Abstract 16424: Cardiac CT as Accurate as Transesophageal Echocardiography for the Detection of LAA Thrombus in Patients With Atrial Fibrillation: A Meta-Analysis
Objectives: To evaluate the diagnostic accuracies of cardiac computed tomography (CCT) assessing left atrial/left atrial appendage thrombi (LA/LAA) in comparison with transesophageal echocardiography (TEE).
Background: TEE is considered the gold standard modality in detecting LA/LAA thrombi especially in patients with atrial fibrillation (AF) undergoing electrical cardioversion (EC), pulmonary vein isolation (PVI) or as an evaluation of cardioembolic cerebrovascular accidents (CVA).
Methods: A systematic review of Medline, Cochrane, and Embase for all the clinical trials assessing detection of LA/LAA thrombi by CCT was performed using standard approach for meta-analysis for diagnostic test and a bivariate analysis of sensitivity, specificity, PPV and NPV.
Results: A total of 19 studies of CCT detecting LA/LAA thrombi with 2955 patients [male: 71%, mean age 61 years (SD = +/- 4)] fulfilled the inclusion criteria. The overall incidence for LA/LAA thrombi was 8.9% (SD = +/- 7). Eleven studies were performed prior to PVI, seven studies after CVA, one prior to EC. The mean sensitivity and specificity were 95% and 94%, whereas the PPV and NPV were 57% and 100% respectively. In a sub-analysis of studies in which delayed images were performed the diagnostic accuracy significantly improved to a mean weighted sensitivity and specificity of 100% and 99%, whereas the PPV and NPV increased to 96% and 100%, respectively.
Conclusion: CCT might be a reliable alternative imaging modality for the detection of LA/LAA thrombi/clot in patients with atrial fibrillation prior to electrical or pharmacological cardioversion, PVI or as an evaluation for cardioembolic source in patients with ischemic CVA avoiding the discomfort and risks associated with TEE.
- © 2012 by American Heart Association, Inc.