Transesophageal echocardiography for the assessment of left atrial appendage thrombus: Study of the additional value of systematic real time 3D imaging after regular 2D evaluation

Squara, Fabien; Bres, Mikael; Baudouy, Delphine; Schouver, Elie-Dan; Moceri, Pamela; Ferrari, Émile

doi:10.1111/echo.13813

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…Moreover, the LAA has a complex and highly variable three-dimensional morphology, which can render its assessment difficult using 2D TOE alone. In particular, the presence of pectinate muscles, multilobed appendage morphology, SEC, or acoustic shadowing from the Coumadin ridge might be misinterpreted as thrombi, and could prevent the accurate evaluation of the LAA with traditional 2D imaging [36]. 3D TOE improves the evaluation of LAA anatomy, overcoming some limitations associated with 2D imaging.…”

Section: The Role Of Echocardiography Before Cardioversionmentioning

confidence: 99%

“…There is a lack of evidence regarding the sensitivity and specificity of 3D TOE for detecting LAA thrombosis. However, a recent report suggests that 3D TOE should be suggested when the diagnosis of LAA thrombosis remains equivocal after a detailed 2D analysis [36]. Moreover, with the widespread diffusion of LAA percutaneous closure techniques and increasing operator experience in 3D imaging, it is reasonable that 3D TOE will have a growing role in the diagnosis of LAA thrombosis.…”

Section: The Role Of Echocardiography Before Cardioversionmentioning

confidence: 99%

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Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

et al. 2019

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Atrial fibrillation is the most common cardiac arrhythmia and is associated with an increased risk of stroke and thromboembolic complications. A rhythm control strategy with both electrical and pharmacological cardioversion is recommended for patients with symptomatic atrial fibrillation. Anticoagulant therapy for 3–4 weeks prior to cardioversion is recommended in order to avoid thromboembolic events deriving from restoring sinus rhythm. Transesophageal echocardiography has a pivotal role in this setting, excluding the presence of left atrial appendage thrombus before cardioversion. The aim of this review is to discuss the epidemiology and risk factors for left atrial appendage thrombosis, the role of echocardiography in the decision making before cardioversion, and the efficacy of different anticoagulant regimens on the detection and treatment of left atrial appendage thrombosis.

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Section: The Role Of Echocardiography Before Cardioversionmentioning

confidence: 99%

Section: The Role Of Echocardiography Before Cardioversionmentioning

confidence: 99%

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

et al. 2019

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“…Then, by browsing the title, abstract and full text, 62 papers were selected from the 1716 papers, and further excluded literature such as unrigorous research design, imperfect outcome indicators and abstracts. Finally, 18 articles [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] were included; flow diagram of references choice. Fig.…”

Section: Resultsmentioning

confidence: 99%

“…This study included 10 diagnostic tests and 4102 patients. TEE was the gold standard, with non-delayed CCT (4 studies) [ 18 , 19 , 20 , 21 ], 1-minute delayed CCT (3 studies) [ 20 , 21 , 22 ], 3-minute delayed CCT (2 studies) [ 21 , 22 ], 6-minute delayed CCT (1 study) [ 21 ], two dimensional (2D)-CMRI (1 study) [ 23 ], DSCT (2 studies) [ 24 , 25 ], multidetector computed tomography (MDCT) (8 studies) [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], three dimensional (3D)-TEE (1 investigation) [ 34 ], 3D-CMRI (1 investigation) [ 23 ], and CCTA (1 study) [ 35 ]. The features and baseline of the selected studies are demonstrated in Tables 1 , 2 (Ref.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic Accuracy of Left Atrial/Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Song,

Liu,

Shi

et al. 2023

Rev. Cardiovasc. Med.

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Background: This paper aimed to appraise the diagnostic precision of assorted methodologies to identify left atrial/left atrial appendage (LA/LAA) thrombus through a network meta-assessment. Methods: Methodologically, we conducted a comprehensive literature search across multiple databases. Utilizing the risk of bias tool from the Cochrane Collaboration, methodological quality of included studies was critically assessed and potential publication bias was examined via funnel plots. The subsequent data analysis was executed using Stata software, with the most efficacious diagnostic modalities being determined based on cumulative ranking curve (SUCRA) values. Results: We scrutinized a sum of 18 papers, comprising 4102 subjects and utilizing 10 different diagnostic techniques. The hierarchical results derived from the network meta-analysis indicated that in regards to sensitivity, the dual-source cardiac computed tomography (DSCT) was superior (with a SUCRA value of 71.7%), it was succeeded by 3-minute delayed cardiac computed tomography (CCT) (scoring 66.8%), which surpassed the transesophageal echocardiography (TEE) (holding a SUCRA value of 57.5%). In terms of specificity, DSCT was the best (SUCRA value of 84.3%), followed by three dimensional (3D) cardiac magnetic resonance imaging (3D-CMRI) (SUCRA value of 78.0%), which was better than TEE (SUCRA value of 66.6%). In terms of positive likelihood ratio (PLR), 6-minute delayed CCT (SUCRA value of 85.6%) was superior to 3-minute delayed CCT (SUCRA value of 80.1%), both of which were superior to TEE (SUCRA value of 69.1%). DSCT (SUCRA value of 89.3%) had the best negative likelihood ratio (NLR), while DSCT (SUCRA value of 79.9%) had the highest accuracy. Conclusions: This study demonstrated that DSCT outperformed TEE in sensitivity, specificity, NLR, and accuracy in identifying thrombus of LA/LAA among patients suffering from atrial fibrillation. Our conclusion is that DSCT is the best in diagnosing LA/LAA. In addition, 3D-CMRI and 3-minute delayed CCT are expected to replace TEE.

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Cardiac Computed Tomography Angiography for Device-Related Thrombus Assessment After WATCHMAN FLX™ Occluder Device Implantation: A Single-Center Retrospective Observational Study

Miller

Hana

Patibandla

et al. 2022

Cardiovascular Revascularization Medicine

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Transesophageal echocardiography for the assessment of left atrial appendage thrombus: Study of the additional value of systematic real time 3D imaging after regular 2D evaluation

Abstract: 3DTEE of the LAA is more effective for thrombus assessment than 2DTEE. 3DTEE should be particularly considered in case of equivocal 2DTEE, as it allows to reach a definite LAA diagnosis in almost all of the patients.

Cited by 9 publications

References 21 publications

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

Diagnostic Accuracy of Left Atrial/Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Cardiac Computed Tomography Angiography for Device-Related Thrombus Assessment After WATCHMAN FLX™ Occluder Device Implantation: A Single-Center Retrospective Observational Study

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