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Imaging of thrombi and assessment of left atrial appendage function: a prospective study comparing transthoracic and
1Department of Medicine, Division of Cardiology, University of Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany.
Insights
Transesophageal echocardiography offers superior imaging of the left atrial appendage compared to transthoracic echocardiography. New transthoracic systems, however, show promise for detecting thrombi and assessing function in stroke patients.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Left atrial appendage (LAA) thrombi are a significant cause of cardioembolic stroke.
- Accurate assessment of LAA function and thrombus detection is crucial for stroke management.
Purpose of the Study:
- To compare the diagnostic value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) for LAA function and thrombus imaging.
- To evaluate the efficacy of new-generation TTE systems in this context.
Main Methods:
- A prospective, single-blind study involving 117 patients with stroke or transient neurological deficit.
- Patients underwent both TTE and TEE, with assessments for LAA imaging feasibility, velocity recording, and thrombus identification.
Main Results:
- TEE provided complete LAA imaging in 95% of patients, compared to 75% with TTE.
- TEE identified two additional LAA thrombi missed by TTE.
- New-generation TTE demonstrated 100% specificity and 91% sensitivity for LAA thrombi when imaging was adequate.
Conclusions:
- While TEE remains superior for comprehensive LAA assessment, advanced TTE systems are increasingly capable of detecting LAA thrombi.
- TTE can accurately assess LAA function, with velocities > 0.3 m/s indicating no thrombus.
Objective:
To compare the value of current transthoracic echocardiographic systems and transoesophageal echocardiography for assessing left atrial appendage function and imaging thrombi.
Design:
Single blind prospective study. Patients were first investigated by transthoracic echocardiography and thereafter by a second investigator using transoesophageal echocardiography. The feasibility of imaging the left atrial appendage, recording its velocities, and identifying thrombi within the appendage were determined by both methods.
Patients:
117 consecutive patients with a stroke or transient neurological deficit.
Setting:
Tertiary cardiac and neurological care centre.
Results:
Imaging of the complete appendage was feasible in 75% of the patients by transthoracic echocardiography and in 95% by transoesophageal echocardiography. Both methods were concordant for the detection of thrombi in 10 cases. Transoesophageal echocardiography revealed two additional thrombi. In one of these patients, transthoracic echocardiography was not feasible and in the other the thrombus had been missed by transthoracic examination. In patients with adequate transthoracic echogenicity, the specificity and sensitivity of detecting left atrial appendage thrombi were 100% and 91%, respectively. Recording of left atrial appendage velocities by transthoracic echocardiography was feasible in 69% of cases. None of the patients with a velocity > 0.3 m/s had left atrial appendage thrombi. In the one patient in whom transthoracic echocardiographic evaluation missed a left atrial appendage thrombus, the peak emptying velocity of the left atrial appendage was 0.25 m/s.
Conclusions:
A new generation echocardiographic system allows for the transthoracic detection of left atrial appendage thrombi and accurate determination of left atrial appendage function in most patients with a neurological deficit.