Abstract 9318: Cardiac Computed Tomography versus Transesophageal Echography for the Detection of Left Atrial Appendage Thrombus: A Systemic Review and Meta-Analysis

Abstract

Introduction: Transesophageal echocardiogram (TEE) has been considered the gold standard for left atrial appendage (LAA) thrombus detection. Nevertheless, TEE is a semi-invasive and time-consuming procedure that may sometimes induce discomfort and cause complications. Cardiac computed tomography (CCT) has been studied extensively for LAA thrombus detection. Hypothesis: We performed this systemic review and meta-analysis to assess the diagnostic accuracy of CCT for LAA thrombus detection compared with TEE. Methods: A systemic search was conducted in the PubMed, Embase and Cochrane Library databases. Sensitivity, specificity and posterior probability were calculated to assess the diagnostic accuracy of CCT. Results: A total of 27 studies involving 6852 were included in our study. The summary sensitivity was 0.98 (95% CI, 0.91-1.00), and the specificity was 0.96 (95% CI, 0.92-0.98). Based on the overall LAA thrombus incidence, the positive posterior probability was 53.21%, and the negative posterior probability was 0.08%. In the subgroup analysis of the early and delayed imaging groups, the delayed imaging method significantly improved the specificity and positive posterior probability. The summary sensitivity of early imaging studies was 0.95 (95% CI, 0.79-0.99), and the specificity was 0.89 (0.85-0.92). The positive posterior probability was 19.11%, and the negative posterior probability was 0.16%. The summary sensitivity of delayed imaging studies was 0.98 (95% CI, 0.92-1.00), and the specificity was 1.00 (0.98-1.00). The positive posterior probability was 95.76%, and the negative posterior probability was 0.12%. Conclusions: Compared with TEE, CCT with a delayed imaging method has good diagnostic accuracy for LAA thrombus detection.