Related Experiment Videos
Selective coronary angiography versus two-dimensional echocardiography for diagnosis of left atrial thrombi
Insights
Coronary angiography shows promise for diagnosing left atrial thrombi, especially in the left atrial appendage, outperforming echocardiography in some aspects. Combining both methods enhances diagnostic accuracy for left atrial clots.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Left atrial thrombi pose a significant risk, particularly in patients undergoing mitral surgery.
- Accurate detection of left atrial thrombi is crucial for effective patient management and stroke prevention.
Purpose of the Study:
- To compare the diagnostic efficacy of coronary angiography and echocardiography in identifying left atrial thrombi.
- To evaluate the diagnostic performance of coronary angiography, specifically neovascularization, against echocardiography in patients with mitral disease.
Main Methods:
- Retrospective analysis of 161 patients who underwent mitral surgery and had available data.
- Comparison of coronary angiographic findings (neovascularization) with echocardiographic data for left atrial thrombi detection.
Main Results:
- Coronary angiography demonstrated higher specificity (100%) and predictive accuracy (100%) for left atrial thrombi compared to echocardiography.
- Coronary angiography was superior in diagnosing thrombi within the left atrial appendage (p < 0.05).
- Combined use of both methods improved diagnostic specificity (77%) and predictive value (95%).
Conclusions:
- Selective coronary angiography is a valuable supplementary diagnostic tool for left atrial thrombi, complementing echocardiography.
- Coronary angiography offers advantages over echocardiography for detecting thrombi in the left atrial appendage.
- Integrated diagnostic approaches utilizing both modalities can enhance the detection of left atrial thrombi.
Abstract:
Coronary angiographic findings indicative for left atrial thrombi (neovascularization in the region of the left atrium) were compared with echocardiographic ones. Of 214 patients who had mitral surgery, the authors had all the available data for 161 (31 of whom had left atrial thrombi). The presence of a neovascularization had a sensitivity of 61%, a specificity of 100%, predictive accuracy of 100%, and predictive value of 92%, while echocardiography had a sensitivity of 52%, specificity of 96%, predictive accuracy of 76%, and predictive value of 89%. There was no difference in the sensitivity of both methods for the detection of thrombi located in the left atrium as a whole cavity (p less than 0.05). However, coronary angiography was superior to echocardiography in the diagnosis of thrombi located in the left atrial appendage (p less than 0.05). The diagnosis of left thrombi could be improved by using both methods (specificity 77%, predictive value 95%). Thus, selective coronary angiography is a useful diagnostic method, in addition to echocardiography, in the diagnosis of left atrial thrombi.