Comprehensive left atrial appendage optimization of thrombus using surface echocardiography: the CLOTS multicenter...

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Atrial fibrillation (AF) poses a risk for left atrial appendage (LAA) thrombus formation.
• Transesophageal echocardiography (TEE) is the traditional method for LAA evaluation.
• The utility of transthoracic echocardiography (TTE) for LAA thrombus detection remains unclear.

Purpose of the Study:

• To evaluate the effectiveness of TTE in identifying LAA thrombus in patients with AF.
• To explore the role of TTE, including harmonic imaging and Doppler Tissue Imaging (DTI), in LAA assessment.

Main Methods:

• The Comprehensive Left Atrial Appendage Optimization of Thrombus (CLOTS) study enrolled 118 AF patients.
• LAA thrombus and spontaneous echo contrast (SEC) were assessed using TEE.
• TTE with harmonic imaging and intravenous contrast, along with LAA wall DTI velocities, were analyzed.

Main Results:

• TEE identified LAA sludge in 5% and thrombi in 2% of patients.
• TTE with harmonic imaging and contrast successfully detected both LAA thrombi.
• Specific TTE DTI velocities (apical E velocity ≤ 9.7 cm/s, anterior S velocity ≤ 5.2 cm/s) correlated with severe SEC, sludge, or thrombus.

Conclusions:

• TTE, particularly with harmonic imaging and contrast, is a viable tool for LAA thrombus detection in AF.
• LAA wall DTI velocities obtained via TTE provide valuable information on SEC severity and the presence of sludge or thrombus.