Document Detail

Diagnosis of left atrial appendage thrombi by multiplane transesophageal echocardiography: interlaboratory comparative study.
MedLine Citation:
PMID:  17186989     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Transesophageal echocardiography (TEE) is regarded as the method of choice for imaging left atrial appendage thrombi (LAAT). However, the interobserver variability among 2 independent echocardiographic laboratories in diagnosing LAAT by multiplane TEE has not yet been assessed. METHODS AND RESULTS: The videorecordings of 50 patients in atrial fibrillation (25 from each laboratory) were blindly reviewed by 1 experienced observer from each institution. LAAT were assessed as present, absent or questionable. Indications for TEE were: cardioversion (n=17), valve disease (n=13), endocarditis (n=12), or embolism (n=8). The prevalence of LAAT was 10% (observer 1) vs 12% (observer 2). A questionable LAAT was assessed in 6% vs 12% and a LAAT was excluded in 84% vs 76%, respectively. By head-to-head comparison, disagreement occurred in 11 cases (22%, kappa=0.5). Discrepant results were not related to the echocardiographic equipment. Problems occurred because of reverberation artifacts of the ridge between the left atrial appendage and left upper pulmonary vein (n=5), and in differentiating LAAT from spontaneous echocardiographic contrast (n=4) or an echogenic atrioventricular groove (n=1). The differentiation of pectinate muscles from LAAT was the reason for disagreement in only 1 case. Eliminating the category of questionable thrombi increased the kappa value to 0.65. In 5 patients undergoing cardiac surgery, both observers had agreed on the presence (n=1) or absence (n=4) of LAAT, and intraoperatively the results of TEE were confirmed. CONCLUSION: Even with multiplane TEE, interobserver variability among 2 independent echocardiographic laboratories for diagnosing LAAT remains high because of problems in differentiating LAAT from spontaneous echocardiographic contrast and reverberation artifacts.
Birke Schneider; Claudia Stöllberger; Barbara Schneider
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  71     ISSN:  1346-9843     ISO Abbreviation:  Circ. J.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-25     Completed Date:  2007-02-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  122-5     Citation Subset:  IM    
Sana Kliniken Lübeck, Klinik für Kardiologie, Kronsforder Allee, Germany.
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MeSH Terms
Aged, 80 and over
Atrial Appendage / pathology*
Atrial Fibrillation
Echocardiography, Transesophageal / methods*
Heart Atria / pathology*
Middle Aged
Observer Variation
Thrombosis / diagnosis*,  pathology*
Video Recording

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