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Left atrial appendage filling defect in exclusive early-phase scanning of dual-phase cardiac computed tomography: An
Yu Qiao1, Zhen Zhao1, Xiang Cai1
1Fuwai Yunnan Cardiovascular Hospital, Department of Cardiac Arrhythmia, Kunming Medical University, Wuhua District, Kunming, Yunnan, People's Republic of China.
Insights
Left atrial appendage filling defects seen only in early-phase CCT scans (LAAFD-EEpS) are common in atrial fibrillation patients. This finding is linked to a higher risk of stroke and transient ischemic attack (TIA).
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Dual-phase cardiac computed tomography (CCT) is used to detect left atrial appendage (LAA) thrombosis, identified as LAA filling defects (LAADF) on both early and delayed scans.
- The clinical significance of LAADF appearing exclusively on early-phase CCT scans (LAAFD-EEpS) in atrial fibrillation (AF) patients remains unclear.
Purpose of the Study:
- To investigate the prevalence and clinical implications of LAAFD-EEpS in patients with AF.
- To assess the association between LAAFD-EEpS and thromboembolic risk, including ischemic stroke and transient ischemic attack (TIA).
Main Methods:
- A cohort of 1183 AF patients undergoing dual-phase CCT was analyzed for baseline clinical data and CCT findings.
- A subgroup of 687 patients had their CCT data further analyzed alongside transesophageal echocardiography (TEE) findings.
- LAAFD-EEpS was defined as the presence of LAADF in early-phase but absence in delayed-phase CCT scans.
Main Results:
- LAAFD-EEpS was identified in 11.2% (133 patients) of the study cohort.
- Patients with LAAFD-EEpS exhibited a significantly higher prevalence of ischemic stroke/TIA and elevated thromboembolic risk (p < 0.001).
- History of ischemic stroke/TIA was an independent predictor of LAAFD-EEpS (OR 11.412, p < 0.001).
Conclusions:
- LAAFD-EEpS is a frequent finding in dual-phase CCT for AF patients.
- This finding is associated with an increased risk of thromboembolic events, highlighting its clinical relevance.
Background:
Dual-phase cardiac computed tomography (CCT) has been applied to detect left atrial appendage (LAA) thrombosis, which is characterized as the presence of left atrial appendage filling defects (LAADF) in both early- and delayed-phase scanning. However, the clinical implication of LAAFD in exclusive early-phase scanning (LAAFD-EEpS) of CCT in patients with atrial fibrillation (AF) is unclear.
Methods:
The baseline clinical data and dual-phase CCT findings in 1183 AF patients (62.1 ± 11.6 years, 59.9% male) was collected and analyzed. A further analysis of CCT and transesophageal echocardiography (TEE) data (within 5 days) in a subgroup of 687 patients was performed. LAAFD-EEpS was defined as LAAFD present in early-phase and absent in delayed-phase scanning of dual-phase CCT.
Results:
A total of 133 (11.2%) patients were detected with LAAFD-EEpS. Patients with LAAFD-EEpS had a higher prevalence of ischemic stroke or transient ischemic attack (TIA) (p < 0.001) and a higher predefined thromboembolic risk (p < 0.001). In multivariate analysis, a history of ischemic stroke or TIA was independently associated with LAAFD-EEpS (odds ratio [OR] 11.412, 95% confidence interval [CI] 6.561-19.851, p < 0.001). When spontaneous echo contrast in TEE was used as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of LAAFD-EEpS was 77.0% (95% CI 66.5-87.6%), 89.0% (95% CI 86.5-91.4%), 40.5% (95% CI 31.6-49.5%), 97.5% (96.3-98.8%), respectively.
Conclusions:
In AF patients, LAAFD-EEpS is not an uncommon finding in dual-phase CCT scanning, and is associated with elevated thromboembolic risk.
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