Abstract TP274: Challenging the Guidelines or Merely an Observation on Transthoracic Echocardiography

Abstract

Introduction: Accurate detection of left atrial appendage (LAA) clot is critical in patients before Balloon Mitral Valvotomy (BMV). There is an elevated risk of thrombus formation and ischemic stroke in Rheumatic Heart Disease (RHD). The yearly prevalence of new stroke is 3-7.5% in RHD. Transesophageal Echocardiogram (TEE) has traditionally been the gold standard for LAA clot detection. But it is semi-invasive and have risks. The need for alternatives in this clinical context has prompted this comparative study. Hypothesis: Visualizing LAA on Transthoracic Echocardiogram (TTE) is facile in severe mitral stenosis due to increased LAA size, which is vital for stroke prevention. Methods: In this comparative study, we assessed the diagnostic accuracy of TTE as a non-invasive alternative to TEE for LAA clot detection in patients scheduled for BMV. A total of 150 patients admitted to a tertiary hospital underwent both TTE and TEE before BMV, with TEE as the reference standard for evaluation. Results: The mean age of our study population was 41.4 years, the majority were females (64.7%). The incidence of thrombus in TEE was 30%, with a significant difference in females (37%) vs. males (17%). TTE missed LAA clots in 18.8%, this discrepancy rate was 6% in males and 26% in females, signifying a significant reduction in clot detection in females. TEE exhibited no such limitations in clot detection between genders. TTE displayed sensitivity of 98% and specificity of 81%. The accuracy rate of TTE was 43.3%.Pearson Correlation coefficient and Fishers Exact test confirms significance. The non-invasive nature of TTE, devoid of procedural complexities, positions it as a Cost-effective option. Conclusion: Our study provides compelling evidence supporting the hypothesis that TTE is an effective and practical alternative to TEE for LAA clot detection in RHD patients Further studies are needed in this regard so that the current Class 1C recommendation for TEE before any BMV may need to be revised.