Diagnosis of left atrial appendage thrombi by multiplane transesophageal echocardiography -: Interlaboratory comparative study
Diagnosis of left atrial appendage thrombi by multiplane transesophageal echocardiography -: Interlaboratory comparative study
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DOI：
10.1253/circj.71.122
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发表时间：
2007-01-01
影响因子：
3.3
通讯作者：
Schneider, Barbara
中科院分区：
文献类型：
--
作者：
Schneider, Birke;Stoellberger, Claudia;Schneider, Barbara
背景经食管超声心动图（TEE）被认为是左房附件血栓（LAAT）的首选成像方法。然而，在两个独立的超声心动图实验室中，通过多平面TEE诊断LAAT的观察者间变异性尚未得到评估。方法与结果对50例房颤患者（各实验室25例）的录像资料，由各机构1名经验丰富的观察员进行盲检。LAAT被评估为存在、不存在或可疑。TEE的适应症为：心脏转复（n=17）、瓣膜疾病（n=13）、心内膜炎（n=12）或栓塞（n=8）。LAAT的患病率为10%（观察者1）vs 12%（观察者2）。评估可疑LAAT的比例分别为6%和12%，排除LAAT的比例分别为84%和76%。经正面比较，有11例出现分歧（22%,kappa=0.5）。结果差异与超声心动图设备无关。出现问题的原因是左心房附件和左上肺静脉之间脊的混响伪影（n=5），以及在区分LAAT与自发超声心动图造影术（n=4）或房室沟回声（n=1）时。只有1例与LAAT的区别在于果突肌。排除可疑血栓类别后kappa值提高至0.65。在5例心脏手术患者中，两名观察者一致认为LAAT存在（n=1）或不存在（n=4），术中TEE结果得到证实。结论：即使采用多平面TEE，由于在区分LAAT与自发超声心动图造影剂和混响伪影方面存在问题，两个独立超声心动图实验室诊断LAAT的观察者间变异性仍然很高。
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 echocardio-graphic 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 I 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 echocardio-graphic 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 echocardio-graphic 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.