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

Author:

Anaissie James1,Monlezun Dominique1ORCID,Seelochan A.2,Siegler James E.1ORCID,Chavez-Keatts Maria3,Tiu Jonathan1,Pineda Denise1,George Alexander1ORCID,Shaban Amir14ORCID,Abi Rafeh Nidal5,Schluter Laurie1ORCID,Martin-Schild Sheryl1ORCID,El Khoury Ramy1ORCID

Affiliation:

1. Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA

2. Meharry Medical College, Nashville, TN, USA

3. Department of Neurology, Louisiana State University Health Sciences Center, New Orleans, LA, USA

4. Department of Neurology, University of Iowa, Iowa City, IA, USA

5. Department of Cardiology, Tulane University Medical Center, New Orleans, LA, USA

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 in06/2008–7/2013and 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.

Publisher

Hindawi Limited

Subject

General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology,General Medicine

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