1
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Sacoransky E, Yu Jia Ke D, Dave P, Alexander B, El Sherbini A, Abunassar J, Abuzeid W. Incidence of left ventricular thrombus following STEMI in the modern era via multimodality imaging: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2024; 52:101396. [PMID: 38584672 PMCID: PMC10992728 DOI: 10.1016/j.ijcha.2024.101396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
Background Left ventricular thrombus (LVT) is a significant complication in STEMI. Previous studies were conducted prior to modern timely percutaneous reperfusion networks. Current expert opinion suggests incidence in the current era has decreased. We conducted a systematic review and meta-analysis to better understand the incidence and diagnosis of LVT in patients with STEMI treated with timely percutaneous techniques as assessed by multimodality imaging. Methods Cochrane, EMBASE, LILACS, and MEDLINE were searched over the last 10 years only including studies using contemporary techniques. The primary outcome was detection of LVT in patients via echocardiogram with or without contrast or Cardiac MRI (cMRI) following STEMI (both anterior and any territory) treated with PCI. Data was pooled across studies and statistical analysis was conducted via random effects model. Results 31 studies were included. 18 studies included data on any territory STEMI, totaling 14,172 patients, and an incidence of 5.6% [95% CI 4.3-7.0]. 18 studies were included in analysis for anterior STEMI, totaling 7382 patients and incidence of 12.7% [95% CI 9.8-15.6]. Relative to cMRI as a gold standard, the sensitivity of non-contrast echocardiography to detect LVT was 58.2% [95% CI 46.6-69.2] with a specificity of 97.8% [95% CI 96.3-98.8]. Conclusions Incidence of LVT in STEMI patients treated with contemporary timely percutaneous revascularization is in keeping with historical data and remains significant, suggesting this remains an ongoing issue for further investigation. Numerically, both cMRI and contrast echo detected more LVT compared to non-contrast echo in any-territory STEMI patients.
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Affiliation(s)
| | - Danny Yu Jia Ke
- School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Prasham Dave
- School of Medicine, Queen’s University, Kingston, ON, Canada
- Division of Cardiology, Kingston Health Sciences Network, Kingston, ON, Canada
| | - Bryce Alexander
- School of Medicine, Queen’s University, Kingston, ON, Canada
- Division of Cardiology, Kingston Health Sciences Network, Kingston, ON, Canada
| | - Adham El Sherbini
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Joseph Abunassar
- School of Medicine, Queen’s University, Kingston, ON, Canada
- Division of Cardiology, Kingston Health Sciences Network, Kingston, ON, Canada
| | - Wael Abuzeid
- School of Medicine, Queen’s University, Kingston, ON, Canada
- Division of Cardiology, Kingston Health Sciences Network, Kingston, ON, Canada
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2
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Hampson R, Senior R, Ring L, Robinson S, Augustine DX, Becher H, Anderson N, Willis J, Chandrasekaran B, Kardos A, Siva A, Leeson P, Rana BS, Chahal N, Oxborough D. Contrast echocardiography: a practical guideline from the British Society of Echocardiography. Echo Res Pract 2023; 10:23. [PMID: 37964335 PMCID: PMC10648732 DOI: 10.1186/s44156-023-00034-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
Ultrasound contrast agents (UCAs) have a well-established role in clinical cardiology. Contrast echocardiography has evolved into a routine technique through the establishment of contrast protocols, an excellent safety profile, and clinical guidelines which highlight the incremental prognostic utility of contrast enhanced echocardiography. This document aims to provide practical guidance on the safe and effective use of contrast; reviews the role of individual staff groups; and training requirements to facilitate its routine use in the echocardiography laboratory.
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Affiliation(s)
| | - Roxy Senior
- London North West University Healthcare NHS Trust, London, UK.
- Royal Brompton Hospital and Imperial College, London, UK.
| | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
| | | | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for, Health University of Bath, Bath, UK
| | - Harald Becher
- Alberta Heart Institute, University of Alberta Hospital, Edmonton, Canada
| | - Natasha Anderson
- Warrington and Halton Teaching Hospital NHS Foundation Trust, Warrington, UK
| | - James Willis
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - Attila Kardos
- Translational Cardiovascular Research Group, Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, UK
- Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham, UK
| | | | - Paul Leeson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Navtej Chahal
- London North West University Healthcare NHS Trust, London, UK
| | - David Oxborough
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
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3
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Jain P, Patel V, Patel Y, Rasool J, Gandhi SK, Patel P. Effectiveness of Transesophageal Echocardiography in Preventing Thromboembolic Complications Before Cardioversion: A Narrative Review. Cureus 2023; 15:e48149. [PMID: 38046740 PMCID: PMC10692994 DOI: 10.7759/cureus.48149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Atrial fibrillation (AFib) is one of the most prevalent irregular heartbeats that doctors encounter. Clinicians typically pursue two main approaches for treatment, namely, controlling the heart rate and managing the heart rhythm. Under the rhythm control approach, AFib is addressed through cardioversion, which is achieved either with medications termed pharmacological cardioversion (PCV) or via an electrical shock termed electric cardioversion (ECV). While ECV proves instrumental in AFib management, it carries its own risk factors, potentially leading to blood clot-related complications such as embolic strokes. To counteract this potential downside, a well-established strategy involves the utilization of transesophageal echocardiography (TEE) to identify possible embolic sources before initiating cardioversion. The goal of this systematic review is to highlight the role of TEE in preempting embolic occurrences following ECV during the management of AFib. After conducting a thorough search of databases, namely, PubMed, PubMed Central, and Medline, a total of 36 studies were selected for this review article. Following a comprehensive evaluation of these studies, it was concluded that TEE plays a pivotal role in preventing thromboembolic complications during ECV for AFib. However, it is important to note that further research is needed to delve deeper into this matter. While existing evidence underscores its efficacy, additional investigation is needed to address this subject matter comprehensively.
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Affiliation(s)
- Prateek Jain
- Department of Internal Medicine, Maulana Azad Medical College, Delhi, IND
| | - Vishwesh Patel
- Department of Internal Medicine, M.P. Shah Government Medical College, Jamnagar, IND
| | - Yashaswi Patel
- Department of Internal Medicine, Government Medical College, Surat, Surat, IND
| | - Jawairiya Rasool
- Department of Internal Medicine, Dow International Medical College, Karachi, PAK
| | | | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
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4
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Baba Y, Ochi Y, Kawaguchi J, Takiishi A, Hirota T, Kubo T, Yamasaki N, Kitaoka H. Where Is the Left Atrial Appendage Wall? Caution during Transesophageal Echocardiography. CASE (PHILADELPHIA, PA.) 2023; 7:338-342. [PMID: 37614695 PMCID: PMC10442515 DOI: 10.1016/j.case.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
•High echoic partition could appear around the LAA wall. •The pericardium attached to the lung has very strong intensity reflection. •The pericardium attached to the lung mimics the LAA wall. •Reflection artifact could also mimic the LAA wall. •These phenomena should be considered when evaluating LAA morphology.
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Affiliation(s)
- Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Juri Kawaguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Azumi Takiishi
- Department of Clinical Laboratory, Kochi Medical School Hospital, Kochi, Japan
| | - Takahiro Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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5
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Adedara VO, Sharma V, Nawaz H, Reyes-Rivera J, Afzal-Tohid S, Pareshbhai PT, Boyapati SP, Sharafshah A. Transesophageal Echocardiogram Before Cardioversion in Atrial Fibrillation Patients. Cureus 2023; 15:e39702. [PMID: 37398783 PMCID: PMC10309076 DOI: 10.7759/cureus.39702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Transesophageal echocardiography (TEE) offers an invaluable, non-invasive avenue for diagnosing and managing various cardiac conditions, including atrial fibrillation (AF). As the most common cardiac arrhythmia, AF affects millions and can lead to severe complications. Cardioversion, a procedure to restore the heart's normal rhythm, is frequently conducted on AF patients resistant to medication. Due to inconclusive data, TEE's utility prior to cardioversion in AF patients remains ambiguous. Understanding TEE's potential benefits and limitations in this population could significantly influence clinical practice. This review aims to scrutinize the current literature on the use of TEE before cardioversion in AF patients. The principal objective is to understand TEE's potential benefits and limitations comprehensively. The study seeks to offer a clear understanding and practical recommendations for clinical practice, thereby improving the management of AF patients before cardioversion using TEE. A literature search of databases was conducted using the keywords "Atrial Fibrillation," "Cardioversion" and "Transesophageal echocardiography," resulting in 640 articles. These were narrowed to 103 following title and abstract reviews. After applying exclusion and inclusion criteria with a quality assessment, 20 papers were included: seven retrospective studies, 12 prospective observational studies, and one randomized controlled trial (RCT). Stroke risk associated with direct-current cardioversion (DCC) potentially results from post-cardioversion atrial stunning. Thromboembolic events occur post cardioversion, with or without prior atrial thrombus or cardioversion complications. Generally, cardiac thrombus localizes in the left atrial appendage (LAA), a clear contraindication to cardioversion. Atrial sludge without LAA thrombus in TEE is a relative contraindication. TEE before electrical cardioversion (ECV) in anticoagulated AF individuals is uncommon. In AF patients planned for cardioversion, contrast enhancement facilitates thrombus exclusion in TEE images, reducing embolic events. Left atrial thrombus (LAT) frequently occurs in AF patients, necessitating TEE examination. Despite the increased use of pre-cardioversion TEE, thromboembolic events persist. Notably, patients with post-DCC thromboembolic events had no LA thrombus or LAA sludge. The use of TEE-guided DCC has grown due to its ability to detect atrial thrombi pre-cardioversion, aiding risk stratification. Thrombus in the left atrium also signals an elevated risk of future thromboembolic events in AF patients. While atrial stunning post cardioversion detected by TEE is a significant risk factor for future thromboembolic events, further evidence is required. Therapeutic anticoagulation is essential during and post cardioversion, even if no atrial thrombus is detected. Current data recommends cardioversion guided by TEE, particularly in outpatient settings.
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Affiliation(s)
- Victor O Adedara
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Vagisha Sharma
- Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Hassan Nawaz
- Medicine, Nishtar Medical University and Hospital, Multan, PAK
| | | | | | | | - Sri P Boyapati
- Medicine, Siddartha Medical College, Dr. YSR University of Health Sciences, Vijayawada, IND
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Quintana RA, Dong T, Vajapey R, Reyaldeen R, Kwon DH, Harb S, Wang TKM, Klein AL. Preprocedural Multimodality Imaging in Atrial Fibrillation. Circ Cardiovasc Imaging 2022; 15:e014386. [PMID: 36256725 DOI: 10.1161/circimaging.122.014386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased risk of heart failure, stroke, and death. In current medical practice, multimodality imaging is routinely used in the management of AF. Twenty-one years ago, the ACUTE trial (Assessment of Cardioversion Using Transesophageal Echocardiography) results were published, and the management of AF changed forever by incorporating transesophageal echocardiography guided cardioversion of patients in AF for the first time. Current applications of multimodality imaging in AF in 2022 include the use of transesophageal echocardiography and computed tomography before cardioversion to exclude left atrial thrombus and in left atrial appendage occlusion device implantation. Transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance are clinically used for AF ablation planning. The decision to use a particular imaging modality in AF is based on patient's characteristics, guideline recommendation, institutional preferences, expertise, and cost. In this first of 2-part review series, we discuss the preprocedural role of echocardiography, computed tomography, and cardiac magnetic resonance in the AF, with regard to their clinical applications, relevant outcomes data and unmet needs, and highlights future directions in this rapidly evolving field.
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Affiliation(s)
- Raymundo A Quintana
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (R.A.Q.)
| | - Tiffany Dong
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Ramya Vajapey
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Reza Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Serge Harb
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
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7
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Li Y, Ren W, Wang X, Xiao Y, Feng Y, Shi P, Sun L, Wang X, Yang H, Song G. The diagnostic accuracy of contrast echocardiography in patients with suspected cardiac masses: A preliminary multicenter, cross-sectional study. Front Cardiovasc Med 2022; 9:1011560. [PMID: 36187014 PMCID: PMC9523017 DOI: 10.3389/fcvm.2022.1011560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background To evaluate the diagnostic accuracy of contrast echocardiography (CE) in patients with suspected cardiac masses. Methods A multicenter, prospective study involving 108 consecutive patients with suspected cardiac masses based on transthoracic echocardiography performed between November 2019 and December 2020 was carried out. CE examinations were performed in all patients. The echocardiographic diagnosis was established according to the qualitative (echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility) and quantitative (area of the masses and peak intensity ratio of the masses and adjacent myocardium A1/A2) evaluations. Results Final confirmed diagnoses were as follows: no cardiac mass (n = 3), pseudomass (n = 3), thrombus (n = 36), benign tumor (n = 30), and malignant tumor (n = 36). ROC analysis revealed the optimal A1/A2 with cutoff value of 0.295 for a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.958 (95% confidence interval (CI): 0.899–0.988), 100, 91.7, 95.7, and 100%, respectively. CE was able to distinguish malignant from benign tumors with an AUC of 0.953 (95% CI: 0.870–0.990). Multivariate logistic regression analysis revealed that tumor area, base, and A1/A2 were associated with the risk of malignant tumor (OR = 1.003, 95% CI: 1.00003–1.005; OR = 22.64, 95% CI: 1.30–395.21; OR = 165.39, 95% CI: 4.68–5,850.94, respectively). When using A1/A2 > 1.28 as the only diagnostic criterion to identify the malignant tumor, AUC, sensitivity, specificity, PPV, and NPV were 0.886 (95% CI: 0.784–0.951), 80.6, 96.7, 96.7, and 80.7%, respectively. Conclusion CE has the potential to accurately differentiate cardiac masses by combining qualitative and quantitative analyses. However, more studies with a large sample size should be conducted to further confirm these findings. Clinical trial registration http://www.chictr.org.cn/, identifier: ChiCTR1900026809.
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Affiliation(s)
- Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yueqin Feng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pengli Shi
- Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Lijuan Sun
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiao Wang
- Department of Ultrasound, Anshan Central Hospital, Anshan, China
| | - Huan Yang
- Department of Ultrasound, Yingkou Central Hospital, Yingkou, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Guang Song
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Abstract
PURPOSE OF REVIEW Ultrasound enhancing agents (UEAs), microbubbles which are composed of lipid or albumin shells containing high molecular weight gases with nonlinear acoustic properties in the ultrasound field, are important components of the diagnostic armamentarium in echocardiography. This review highlights the substantial value of UEAs in delineating endocardial border definition and influencing downstream decision-making in cardiovascular ultrasound. RECENT FINDINGS In this article, we review recent updates to the clinical applications of UEAs, special circumstances regarding use, the impact of use on downstream testing and cost-effectiveness, and recommended approaches for optimizing workflow in the echocardiography laboratory with UEAs. SUMMARY In multiple studies, UEAs have been identified as a useful tool in echocardiography, improving study accuracy and reader confidence, while reducing downstream testing and procedures and resulting in significant changes in clinical management. Despite their proven efficacy and cost-effectiveness, recent studies have suggested utilization remains low, in part due to perceived concerns and workflow issues that impair uptake. With an increasingly broader list of indications for echocardiography, UEAs will continue to play an important role in the diagnosis and management of patients with cardiovascular and noncardiovascular diseases.
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Affiliation(s)
- Ariane M. Fraiche
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School
| | - Jordan B. Strom
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
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9
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Strachinaru M, ten Cate FJ. Microbubble Enhanced Echocardiography in Current Cardiology Practice. Rev Cardiovasc Med 2022; 23:202. [PMID: 39077192 PMCID: PMC11283996 DOI: 10.31083/j.rcm2306202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 07/31/2024] Open
Abstract
Contrast-enhanced ultrasound imaging is a radiation-free clinical diagnostic tool that uses biocompatible contrast agents to enhance ultrasound signal, in order to improve image clarity and diagnostic performance. Ultrasound enhancing agents (UEA), which are usually gas microbubbles, are administered intravenously either by bolus injection or continuous infusion. UEA increase the accuracy and reliability of echocardiography, leading to changes in treatment, improving patient outcomes and lowering overall health care costs. In this review we describe: (1) the current clinical applications of ultrasound enhancing agents in echocardiography, with a brief review of the evidence underlying each of these applications; (2) emerging diagnostic and therapeutic applications of microbubble enhanced echocardiography (MEE), which rely either on the specific properties and composition of ultrasound enhancing agents or on the technical advances of clinical ultrasound systems; and (3) safety of MEE.
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Affiliation(s)
- Mihai Strachinaru
- Department of Cardiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Department of Biomedical Engineering, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Folkert J ten Cate
- Department of Cardiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
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10
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Implantation of Watchman FLX for Patients with Difficult Left Atrial Appendage Anatomy: A Case-Based Discussion. Curr Probl Cardiol 2022; 47:101266. [DOI: 10.1016/j.cpcardiol.2022.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
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11
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Mbonde AA, O'Carroll CB, Dulamea OA, Anghel D, Chong BW, Dumitrascu OM. Current Guidelines on Management of Amaurosis Fugax and Transient Ischemic Attacks. Asia Pac J Ophthalmol (Phila) 2022; 11:168-176. [PMID: 35213421 DOI: 10.1097/apo.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ABSTRACT Transient ischemic attack (TIA) is defined as a transient episode of neurological dysfunction resulting from focal brain, spinal cord, or retinal ischemia, without associated infarction. Consequently, a TIA encompasses amaurosis fugax (AF) that is a term used to denote momentary visual loss from transient retinal ischemia. In this review, we use the word TIA to refer to both cerebral TIAs (occurring in the brain) and AF (occurring in the retina). We summarize the key components of a comprehensive evaluation and management of patients presenting with cerebral and retinal TIA.All TIAs should be treated as medical emergencies, as they may herald permanent disabling visual loss and devastating hemispheric or vertebrobasilar ischemic stroke. Patients with suspected TIA should be expeditiously evaluated in the same manner as those with an acute stroke. This should include a detailed history and examination followed by specific diagnostic studies. Imaging of the brain and extracranial and intracranial blood vessels forms the cornerstone of diagnostic workup of TIA. Cardiac investigations and serum studies to evaluate for etiological risk factors are also recommended.The management of all TIAs, whether cerebral or retinal, is similar and should focus on stroke prevention strategies, which we have categorized into general and specific measures. General measures include the initiation of appropriate antiplatelet therapy, encouraging a healthy lifestyle, and managing traditional risk factors, such as hypertension, dyslipidemia, and diabetes. Specific management measures require the identification of a specific TIA etiology, such as moderate-severe (greater than 50% of stenosis) symptomatic extracranial large vessel or intracranial steno-occlusive atherosclerotic disease, aortic arch atherosclerosis, and atrial fibrillation.
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Affiliation(s)
- Amir A Mbonde
- Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, US
| | - Cumara B O'Carroll
- Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, US
| | - Octaviana A Dulamea
- Department of Neurology, Fundeni Clinical institute and University of Medicine Carol Davila, Bucharest, Romania
| | - Daniela Anghel
- Department of Neurology, Fundeni Clinical institute and University of Medicine Carol Davila, Bucharest, Romania
| | - Brian W Chong
- Department of Neuroradiology, Mayo Clinic College of Medicine and Science, Phoenix, AZ, US
| | - Oana M Dumitrascu
- Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, US
- Department of Ophthalmology, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, US
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12
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Lozier MR, Sanchez AM, Mihos CG. A systematic review on the use of ultrasound enhancing agents with transesophageal echocardiography to assess the left atrial appendage prior to cardioversion. Echocardiography 2021; 38:1414-1421. [PMID: 34212409 DOI: 10.1111/echo.15150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Assessment of the left atrium and atrial appendage (LAA) for thrombus by transesophageal echocardiography (TEE) may be suboptimal due to difficult imaging windows and ultrasound artifacts. The present study analyzed the benefit of using ultrasound enhancing agents (UEAs) with TEE to improve diagnostic accuracy and image quality. METHODS A systematic review of studies published through December 2020 was performed, and included investigations comparing the number of cases deemed indeterminate for visualization of LAA thrombi on TEE pre- versus post-UEAs prior to cardioversion for atrial fibrillation or flutter (AF). Study results were pooled where the number of indeterminate cases by conventional TEE were re-classified as thrombus present, indeterminate, or thrombus excluded following administration of UEAs. RESULTS Three studies with a total of 399 patients were identified. Of these, 83 (26%) participants met the inclusion criteria. The mean age of the study population from the three studies was 66 ± 12 years, 29% were female, and prevalence of congestive heart failure or neurologic events was 22% and 5%, respectively. Use of UEAs with TEE re-classified 66% (55/83) of cases initially deemed to be indeterminate for LAA thrombus on conventional TEE. Thrombus was present in 13% (11/83) and excluded in 53% (44/83) of cases; 34% (28/83) of cases remained indeterminate on TEE post-UEAs. There were no complications reported with the administration of UEAs. CONCLUSION Adjunctive use of UEAs with TEE can facilitate the diagnosis or exclusion of LAA thrombus, and improve the procedural confidence and cost-efficiency of cardioversion for AF.
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Affiliation(s)
- Matthew R Lozier
- Mount Sinai Heart Institute, Columbia University Division of Cardiology, Miami Beach, Florida, USA
| | | | - Christos G Mihos
- Echocardiography Laboratory, Mount Sinai Heart Institute, Columbia University Division of Cardiology, Miami Beach, Florida, USA
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Improved Thrombus Assessment by Transesophageal Echocardiography: The DOLOP (Detection of Left Atrial Appendage Thrombosis Utilizing Optison) Study. J Am Soc Echocardiogr 2021; 34:916-917. [PMID: 33819620 DOI: 10.1016/j.echo.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/21/2022]
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14
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Ebelt H, Goetze S, Weida A, Offhaus A. Impact of ultrasound contrast agent during transoesophageal echocardiography on the sizing of the left atrial appendage. Open Heart 2021; 8:openhrt-2020-001403. [PMID: 33757976 PMCID: PMC7993222 DOI: 10.1136/openhrt-2020-001403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/19/2020] [Accepted: 03/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Interventional closure of the left atrial appendage closure (LAAC) has been established as an alternative treatment in patients with atrial fibrillation (AF) and an increased risk of stroke. So far it is unknown whether the use of ultrasound contrast agent (UCA) would influence the correct sizing of the LAA and thereby have an impact on device selection during interventional LAAC. METHODS Between January 2017 and April 2018, 223 transoesophageal echocardiography (TOE) examinations were prospectively performed in adult patients with non-valvular AF (Impact of the use of ultrasound contrast agent on the detection of thrombi in the left atrial appendage during transesophageal echocardiography (CONDOR) study). LAA was examined both with and without the use of UCA. The following measurements were taken at 0o, 45o, 90o and 135o: diameter of LAA ostium, maximal depth of the LAA, maximal available depth of the LAA orthogonal to the ostial plane and area of the LAA. RESULTS The use of UCA had no relevant influence on the size determination of the LAA. Additionally, Bland-Altman blots demonstrate a high degree of correlation between the measurements with and without UCA with no evidence for a systematic effect arising from the use of UCA. When comparing the measurements of two independent investigators, the use of UCA rather leads to a higher variability than to an improved precision. DISCUSSION Despite the fact that the use of UCA during TOE leads to an improved rule out of thrombi, our study shows that there is no advantageous effect of UCA on the size determination of the LAA and should therefore not be used for this purpose.
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Affiliation(s)
- Henning Ebelt
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Sarah Goetze
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Anja Weida
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Alexandra Offhaus
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
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15
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Huisman LA, Steinkamp PJ, Hillebrands JL, Zeebregts CJ, Linssen MD, Jorritsma-Smit A, Slart RHJA, van Dam GM, Boersma HH. Feasibility of ex vivo fluorescence imaging of angiogenesis in (non-) culprit human carotid atherosclerotic plaques using bevacizumab-800CW. Sci Rep 2021; 11:2899. [PMID: 33536498 PMCID: PMC7858611 DOI: 10.1038/s41598-021-82568-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/11/2021] [Indexed: 01/30/2023] Open
Abstract
Vascular endothelial growth factor-A (VEGF-A) is assumed to play a crucial role in the development and rupture of vulnerable plaques in the atherosclerotic process. We used a VEGF-A targeted fluorescent antibody (bevacizumab-IRDye800CW [bevacizumab-800CW]) to image and visualize the distribution of VEGF-A in (non-)culprit carotid plaques ex vivo. Freshly endarterectomized human plaques (n = 15) were incubated in bevacizumab-800CW ex vivo. Subsequent NIRF imaging showed a more intense fluorescent signal in the culprit plaques (n = 11) than in the non-culprit plaques (n = 3). A plaque received from an asymptomatic patient showed pathologic features similar to the culprit plaques. Cross-correlation with VEGF-A immunohistochemistry showed co-localization of VEGF-A over-expression in 91% of the fluorescent culprit plaques, while no VEGF-A expression was found in the non-culprit plaques (p < 0.0001). VEGF-A expression was co-localized with CD34, a marker for angiogenesis (p < 0.001). Ex vivo near-infrared fluorescence (NIRF) imaging by incubation with bevacizumab-800CW shows promise for visualizing VEGF-A overexpression in culprit atherosclerotic plaques in vivo.
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Affiliation(s)
- Lydian A. Huisman
- grid.4494.d0000 0000 9558 4598Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Pieter J. Steinkamp
- grid.4494.d0000 0000 9558 4598Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- grid.4494.d0000 0000 9558 4598Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Clark J. Zeebregts
- grid.4494.d0000 0000 9558 4598Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs D. Linssen
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annelies Jorritsma-Smit
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riemer H. J. A. Slart
- grid.4494.d0000 0000 9558 4598Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.6214.10000 0004 0399 8953Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Gooitzen M. van Dam
- grid.4494.d0000 0000 9558 4598Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Surgery, Nuclear Medicine and Molecular Imaging and Intensive Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrikus H. Boersma
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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16
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Patel K, Natale A, Yang R, Trivedi C, Romero J, Briceno D, Mohanty S, Alviz I, Natale V, Sanchez J, Della Rocca DG, Tarantino N, Zhang XD, Mohanty P, Horton R, Burkhardt D, Gopinathannair R, Joseph Gallinghouse G, Lakkireddy D, Di Biase L. Is transesophageal echocardiography necessary in patients undergoing ablation of atrial fibrillation on an uninterrupted direct oral anticoagulant regimen? Results from a prospective multicenter registry. Heart Rhythm 2020; 17:2093-2099. [PMID: 32681991 DOI: 10.1016/j.hrthm.2020.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Thromboembolic stroke is a rare but devastating consequence of atrial fibrillation (AF) ablation. Transesophageal echocardiography (TEE) is recommended to rule out left atrial appendage thrombus; however, its use is variable. OBJECTIVE The purpose of this study was to assess whether TEE is mandatory in patients undergoing AF ablation on uninterrupted direct oral anticoagulants (DOACs). METHODS Data from our prospective multicenter registry of patients with AF undergoing radiofrequency catheter ablation on uninterrupted DOACs were analyzed. All the included patients were on anticoagulation for at least 4 weeks before ablation. All AF ablation procedures were performed under intracardiac echocardiography guidance. Before transseptal puncture, heparin bolus was administered, followed by continuous infusion, with a target activated clotting time of >300 seconds. RESULTS A total of 6186 patients (3180 on apixaban [51.4%], 2528 on rivaroxaban [40.9%], 404 on dabigatran [6.5%], and 74 on edoxaban [1.2%]) were analyzed. The mean age of the study population was 69.4 ± 10.3 years; 4194 patients (67.8%) were male, and 5120 patients (82.8%) had persistent and long-standing persistent AF. The mean CHA2DS2-VASc score was 2.86 ± 1.58; the mean CHADS2 score was 1.65 ± 1.14. Intracardiac echocardiography ruled out left atrial appendage and left atrial thrombi in all patients and revealed "smoke" in 1672 patients (27.03%). Transient ischemic attack was noted in 1 patient with long-standing persistent AF in the setting of a missed dose of rivaroxaban before ablation. CONCLUSION Our study showed that performing AF ablation in patients on uninterrupted DOACs without TEE is safe and feasible in high stroke risk patients. Elimination of routine preablation TEE would have significant economic and clinical implications.
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Affiliation(s)
- Kavisha Patel
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Ruike Yang
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chintan Trivedi
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Jorge Romero
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - David Briceno
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sanghamitra Mohanty
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Isabella Alviz
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Veronica Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Javier Sanchez
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Domenico G Della Rocca
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Nicola Tarantino
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xiao-Dong Zhang
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Prasant Mohanty
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Rodney Horton
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - David Burkhardt
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Rakesh Gopinathannair
- Department of Electrophysiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - G Joseph Gallinghouse
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Dhanunjaya Lakkireddy
- Department of Electrophysiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Luigi Di Biase
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
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17
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Pathan F, Hecht H, Narula J, Marwick TH. Roles of Transesophageal Echocardiography and Cardiac Computed Tomography for Evaluation of Left Atrial Thrombus and Associated Pathology: A Review and Critical Analysis. JACC Cardiovasc Imaging 2019; 11:616-627. [PMID: 29622180 DOI: 10.1016/j.jcmg.2017.12.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/21/2017] [Indexed: 01/23/2023]
Abstract
Evaluation of the left atrium and left atrial appendage for the presence of thrombus prior to cardioversion and pulmonary vein isolation, and of the entire heart for embolic sources in the setting of cryptogenic stroke, has long been standard medical care. Guidelines have uniformly recommended transesophageal echocardiography (TEE) to accomplish these goals. In recent years, computed tomographic angiography has demonstrated diagnostic accuracy similar to that of TEE for the detection of thrombus. Analysis of the pertinent data and relative merits of the 2 technologies leads to the conclusions that: 1) both modalities have some unique, nonoverlapping capabilities that may dictate their use in specific situations; 2) computed tomographic angiography is a reasonable alternative to TEE when the primary aim is to exclude left atrial and left atrial appendage thrombus and in patients in whom the risks associated with TEE outweigh the benefits; and 3) both options should be discussed with the patient in the setting of shared decision making.
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Affiliation(s)
- Faraz Pathan
- Menzies Institute for Medical Research, Hobart, Australia
| | - Harvey Hecht
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York
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18
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Ebelt H, Offhaus A, Wiora M, Roehl P, Schwenzky A, Weida A, Hoyme M, Bindemann-Koecher J, Anacker J. Impact of ultrasound contrast agent on the detection of thrombi during transoesophageal echocardiography. Open Heart 2019; 6:e001024. [PMID: 31673382 PMCID: PMC6803001 DOI: 10.1136/openhrt-2019-001024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/14/2019] [Accepted: 09/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Atrial fibrillation (AF) carries the risk of thrombus formation in the left atrium and especially in the left atrial appendage (LAA). A transoesophageal echocardiography (TOE) is routinely performed in these patients to rule out thrombi before cardioversion or structural interventions like LAA closure or pulmonary vein isolation. However, in a certain number of cases, inconclusive results of the TOE may result. This study was performed to analyse whether the routine use of ultrasound contrast agent (UCA) has an influence on the frequency of thrombus detection. Methods In patients with AF who were scheduled for a subsequent interventional procedure, a TOE was initially performed without contrast agent. Then, the TOE was repeated with the use of UCA. The percentage of diagnostic findings regarding the prevalence of thrombus in the LAA with and without UCA were compared (thrombus present (T+), no thrombus (T−) and inconclusive result (T+/−)). Results 223 patients were prospectively included into the trial. The numbers of thrombus detection were as follows: without UCA: 17 T+ (7.6%), 154 T− (69.1%), 52 T+/− (23,3%); with UCA: 16 T+ (7.2%), 179 T− (80.3%), 28 T+/− (12.6%; χ2: p<0.01). In 29 examinations (13.0%), the use of UCA had an impact on the subsequent treatment strategy. Conclusions The use of UCA during TOE in patients with AF has a significant impact on the subsequent patient management especially due to an improved rule out of LAA thrombi.
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Affiliation(s)
- Henning Ebelt
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Alexandra Offhaus
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Matthias Wiora
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Peter Roehl
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Andreas Schwenzky
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Anja Weida
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Matthias Hoyme
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | | | - Jelena Anacker
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
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19
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Posada-Martinez EL, Trejo-Paredes C, Ortiz-Leon XA, Ivey-Miranda JB, Lin BA, McNamara RL, Arias-Godinez JA, Lombo B, Sugeng L. Differentiating spontaneous echo contrast, sludge, and thrombus in the left atrial appendage: Can ultrasound enhancing agents help? Echocardiography 2019; 36:1413-1417. [DOI: 10.1111/echo.14405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | - Ben A. Lin
- Cardiovascular Division; Yale University; New Haven Connecticut
| | | | | | - Bernardo Lombo
- Cardiovascular Division; Yale University; New Haven Connecticut
| | - Lissa Sugeng
- Cardiovascular Division; Yale University; New Haven Connecticut
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20
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Csecs I, Merkely B, Wilson BD. Cardiac Amyloidosis and Electrical Cardioversion. J Am Coll Cardiol 2019; 73:2909-2910. [DOI: 10.1016/j.jacc.2019.03.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/03/2019] [Indexed: 10/26/2022]
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21
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El-Am EA, Dispenzieri A, Grogan M, Nkomo VT. Reply. J Am Coll Cardiol 2019; 73:2911-2913. [DOI: 10.1016/j.jacc.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/25/2022]
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22
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Doukky R, Donenberg MJ, Parker J, Kaplan J, Travers C, Soble JS, Sattar P, Krishnan K, Madias C, Tracy M, Feinstein SB. Use of ultrasound enhancing agents in transesophageal echocardiography to improve interpretive confidence of left atrial appendage thrombus. Echocardiography 2018; 36:362-369. [DOI: 10.1111/echo.14228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Rami Doukky
- Division of CardiologyCook County Health Chicago Illinois
- Division of CardiologyRush University Medical Center Chicago Illinois
| | | | - Jeremy Parker
- Division of CardiologyRush University Medical Center Chicago Illinois
| | - Jonathan Kaplan
- Division of CardiologyRush University Medical Center Chicago Illinois
| | - Chad Travers
- Division of CardiologyRush University Medical Center Chicago Illinois
| | - Jeffrey S. Soble
- Division of CardiologyRush University Medical Center Chicago Illinois
| | - Payman Sattar
- Division of CardiologyCook County Health Chicago Illinois
- Division of CardiologyRush University Medical Center Chicago Illinois
| | - Kousik Krishnan
- Division of CardiologyRush University Medical Center Chicago Illinois
| | | | - Melissa Tracy
- Division of CardiologyRush University Medical Center Chicago Illinois
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Abstract
This literature review in devoted to the potential of application of contrast-enhanced echocardiography (CEE) for assessment of structure and function of left cardiac chambers. It contains based on current recommendations discussion of main indications for CEE and analysis of its possibilities in evaluation of perfusion of the left ventricular myocardium, detection of myocardial ischemia, and assessment of myocardial viability. Data on CEE safety and possible side effects associated with the use of ultrasound contrasts are also presented.
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Affiliation(s)
- M N Alekhin
- Central Clinical Hospital with Policlinic of the Presidential Administration of the Russian Federation.
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24
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Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P, Edvardsen T, Lancellotti P. Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017. Eur Heart J Cardiovasc Imaging 2018; 18:1205-1205af. [PMID: 28950366 DOI: 10.1093/ehjci/jex182] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
Contrast echocardiography is widely used in cardiology. It is applied to improve image quality, reader confidence and reproducibility both for assessing left ventricular (LV) structure and function at rest and for assessing global and regional function in stress echocardiography. The use of contrast in echocardiography has now extended beyond cardiac structure and function assessment to evaluation of perfusion both of the myocardium and of the intracardiac structures. Safety of contrast agents have now been addressed in large patient population and these studies clearly established its excellent safety profile. This document, based on clinical trials, randomized and multicentre studies and published clinical experience, has established clear recommendations for the use of contrast in various clinical conditions with evidence-based protocols.
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Affiliation(s)
- Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK
| | | | | | | | - Jose Zamorano
- CIBERCV, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | - Patrizio Lancellotti
- University of Liege Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liege, Belgium
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25
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Cone AK. The Role of Echocardiography in Determining the Method of Ablation for the Treatment of Paroxysmal Atrial Fibrillation: A Literature Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318755672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Atrial fibrillation is the most common cardiac arrhythmia, affecting approximately 1 out of every 250 people. It is associated with thrombus formation in the left atrium, decreased cardiac output, and deterioration of the myocardium. There are multiple treatments available for paroxysmal atrial fibrillation. This literature review will assess the benefits, risks, and complications associated with radiofrequency ablation and cryoablation, which utilize heat and freezing mechanisms, respectively. The review will also assess the role of echocardiography in determining which treatment, if any, is appropriate for atrial fibrillation.
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26
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Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, Choy J, Gaibazzi N, Gillam LD, Janardhanan R, Kutty S, Leong-Poi H, Lindner JR, Main ML, Mathias W, Park MM, Senior R, Villanueva F. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 2018; 31:241-274. [DOI: 10.1016/j.echo.2017.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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27
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Delgado V, Di Biase L, Leung M, Romero J, Tops LF, Casadei B, Marrouche N, Bax JJ. Structure and Function of the Left Atrium and Left Atrial Appendage. J Am Coll Cardiol 2017; 70:3157-3172. [DOI: 10.1016/j.jacc.2017.10.063] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/22/2017] [Indexed: 12/12/2022]
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28
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Fastner C, Behnes M, Ansari U, El-Battrawy I, Borggrefe M. Interventional Left Atrial Appendage Closure: Focus on Practical Implications. Interv Cardiol 2017. [DOI: 10.5772/67773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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29
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Lempereur M, Aminian A, Dulgheru R, De Potter T, Oury C, Lancellotti P. Role of Imaging in Left Atrial Appendage Occlusion. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2017. [DOI: 10.21859/ijcp-020203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kamperidis V, Michou E, Kouskouras K, Nikolaidou O, Karvounis H. Left atrial appendage pericardial fluid: contrast-enhanced transesophageal echocardiography makes it visible. Hippokratia 2016; 20:235-237. [PMID: 29097892 PMCID: PMC5654443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Contrast-enhanced transesophageal echocardiography (TEE) for the opacification of left atrial appendage (LAA) is not clearly suggested by the current guidelines and only scarce data are available. CASE PRESENTATION A patient with a membrane-like structure in the LAA cavity is presented. Contrast-enhanced TEE revealed LAA pericardial effusion and this diagnosis was confirmed by cardiac magnetic resonance that offered comparable images and tissue characterization. CONCLUSION Contrast-enhanced TEE has been demonstrated to safely and accurately enlighten LAA anatomy. Hippokratia 2016, 20(3): 235-237.
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Affiliation(s)
- V Kamperidis
- 1 Cardiology Department, AHEPA Hospital, Medical Faculty, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Michou
- 1 Cardiology Department, AHEPA Hospital, Medical Faculty, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Kouskouras
- Radiology Department, AHEPA Hospital, Medical Faculty, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - O Nikolaidou
- Radiology Department, AHEPA Hospital, Medical Faculty, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Karvounis
- 1 Cardiology Department, AHEPA Hospital, Medical Faculty, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bejinariu AG, Härtel DU, Brockmeier J, Oeckinghaus R, Herzer A, Tebbe U. Left atrial thrombi and spontaneous echo contrast in patients with atrial fibrillation : Systematic analysis of a single-center experience. Herz 2016; 41:706-714. [PMID: 27100878 DOI: 10.1007/s00059-016-4423-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/30/2016] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation is associated with a high risk for thromboembolic events. Thrombi in the left atrial appendage and spontaneous echo contrast (SEC) correlate positively with this embolic risk. We studied the laboratory, echocardiographic, and epidemiologic parameters that could predict left atrial thrombi and the intensity of the SEC. PATIENTS AND METHODS Between September 2013 and June 2015 we included 372 patients with atrial fibrillation before planned electrical cardioversion (transesophageal-guided strategy) in this study. After assessing the risk of stroke and bleeding (CHA2DS2-VASc and HAS-BLED scores), we measured the concentration of the D-dimer and B-type natriuretic peptide at the time of the transesophageal echocardiography as well as the left atrial volume and the ejection fraction during transthoracic echocardiography. RESULTS The ejection fraction and the CHA2DS2-VASc score were identified as independent predictors of both left atrial thrombi and SEC, whereas the left atrial volume could only predict the intensity of SEC. In contrast to the results of other studies, the biomarkers in this study failed to predict the outcome. CONCLUSION Only the echocardiographic and epidemiologic parameters were predictors of left atrial thrombi and SEC intensity, while the studied biomarkers had no predictive power. Using clinical data and transthoracic echocardiography, we can change the therapeutic strategy in high-risk patients.
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Affiliation(s)
- A G Bejinariu
- Clinic for Cardiology, Angiology and Intensive Care, Klinikum Lippe Detmold, Röntgenstr. 18, 32756, Detmold, Germany.
| | - D U Härtel
- Clinic for Cardiology, Angiology and Intensive Care, Klinikum Lippe Detmold, Röntgenstr. 18, 32756, Detmold, Germany
| | - J Brockmeier
- Clinic for Cardiology, Angiology and Intensive Care, Klinikum Lippe Detmold, Röntgenstr. 18, 32756, Detmold, Germany
| | - R Oeckinghaus
- Clinic for Cardiology, Angiology and Intensive Care, Klinikum Lippe Detmold, Röntgenstr. 18, 32756, Detmold, Germany
| | - A Herzer
- Clinic for Cardiology, Angiology and Intensive Care, Klinikum Lippe Detmold, Röntgenstr. 18, 32756, Detmold, Germany
| | - U Tebbe
- Clinic for Cardiology, Angiology and Intensive Care, Klinikum Lippe Detmold, Röntgenstr. 18, 32756, Detmold, Germany
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Wunderlich NC, Beigel R, Swaans MJ, Ho SY, Siegel RJ. Percutaneous interventions for left atrial appendage exclusion: options, assessment, and imaging using 2D and 3D echocardiography. JACC Cardiovasc Imaging 2016; 8:472-488. [PMID: 25882576 DOI: 10.1016/j.jcmg.2015.02.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/22/2015] [Accepted: 02/05/2015] [Indexed: 12/26/2022]
Abstract
Percutaneous left atrial appendage (LAA) exclusion is an evolving treatment to prevent embolic events in patients with nonvalvular atrial fibrillation. In the past few years multiple percutaneous devices have been developed to exclude the LAA from the body of the left atrium and thus from the systemic circulation. Two- and 3-dimensional transesophageal echocardiography (TEE) is used to assess the LAA anatomy and its suitability for percutaneous closure to select the type and size of the closure device and to guide the device implantation procedure in conjunction with fluoroscopy. In addition, 2- and 3-dimensional TEE is also used to assess the effectiveness of device implantation acutely and on subsequent follow-up examination. Knowledge of the implantation options that are currently available along with their specific characteristics is essential for choosing the appropriate device for a given patient with a specific LAA anatomy. We present the currently available LAA exclusion devices and the echocardiographic imaging approaches for evaluation of the LAA before, during, and after LAA occlusion.
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Affiliation(s)
| | - Roy Beigel
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; The Heart Institute, Sheba Medical Center, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
| | - Robert J Siegel
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Di Minno MND, Ambrosino P, Dello Russo A, Casella M, Tremoli E, Tondo C. Prevalence of left atrial thrombus in patients with non-valvular atrial fibrillation. A systematic review and meta-analysis of the literature. Thromb Haemost 2015; 115:663-77. [PMID: 26607276 DOI: 10.1160/th15-07-0532] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/22/2015] [Indexed: 11/05/2022]
Abstract
We performed a meta-analysis about the prevalence of left atrial thrombus (LAT) in patients with atrial fibrillation (AF) undergoing trans-esophageal echocardiography (TEE). Studies reporting on LAT presence in AF patients were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases and the pooled LAT prevalence was evaluated as weighted mean prevalence (WMP). Seventy-two studies (20,516 AF patients) showed a LAT WMP of 9.8 % (95 %CI: 7.6 %-12.5 %). LAT presence was associated with a higher age (mean difference: 2.56, 95 %CI: 1.49-3.62), and higher prevalence of female gender (OR: 1.35, 95 %CI: 1.04-1.75), hypertension (OR: 1.78, 95 %CI: 1.38-2.30), diabetes mellitus (OR: 1.86, 95 %CI: 1.33-2.59) and chronic heart failure (OR: 3.67, 95 %CI: 2.40-5.60). Overall, LAT patients exhibited a higher CHADS2-score (mean difference 0.88, 95 %CI: 0.68-1.07) and a higher risk of stroke/systemic embolism (OR: 3.53, 95 %CI: 2.24-5.56) compared with those without LAT. A meta-regression showed an inverse association between LAT prevalence and the presence of anticoagulation (Z-value: -7.3, p< 0.001). Indeed, studies in which 100 % of patients received oral anticoagulation reported a 3.4 % WMP of LAT (95 %CI: 1.3 %-8.7 %), whereas studies in which 0 % of patients received anticoagulation showed a LAT WMP of 7.4 % (95 %CI: 2.3 %-21.5 %). Our data suggest that LAT is present in ≍10 % of AF patients, and is associated with a 3.5-fold increased risk of stroke/systemic embolism. Interestingly, LAT is also reported in some of patients receiving anticoagulation. The implementation of the screening of LAT in AF patients before cardioversion/ablation could be useful for the prevention of vascular events.
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Affiliation(s)
- Matteo Nicola Dario Di Minno
- Matteo Nicola Dario Di Minno, MD, PhD, Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy, Tel./Fax: +39 02 58002857, E-mail:
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Abstract
Ultrasound enhancing agents (UEAs) are being utilized for a growing number of applications with real-time very low mechanical index (MI) techniques in clinical cardiology today. This article will review recent developments on the safety of UEAs and their effectiveness in myocardial perfusion imaging, three-dimensional quantification of left ventricular function, and vascular imaging. UEAs are now being utilized in all age groups, with new indications that add incremental value to the currently approved by the Food and Drug Administration. These include the incremental value in cardiac imaging, where the off-label analysis of myocardial perfusion observed with UEAs adds to the enhanced endocardial border delineation. In carotid artery imaging, UEAs improve the detection of plaque but also can examine plaque neovascularization. Vascular surgeons now utilize UEAs in the evaluation of endovascular repair to detect endoleaks without the need of ionizing radiation. Newer applications are emerging in the detection of left atrial appendage thrombi and quantification of myocardial blood flow and volume in transplant patients.
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Affiliation(s)
- Thomas R Porter
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, 68198, USA,
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Emerging Role of Cardiovascular CT and MRI in the Evaluation of Stroke. AJR Am J Roentgenol 2015; 204:269-80. [DOI: 10.2214/ajr.14.13051] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2014; 27:797-810. [DOI: 10.1016/j.echo.2014.05.011] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abdelmoneim SS, Mulvagh SL. Techniques To Improve Left Atrial Appendage Imaging. J Atr Fibrillation 2014; 7:1059. [PMID: 27957080 DOI: 10.4022/jafib.1059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 01/20/2023]
Abstract
The clinical importance of the left atrial appendage (LAA) is increasingly recognized. The assessment of the unique anatomy and function of the LAA is especially important in the setting of atrial fibrillation (AF). AF is the most commonly occurring cardiac arrhythmia, and the association of LAA thrombi and AF has been well established. Transesophageal echocardiography (TEE) is a widely available imaging tool to exclude the potential presence of LAA thrombus prior to cardioversion in patients with AF. Commercially available products containing microbubbles to enhance ultrasound images, termed "ultrasound contrast agents" (UCA) are indicated for use with transthoracic echocardiography to improve cardiac structure and function assessment, but can also be used with TEE as an adjunctive tool to assess the LAA. Integrative multimodality imaging techniques can be used in evaluation of the LAA as indicated in various clinical scenarios including: stroke risk assessment, decision-making prior to cardioversion in AF, placement and assessment percutaneous transcatheter LAA occlusion procedures, and assessment of results of procedural or surgical exclusion of LAA. In this article, various imaging techniques that are available for non-invasive visualization of the LAA will be reviewed along with the clinical importance of assessment of LAA anatomy and function.
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Affiliation(s)
- Sahar S Abdelmoneim
- Mayo Clinic Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States; Division of Cardiovascular Medicine, Assiut University, Assiut, Egypt
| | - Sharon L Mulvagh
- Mayo Clinic Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Using technology to find the secret places of the heart. Vet J 2014; 200:216-7. [DOI: 10.1016/j.tvjl.2014.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 11/19/2022]
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Sun L, Li Y, Zhang YT, Shen JX, Xue FH, Cheng HD, Qu XF. A computer-aided diagnostic algorithm improves the accuracy of transesophageal echocardiography for left atrial thrombi: a single-center prospective study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:83-91. [PMID: 24371102 DOI: 10.7863/ultra.33.1.83] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES We investigated whether transesophageal echocardiography (TEE) assisted with a computer-aided diagnostic (CAD) algorithm was superior to TEE in diagnosing left atrial (LA)/left atrial appendage (LAA) thrombi in patients with atrial fibrillation (AF) in a single prospective study. METHODS Transesophageal echocardiography was performed in patients with AF, and images were reconstructed. Gray level co-occurrence matrix-based features were calculated and then classified using an artificial neural network. The original data and processed images by the CAD system were studied by 5 radiologists independently in a blind manner. The diagnostic performance of each radiologist was evaluated. RESULTS One hundred thirty patients with AF were investigated. Thirty-one patients (23.9%) had a diagnosis of LA/LAA thrombi. The mean sensitivity ± SD of TEE for LA/LAA thrombi was 0.933 ± 0.027, which was noticeably improved by CAD (0.955 ± 0.021; P < .05). The specificity of TEE was 0.811 ± 0.055, which was markedly lower than that by TEE plus CAD (0.970 ± 0.009; P < .05). The positive predictive value of TEE was low (0.613 ± 0.073) compared to that of TEE plus CAD (0.908 ± 0.027; P < .001), whereas the negative predictive values were comparable for TEE, CAD, and TEE plus CAD. Diagnosis of an LA/LAA thrombus by TEE plus CAD had a higher accuracy rate (0.966 ± 0.011) than that by TEE (0.840 ± 0.047; P < .01). The mean area under the receiver operating characteristic curve (Az) for TEE was 0.834 ± 0.009 (95% confidence interval [CI], 0.815-0.852), which was markedly lower than the Az for TEE plus CAD (0.932 ± 0.005; 95% CI, 0.921-0.943). The use of CAD significantly improved the Az values for all 5 radiologists (P < .001). CONCLUSIONS The CAD algorithm significantly improves the diagnostic accuracy of TEE for LA/LAA thrombi in patients with AF.
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Affiliation(s)
- Lin Sun
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, 23 Youzheng St, Nangang District, 150001 Harbin City, Heilongjiang Province, China.
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KUMAGAI TOMOHIRO, MATSUURA YUTAKA, YAMAMOTO TEIJI, UGAWA YOSHIKAZU, FUKUSHIMA TETSUHITO. RISK FACTORS FOR LEFT ATRIAL THROMBUS FROM TRANSESOPHAGEAL ECHOCARDIOGRAPHY FINDINGS IN ISCHEMIC STROKE PATIENTS. Fukushima J Med Sci 2014; 60:154-8. [DOI: 10.5387/fms.2013-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- TOMOHIRO KUMAGAI
- Division of Neurology, Ohta Nishinouchi Hospital
- Department of Neurology, Fukushima Medical University School of Medicine
- Department of Hygiene & Preventive Medicine, Fukushima Medical University School of Medicine
| | | | - TEIJI YAMAMOTO
- Department of Neurology, Fukushima Medical University School of Medicine
| | - YOSHIKAZU UGAWA
- Department of Neurology, Fukushima Medical University School of Medicine
| | - TETSUHITO FUKUSHIMA
- Department of Hygiene & Preventive Medicine, Fukushima Medical University School of Medicine
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Baran J, Stec S, Pilichowska-Paszkiet E, Zaborska B, Sikora-Frąc M, Kryński T, Michałowska I, Łopatka R, Kułakowski P. Intracardiac Echocardiography for Detection of Thrombus in the Left Atrial Appendage. Circ Arrhythm Electrophysiol 2013; 6:1074-81. [DOI: 10.1161/circep.113.000504] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jakub Baran
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Sebastian Stec
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Ewa Pilichowska-Paszkiet
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Beata Zaborska
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Małgorzata Sikora-Frąc
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Tomasz Kryński
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Ilona Michałowska
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Rafał Łopatka
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
| | - Piotr Kułakowski
- From the Division of Clinical Electrophysiology (J.B., S.S., T.K., P.K.) and Department of Cardiology (J.B., S.S., E.P.-P., B.Z., M.S.-F., T.K., P.K.), Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland; Department of Radiology, Institute of Cardiology, Warsaw, Poland (I.M.); Institute of Control & Industrial Electronics, Warsaw University of Technology, Warsaw, Poland (R.L.)
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Becher H, Gibson PH. Contrast Echocardiography: Current Applications and Future Perspectives. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9234-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Providência R, Trigo J, Paiva L, Barra S. The Role of Echocardiography in Thromboembolic Risk Assessment of Patients with Nonvalvular Atrial Fibrillation. J Am Soc Echocardiogr 2013; 26:801-12. [DOI: 10.1016/j.echo.2013.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Indexed: 11/25/2022]
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