The Comparison of the Diagnostic Value of Left Atrial Pulmonary Vein Single-Phase and Dual-Phase Enhanced CT Scanning for Left Atrial Appendage Thrombosis and SEC in Patients with Atrial Fibrillation

Abstract

Objective. The accuracy of left atrial pulmonary vein CT enhanced single-phase and dual-phase scanning in the detection of left atrial appendage (LAA) thrombosis and spontaneous echo contrast (SEC) before radio frequency ablation was compared in atrial fibrillation patients, so as to optimize the scanning scheme. Methods. 78 patients with atrial fibrillation who were admitted to Cangzhou Central Hospital from October 2020 to September 2021 and underwent bilateral enhanced CT scan of left atrial pulmonary vein and transesophageal echocardiography (TEE) examination for planned frequency ablation were selected. TEE results were used as the “gold standard” to compare the diagnostic efficacy of the first phase, second phase, and double-phase comprehensive mode of enhanced left atrial pulmonary vein CT in detecting left atrial thrombosis and SEC. Results. The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the first phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 22.2%, 98.6%, 66.6%, and 90.7%, respectively, in the detection of left atrial thrombosis and SEC by the second phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the double-phase comprehensive mode of CT enhanced scan. There was no statistically significant difference in the accuracy of CT diagnosis of left atrial appendage thrombosis and SEC between the three modes of the first phase, the second phase, and the double-phase comprehensive CT ( P > 0.05 ). The mean effective radiation dose of double-phase enhanced scan was 7.49 ± 1.02 mSv. Conclusion. Single-phase enhanced CT scan of left atrial pulmonary vein can meet clinical requirements and significantly reduce the radiation dose compared with double-phase enhanced CT scan. Therefore, it is recommended as an initial screening examination for patients with atrial fibrillation before radiofrequency ablation.

Study on the correlation between false‐positive filling defect in LAA CT and LAA structure in patients with atrial fibrillation based on TEE

“…Case groups: (1) True‐positive group: The CT showed a filling defect, and the TEE showed a positive result (Figures 1 and 2); (2) false‐positive group: The CT showed a filling defect, and the TEE showed a negative result (Figure 3); (3) true‐negative group: The CT showed no filling defect, and the TEE showed a negative result (Figure 4); (4) false‐negative group: The CT showed no filling defect, and the TEE showed a positive result. The CT has an extremely high negative predictive value in the detection of LAA thrombus and SEC (Guo et al, 2022; He et al, 2017; Tian et al, 2020; Yu et al, 2021), and only one CT false‐negative case occurred in this study; hence, the false‐negative result was not included in the statistics.…”

“…Currently, radiofrequency catheter ablation (RFCA) has become a radical surgery for patients with AF, and thrombosis in LAA is an absolute contraindication of RFCA (Hindricks et al, 2021). Spontaneous echocardiographic contrast (SEC) represents blood flow stasis and the state before thrombosis (Wang et al, 2000); studies have demonstrated that LAA SEC in patients with AF has an equally important clinical significance as thrombus (Guo et al, 2022; Kosmalska et al, 2022).…”

“…Currently, multislice spiral computed tomography (CT) angiography (CTA) has become a routine examination for patients with AF before RFCA; it aims to objectively and spatially display the anatomic relationship between the left atrium (LA) and the pulmonary vein as well as accurately measure data related to the pulmonary vein, LA, and LAA due to its high temporal and spatial resolution, facilitating individualized treatment with RFCA based on patient anatomic variation. Studies have also demonstrated multislice spiral CTA's significant application value in the detection of LAA thrombus and SEC (He et al, 2017, 2020; Liu et al, 2017; Romero et al, 2013; Xing et al, 2017); this is particularly due to its extremely high negative predictive values (Guo et al, 2022; He et al, 2017; Tian et al, 2020; Yu et al, 2021). However, some patients with false‐positive results were found in daily operations.…”

Retracted: The Comparison of the Diagnostic Value of Left Atrial Pulmonary Vein Single‐Phase and Dual‐Phase Enhanced CT Scanning for Left Atrial Appendage Thrombosis and SEC in Patients with Atrial Fibrillation

“…This article has been retracted by Hindawi following an investigation undertaken by the publisher [ 1 ]. This investigation has uncovered evidence of one or more of the following indicators of systematic manipulation of the publication process: Discrepancies in scope Discrepancies in the description of the research reported Discrepancies between the availability of data and the research described Inappropriate citations Incoherent, meaningless and/or irrelevant content included in the article Peer-review manipulation …”

“…This article has been retracted by Hindawi following an investigation undertaken by the publisher [1]. This investigation has uncovered evidence of one or more of the following indicators of systematic manipulation of the publication process:…”