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Heart 1999;81:192-198 ( February )
Department of
Medicine, Division of Cardiology, University of Bonn, Sigmund-Freud-Str
25, 53105 Bonn, Germany
Correspondence to: Dr Omran.
Accepted for publication 9 October 1998
Objective
To compare
the value of current transthoracic echocardiographic systems and
transoesophageal echocardiography for assessing left atrial
appendage function and imaging thrombi.
DesignSingle
blind prospective study. Patients were first investigated by
transthoracic echocardiography and thereafter by a second investigator
using transoesophageal echocardiography. The feasibility of imaging
the left atrial appendage, recording its velocities, and identifying
thrombi within the appendage were determined by both methods.
Patients117
consecutive patients with a stroke or transient neurological deficit.
SettingTertiary
cardiac and neurological care centre.
ResultsImaging of the
complete appendage was feasible in 75% of the patients by
transthoracic echocardiography and in 95% by transoesophageal echocardiography. Both methods were concordant for the detection of
thrombi in 10 cases. Transoesophageal echocardiography revealed two
additional thrombi. In one of these patients, transthoracic echocardiography was not feasible and in the other the thrombus had
been missed by transthoracic examination. In patients with adequate
transthoracic echogenicity, the specificity and sensitivity of
detecting left atrial appendage thrombi were 100% and 91%, respectively. Recording of left atrial appendage velocities by transthoracic echocardiography was feasible in 69% of cases. None of
the patients with a velocity > 0.3 m/s had left atrial appendage thrombi. In the one patient in whom transthoracic echocardiographic evaluation missed a left atrial appendage thrombus, the peak emptying velocity of the left atrial appendage was 0.25 m/s.
ConclusionsA new
generation echocardiographic system allows for the transthoracic
detection of left atrial appendage thrombi and accurate determination
of left atrial appendage function in most patients with a neurological deficit.
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