indicators and abstracts. Finally, 18 articles [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] were included; flow diagram of references choice. Fig.…”

Section: Resultsmentioning

confidence: 99%

“…This study included 10 diagnostic tests and 4102 patients. TEE was the gold standard, with non-delayed CCT (4 studies) [ 18 , 19 , 20 , 21 ], 1-minute delayed CCT (3 studies) [ 20 , 21 , 22 ], 3-minute delayed CCT (2 studies) [ 21 , 22 ], 6-minute delayed CCT (1 study) [ 21 ], two dimensional (2D)-CMRI (1 study) [ 23 ], DSCT (2 studies) [ 24 , 25 ], multidetector computed tomography (MDCT) (8 studies) [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], three dimensional (3D)-TEE (1 investigation) [ 34 ], 3D-CMRI (1 investigation) [ 23 ], and CCTA (1 study) [ 35 ]. The features and baseline of the selected studies are demonstrated in Tables 1 , 2 (Ref.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic Accuracy of Left Atrial/Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Song,

Liu,

Shi

et al. 2023

Rev. Cardiovasc. Med.

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Background: This paper aimed to appraise the diagnostic precision of assorted methodologies to identify left atrial/left atrial appendage (LA/LAA) thrombus through a network meta-assessment. Methods: Methodologically, we conducted a comprehensive literature search across multiple databases. Utilizing the risk of bias tool from the Cochrane Collaboration, methodological quality of included studies was critically assessed and potential publication bias was examined via funnel plots. The subsequent data analysis was executed using Stata software, with the most efficacious diagnostic modalities being determined based on cumulative ranking curve (SUCRA) values. Results: We scrutinized a sum of 18 papers, comprising 4102 subjects and utilizing 10 different diagnostic techniques. The hierarchical results derived from the network meta-analysis indicated that in regards to sensitivity, the dual-source cardiac computed tomography (DSCT) was superior (with a SUCRA value of 71.7%), it was succeeded by 3-minute delayed cardiac computed tomography (CCT) (scoring 66.8%), which surpassed the transesophageal echocardiography (TEE) (holding a SUCRA value of 57.5%). In terms of specificity, DSCT was the best (SUCRA value of 84.3%), followed by three dimensional (3D) cardiac magnetic resonance imaging (3D-CMRI) (SUCRA value of 78.0%), which was better than TEE (SUCRA value of 66.6%). In terms of positive likelihood ratio (PLR), 6-minute delayed CCT (SUCRA value of 85.6%) was superior to 3-minute delayed CCT (SUCRA value of 80.1%), both of which were superior to TEE (SUCRA value of 69.1%). DSCT (SUCRA value of 89.3%) had the best negative likelihood ratio (NLR), while DSCT (SUCRA value of 79.9%) had the highest accuracy. Conclusions: This study demonstrated that DSCT outperformed TEE in sensitivity, specificity, NLR, and accuracy in identifying thrombus of LA/LAA among patients suffering from atrial fibrillation. Our conclusion is that DSCT is the best in diagnosing LA/LAA. In addition, 3D-CMRI and 3-minute delayed CCT are expected to replace TEE.

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“…Finally, 27 articles that met the inclusion criteria were identified (Figure 1 ). Six studies were excluded because not all patients underwent TEE, 23 , 24 , 25 no thrombus was found, 26 the sensitivity and specificity could not be calculated because the reference test was surgical finding, 27 and one study was not limited to LAA thrombus detection. 9 …”

Section: Resultsmentioning

confidence: 99%

Cardiac Computed Tomography Versus Transesophageal Echocardiography for the Detection of Left Atrial Appendage Thrombus: A Systemic Review and Meta‐Analysis

Zhang

2021

JAHA

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Background Transesophageal echocardiography (TEE) has been considered the gold standard for left atrial appendage (LAA) thrombus detection. Nevertheless, TEE may sometimes induce discomfort and cause complications. Cardiac computed tomography has been studied extensively for LAA thrombus detection. We performed this systemic review and meta‐analysis to assess the diagnostic accuracy of cardiac computed tomography for LAA thrombus detection compared with TEE. Methods and Results A systemic search was conducted in the PubMed, Embase, and Cochrane Library databases from January 1977 to February 2021. Studies performed for assessment diagnostic accuracy of cardiac computed tomography on LAA thrombus compared with TEE were included. Summary sensitivity, specificity, and posterior probability of LAA thrombus was calculated by using bivariate random‐effects model. The Quality Assessment of Diagnostic Accuracy Studies‐2 tool was used for the quality assessment. A total of 27 studies involving 6960 patients were included in our study. The summary sensitivity of early imaging studies was 0.95 (95% CI, 0.79–0.99), and the specificity was 0.89 (95% CI, 0.85–0.92). The positive posterior probability was 19.11%, and the negative posterior probability was 0.16%. The summary sensitivity of delayed imaging studies was 0.98 (95% CI, 0.92–1.00), and the specificity was 1.00 (95% CI, 0.98–1.00). The positive posterior probability was 95.76%, and the negative posterior probability was 0.12%. The delayed imaging method significantly improved the specificity (1.00 versus 0.89; P <0.05) and positive posterior probability (95.76% versus 19.11%; P <0.05). Conclusions Cardiac computed tomography with a delayed imaging is a reliable alternative to TEE. It may save the patient and health care from an excess TEE. Registration URL: https://www.crd.york.ac.uk/PROSPERO ; Unique identifier: CRD42021236352.

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Atrial thrombi detection prior to pulmonary vein isolation: Diagnostic accuracy of cardiac computed tomography versus transesophageal echocardiography

Abstract: Background: Patients routinely undergo transesophageal echocardiography (TEE) prior to pulmonary vein isolation (PVI) in order to (Cardiol J 2015; 22, 5: 576-582)

Cited by 5 publications

References 21 publications

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism

Diagnostic Accuracy of Left Atrial/Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Cardiac Computed Tomography Versus Transesophageal Echocardiography for the Detection of Left Atrial Appendage Thrombus: A Systemic Review and Meta‐Analysis

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