Detection of left atrial appendage thrombi using multidetector CT-angiography compared with transesophageal echocardiography
Abstrakt
Introduction: The presence of left atrial appendage (LAA) thrombi is the important risk factor for cardioembolic stroke. TEE is recognized as a gold standard for detecting intracardiac thrombi.
A noninvasive alternative method would be of clinical value. Aim: To assess the sensitivity, specificity and diagnostic accuracy of 256-multidetector CT (MDCT) angiography in LAA thrombi detection compared to TEE.
Methods: 107 patients underwent contrast MDCT for different indications. All patients were simultaneously examined within 7 days by TEE.
The presence of LAA thrombi/filling defects were assessed and statistically analyzed. Results: From a total number of 107 patients examined by MDCT the filling defect was found in 11(10.3%) patients.
Using the TEE, LAA thrombi were detected in 6(5.6%) patients. With TEE as a reference method the sensitivity of MDCT in LAA thrombi detection was 100% (95 confidence interval [CI]: 56%-100%), specificity 95% (95% CI: 92%-95%) and diagnostic accuracy 95% (95% CI: 90%-95%).
The agreement of both methods for the detection of LAA thrombi was high: in 96 patients there were no thrombi detected using MDCT and TEE, in 6 patients there were thrombi found using MDCT and TEE, in 5 patients there were thrombi detected using MDCT but not proven by TEE (kappa = 0.683 [95% CI: 0.344-0.683]). Conclusion: 256-MDCT angiography is a noninvasive imaging method with high sensitivity, specificity and diagnostic accuracy for LAA thrombi detection.
In our trial the negative predictive value was 100%. When compared to TEE, MDCT is burdened with radiation exposure and the need of contrast agent.