Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients

Abstract

Background. Transesophageal echocardiogram (TEE) is superior to transthoracic echocardiogram (TTE) in detecting left atrial thrombus (LAT), a risk factor for stroke, but is costly and invasive, carrying a higher risk for complications. Aims. To determine the utility of using left atrial enlargement (LAE) on TTE to predict LAT on TEE. Methods. AIS patients who presented in 06/2008–7/2013 and underwent both TTE and TEE were identified from our prospective stroke registry. Analysis consisted of multivariate logistic regression with propensity score adjustment and receiver operating characteristic (ROC) area under the curve (AUC) analyses. Results. 219 AIS patients underwent both TTE and TEE. LAE on TTE was detected in 113 (51.6%) of AIS patients. Patients with LAE on TTE had higher proportion of LAT on TEE (8.4% versus 1.0%, p = 0.018). LAE on TTE predicted increased odds of LAT on TEE (OR = 8.83, 95% CI 1.04–74.83, p = 0.046). The sensitivity and specificity for LAT on TEE by LAE on TEE were 88.89% and 52.20%, respectively (AUC = 0.7054, 95% CI 0.5906–0.8202). Conclusions. LAE on TTE can predict LAT detected on TEE in nearly 90% of patients. This demonstrates the utility of LAE on TTE as a potential screening tool for LAT, potentially limiting unneeded costs and complications associated with TEE.

Left Atrial Enlargement and the Risk of Stroke: A Meta-Analysis of Prospective Cohort Studies

“…It may be proposed that the left atrial size could serve as a more ideal and stable predictor than AF/underlying AF in ischemic stroke patients, especially in cryptogenic ischemic stroke, which would be also helpful in differentiating etiological diagnoses of ischemic stroke and treatment of the ischemic stroke: choosing or not choosing oral anticoagulant (OAC) treatment. Second, a study (29) that investigated the relationship between LAE and ischemic stroke had found on TTE that LAE had a satisfying predictive value for left atrial thrombus (LAT) on TEE. Thus, patients will not need to undergo TEE, which is expensive and invasive and has a higher risk of complications.…”

The Frequency of Left Atrial Thrombus on Transthoracic Echocardiogram in Patients with Mitral Stenosis

“…Most of the studies conducted for this population are based on TEE [20,23,24]. Although the sensitivity and specificity of TTE are disputed, the detection of LA thrombus using LA enlargement of TTE is reported to be nearly 90% accurate, with a sensitivity of 88.9% and specificity of 52.2%, based on a study of patients with ischemic stroke [25]. Atrial fibrillation, smaller LA size, bigger MVA, and no low-flow velocities are also reported to be associated with LA thrombus [20,23].…”

LDL-C/HDL-C is Associated With Ischaemic Stroke in Patients With Non-Valvular Atrial Fibrillation: A Case-Control Study

“…Friberg et al [6] have shown that clinically diagnosed heart failure is not an independent risk factor for stroke in AF patients. Previous studies have shown that left atrial enlargement and low-density lipoprotein cholesterol (LDL-C) are clinically easy-to-obtain indicators for risk strati cation of thromboembolism events in patients with AF [7][8][9]. High-density lipoprotein (HDL-C) was negatively correlated with the risk or severity of IS [10][11].…”