Key result
Coupling 3DTEE to 2DTEE permitted a definite left atrial appendage diagnosis in 99% of patients compared to 88.5% when 2DTEE was used alone (P = .002).
Why the study?
Does systematic real-time 3DTEE improve the diagnostic certainty of LAA thrombus assessment compared to 2DTEE alone in patients undergoing TEE?
Observational (n=104)
Does systematic real-time 3DTEE improve the diagnostic certainty of LAA thrombus assessment compared to 2DTEE alone in patients undergoing TEE?
Answers are grounded in this paper and cite their sources.
Adding 3DTEE to standard 2DTEE significantly improves the diagnostic certainty of left atrial appendage thrombus assessment, particularly in cases with equivocal 2DTEE findings.
BACKGROUND: Two-dimensional transesophageal echocardiography (2DTEE) is currently validated for left atrial appendage (LAA) thrombus assessment but has some limitations. AIMS: To evaluate the performance and interest of systematic real time three-dimensional transesophageal echocardiography (3DTEE) for LAA thrombus assessment, when performed after 2DTEE. METHODS AND RESULTS: Consecutive patients undergoing TEE were prospectively included. LAA was first evaluated using 2DTEE, and patients were classified as "2D-NT" if no thrombus was found, "2D-T" in case of clear thrombus, or "2D-EQ" if equivocal. Then, 3DTEE of the LAA was performed and patients were similarly classified as "3D-NT," "3D-T," or "3D-EQ." Additional LAA CT scan was only performed if LAA thrombus was not clearly ruled out or confirmed by TEE. Additional value of 3DTEE after 2DTEE LAA evaluation was then assessed. We included 104 patients undergoing TEE. Agreement between 2DTEE and 3DTEE was very good for thrombus diagnosis (k = 0.936), but moderate for vacant LAA (k = 0.562) due to more frequent 2D-EQ than 3D-EQ (11.5% vs 2.9%; P = .016). 3DTEE allowed to refine the LAA status in 11 of 12 (91.7%) 2D-EQ patients: 10 3D-NT, 1 3D-T, and 1 3D-EQ. Coupling 3DTEE to 2DTEE permitted a definite LAA diagnosis in 103 of 104 (99%) vs 92 of 104 (88.5%) patients when 2DTEE was used alone (P = .002). Nine (8.7%) LAA thrombi were diagnosed, and 3 CT scan were performed. CONCLUSION: 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.
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Squara et al. (2018) conducted an observational in Left atrial appendage thrombus (n=104). Real time three-dimensional transesophageal echocardiography (3DTEE) vs. Two-dimensional transesophageal echocardiography (2DTEE) was evaluated on Definite LAA diagnosis (p=.002). Coupling 3DTEE to 2DTEE permitted a definite left atrial appendage diagnosis in 99% of patients compared to 88.5% when 2DTEE was used alone (P = .002).
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