Echocardiography versus computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta-analysis.
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
20
07
2020
accepted:
03
09
2020
pubmed:
14
9
2020
medline:
19
2
2022
entrez:
13
9
2020
Statut:
ppublish
Résumé
Accurate and reproducible diagnostic techniques are essential to detect left-sided cardiac thrombi [either in the left ventricle (LV) or in the left atrial appendage (LAA)] and to guide the onset and duration of antithrombotic treatment while minimizing the risk for thromboembolic and hemorrhagic events. We conducted a systematic review and meta-analysis aiming to compare the diagnostic performance of transthoracic echocardiography (TTE) vs. cardiac magnetic resonance (CMR) for the detection of LV thrombi, and transesophageal echocardiography (TEE) vs. computed tomography (CT) for the detection of LAA thrombi. Six studies were included in the first meta-analysis (TTE vs. CMR for LV thrombosis). Pooled sensitivity and specificity values were 62% [95% confidence interval (CI), 37-81%] and 97% (95% CI, 94-99%). The shape of the hierarchical summary receiver operating characteristic (HSROC) curve and the area under the curve (AUC) of 0.96 suggested a high accuracy. Ten studies were included in the second meta-analysis (CT versus TEE for LAA thrombosis). The pooled values of sensitivity and specificity were 97% (95% CI, 77-100%) and 94% (95% CI, 87-98%). The pooled diagnostic odds ratio (DOR) was 500 (95% CI, 52-4810), and the pooled likelihood ratios (LR + and LR-) were 17% (95% CI, 7-40%) and 3% (95% CI, 0-28%). The shape of the HSROC curve and 0.99 AUC suggested a high accuracy of CT vs. TEE. TTE is a fair alternative to DE-CMR for the identification of LV thrombi, while CT has a good accuracy compared to TEE for the detection of LAA thrombosis. CRD42020185842.
Sections du résumé
BACKGROUND
BACKGROUND
Accurate and reproducible diagnostic techniques are essential to detect left-sided cardiac thrombi [either in the left ventricle (LV) or in the left atrial appendage (LAA)] and to guide the onset and duration of antithrombotic treatment while minimizing the risk for thromboembolic and hemorrhagic events.
METHODS
METHODS
We conducted a systematic review and meta-analysis aiming to compare the diagnostic performance of transthoracic echocardiography (TTE) vs. cardiac magnetic resonance (CMR) for the detection of LV thrombi, and transesophageal echocardiography (TEE) vs. computed tomography (CT) for the detection of LAA thrombi.
RESULTS
RESULTS
Six studies were included in the first meta-analysis (TTE vs. CMR for LV thrombosis). Pooled sensitivity and specificity values were 62% [95% confidence interval (CI), 37-81%] and 97% (95% CI, 94-99%). The shape of the hierarchical summary receiver operating characteristic (HSROC) curve and the area under the curve (AUC) of 0.96 suggested a high accuracy. Ten studies were included in the second meta-analysis (CT versus TEE for LAA thrombosis). The pooled values of sensitivity and specificity were 97% (95% CI, 77-100%) and 94% (95% CI, 87-98%). The pooled diagnostic odds ratio (DOR) was 500 (95% CI, 52-4810), and the pooled likelihood ratios (LR + and LR-) were 17% (95% CI, 7-40%) and 3% (95% CI, 0-28%). The shape of the HSROC curve and 0.99 AUC suggested a high accuracy of CT vs. TEE.
CONCLUSIONS
CONCLUSIONS
TTE is a fair alternative to DE-CMR for the identification of LV thrombi, while CT has a good accuracy compared to TEE for the detection of LAA thrombosis.
PROSPERO REGISTRATION
UNASSIGNED
CRD42020185842.
Identifiants
pubmed: 32920662
doi: 10.1007/s00392-020-01741-7
pii: 10.1007/s00392-020-01741-7
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1697-1703Informations de copyright
© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Vaitkus PT, Barnathan ES (1993) Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol 22:1004–1009. https://doi.org/10.1016/0735-1097(93)90409-t
doi: 10.1016/0735-1097(93)90409-t
pubmed: 8409034
Beigel R, Wunderlich NC, Ho SY, Arsanjani R, Siegel RJ (2014) The left atrial appendage: anatomy, function, and noninvasive evaluation. JACC Cardiovasc Imaging 7:1251–1265. https://doi.org/10.1016/j.jcmg.2014.08.009
doi: 10.1016/j.jcmg.2014.08.009
pubmed: 25496544
Kovacs RJ, Flaker GC, Saxonhouse SJ, Doherty JU, Birtcher KK, Cuker A, Davidson BL, Giugliano RP, Granger CB, Jaffer AK, Mehta BH, Nutescu E, Williams KA (2015) Practical management of anticoagulation in patients with atrial fibrillation. J Am Coll Cardiol 65:1340–1360. https://doi.org/10.1016/j.jacc.2015.01.049
doi: 10.1016/j.jacc.2015.01.049
pubmed: 25835447
Abdelmoneim SS, Pellikka PA, Mulvagh SL (2014) Contrast echocardiography for assessment of left ventricular thrombi. J Ultrasound Med 33:1337–1344. https://doi.org/10.7863/ultra.33.8.1337
doi: 10.7863/ultra.33.8.1337
pubmed: 25063398
Omran H, Jung W, Rabahieh R, Wirtz P, Becher H, Illien S, Schimpf R, Lüderitz B (1999) Imaging of thrombi and assessment of left atrial appendage function: a prospective study comparing transthoracic and transoesophageal echocardiography. Heart 81:192–198. https://doi.org/10.1136/hrt.81.2.192
doi: 10.1136/hrt.81.2.192
pubmed: 9922358
pmcid: 1728943
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 251:683–690. https://doi.org/10.1148/radiol.2513090794
doi: 10.1148/radiol.2513090794
pubmed: 19366905
Freitas-Ferraz AB, Bernier M, Vaillancourt R, Ugalde PA, Nicodème F, Paradis JM, Champagne J, O'Hara G, Junquera L, Del Val D, Muntané-Carol G, O'Connor K, Beaudoin J, Rodés-Cabau J (2020) Safety of transesophageal echocardiography to guide structural cardiac interventions. J Am Coll Cardiol 75:3164–3173. https://doi.org/10.1016/j.jacc.2020.04.069
doi: 10.1016/j.jacc.2020.04.069
pubmed: 32586591
Mollet NR, Dymarkowski S, Volders W, Wathiong J, Herbots L, Rademakers FE, Bogaert J (2002) Visualization of ventricular thrombi with contrast-enhanced magnetic resonance imaging in patients with ischemic heart disease. Circulation 106:2873–2876. https://doi.org/10.1161/01.cir.0000044389.51236.91
doi: 10.1161/01.cir.0000044389.51236.91
pubmed: 12460863
Paydarfar D, Krieger D, Dib N, Blair RH, Pastore JO, Stetz JJ Jr, Symes JF (2001) In vivo magnetic resonance imaging and surgical histopathology of intracardiac masses: distinct features of subacute thrombi. Cardiology 95:40–47. https://doi.org/10.1159/000047342
doi: 10.1159/000047342
pubmed: 11385191
Lattuca B, Bouziri N, Kerneis M, Portal JJ, Zhou J, Hauguel-Moreau M, Mameri A, Zeitouni M, Guedeney P, Hammoudi N, Isnard R, Pousset F, Collet JP, Vicaut E, Montalescot G, Silvain J; ACTION Study Group (2020) Antithrombotic therapy for patients with left ventricular mural thrombus. J Am Coll Cardiol 75:1676–1685. https://doi.org/10.1016/j.jacc.2020.01.057
doi: 10.1016/j.jacc.2020.01.057
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200. https://doi.org/10.1093/eurheartj/ehw128
doi: 10.1093/eurheartj/ehw128
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39:119–177. https://doi.org/10.1093/eurheartj/ehx393
doi: 10.1093/eurheartj/ehx393
Weinsaft JW, Kim J, Medicherla CB, Ma CL, Codella NC, Kukar N, Alaref S, Kim RJ, Devereux RB (2016) Echocardiographic algorithm for post-myocardial infarction LV thrombus: a gatekeeper for thrombus evaluation by delayed enhancement CMR. JACC Cardiovasc Imaging 9:505–515. https://doi.org/10.1016/j.jcmg.2015.06.017
doi: 10.1016/j.jcmg.2015.06.017
pubmed: 26476503
Woolen SA, Shankar PR, Gagnier JJ, MacEachern MP, Singer L, Davenport MS (2019) Risk of nephrogenic systemic fibrosis in patients with stage 4 or 5 chronic kidney disease receiving a group ii gadolinium-based contrast agent: a systematic review and meta-analysis. JAMA Intern Med 180:223–230. https://doi.org/10.1001/jamainternmed.2019.5284
doi: 10.1001/jamainternmed.2019.5284
pmcid: 6902198
Roifman I, Connelly KA, Wright GA, Wijeysundera HC (2015) Echocardiography vs. cardiac magnetic resonance imaging for the diagnosis of left ventricular thrombus: a systematic review. Can J Cardiol 31:785–791. https://doi.org/10.1016/j.cjca.2015.01.011
doi: 10.1016/j.cjca.2015.01.011
pubmed: 25913472
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P; ESC Scientific Document Group (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962. https://doi.org/10.1093/eurheartj/ehw210
doi: 10.1093/eurheartj/ehw210
Farkowski MM, Jubele K, Marín F, Gandjbakhch E, Ptaszynski P, Merino JL, Lenarczyk R, Potpara TS (2020) Diagnosis and management of left atrial appendage thrombus in patients with atrial fibrillation undergoing cardioversion or percutaneous left atrial procedures: results of the European Heart Rhythm Association survey. Europace 22:162–169. https://doi.org/10.1093/europace/euz257
doi: 10.1093/europace/euz257
pubmed: 31501852
O'Rourke MC, Mendenhall BR. Transesophageal Echocardiogram (TEE) [Updated 2020 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442026/ . Accessed 15 July 2020
Schroeder S, Achenbach S, Bengel F et al (2008) Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J 29:531–556. https://doi.org/10.1093/eurheartj/ehm544
doi: 10.1093/eurheartj/ehm544
pubmed: 18084017
Davenport MS, Perazella MA, Yee J et al (2020) Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology 294:660–668. https://doi.org/10.1148/radiol.2019192094
doi: 10.1148/radiol.2019192094
pubmed: 31961246
Weinsaft JW, Kim RJ, Ross M et al (2009) Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus. JACC Cardiovasc Imaging 2:969–979
doi: 10.1016/j.jcmg.2009.03.017
Weinsaft JW, Kim HW, Crowley AL et al (2011) LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. JACC Cardiovasc Imaging 4:702–712
doi: 10.1016/j.jcmg.2011.03.017
Delewi R, Nijveldt R, Hirsch A et al (2012) Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging. Eur J Radiol 81:3900–3904
doi: 10.1016/j.ejrad.2012.06.029
Weinsaft JW, Kim J, Medicherla CB et al (2016) Echocardiographic algorithm for post-myocardial infarction lv thrombus: a gatekeeper for thrombus evaluation by delayed enhancement CMR. JACC Cardiovasc Imaging 9:505–515
doi: 10.1016/j.jcmg.2015.06.017
Sürder D, Gisler V, Corti R et al (2015) Thrombus formation in the left ventricle after large myocardial infarction – assessment with cardiac magnetic resonance imaging. Swiss Med Wkly 145:w14122
pubmed: 26098589
Meurin P, Brandao Carreira V, Dumaine R et al (2015) Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study. Am Heart J 170:256–262
doi: 10.1016/j.ahj.2015.04.029
Hur J, Pak HN, Kim YJ et al (2013) Dual-enhancement cardiac computed tomography for assessing left atrial thrombus and pulmonary veins before radiofrequency catheter ablation for atrial fibrillation. Am J Cardiol 112:238–244
doi: 10.1016/j.amjcard.2013.03.018
Dorenkamp M, Sohns C, Vollmann D et al (2013) Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation: role of transesophageal echocardiography and multidetector computed tomography. Int J Cardiol 163:26–33
doi: 10.1016/j.ijcard.2011.06.124
Kim SC, Chun EJ, Choi SI et al (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 106:1174–1181
doi: 10.1016/j.amjcard.2010.06.033
Kim YY, Klein AL, Halliburton SS et al (2007) Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation: a comparison with transesophageal echocardiography. Am Heart J 154:1199–1205
doi: 10.1016/j.ahj.2007.08.004
Feuchtner GM, Dichtl W, Bonatti JO et al (2008) Diagnostic accuracy of cardiac 64-slice computed tomography in detecting atrial thrombi. Comparative study with transesophageal echocardiography and cardiac surgery. Invest Radiol 43:794–801
doi: 10.1097/RLI.0b013e318184cd6c
Hur J, Kim YJ, Nam JE et al (2008) Thrombus in the left atrial appendage in stroke patients: detection with cardiac CT angiography–a preliminary report. Radiology 249:81–87
doi: 10.1148/radiol.2491071544
Sawit ST, Garcia-Alvarez A, Suri B et al (2012) Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation. Am J Cardiol 109:677–684
doi: 10.1016/j.amjcard.2011.10.028
Shapiro MD, Neilan TG, Jassal DS et al (2007) Multidetector computed tomography for the detection of left atrial appendage thrombus: a comparative study with transesophageal echocardiography. J Comput Assist Tomogr 31:905–909
doi: 10.1097/rct.0b013e31803c55e3
Budoff MJ, Shittu A, Hacioglu Y et al (2014) Comparison of transesophageal echocardiography versus computed tomography for detection of left atrial appendage filling defect (thrombus). Am J Cardiol 113:173–177
doi: 10.1016/j.amjcard.2013.09.037
Martinez MW, Kirsch J, Williamson EE et al (2009) Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation. JACC Cardiovasc Imaging 2:69–76
doi: 10.1016/j.jcmg.2008.09.011