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. 2016:2016:7194676.
doi: 10.1155/2016/7194676. Epub 2016 Oct 16.

Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients

James Anaissie  1 , Dominique Monlezun  1 , A Seelochan  2 , James E Siegler  1 , Maria Chavez-Keatts  3 , Jonathan Tiu  1 , Denise Pineda  1 , Alexander George  1 , Amir Shaban  4 , Nidal Abi Rafeh  5 , Laurie Schluter  1 , Sheryl Martin-Schild  1 , Ramy El Khoury  1
Affiliations

Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients

James Anaissie et al. Biomed Res Int. 2016.

Abstract

Background. Transesophageal echocardiogram (TEE) is superior to transthoracic echocardiogram (TTE) in detecting left atrial thrombus (LAT), a risk factor for stroke, but is costly and invasive, carrying a higher risk for complications. Aims. To determine the utility of using left atrial enlargement (LAE) on TTE to predict LAT on TEE. Methods. AIS patients who presented in 06/2008-7/2013 and underwent both TTE and TEE were identified from our prospective stroke registry. Analysis consisted of multivariate logistic regression with propensity score adjustment and receiver operating characteristic (ROC) area under the curve (AUC) analyses. Results. 219 AIS patients underwent both TTE and TEE. LAE on TTE was detected in 113 (51.6%) of AIS patients. Patients with LAE on TTE had higher proportion of LAT on TEE (8.4% versus 1.0%, p = 0.018). LAE on TTE predicted increased odds of LAT on TEE (OR = 8.83, 95% CI 1.04-74.83, p = 0.046). The sensitivity and specificity for LAT on TEE by LAE on TEE were 88.89% and 52.20%, respectively (AUC = 0.7054, 95% CI 0.5906-0.8202). Conclusions. LAE on TTE can predict LAT detected on TEE in nearly 90% of patients. This demonstrates the utility of LAE on TTE as a potential screening tool for LAT, potentially limiting unneeded costs and complications associated with TEE.

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Figures

Figure 1
Figure 1
Receiver operating characteristic curve of left atrial enlargement on transthoracic echocardiogram classifying left atrial thrombus on transesophageal echocardiogram. Area under curve = 0.7054 (95% CI 0.5906–0.8202).
Figure 2
Figure 2
Number of patients demonstrating left atrial enlargement on each echocardiographic imaging modality. TTE = transthoracic echocardiogram; TEE = transesophageal echocardiogram.
See this image and copyright information in PMC

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References

    1. Palacio S., Hart R. G. Neurologic manifestations of cardiogenic embolism. Neurologic Clinics. 2002;20(1):179–193. doi: 10.1016/s0733-8619(03)00058-6. - DOI - PubMed
    1. Arboix A., Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Current Cardiology Reviews. 2010;6(3):150–161. doi: 10.2174/157340310791658730. - DOI - PMC - PubMed
    1. De Abreu T. T., Mateus S., Carreteiro C., Correia J. Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients. Vascular Health and Risk Management. 2008;4(1):167–172. doi: 10.2147/vhrm.2008.04.01.167. - DOI - PMC - PubMed
    1. Lesh M. D., van der Burg E. J. Method and device for left atrial appendage occlusion. Google Patents, 2000.
    1. De Bruijn S. F. T. M., Agema W. R. P., Lammers G. J., et al. Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke. Stroke. 2006;37(10):2531–2534. doi: 10.1161/01.STR.0000241064.46659.69. - DOI - PubMed