Does transesophageal echocardiography improve the detection of left atrial thrombi compared to transthoracic echocardiography in patients with suspected cardiogenic embolism and/or atrial fibrillation?
Transesophageal echocardiography significantly increases the detection rate of left atrial thrombi, especially in the left atrial appendage, compared to transthoracic echocardiography in patients with suspected cardiogenic embolism or atrial fibrillation.
Sensitivity of transthoracic echocardiography in the detection of left atrial thrombi, in particular thrombi confined to the left atrial appendage, is surprisingly low (33%-72%). Concerning the detection of left atrial thrombi, transthoracic echocardiography appears as an inadequate technique in patients with suspected cardiogenic embolism with a success rate of only 0.8% in earlier, and about 3% in recent studies. Imaging from the esophagus substantially increases the detection rate for left atrial thrombi, and is the only clinically relevant semiinvasive technique to diagnose thrombi confined to the left atrial appendage. Transesophageal echocardiography has markedly increased the diagnostic power of cardiovascular ultrasound in patients with suspected cardiogenic embolism and/or atrial fibrillation. Meta-analysis of pooled studies using the transesophageal approach in these patients revealed thrombi within the left atrial cavity in about 7% and within the atrial appendage in about 12% of cases.
Mügge et al. (Thu,) studied this question.