Related Experiment Video
Updated: Jul 9, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transesophageal echocardiography and computerized tomography angiography mismatch in left atrial appendage thrombus
Natalie Bloch-Isenberg1, Robert Zukermann2, Samia Massalha2
1Internal Medicine Department D.
Insights
Chest CT angiography (CTA) shows low agreement with transesophageal echocardiography (TEE) for diagnosing left atrial appendage (LAA) thrombus in atrial fibrillation patients. These imaging methods may be better used together to rule out LAA thrombus.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Procedures
Background:
- Transesophageal echocardiography (TEE) is the gold standard for diagnosing left atrial appendage (LAA) thrombus.
- Chest CT angiography (CTA) is frequently used to rule out LAA thrombus before procedures like pulmonary vein isolation (PVI) and LAA closure.
- The diagnostic accuracy of CTA for LAA thrombus compared to TEE requires further assessment.
Purpose of the Study:
- To compare the diagnostic accuracy of chest CTA with TEE for detecting LAA thrombus in patients with atrial fibrillation.
- To evaluate the concordance between CTA and TEE findings for LAA thrombus diagnosis.
Main Methods:
- Retrospective analysis of consecutive atrial fibrillation patients who underwent both TEE and chest CTA within 30 days.
- Patients with spontaneous echo contrast (SEC) or LAA thrombus on TEE were included.
- Prospective analysis of CTA scans for LAA thrombus and comparison with TEE results.
Main Results:
- Out of 63 patients meeting inclusion criteria, 23 had LAA thrombus and 40 had SEC on TEE.
- CTA identified LAA thrombus in 11 patients with high suspicion.
- Only 6 patients (26.1%) had concordant LAA thrombus diagnosis between CTA and TEE, indicating low agreement.
Conclusions:
- There is a significant discrepancy between CTA and TEE in diagnosing LAA thrombus.
- CTA and TEE may serve as complementary rather than interchangeable diagnostic tools for excluding LAA thrombus.
Background:
Transesophageal echocardiography (TEE) is the gold standard test for the diagnosis of left atrial appendage (LAA) thrombus. Nonetheless, computerized tomography angiography (CTA) is readily used to exclude LAA thrombus before pulmonary vein isolation (PVI) and LAA closure procedures. We aimed to assess the comparability of LAA thrombus diagnosis using chest CTA scans in patients with atrial fibrillation who underwent TEE.
Methods:
Retrospective collection of consecutive patients with atrial fibrillation who underwent TEE and chest CTA within 30 days and had evidence of spontaneous echo contrast (SEC) or LAA thrombus on TEE. Clinical, demographic, and echo data were collected. Prospective analysis of the CTA for evidence of LAA thrombus in the same group of patients was performed. We compared the findings of the two modalities.
Results:
Out of 1550 patients with atrial fibrillation who underwent TEE examinations in the study period, 63 patients underwent TEE within 30 days of a chest CTA scan. Twenty-three patients had LAA thrombus and 40 had some degree of SEC according to TEE. On CTA, 11 were interpreted as positive with a high level of suspicion for the presence of an LAA thrombus. Six patients (26.1%) had LAA thrombus according to both CT and TEE. Therefore, low concordance was found between test results (chi-squared continuity correction = 5.5, df = 1, and P -value = 0.01902).
Conclusion:
The discrepancy between CTA and TEE results suggests these examinations might be more suitable as complementary examinations to exclude LAA thrombus.
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