New to MyHealth?
Manage Your Care From Anywhere.
Access your health information from any device with MyHealth. You can message your clinic, view lab results, schedule an appointment, and pay your bill.
ALREADY HAVE AN ACCESS CODE?
DON'T HAVE AN ACCESS CODE?
NEED MORE DETAILS?
MyHealth for Mobile
External validation of a novel transthoracic echocardiographic tool in predicting left atrial appendage thrombus formation in patients with nonvalvular atrial fibrillation
External validation of a novel transthoracic echocardiographic tool in predicting left atrial appendage thrombus formation in patients with nonvalvular atrial fibrillation EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING Doukky, R., Khandelwal, A., Garcia-Sayan, E., Gage, H. 2013; 14 (9): 876-881Abstract
A recent study demonstrated that in patients with nonvalvular atrial fibrillation (AF), a ratio of left ventricular ejection fraction (LVEF) to the left atrial volume index (LAVI) of <1.5 has 100% sensitivity for detecting left atrial appendage (LAA) thrombus. We sought to validate this prediction tool in an external cohort.We conducted a cohort study of consecutive AF patients who underwent transoesophageal echocardiogram (TEE) to 'rule-out' LAA thrombus and had a prior transthoracic echocardiogram (TTE). The LAVI and LVEF were measured to calculate LVEF/LAVI ratio. The sensitivity and specificity of LVEF/LAVI <1.5 were calculated.Among 215 subjects, 19 (8.8%) had LAA thrombus and also had a higher mean CHADS2 score (2.5 vs. 1.9, P = 0.04), lower mean LVEF (24 vs. 44%, P < 0.001), higher mean LAVI (44 mL/m2 vs. 30 mL/m2, P < 0.001), and higher prevalence of cardiac failure (79 vs. 52%, P = 0.02). The LVEF and LAVI were found to be independent predictors of LAA thrombus (P < 0.05). The LVEF/LAVI ratio diagnosed LAA thrombus with an area under the curve = 0.83 by the receiver operator characteristics curve analysis (P < 0.001). All 19 (100%) subjects with LAA thrombus had LVEF/LAVI <1.5 vs. 87 (44%) among those without LAA thrombus (P < 0.001). The sensitivity and specificity of LVEF/LAVI <1.5 were 100 and 55.6%, respectively.This investigation validates a simple TTE prediction rule to exclude the diagnosis of LAA thrombus, which may obviate the need for pre-cardioversion TEE in selected patients with nonvalvular AF.
View details for DOI 10.1093/ehjci/jes313
View details for Web of Science ID 000322953100008
View details for PubMedID 23291395