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[Coronarography in the diagnosis of left atrial thrombosis]
Insights
Coronary angiography can help diagnose left atrial thrombosis in mitral valve disease patients. While sensitive, its high specificity suggests it
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
Background:
- Left atrial thrombosis is a common complication in patients with mitral valve defects.
- Systemic embolism is a significant risk associated with left atrial thrombus.
- Echocardiography is the standard diagnostic tool for left atrial thrombosis.
Purpose of the Study:
- To evaluate the diagnostic performance of coronary angiography for left atrial thrombosis.
- To compare coronary angiography findings with intraoperative observations in mitral valve disease patients.
Main Methods:
- Retrospective analysis of 60 operated patients with mitral valve disease.
- Preoperative coronary angiography performed on all patients.
- Intraoperative assessment for the presence of left atrial thrombus.
Main Results:
- Left atrial thrombus was confirmed intraoperatively in 13 patients.
- Coronary angiography detected thrombus in 9 of these 13 patients (sensitivity 69%).
- Angiography showed a high specificity (97%) and accuracy (90%) for diagnosing left atrial thrombosis.
Conclusions:
- Coronary angiography demonstrates high specificity and accuracy in diagnosing left atrial thrombosis.
- While sensitive, coronary angiography can miss some cases of left atrial thrombus.
- Findings suggest coronary angiography is a valuable, albeit not perfect, diagnostic tool for this condition.
Abstract:
Thrombosis of left atrium is frequent in the patients with mitral defect. Systemic embolism that generates by separated thrombus parts is a possible complication during the disease. Echocardiography is routinely used in the diagnosis of left atrial thrombosis. On the basis of angiographic experience, we have set the hypothesis: coronary angiography has a great sensitivity, but small specificity in the diagnosis of left atrial thrombosis. The presence of thrombus in left atrium was analyzed in 60 operated patients with mitral valve disease. During the surgery, thrombus was found in 13, and not found in 47 patients. Coronary angiography was preoperatively performed in all patients. In 9 out of 13 patients with intraoperatively observed left atrial thrombus, thrombus was also found by angiography. In 47 patients thrombus was found neither intraoperatively, and in 45 nor by angiography. The sensitivity of angiography in the diagnosis of left atrial thrombosis is 69%, specificity is 97%, and the accuracy is 90%. Positive index of anticipation is 81%, and negative index of anticipation is 91%.