OBJECTIVES: Transesophageal echocardiogram (TEE) is considered the gold standard modality in detecting left atrial/LA appendage (LA/LAA) thrombi.Â However, this is a semi-invasive procedure with rare but potential life-threatening complications.Â Cardiac computed tomography has been proposed as an alternative method.Â The purpose of this meta-analysis was to evaluate the diagnostic accuracy of cardiac computed tomography assessing LA/LAA thrombi in comparison with TEE.
METHODS: A systematic review of Medline, Cochrane, and Embase to look for clinical trials assessing detection of LA/LAA thrombi by cardiac computed tomography when compared with TEE in patients with a history of atrial fibrillation before electric cardioversion/pulmonary vein isolation or after cardioembolic cerebrovascular accident was performed using standard approach and bivariate analysis.
RESULTS: Nineteen studies with 2955 patients (men, 71%; mean age, 61Â±4 years) fulfilled the inclusion criteria.Â Most studies (85%, 16 studies) used 64-slide multidetector computed tomography and 15 studies (79%) were electrocardiographic-gated.Â The incidence of LA/LAA thrombi was 8.9% (SD, Â±7).Â The mean sensitivity and specificity were 96% and 92%, whereas the positive predictive value and negative predictive value were 41% and 99%, respectively.Â The diagnostic accuracy was 94%.Â In a subanalysis of studies in which delayed imaging was performed, the diagnostic accuracy significantly improved to a mean weighted sensitivity and specificity of 100% and 99%, respectively, whereas the positive predictive value and negative predictive value increased to 92% and 100%, respectively.Â The accuracy for this technique was 99%.
CONCLUSIONS: Cardiac computed tomography, particularly when delayed imaging is performed, is a reliable alternative to TEE for the detection of LA/LAA thrombi/clot, avoiding the discomfort and risks associated with TEE. Nazair Jones Womens Jersey