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Published on: November 28, 2018
Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study
W J Manning1, R M Weintraub, C A Waksmonski
1Cardiovascular Division, Beth Israel Hospital, Boston, MA 02215, USA.
Insights
Transesophageal echocardiography accurately identifies left atrial thrombi, showing high sensitivity and specificity. This imaging technique is reliable for excluding thrombi before cardiac surgery.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Left atrial thrombi pose a significant risk in patients undergoing cardiac surgery.
- Accurate pre-operative identification of thrombi is crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of transesophageal echocardiography (TEE) in detecting left atrial thrombi.
- To determine TEE's utility in excluding left atrial thrombi prior to cardiac procedures.
Main Methods:
- A prospective cohort study was conducted at a university hospital.
- 231 patients scheduled for mitral valve surgery or left atrial tumor excision underwent TEE.
- TEE findings were compared with direct surgical visualization.
Main Results:
- Transesophageal echocardiography detected 14 left atrial thrombi in 14 patients (6% prevalence).
- Surgical confirmation validated 12 of 14 detected thrombi (86% positive predictive value).
- TEE demonstrated high sensitivity (100%) and specificity (99%) for thrombus identification.
Conclusions:
- Transesophageal echocardiography is a highly accurate method for identifying left atrial thrombi.
- TEE can be reliably used in clinical practice to exclude the presence of left atrial thrombi.
Objective:
To determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi.
Design:
Prospective cohort study.
Setting:
University hospital.
Patients:
231 consecutive patients having transesophageal echocardiography before elective repair or replacement of the mitral valve or excision of a left atrial tumor. Fifty-six percent of patients had a history of atrial fibrillation, and 17% had a history of thromboembolism.
Measurement:
Identification of left atrial thrombi during transesophageal echocardiographic examination and comparison with direct near-simultaneous visualization during cardiac surgery.
Results:
Transesophageal echocardiography identified 14 left atrial thrombi in 14 patients (6%). Thrombus size range from 3 to 80 mm. Surgery confirmed 12 of 14 thrombi (86%), including 9 thrombi confined to the left appendage. No additional thrombi were found on direct inspection of the atria (sensitivity, 100% [95% CI, 74% to 100%]; specificity, 99% [CI, 97% to 99.9%]; positive predictive value, 86% [12/14]; negative predictive value, 100% [217/217]; for a population that had a 5.2% prevalence of thrombi). All 12 surgically confirmed thrombi were identified by two independent observers. Neither thrombus seen by only a single observer on transesophageal echocardiography was confirmed during direct inspection of the atria at surgery.
Conclusion:
Transesophageal echocardiography is highly accurate for identifying left atrial thrombi and can be used clinically to exclude left atrial thrombi.
