Cardiac Computed Tomography Versus Transesophageal Echocardiography for the Detection of Left Atrial Appendage Thrombus: A Systemic Review and Meta-Analysis
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Published on: February 26, 2013
Shandong Yu1, Heping Zhang1, Hongwei Li1,2,3
1Department of Cardiology Cardiovascular Center Beijing Friendship Hospital Beijing China.
Insights
Cardiac computed tomography (CT) is a reliable alternative to transesophageal echocardiography (TEE) for detecting left atrial appendage (LAA) thrombus. Delayed imaging CT significantly improves accuracy, potentially reducing patient discomfort and healthcare costs associated with TEE.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Transesophageal echocardiography (TEE) is the gold standard for left atrial appendage (LAA) thrombus detection but can cause discomfort and complications.
- Cardiac computed tomography (CT) has emerged as a potential alternative for LAA thrombus assessment.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic accuracy of cardiac CT for LAA thrombus detection compared to TEE.
- To evaluate the impact of imaging timing (early vs. delayed) on cardiac CT accuracy for LAA thrombus.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane Library (January 1977–February 2021).
- Inclusion of studies comparing diagnostic accuracy of cardiac CT and TEE for LAA thrombus.
- Bivariate random-effects model used for calculating summary sensitivity, specificity, and posterior probabilities.
- Quality assessment conducted using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Main Results:
- 27 studies involving 6960 patients were included.
- Early imaging CT showed a summary sensitivity of 0.95 and specificity of 0.89.
- Delayed imaging CT demonstrated a higher summary sensitivity of 0.98 and specificity of 1.00.
- Delayed imaging significantly improved specificity (1.00 vs. 0.89) and positive posterior probability (95.76% vs. 19.11%).
Conclusions:
- Cardiac CT with delayed imaging is a reliable alternative to TEE for LAA thrombus detection.
- This method offers improved diagnostic accuracy, particularly in specificity.
- Utilizing delayed imaging CT may reduce the need for TEE, benefiting patients and healthcare systems.
Abstract:
Background Transesophageal echocardiography (TEE) has been considered the gold standard for left atrial appendage (LAA) thrombus detection. Nevertheless, TEE may sometimes induce discomfort and cause complications. Cardiac computed tomography has been studied extensively for LAA thrombus detection. We performed this systemic review and meta-analysis to assess the diagnostic accuracy of cardiac computed tomography for LAA thrombus detection compared with TEE. Methods and Results A systemic search was conducted in the PubMed, Embase, and Cochrane Library databases from January 1977 to February 2021. Studies performed for assessment diagnostic accuracy of cardiac computed tomography on LAA thrombus compared with TEE were included. Summary sensitivity, specificity, and posterior probability of LAA thrombus was calculated by using bivariate random-effects model. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used for the quality assessment. A total of 27 studies involving 6960 patients were included in our study. The summary sensitivity of early imaging studies was 0.95 (95% CI, 0.79-0.99), and the specificity was 0.89 (95% CI, 0.85-0.92). The positive posterior probability was 19.11%, and the negative posterior probability was 0.16%. The summary sensitivity of delayed imaging studies was 0.98 (95% CI, 0.92-1.00), and the specificity was 1.00 (95% CI, 0.98-1.00). The positive posterior probability was 95.76%, and the negative posterior probability was 0.12%. The delayed imaging method significantly improved the specificity (1.00 versus 0.89; P<0.05) and positive posterior probability (95.76% versus 19.11%; P<0.05). Conclusions Cardiac computed tomography with a delayed imaging is a reliable alternative to TEE. It may save the patient and health care from an excess TEE. Registration URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42021236352.
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