Abstract
PurposeAim of the study was to investigate diagnostic accuracy of cardiac computed tomography angiography (CCTA) between left ventricular end-systolic (LVES) and left ventricular end-diastolic (LVED) cardiac phase for thrombus detection in patient’s prior to pulmonary vein isolation (PVI).Materials and methods182 consecutive Patients with drug refractory AF scheduled for PVI (62.6% male, mean age 64.1 ± 10.2 years) underwent routine pre-procedural evaluation including transesophageal echocardiography (TEE) and CCTA for evaluation of left atrial (LA)/left atrial appendage (LAA) anatomy and thrombus formation. Qualitative and quantitative analysis (using aorta ascendens (AA)/LAA ratio) was performed. Measurements of the LA/LAA in LVES and LVED cardiac phase were obtained.ResultsEnd-systolic volumes (LA/LAA) measured in 30 patients without filling defects as control group and all 14 with filling defects of 182 patients were significantly larger (p < 0.01) than in end-diastolic phase. Qualitative analysis was inferior to quantitative analysis using LA/LAA ratio (<0.5; accuracy: 100%, 88%,100%, 99% vs 100%). 5 out of 182 patients (2.7%) showed thrombus formation of the LAA in CCTA confirmed by TEE and quantitative analysis. Intra/-interobserver variability was lower in end-systolic vs end-diastolic reconstruction interval.ConclusionFor evaluating CCTA datasets in patients prior PVI, the LVES reconstruction interval is recommended due to significantly larger LA/LAA volumes and lower intra/- interobserver variability’s.
Highlights
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with a significant increase of morbidity and mortality due to its associated risk of thrombembolism
Qualitative analysis was inferior to quantitative analysis using left atrial (LA)/left atrial appendage (LAA) ratio (
Left atrial and left atrial appendage (LA/LAA) evaluation was feasible in all cases and no adverse events were reported during TEE and CCTA examination
Summary
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with a significant increase of morbidity and mortality due to its associated risk of thrombembolism. Pulmonary vein isolation (PVI) by percutaneous radiofrequency ablation has emerged as a therapeutic option. In the traditional retrospective ECG-gated-CCTA method, the full cardiac cycle is imaged (0-100%), and the heart is retrospectively reconstructed at the required cardiac phases (Dewey 2011). In this context, retrospective gating is chosen because temporal as well as dynamic information is obtained and CCTA images can be reconstructed at other cardiac phases (0-100%), if the standard phase was not diagnostic or interpretable (Steigner et al 2009; Menke et al 2013). Aim of the study was to investigate diagnostic performance of thrombus detection in CCTA between cardiac cycles, intra/- interobserver variability’s of thrombus detection as well as comparing acquired volumetric and diametric datasets
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