Real time 3-dimensional transesophageal echocardiography is more specific than 2-dimensional TEE in the assessment of left atrial appendage thrombosis

Abstract

Background. In patients indicated for detection of intraatrial thrombus (T), 2-dimensional transesophageal echocardiography (2DTEE) is routinely used but differentiation between T and trabeculae or artifacts in the left atrial appendage (LAA) is often difficult. Aims. To compare the diagnostic value of real time 3D-transesophageal echocardiography (RT3DTEE) and 2DTEE in the assessment of LAA thrombosis. Patients and Methods. One hundred and ten consecutive patients (73M, aged 64+-13) were examined by 2DTEE. In terms of possible T, individual pts were diagnosed as negative (N2), uncertain trabecular finding (U2), other/artifacts (O2), and clearly positive (T2). The RT3DTEE was then applied and the categorization repeated (N3,U3,O3 and T3, resp.). Finally, the operator decided whether the RT3DTEE. A: had an additional diagnostic value, and/or B: changed the definite diagnosis of thrombosis. Results. N2:71; U2:17; O2:19; T2:3; N3:97; U3:1; O3:12; T3:0. Ad A/ RT3DTEE enabled us to refine or change the diagnosis in 26/110 cases. 17 pts were switched from group U2 to N3, 7:O2-N3 and 2:T2-N3. 12 pts from O2 and 1 pt from T2 remained unclarified. Ad B/ Diagnoses were changed in 6 patients after RT3DTEE. A very suspicious T2 was found in 3 patients. In 1, the finding was requalified definitely as musculi pectinati. In the second patient, the finding was recategorized as just a spontaneous echocontrast without T. In another 4 patients, T in LAA was definitely excluded after RT3DTEE (1 patient switched from U2 to N3, 3 from O2 to N3). In another 13, the findings remained unclear, mostly because of poor quality image. No real thrombus was found in this study. Conclusion. RT3DTEE provides additional information, which may be helpful in the differentiation of thrombus from other findings. It is particularly useful in the identification of muscular trabeculae in the left atrial appendage.

Transoesophageal echocardiography: what the general cardiologist needs to know

“…Administration of echo contrast (eg, Sonovue, Optison) to look for a filling defect can also improve diagnostic certainty, although most TOE platforms are not optimised for use with echo contrast 36. Combined 2D and 3D TOE offers advantages including improved differentiation of thrombus from myocardium and pectinate muscles,37 38 more accurate measurement of LAA size39 and superior visualisation of LAA anatomy (important in multilobed LAA) and surrounding structures 40…”

Cardiac tumors and sources of embolism

“…Recently, Marek et al demonstrated an additional value for RT3D TEE for discrimination of LAA thrombi and identification of muscular trabeculae [14]. Beside improved detection of LA thrombi, RT3DE can be helpful in the discrimination and localization of multiple masses in the LA atrium as illustrated in .…”

Transesophageal echocardiography for the assessment of left atrial appendage thrombus: Study of the additional value of systematic real time 3D imaging after regular 2D evaluation

“…Real time three‐dimensional transesophageal echocardiography (3DTEE) has been more recently described for LAA imaging and has shown to be efficient for thrombus assessment in case reports or noncomparative studies . Only one study previously compared 2DTEE and real time 3DTEE for thrombus assessment in the LAA; unfortunately, no actual LAA thrombus was found in this series, and no validation with CT scan was performed in case of remaining doubt after TEE, rendering the results of this study difficult to interpret and to consider in daily practice. Moreover, the 3D imaging of the LAA always follows a regular 2D evaluation, and the additional value of systematic 3D imaging of the LAA remains unclear.…”