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Differentiating spontaneous echo contrast, sludge, and thrombus in the left atrial appendage: Can ultrasound

Edith Liliana Posada-Martinez1, Camila Trejo-Paredes1, Xochitl A Ortiz-Leon1

  • 1Cardiovascular Division, Yale University, New Haven, Connecticut.

Echocardiography (Mount Kisco, N.Y.)
|July 2, 2019
PubMed

Insights

Accurately identifying left atrial appendage thrombus using transesophageal echocardiogram (TEE) in atrial fibrillation (AF) patients is crucial. Ultrasound enhancing agents (UEAs) may help differentiate severe spontaneous echo contrast (SEC) or "sludge" from less severe SEC before cardioversion.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Accurate thrombus identification in the left atrial appendage (LAA) is vital for atrial fibrillation (AF) patients undergoing cardioversion.
  • Spontaneous echo contrast (SEC) is common in these patients, with severe SEC termed
  • sludge,
  • whose clinical significance remains debated.
  • Current guidelines recommend ultrasound enhancing agents (UEAs) for significant SEC, but their role in differentiating sludge is unclear.

Purpose of the Study:

  • To investigate the utility of ultrasound enhancing agents (UEAs) in distinguishing between severe spontaneous echo contrast (SEC) or "sludge" and less severe SEC within the left atrial appendage (LAA).

Main Methods:

  • Transesophageal echocardiogram (TEE) was performed on patients with atrial fibrillation (AF) prior to cardioversion.
  • The study assessed the presence and grade of spontaneous echo contrast (SEC).
  • Ultrasound enhancing agents (UEAs) were considered in cases of significant SEC.

Main Results:

  • The study focused on the diagnostic capability of UEAs in differentiating between "sludge" and other grades of SEC.
  • Findings regarding the specific utility of UEAs in this differentiation were evaluated.

Conclusions:

  • Further research is needed to clarify the role and effectiveness of UEAs in differentiating "sludge" from less severe SEC in the left atrial appendage.
  • Understanding this distinction is important for guiding treatment decisions in AF patients.

Keywords:
atrial fibrillationechocardiographyleft atrial appendagesludgespontaneous echo contrastultrasound enhancing agents

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