Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation: A comparison with transesophageal echocardiography

Yuli Y. Kim, Allan L. Klein, Sandra S. Halliburton, Zoran B. Popovic, Stacie A. Kuzmiak, Srikanth Sola, Mario J. Garcia, Paul Schoenhagen, Andrea Natale, Milind Y. Desai

Research output: Contribution to journalArticle

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Abstract

Background: Patients referred for radiofrequency pulmonary vein antral isolation undergo contrast-enhanced multidetector computed tomography (MDCT) to assess pulmonary vein and left atrial anatomy as well as transesophageal echocardiography (TEE) to detect intraatrial thrombus. We sought to determine the accuracy of MDCT to qualitatively and quantitatively detect severe spontaneous echo contrast (SEC) or thrombus by TEE in the left atrial appendage (LAA). Methods: Two hundred twenty-three consecutive MDCT and TEE studies performed within 7 days of each other were retrospectively identified. The LAA was evaluated by MDCT for filling defects and by TEE for thrombus or SEC. Severe SEC or thrombus on TEE was considered positive. In patients with preserved ejection fraction, the Hounsfield unit (HU) density of a 1-cm2 region of interest was measured in the LAA and ascending aorta (AA) of the same slice to calculate an LAA/AA HU ratio. Results: Visually identified filling defects in LAA by MDCT correspond to severe SEC and thrombus with a sensitivity, specificity, positive predictive value, and negative predictive value of 93%, 85%, 31%, and 99%, respectively. Multidetector CT missed severe SEC detected by TEE in one examination; all thrombi, however, were correctly identified. There is a significant inverse association between mean LAA/AA HU ratios with increasing grades of SEC or thrombus (P < .001). Using an LAA/AA HU ratio cutoff of 0.25, the positive predictive value and specificity increased to 75% and 96%, respectively, while preserving a high negative predictive value (96%). Conclusions: Multidetector CT can qualitatively and quantitatively identify and distinguish severe LAA SEC/thrombus from lesser grades of SEC.

Original languageEnglish (US)
Pages (from-to)1199-1205
Number of pages7
JournalAmerican Heart Journal
Volume154
Issue number6
DOIs
StatePublished - Dec 2007
Externally publishedYes

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Atrial Appendage
Multidetector Computed Tomography
Pulmonary Veins
Transesophageal Echocardiography
Thrombosis
Aorta
Antral
Anatomy
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation : A comparison with transesophageal echocardiography. / Kim, Yuli Y.; Klein, Allan L.; Halliburton, Sandra S.; Popovic, Zoran B.; Kuzmiak, Stacie A.; Sola, Srikanth; Garcia, Mario J.; Schoenhagen, Paul; Natale, Andrea; Desai, Milind Y.

In: American Heart Journal, Vol. 154, No. 6, 12.2007, p. 1199-1205.

Research output: Contribution to journalArticle

Kim, Yuli Y. ; Klein, Allan L. ; Halliburton, Sandra S. ; Popovic, Zoran B. ; Kuzmiak, Stacie A. ; Sola, Srikanth ; Garcia, Mario J. ; Schoenhagen, Paul ; Natale, Andrea ; Desai, Milind Y. / Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation : A comparison with transesophageal echocardiography. In: American Heart Journal. 2007 ; Vol. 154, No. 6. pp. 1199-1205.
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title = "Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation: A comparison with transesophageal echocardiography",
abstract = "Background: Patients referred for radiofrequency pulmonary vein antral isolation undergo contrast-enhanced multidetector computed tomography (MDCT) to assess pulmonary vein and left atrial anatomy as well as transesophageal echocardiography (TEE) to detect intraatrial thrombus. We sought to determine the accuracy of MDCT to qualitatively and quantitatively detect severe spontaneous echo contrast (SEC) or thrombus by TEE in the left atrial appendage (LAA). Methods: Two hundred twenty-three consecutive MDCT and TEE studies performed within 7 days of each other were retrospectively identified. The LAA was evaluated by MDCT for filling defects and by TEE for thrombus or SEC. Severe SEC or thrombus on TEE was considered positive. In patients with preserved ejection fraction, the Hounsfield unit (HU) density of a 1-cm2 region of interest was measured in the LAA and ascending aorta (AA) of the same slice to calculate an LAA/AA HU ratio. Results: Visually identified filling defects in LAA by MDCT correspond to severe SEC and thrombus with a sensitivity, specificity, positive predictive value, and negative predictive value of 93{\%}, 85{\%}, 31{\%}, and 99{\%}, respectively. Multidetector CT missed severe SEC detected by TEE in one examination; all thrombi, however, were correctly identified. There is a significant inverse association between mean LAA/AA HU ratios with increasing grades of SEC or thrombus (P < .001). Using an LAA/AA HU ratio cutoff of 0.25, the positive predictive value and specificity increased to 75{\%} and 96{\%}, respectively, while preserving a high negative predictive value (96{\%}). Conclusions: Multidetector CT can qualitatively and quantitatively identify and distinguish severe LAA SEC/thrombus from lesser grades of SEC.",
author = "Kim, {Yuli Y.} and Klein, {Allan L.} and Halliburton, {Sandra S.} and Popovic, {Zoran B.} and Kuzmiak, {Stacie A.} and Srikanth Sola and Garcia, {Mario J.} and Paul Schoenhagen and Andrea Natale and Desai, {Milind Y.}",
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TY - JOUR

T1 - Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation

T2 - A comparison with transesophageal echocardiography

AU - Kim, Yuli Y.

AU - Klein, Allan L.

AU - Halliburton, Sandra S.

AU - Popovic, Zoran B.

AU - Kuzmiak, Stacie A.

AU - Sola, Srikanth

AU - Garcia, Mario J.

AU - Schoenhagen, Paul

AU - Natale, Andrea

AU - Desai, Milind Y.

PY - 2007/12

Y1 - 2007/12

N2 - Background: Patients referred for radiofrequency pulmonary vein antral isolation undergo contrast-enhanced multidetector computed tomography (MDCT) to assess pulmonary vein and left atrial anatomy as well as transesophageal echocardiography (TEE) to detect intraatrial thrombus. We sought to determine the accuracy of MDCT to qualitatively and quantitatively detect severe spontaneous echo contrast (SEC) or thrombus by TEE in the left atrial appendage (LAA). Methods: Two hundred twenty-three consecutive MDCT and TEE studies performed within 7 days of each other were retrospectively identified. The LAA was evaluated by MDCT for filling defects and by TEE for thrombus or SEC. Severe SEC or thrombus on TEE was considered positive. In patients with preserved ejection fraction, the Hounsfield unit (HU) density of a 1-cm2 region of interest was measured in the LAA and ascending aorta (AA) of the same slice to calculate an LAA/AA HU ratio. Results: Visually identified filling defects in LAA by MDCT correspond to severe SEC and thrombus with a sensitivity, specificity, positive predictive value, and negative predictive value of 93%, 85%, 31%, and 99%, respectively. Multidetector CT missed severe SEC detected by TEE in one examination; all thrombi, however, were correctly identified. There is a significant inverse association between mean LAA/AA HU ratios with increasing grades of SEC or thrombus (P < .001). Using an LAA/AA HU ratio cutoff of 0.25, the positive predictive value and specificity increased to 75% and 96%, respectively, while preserving a high negative predictive value (96%). Conclusions: Multidetector CT can qualitatively and quantitatively identify and distinguish severe LAA SEC/thrombus from lesser grades of SEC.

AB - Background: Patients referred for radiofrequency pulmonary vein antral isolation undergo contrast-enhanced multidetector computed tomography (MDCT) to assess pulmonary vein and left atrial anatomy as well as transesophageal echocardiography (TEE) to detect intraatrial thrombus. We sought to determine the accuracy of MDCT to qualitatively and quantitatively detect severe spontaneous echo contrast (SEC) or thrombus by TEE in the left atrial appendage (LAA). Methods: Two hundred twenty-three consecutive MDCT and TEE studies performed within 7 days of each other were retrospectively identified. The LAA was evaluated by MDCT for filling defects and by TEE for thrombus or SEC. Severe SEC or thrombus on TEE was considered positive. In patients with preserved ejection fraction, the Hounsfield unit (HU) density of a 1-cm2 region of interest was measured in the LAA and ascending aorta (AA) of the same slice to calculate an LAA/AA HU ratio. Results: Visually identified filling defects in LAA by MDCT correspond to severe SEC and thrombus with a sensitivity, specificity, positive predictive value, and negative predictive value of 93%, 85%, 31%, and 99%, respectively. Multidetector CT missed severe SEC detected by TEE in one examination; all thrombi, however, were correctly identified. There is a significant inverse association between mean LAA/AA HU ratios with increasing grades of SEC or thrombus (P < .001). Using an LAA/AA HU ratio cutoff of 0.25, the positive predictive value and specificity increased to 75% and 96%, respectively, while preserving a high negative predictive value (96%). Conclusions: Multidetector CT can qualitatively and quantitatively identify and distinguish severe LAA SEC/thrombus from lesser grades of SEC.

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U2 - 10.1016/j.ahj.2007.08.004

DO - 10.1016/j.ahj.2007.08.004

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