ACCURACY OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR IDENTIFYING LEFT ATRIAL THROMBI - A PROSPECTIVE, INTRAOPERATIVE STUDY
ACCURACY OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR IDENTIFYING LEFT ATRIAL THROMBI - A PROSPECTIVE, INTRAOPERATIVE STUDY
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DOI：
10.7326/0003-4819-123-11-199512010-00001
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发表时间：
1995-12-01
影响因子：
39.2
通讯作者：
DOUGLAS, PS
中科院分区：
文献类型：
--
作者：
MANNING, WJ;WEINTRAUB, RM;DOUGLAS, PS
目的：探讨经食管超声心动图准确识别或排除左房血栓的能力。设计：前瞻性队列研究。单位：大学医院。患者：231例连续患者在选择性二尖瓣修复或置换术或左心房肿瘤切除前接受经食管超声心动图检查。56%的患者有心房颤动史，17%有血栓栓塞史。测量：经食管超声心动图检查中左房血栓的识别，并与心脏手术中直接近同时显像的比较。结果：经食管超声心动图发现14例左心房血栓（6%）。血栓大小从3到80毫米不等。手术证实了14例血栓中的12例（86%），其中9例血栓局限于左附件。直接检查心房未发现额外血栓（敏感性为100% [95% CI， 74%至100%]；特异性为99% [CI， 97%至99.9%]；阳性预测值为86%[12/14]；阴性预测值为100%[217/217]；在血栓患病率为5.2%的人群中）。所有12例手术证实的血栓均由两名独立观察员发现。经食管超声心动图上单个观察者所见的血栓均未在手术中直接检查心房时被证实。结论：经食管超声心动图诊断左房血栓准确率高，可用于临床排除左房血栓。
Objective: To determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi.Design: Prospective cohort study.Setting: University hospital.Patients: 231 consecutive patients having transesophageal echocardiography before elective repair or replacement of the mitral valve or excision of a left atrial tumor. Fifty-six percent of patients had a history of atrial fibrillation, and 17% had a history of thromboembolism.Measurement: Identification of left atrial thrombi during transesophageal echocardiographic examination and comparison with direct near-simultaneous visualization during cardiac surgery.Results: Transesophageal echocardiography identified 14 left atrial thrombi in 14 patients (6%). Thrombus size ranged from 3 to 80 mm. Surgery confirmed 12 of 14 thrombi (86%), including 9 thrombi confined to the left appendage. No additional thrombi were found on direct inspection of the atria (sensitivity, 100% [95% CI, 74% to 100%]; specificity, 99% [CI, 97% to 99.9%]; positive predictive value, 86% [12/14]; negative predictive value, 100% [217/217]; for a population that had a 5.2% prevalence of thrombi). All 12 surgically confirmed thrombi were identified by two independent observers. Neither thrombus seen by only a single observer on transesophageal echocardiography was confirmed during direct inspection of the atria at surgery.Conclusion: Transesophageal echocardiography is highly accurate for identifying left atrial thrombi and can be used clinically to exclude left atrial thrombi.