A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography
Background: Transesophageal echocardiography (TEE) is currently the gold standard technique for diagnosing left atrial appendage (LAA) thrombi. Cardiac computed tomography (CT) has been expected to become an alternative method to TEE; however, a reliable quantitative evaluation method has not been e...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-10-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906721001548 |
| _version_ | 1819022368844021760 |
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| author | Motohide Tanaka Ryobun Yasuoka Tomoya Nagano Yasuhito Kotake Masahiro Maruyama Hiromi Yamamoto Yoshitaka Iwanaga Yutaka Hirano Gaku Nakazawa Takashi Kurita |
| author_facet | Motohide Tanaka Ryobun Yasuoka Tomoya Nagano Yasuhito Kotake Masahiro Maruyama Hiromi Yamamoto Yoshitaka Iwanaga Yutaka Hirano Gaku Nakazawa Takashi Kurita |
| author_sort | Motohide Tanaka |
| collection | DOAJ |
| description | Background: Transesophageal echocardiography (TEE) is currently the gold standard technique for diagnosing left atrial appendage (LAA) thrombi. Cardiac computed tomography (CT) has been expected to become an alternative method to TEE; however, a reliable quantitative evaluation method has not been established. Methods and results: We enrolled 177 patients with persistent atrial fibrillation who underwent both cardiac CT and TEE before catheter ablation. The patients were classified into two groups according to the TEE results: the thrombus group (13 patients) and non-thrombus group (164 patients). The Hounsfield unit (HU) density at the proximal LAA (LAAp) and distal LAA (LAAd) was measured on cardiac CT images. The LAAd/LAAp HU ratio and standard deviation of HU density (HU-SD) at the LAAd were evaluated. We created an algorithm by decision tree analysis to predict LAA thrombus formation using the HU ratio and HU-SD. Definite absence of LAA thrombus (Category-I) was diagnosed for 139 patients by combining the first and second branching of the decision tree (Category-Ia: HU ratio of ≥0.26, Category-Ib: HU ratio of <0.26, HD-SD of ≥26.94). Definite presence of LAA thrombus (Category-Ⅱ) was diagnosed for 3 patients using the third branching of the decision tree (Category-Ⅱ: HU ratio of <0.26 and HU-SD of <13.85). Highly possibility of LAA thrombus (Category-III), but not definite, was diagnosed for the remaining 35 patients; therefore, these patients required diagnostic TEE. The diagnostic accuracy of this algorithm was 0.95. Conclusion: We have proposed a reliable algorithm to diagnose LAA thrombus formation using the HU ratio and HU-SD. |
| first_indexed | 2024-12-21T04:21:54Z |
| format | Article |
| id | doaj.art-434909772a1940ae81228b12007533b4 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-21T04:21:54Z |
| publishDate | 2021-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-434909772a1940ae81228b12007533b42022-12-21T19:16:09ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672021-10-0136100866A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomographyMotohide Tanaka0Ryobun Yasuoka1Tomoya Nagano2Yasuhito Kotake3Masahiro Maruyama4Hiromi Yamamoto5Yoshitaka Iwanaga6Yutaka Hirano7Gaku Nakazawa8Takashi Kurita9Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanDivision of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanDivision of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanDivision of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanDivision of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanDivision of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanDivision of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanDivision of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanDivision of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanCorresponding author.; Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osaka-Sayama, Osaka 589-8511, JapanBackground: Transesophageal echocardiography (TEE) is currently the gold standard technique for diagnosing left atrial appendage (LAA) thrombi. Cardiac computed tomography (CT) has been expected to become an alternative method to TEE; however, a reliable quantitative evaluation method has not been established. Methods and results: We enrolled 177 patients with persistent atrial fibrillation who underwent both cardiac CT and TEE before catheter ablation. The patients were classified into two groups according to the TEE results: the thrombus group (13 patients) and non-thrombus group (164 patients). The Hounsfield unit (HU) density at the proximal LAA (LAAp) and distal LAA (LAAd) was measured on cardiac CT images. The LAAd/LAAp HU ratio and standard deviation of HU density (HU-SD) at the LAAd were evaluated. We created an algorithm by decision tree analysis to predict LAA thrombus formation using the HU ratio and HU-SD. Definite absence of LAA thrombus (Category-I) was diagnosed for 139 patients by combining the first and second branching of the decision tree (Category-Ia: HU ratio of ≥0.26, Category-Ib: HU ratio of <0.26, HD-SD of ≥26.94). Definite presence of LAA thrombus (Category-Ⅱ) was diagnosed for 3 patients using the third branching of the decision tree (Category-Ⅱ: HU ratio of <0.26 and HU-SD of <13.85). Highly possibility of LAA thrombus (Category-III), but not definite, was diagnosed for the remaining 35 patients; therefore, these patients required diagnostic TEE. The diagnostic accuracy of this algorithm was 0.95. Conclusion: We have proposed a reliable algorithm to diagnose LAA thrombus formation using the HU ratio and HU-SD.http://www.sciencedirect.com/science/article/pii/S2352906721001548Persistent atrial fibrillationLeft atrial appendageThrombusCardiac computed tomographyTransesophageal echocardiographyAlgorithm |
| spellingShingle | Motohide Tanaka Ryobun Yasuoka Tomoya Nagano Yasuhito Kotake Masahiro Maruyama Hiromi Yamamoto Yoshitaka Iwanaga Yutaka Hirano Gaku Nakazawa Takashi Kurita A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography International Journal of Cardiology: Heart & Vasculature Persistent atrial fibrillation Left atrial appendage Thrombus Cardiac computed tomography Transesophageal echocardiography Algorithm |
| title | A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography |
| title_full | A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography |
| title_fullStr | A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography |
| title_full_unstemmed | A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography |
| title_short | A novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography |
| title_sort | novel method to demonstrate thrombus formation of the left atrial appendage in patients with persistent atrial fibrillation by cardiac computed tomography |
| topic | Persistent atrial fibrillation Left atrial appendage Thrombus Cardiac computed tomography Transesophageal echocardiography Algorithm |
| url | http://www.sciencedirect.com/science/article/pii/S2352906721001548 |
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