The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.
Detection of Left Atrial Appendage Thrombus by Cardiac Computed Tomography in Patients With Atrial Fibrillation: A Meta-Analysis
Abstract
Background—: Transesophageal echocardiogram (TEE) is considered the gold standard modality in detecting left atrial/LA appendage (LA/LAA) thrombi. However, this is a semi-invasive procedure with rare but potential life-threatening complications. Cardiac computed tomography has been proposed as an alternative method. The purpose of this meta-analysis was to evaluate the diagnostic accuracy of cardiac computed tomography assessing LA/LAA thrombi in comparison with TEE. Methods and Results—: A systematic review of Medline, Cochrane, and Embase to look for clinical trials assessing detection of LA/LAA thrombi by cardiac computed tomography when compared with TEE in patients with a history of atrial fibrillation before electric cardioversion/pulmonary vein isolation or after cardioembolic cerebrovascular accident was performed using standard approach and bivariate analysis. Nineteen studies with 2955 patients (men, 71%; mean age, 61±4 years) fulfilled the inclusion criteria. Most studies (85%, 16 studies) used 64-slide multidetector computed tomography and 15 studies (79%) were electrocardiographic-gated. The incidence of LA/LAA thrombi was 8.9% (SD, ±7). The mean sensitivity and specificity were 96% and 92%, whereas the positive predictive value and negative predictive value were 41% and 99%, respectively. The diagnostic accuracy was 94%. In a subanalysis of studies in which delayed imaging was performed, the diagnostic accuracy significantly improved to a mean weighted sensitivity and specificity of 100% and 99%, respectively, whereas the positive predictive value and negative predictive value increased to 92% and 100%, respectively. The accuracy for this technique was 99%. Conclusions—: Cardiac computed tomography, particularly when delayed imaging is performed, is a reliable alternative to TEE for the detection of LA/LAA thrombi/clot, avoiding the discomfort and risks associated with TEE.
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Cites
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Cited by
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Circulation · doi:10.1161/cir.0000000000001193 · Cited by 2,765
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2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
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EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update
Glikson, M., Wolff, R., Hindricks, G., Mandrola, J., Camm, A. J., Lip, G. Y. H., Fauchier, L., Betts, T. R., Lewalter, T., Saw, J., et al. (2020) · EP Europace · doi:10.1093/europace/euz258 · Cited by 331
Metadata
- Authors
- Romero, J., Husain, S. A., Kelesidis, I., Sanz, J., Medina, H. M., & Garcia, M. J.
- Venue
- Circulation: Cardiovascular Imaging
- Published
- 2013-03
- Volume
- 6
- Issue
- 2
- Pages
- 185-194
- ISSN
- 1941-9651 (ISSN-L)
- 1942-0080
- OpenAlex
- W2160613225
- Cited by
- 382
- References
- 38
- FWCI
- 15.04
- Type
- journal article
- Language
- en
- Open access
- closed
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- Romero, J., Husain, S. A., Kelesidis, I., Sanz, J., Medina, H. M., & Garcia, M. J. (2013). Detection of Left Atrial Appendage Thrombus by Cardiac Computed Tomography in Patients With Atrial Fibrillation: A Meta-Analysis. Circulation: Cardiovascular Imaging. https://doi.org/10.1161/circimaging.112.000153
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