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Detection of Device-Related Thrombosis Following Left Atrial Appendage Occlusion: A Comparison Between Cardiac
Kasper Korsholm1, Jesper Møller Jensen1, Bjarne Linde Nørgaard1
1Department of Cardiology, Aarhus University Hospital, Denmark.
Insights
Cardiac CT effectively detects device-related thrombosis (DRT) after left atrial appendage occlusion, comparable to TEE. It also identifies low-grade hypoattenuated thickening (HAT) not visible with TEE, warranting further clinical significance investigation.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Device-related thrombosis (DRT) is a rare complication of left atrial appendage occlusion.
- The diagnostic capability of cardiac computed tomography (CT) for DRT is not well-established.
- Transesophageal echocardiography (TEE) is the current standard for DRT detection.
Purpose of the Study:
- To evaluate the clinical utility of cardiac CT in detecting DRT.
- To compare cardiac CT with TEE for DRT diagnosis.
- To explore the causes, natural history, and risks associated with DRT.
Main Methods:
- Retrospective review of 301 patients undergoing left atrial appendage occlusion.
- Analysis of cardiac CT and TEE imaging at 8-week and 12-month follow-ups.
- Classification of hypoattenuated thickening (HAT) on CT as low-grade or high-grade, with high-grade HAT defined as definite DRT.
Main Results:
- At 8 weeks, TEE detected 2% DRT, while cardiac CT identified 2.4% high-grade HAT.
- At 12 months, both modalities detected 1.4% DRT/high-grade HAT.
- Cardiac CT revealed low-grade HAT in 3.6% at 8 weeks and 9.4% at 12 months, which resolved spontaneously and was not linked to embolic events.
Conclusions:
- Cardiac CT demonstrates comparable efficacy to TEE for DRT detection.
- Cardiac CT can identify low-grade HAT, a finding not visible with TEE.
- The clinical implications of low-grade HAT require additional research.
Background:
Device-related thrombosis (DRT) following left atrial appendage occlusion is a rare but feared complication. The diagnostic value of cardiac compute tomography (CT) for detection of DRT is unknown. This study sought to evaluate the clinical value of cardiac CT for detection of DRT using transesophageal echocardiography (TEE) as the reference standard and to provide insights into the causes, natural history, and risk of DRT.
Methods:
We reviewed 301 consecutive patients undergoing left atrial appendage occlusion at Aarhus University Hospital, Denmark, between 2010 and 2017. Of these, 248 patients had cardiac CT and TEE imaging available at 8-week follow-up; 139 had complete 12-month imaging. A blinded investigator analyzed all images. On TEE, an echo-dense mass attached to the device was defined as DRT. Cardiac CT was analyzed for presence of hypoattenuated thickening (HAT) on the device, which was subclassified as low grade or high grade. High-grade HAT was considered as definite DRT.
Results:
At 8 weeks, TEE detected 5 (2%) cases with DRT; and cardiac CT 6 (2.4%) cases with high-grade HAT. At 12 months, both TEE and cardiac CT detected 2 (1.4%) cases with DRT or high-grade HAT, respectively. Cardiac CT demonstrated low-grade HAT in 9 (3.6%) cases at 8 weeks; and 13 cases (9.4%) at 12-months. High-grade HAT/DRT was associated with thromboembolism in 2 cases, whereas low-grade HAT was not related to embolic events. Low-grade HAT resolved spontaneously over time.
Conclusions:
Cardiac CT seems equally good as TEE for detection of DRT. In addition, cardiac CT demonstrates cases with low-grade HAT, not visualized by TEE. The clinical significance hereof requires further investigation.
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