Detection of thrombus in the left atrial by 64-slice CT compared to transesophageal echocardiography

Abstract

Objective To investigate the application value of 64-slice spiral CT (64SCT) scan in detecting thrombi in the left atrial or left atrial appendage (LAA) in patients with atrial fibrillation. Methods We included atrial fibrillation cases admitted in the department of cardiology of Aerospace Center Hospital from January 2009 to February 2015. There were 89 cases of atrial fibrillation patients received both 64SCT and transesophageal echocardiography (TEE) examination after admitted. The results of 64SCT and TEE were compared and analyzed. Results In the 89 patients with atrial fibrillation enrolled, taking TEE as the gold standard, the results of 75 cases of 64SCT were consistent with the diagnosis of TEE in 84.27%(75/89). The diagnostic specificity of 64SCT for the detection of thrombus in the left atrial or left atrial appendage was 98.48%(65/66), the diagnostic sensitivity was 43.48% (10/23), the positive predictive value was 90.91%(10/11), the negative predictive value was 83.33%(65/78), the positive likelihood ratio was 28.7, and the negative likelihood ratio was 0.57. However, after analysis, the result of McNemar χ2 test showed P=0.014, statistically, less than 0.05, which means the 64SCT can not replace TEE. Conclusions 64SCT scan is a promising noninvasive examination in the detection of left atrial or left atrial appendage thrombi in patients with atrial fibrillation. However in the atrial fibrillation radiofrequency catheter ablation, the sensitivity of 64SCT is not enough, can not completely replace the TEE in the left atrial or left atrial appendage thrombus assessment. Key words: Atrial fibrillation; Left atrial thrombus; Left atrial appendage thrombus; 64 slice spiral CT; Transesophageal echocardiography