Abstract
To investigate the capacity of biphasic cardiac CT (CCT) for qualitative and quantitative evaluation of different grades of left atrial appendage spontaneous echo contrast (LAASEC). The study included 267 inpatients with confirmed atrial fibrillation who underwent both CCT and transesophageal echocardiography (TEE). CT numbers for LAA, ascending aorta (AA), and left atrium (LA) were identified, and ROC curves for LAA, LAA/AA, and LAA/LA were plotted. With TEE as the standard, the sensitivity, specificity, PPV, NPV, and accuracy of CCT for LAASEC grade ≥ 1 were 60.3, 92.9, 92.4, 64.8, and 75.7%; and for grade ≥ 2 were 100.0, 84.4, 71.4, 100.0, and 88.8% respectively. The values of LAA, LAA/AA, and LAA/LA were significantly larger in LAASEC grade 0 versus 1 and in grade 1 versus 2, but were similar in grades 2 and 3 or in grades 3 and 4. The values of LAA/AA were larger in grade 2 versus 4. When the cutoff value for LAA/AA = 0.897, sensitivity, specificity, PPV, NPV, and accuracy of CCT for LAASEC grade ≥ 1 was 89.6, 83.2, 87.9, 85.5, and 86.9% and with a cutoff for LAA/AA of 0.524, the sensitivity, specificity, PPV, NPV, and accuracy for LAASEC grade ≥ 2 was 98.7, 92.7, 84.1, 99.4, and 94.4%. Although CCT showed limited diagnostic accuracy for grade 1 LAASEC, grade ≥ 2 LAASEC could be excluded when there was no LAA filling defect on first-phase CCT, and TEE can be avoided. CCT has an excellent accuracy in diagnosing LAASEC, and quantitative analysis (in particular LAA/AA) is superior.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, D’Agostino RB, Massaro JM, Beiser A, Wolf PA, Benjamin EJ (2004) Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110(9):1042–1046. https://doi.org/10.1161/01.CIR.0000140263.20897.42
Sun GZ, Guo L, Wang XZ, Song HJ, Li Z, Wang J, Sun YX (2015) Prevalence of atrial fibrillation and its risk factors in rural China: a cross-sectional study. Int J Cardiol 182:13–17. https://doi.org/10.1016/j.ijcard.2014.12.063
Fatkin D, Kelly RP, Feneley MP (1994) Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol 23(4):961–969
Yoo J, Song D, Baek JH, Kim YD, Nam HS, Hong GR, Kim J, Lee HS, Heo JH (2016) Poor outcome of stroke patients with atrial fibrillation in the presence of coexisting spontaneous echo contrast stroke. 47(7):1920–1922.https://doi.org/10.1161/STROKEAHA.116.013351
Zhao Y, Ji L, Liu J, Wu J, Wang Y, Shen S, Guo S, Jian R, Chen G, Wei X, Liao W, Kutty S, Liao Y, Bin J (2016) Intensity of left atrial spontaneous echo contrast as a correlate for stroke risk stratification in patients with nonvalvular atrial fibrillation. Sci Rep 6:27650. https://doi.org/10.1038/srep27650
Patel A, Au E, Donegan K, Kim RJ, Lin FY, Stein KM, Markowitz SM, Iwai S, Weinsaft JW, Min JK, Lerman BB (2008) Multidetector row computed tomography for identification of left atrial appendage filling defects in patients undergoing pulmonary vein isolation for treatment of atrial fibrillation: comparison with transesophageal echocardiography. Heart Rhythm 5(2):253–260. https://doi.org/10.1016/j.hrthm.2007.10.025
Romero J, Cao JJ, Garcia MJ, Taub CC (2014) Cardiac imaging for assessment of left atrial appendage stasis and thrombosis. Nat Rev Cardiol 11(8):470–480. https://doi.org/10.1038/nrcardio.2014.77
Hilberath JN, Oakes DA, Shernan SK, Bulwer BE, D’Ambra MN, Eltzschig HK (2010) Safety of transesophageal echocardiography. J Am Soc Echocardiogr 23(11):1115–1127. https://doi.org/10.1016/j.echo.2010.08.013
Yamamoto M, Seo Y, Kawamatsu N, Sato K, Sugano A, Machino-Ohtsuka T, Kawamura R, Nakajima H, Igarashi M, Sekiguchi Y, Ishizu T, Aonuma K (2014) Complex left atrial appendage morphology and left atrial appendage thrombus formation in patients with atrial fibrillation. Circ Cardiovasc Imaging 7(2):337–343. https://doi.org/10.1161/CIRCIMAGING.113.001317
Munir S, Chang JH, Salahudeen SR, Baranchuk A, Morris C, O’Reilly M, Pal RS (2015) Atrial thrombi detection prior to pulmonary vein isolation: diagnostic accuracy of cardiac computed tomography versus transesophageal echocardiography. Cardiol J 22(5):576–582. https://doi.org/10.5603/CJ.a2015.0017
Lazoura O, Ismail TF, Pavitt C, Lindsay A, Sriharan M, Rubens M, Padley S, Duncan A, Wong T, Nicol E (2016) A low-dose, dual-phase cardiovascular CT protocol intervention. Int J Cardiovasc Imaging 32(2):347–354. https://doi.org/10.1007/s10554-015-0776-x
Sawit ST, Garcia-Alvarez A, Suri B, Gaztanaga J, Fernandez-Friera L, Mirelis JG, D’Anca M, Fuster V, Sanz J, Garcia MJ (2012) Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation. Am J Cardiol 109(5):677–684. https://doi.org/10.1016/j.amjcard.2011.10.028
Romero J, Husain SA, Kelesidis I, Sanz J, Medina HM, Garcia MJ (2013) Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis. Circ Cardiovasc Imaging 6(2):185–194. https://doi.org/10.1161/CIRCIMAGING.112.000153
Kapa S, Martinez MW, Williamson EE, Ommen SR, Syed IS, Feng D, Packer DL, Brady PA (2010) ECG-gated dual-source CT for detection of left atrial appendage thrombus in patients undergoing catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 29(2):75–81. https://doi.org/10.1007/s10840-010-9505-5
Martinez MW, Kirsch J, Williamson EE, Syed IS, Feng D, Ommen S, Packer DL, Brady PA (2009) Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation. JACC Cardiovasc Imaging 2(1):69–76. https://doi.org/10.1016/j.jcmg.2008.09.011
Maltagliati A, Pontone G, Annoni A, Formenti A, Galli CA, Tamborini G, Alimento M, Andreini D, Tondo C, Pepi M (2011) Multidetector computed tomography vs multiplane transesophageal echocardiography in detecting atrial thrombi in patients candidate to radiofrequency ablation of atrial fibrillation. Int J Cardiol 152(2):251–254. https://doi.org/10.1016/j.ijcard.2011.07.086
Hur J, Kim YJ, Lee HJ, Ha JW, Heo JH, Choi EY, Shim CY, Kim TH, Nam JE, Choe KO, Choi BW (2009) Left atrial appendage thrombi in stroke patients: detection with two-phase cardiac CT angiography versus transesophageal echocardiography. Radiology 251(3):683–690. https://doi.org/10.1148/radiol.2513090794
Kim SC, Chun EJ, Choi SI, Lee SJ, Chang HJ, Han MK, Bae HJ, Park JH (2010) Differentiation between spontaneous echocardiographic contrast and left atrial appendage thrombus in patients with suspected embolic stroke using two-phase multidetector computed tomography. Am J Cardiol 106(8):1174–1181. https://doi.org/10.1016/j.amjcard.2010.06.033
Wang L, Kadiyala M, Koss E, Yarramaneni A, Rapelje K, Kampfer S, Reichek N, Hoch D, Jayam V, Levine J, Cao JJ (2016) CTA detection of left atrial stasis and thrombus in patients with atrial fibrillation. Pacing Clin Electrophysiol 39(12):1388–1393. https://doi.org/10.1111/pace.12959
Rastegar R, Harnick DJ, Weidemann P, Fuster V, Coller B, Badimon JJ, Chesebro J, Goldman ME (2003) Spontaneous echo contrast videodensity is flow-related and is dependent on the relative concentrations of fibrinogen and red blood cells. J Am Coll Cardiol 41(4):603–610
Kwaan HC, Sakurai S, Wang J (2003) Rheological abnormalities and thromboembolic complications in heart disease: spontaneous echo contrast and red cell aggregation. Semin Thromb Hemost 29(5):529–534. https://doi.org/10.1055/s-2003-44559
Hur J, Kim YJ, Lee HJ, Nam JE, Ha JW, Heo JH, Chang HJ, Kim HS, Hong YJ, Kim HY, Choe KO, Choi BW (2011) Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke: a prospective comparison study with transesophageal echocardiography. Stroke 42(9):2471–2477. https://doi.org/10.1161/STROKEAHA.110.611293
Budoff MJ, Shittu A, Hacioglu Y, Gang E, Li D, Bhatia H, Alvergue J, Karlsberg RP (2014) Comparison of transesophageal echocardiography versus computed tomography for detection of left atrial appendage filling defect (thrombus). Am J Cardiol 113(1):173–177. https://doi.org/10.1016/j.amjcard.2013.09.037
Homsi R, Nath B, Luetkens JA, Schwab JO, Schild HH, Naehle CP (2016) Can contrast-enhanced multi-detector computed tomography replace transesophageal echocardiography for the detection of thrombogenic milieu and thrombi in the left atrial appendage: a prospective study with 124 patients. Rofo 188(1):45–52. https://doi.org/10.1055/s-0041-106067
Taina M, Vanninen R, Sipola P, Muuronen A, Jäkälä P, Hedman M (2016) Cardiac CT Differentiates Left Atrial Appendage Thrombi from Circulatory Stasis in Acute Stroke Patients. Vivo. 30(5):671–676
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
All Authors in our study declares that we have no conflict of interest.
Ethical approval
The content of this study is proved by the institution ethics committee of the first affiliated hospital of Dalian Medical University. Our public trials Registry Number is ChiCTR-RIC-15007482.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Zhao-qian Wang: Co-corresponding author.
Rights and permissions
About this article
Cite this article
He, Cl., Wang, Zq., Jia, Cf. et al. Accuracy of cardiac CT in evaluating severity of left atrial appendage spontaneous echo contrast: comparison with transesophageal echocardiography. Int J Cardiovasc Imaging 34, 1147–1154 (2018). https://doi.org/10.1007/s10554-018-1313-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-018-1313-5