Imaging of thrombi and assessment of left atrial appendage function: a prospective study comparing transthoracic and transoesophageal echocardiography

Abstract

Objective-To compare the value of current transthoracic echocardiographic systems and transoesophageal echocardiography for assessing left atrial appendage function and imaging thrombi. Design-Single blind prospective study. Patients were first investigated by transthoracic echocardiography and thereafter by a second investigator using transoesophageal echocardiography. The feasibility of imaging the left atrial appendage, recording its velocities, and identifying thrombi within the appendage were determined by both methods. Patients-117 consecutive patients with a stroke or transient neurological deficit. Setting-Tertiary cardiac and neurological care centre. Results-Imaging of the complete appendage was feasible in 75% of the patients by transthoracic echocardiography and in 95% by transoesophageal echocardiography. Both methods were concordant for the detection of thrombi in 10 cases. Transoesophageal echocardiography revealed two additional thrombi. In one of these patients, transthoracic echocardiography was not feasible and in the other the thrombus had been missed by transthoracic examination. In patients with adequate transthoracic echogenicity, the specificity and sensitivity of detecting left atrial appendage thrombi were 100% and 91%, respectively. Recording of left atrial appendage velocities by transthoracic echocardiography was feasible in 69% of cases. None of the patients with a velocity > 0.3 m/s had left atrial appendage thrombi. In the one patient in whom transthoracic echocardiographic evaluation missed a left atrial appendage thrombus, the peak emptying velocity of the left atrial appendage was 0.25 m/s. Conclusions-A new generation echocardiographic system allows for the transthoracic detection of left atrial appendage thrombi and accurate determination of left atrial appendage function in most patients with a neurological deficit. (Heart 1999;81:192-198)

The value of left atrial strain and strain rate in predicting left atrial appendage stasis in patients with nonvalvular atrial fibrillation

“…Besides, the multivariate logistic regression analysis showed that LA S res was the strongest independent predictor of the presence of LAA stasis. Conventional 2D TTE has a low sensitivity of only 3-19% for the detection of thrombi in LA and especially in LAA [10]. When the formed thrombi are absent, a dense SEC has been demonstrated to be a strong predictor of ischemic stroke [11].…”

Left Atrial and Left Atrial Appendage Mass Diagnosed by Cardiac Imaging: A Case Report

“…So far, only a few studies (3)(4)(5) have reported the detection of LAA thrombi by TTE using second harmonic imaging, and all the visualized LAA thrombi have been large (length > 1.0 cm). This was in accordance with our case, where the LAA thrombus was also large (length = 1.7 cm).…”

“…The sensitivity of TTE for detecting LAA thrombi is low, and only a few case reports have been described in the literature (3)(4)(5). We describe a patient with rheumatic MS and chronic AF presenting with an LA cavity mass and an LAA mass identified as a thrombus by TTE.…”

“…The differential diagnosis between tumors and thrombi is difficult without the presence of precipitating factors for thrombus formation. The LA has a predisposition for thrombus formation, especially in patients with low flow states such as AF, MS, and LA enlargement (3).…”

Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

“…It has been shown that increased LAA area or volume, and reduced LAA fractional area change, determined by B-mode 2D echocardiography, is associated with the presence of LAA thrombus in both AF and SR [16,22,26,27]. It should be emphasised that LAA size is increased along with LA enlargement: LAA enlargement was observed in 59% of patients with dilated LA and in only 15% of patients with normal LA size [8].…”