Tasnim Vira1, Petros Pechlivanoglou2,3, Kim Connelly1,4, Harindra C Wijeysundera1,3, Idan Roifman1,3. 1. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada. 2. Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada. 3. Institute for Health Policy Management and Evaluation and the Institute for Clinical Evaluative Sciences, 155 College St, Toronto, Ontario, Canada. 4. St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, Ontario, Canada.
Abstract
AIMS: Transoesophageal echocardiography (TOE) is the gold standard for identification of left atrial appendage (LAA) thrombi. However, TOE is semi-invasive and cannot be performed in certain patients. Left atrial appendage thrombi can also be identified by cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR); however, the diagnostic performance of these techniques vs. TOE is unclear. METHODS AND RESULTS: We performed a systematic review and meta-analysis of 22 CCT and 4 CMR studies comparing diagnostic performance to TOE for identification of LAA thrombi. Meta-regression was performed to determine whether expected sensitivity and specificity differed between early and delayed image acquisition protocols for CCT vs. TOE and between CCT and CMR. Cardiac computed tomography demonstrated sensitivity and specificity of 0.99 [confidence interval (CI 0.93-1.00)] and 0.94 (CI 0.90-0.97) respectively vs. TOE. A subgroup analysis comparing early vs. delayed protocol CCT imaging was performed showing no significant differences in sensitivity (P-value = 0.17) however improved specificity of the delayed imaging protocols (P-value = 0.04). Cardiac magnetic resonance imaging demonstrated sensitivity and specificity of 0.80 (CI 0.63-0.91) and 0.98 (CI 0.97-0.99), respectively when compared to TOE. There was no significant difference in sensitivity or specificity between CMR and CCT (P-values 0.996 and 0.484, respectively). CONCLUSION: Cardiac computed tomography and CMR had good to excellent sensitivity and specificity vs. TOE. Further, there was no significant difference in the sensitivity and specificity of CCT vs. CMR, suggesting that both modalities can be considered reasonable alternatives to TOE in the identification of LAA thrombi. Cardiac magnetic resonance imaging may be especially beneficial when TOE and CCT cannot be performed.
AIMS: Transoesophageal echocardiography (TOE) is the gold standard for identification of left atrial appendage (LAA) thrombi. However, TOE is semi-invasive and cannot be performed in certain patients. Left atrial appendage thrombi can also be identified by cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR); however, the diagnostic performance of these techniques vs. TOE is unclear. METHODS AND RESULTS: We performed a systematic review and meta-analysis of 22 CCT and 4 CMR studies comparing diagnostic performance to TOE for identification of LAA thrombi. Meta-regression was performed to determine whether expected sensitivity and specificity differed between early and delayed image acquisition protocols for CCT vs. TOE and between CCT and CMR. Cardiac computed tomography demonstrated sensitivity and specificity of 0.99 [confidence interval (CI 0.93-1.00)] and 0.94 (CI 0.90-0.97) respectively vs. TOE. A subgroup analysis comparing early vs. delayed protocol CCT imaging was performed showing no significant differences in sensitivity (P-value = 0.17) however improved specificity of the delayed imaging protocols (P-value = 0.04). Cardiac magnetic resonance imaging demonstrated sensitivity and specificity of 0.80 (CI 0.63-0.91) and 0.98 (CI 0.97-0.99), respectively when compared to TOE. There was no significant difference in sensitivity or specificity between CMR and CCT (P-values 0.996 and 0.484, respectively). CONCLUSION: Cardiac computed tomography and CMR had good to excellent sensitivity and specificity vs. TOE. Further, there was no significant difference in the sensitivity and specificity of CCT vs. CMR, suggesting that both modalities can be considered reasonable alternatives to TOE in the identification of LAA thrombi. Cardiac magnetic resonance imaging may be especially beneficial when TOE and CCT cannot be performed.
Authors: Idan Roifman; Atul Sivaswamy; Anna Chu; Peter C Austin; Dennis T Ko; Pamela S Douglas; Harindra C Wijeysundera Journal: J Am Heart Assoc Date: 2020-07-01 Impact factor: 5.501
Authors: Runxin Fang; Yang Li; Jun Wang; Zidun Wang; John Allen; Chi Keong Ching; Liang Zhong; Zhiyong Li Journal: Front Cardiovasc Med Date: 2022-08-22
Authors: Axel Brandes; Harry J G M Crijns; Michiel Rienstra; Paulus Kirchhof; Erik L Grove; Kenneth Bruun Pedersen; Isabelle C Van Gelder Journal: Europace Date: 2020-08-01 Impact factor: 5.214
Authors: Idan Roifman; Lu Han; Jiming Fang; Anna Chu; Peter Austin; Dennis T Ko; Pamela Douglas; Harindra Wijeysundera Journal: BMJ Open Date: 2022-03-10 Impact factor: 2.692