Key result
Systemic anticoagulation linked to ~77% lower odds of CIED lead-based echodensities on TEE.
Why the study?
Lead-based echodensities are often found on TEE in patients with a CIED and may not represent infection, but their predictors, characteristics, and clinical significance need evaluation.
Does systemic anticoagulant use or lead dwell time affect the odds of detecting lead-based echodensities on transesophageal echocardiography in patients with cardiac implantable electronic devices?
Cohort (n=231)
Blind TEE image review (board-certified echocardiographer blinded to all clinical information)
No
Does systemic anticoagulant use or lead dwell time affect the odds of detecting lead-based echodensities on transesophageal echocardiography in patients with cardiac implantable electronic devices?
Incidental lead-based echodensities on TEE in CIED patients without suspected infection are common (17.3%), do not progress to clinical infection, and are significantly less frequent among patients on systemic anticoagulation, suggesting they likely represent sterile organized thrombi rather than vegetations.
Answers are grounded in this paper and cite their sources.
Suggests incidental lead echodensities may be thrombi; hypothesis-generating and should not yet change anticoagulation practice.
INTRODUCTION: Transesophageal echocardiography (TEE) is recommended to rule out endocarditis in patients with cardiac implantable electronic devices (CIED). A lead-based echodensity (LBE), however, is often found on TEE in patients with a CIED and may not represent an infection. We sought to evaluate the predictors, characteristics, and clinical significance of LBEs seen on TEE in patients with a CIED. METHODS: Patients with a CIED were retrospectively identified from a database using International Classification of Diseases (ICD)-9/ICD-10 codes and were cross-matched with Current Procedural Terminology codes for a TEE. Clinical and follow-up data were collected. A blinded echo board-certified cardiologist reviewed all TEEs. RESULTS: Out of the 231 patients in the cohort, 191 had TEE performed for a noninfection-related indication while 40 TEEs were part of an endocarditis workup. A total of 50 LBEs were identified, and a majority were in the noninfection cohort. Systemic anticoagulant use in the noninfection cohort was associated with a decreased odds of having LBE on TEE (odds ratio [OR] of 0.23 [95% confidence interval [CI]: 0.06-0.60, p = .003]). Lead dwell time in the noninfection cohort was associated with an increased odds of having LBE on TEE (OR 1.21 (95% CI: 1.04-1.39, p = .009]). CONCLUSION: In our cohort of patients who had TEE for noninfection indications we found that systemic anticoagulant use is associated with fewer LBEs on TEEs, suggesting possible thrombin fibrin composition of LBE.
No takes yet. Share an insight, caveat, or question.
Patel et al. (2022) conducted a cohort in Patients with cardiac implantable electronic devices (CIEDs) undergoing transesophageal echocardiography (TEE) (n=231). Systemic anticoagulant use (warfarin, apixaban, rivaroxaban, dabigatran, or edoxaban) in the noninfectious TEE cohort vs. No systemic anticoagulant use in the noninfectious TEE cohort was evaluated on Presence of lead-based echodensity (LBE) on TEE in the noninfection cohort (OR 0.23, 95% CI 0.06-0.60, p=0.003). Systemic anticoagulant use was associated with significantly lower odds of lead-based echodensities on TEE (OR 0.23, 95% CI 0.06-0.60, p=0.003) in CIED patients undergoing noninfectious TEE.
Synapse has enriched 10 related papers. Consider them for comparative context: