Key result
MDCT accurately detects LAA thrombi vs TEE, with LA diameter linked to ~390% greater defect odds.
Why the study?
The accuracy and predictors of left atrial appendage filling defects on 64-slice MDCT for detecting LAA thrombus in patients undergoing pulmonary vein isolation were unclear.
Does 64-slice MDCT accurately predict or exclude LAA thrombus compared to TEE in patients with nonvalvular atrial fibrillation undergoing pulmonary vein isolation?
Cross-Sectional (n=51)
Does 64-slice MDCT accurately predict or exclude LAA thrombus compared to TEE in patients with nonvalvular atrial fibrillation undergoing pulmonary vein isolation?
Odds Ratio: 4.9 (95% CI 1.19–20.25)
The absence of LAA filling defects on 64-slice MDCT has a 100% negative predictive value for LAA thrombus, potentially obviating the need for pre-procedural TEE in patients undergoing pulmonary vein isolation.
MDCT absence of LAA filling defects may exclude thrombus before PV isolation; leaves open replacement of TEE pending prospective validation.
OBJECTIVES: To evaluate predictor variables and accuracy of left atrial appendage (LAA) filling defects seen on multidetector computed tomographic (MDCT) scan in predicting LAA thrombus in patients undergoing pulmonary vein (PV) isolation procedure. METHODS: Electrocardiogram-gated 64-slice MDCT and transesophageal echocardiography (TEE) were undertaken in 51 consecutive patients with nonvalvular atrial fibrillation who were referred for circumferential antral pulmonary vein isolation. RESULTS: In 51 patients (37 men; mean age, 64 years), left atrium (LA) diameter emerged as the predictor of LAA filling defects (odds ratio, 4.9; 95% confidence interval, 1.19-20.25). Left atrial appendage filling defects had sensitivity of 100%, specificity of 95.92%, positive predictive value of 0.5, and negative predictive value of 1, for thrombi seen on TEE image. A mean LAA/ascending aorta Hounsfield unit ratio of 0.78 or less was identified as a sensitive predictor of thrombus on TEE (sensitivity, 100%; specificity, 87.8%; positive predictive value, 0.25; and negative predictive value, 1). CONCLUSIONS: A larger LA predisposes to LAA filling defects on MDCT scan. Pending prospective validation, absence of LAA filling defects on 64-slice MDCT may reliably exclude LAA thrombi in patients with nonvalvular atrial fibrillation obviating the need for TEE.
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Singh et al. (2009) conducted a cross-sectional in Nonvalvular atrial fibrillation (n=51). 64-slice multidetector computed tomography (MDCT) vs. Transesophageal echocardiography (TEE) was evaluated on Left atrium (LA) diameter as a predictor of LAA filling defects (OR 4.9, 95% CI 1.19-20.25). Left atrial appendage filling defects on 64-slice MDCT showed 100% sensitivity and 96% specificity for detecting thrombi, with left atrial diameter predicting defects (OR 4.9; 95% CI 1.19-20.25).
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