Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients.
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 in 06/2008-7/2013 and 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.
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
James
J
Anaissie
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
Dominique
0000-0001-7671-1886
D
Monlezun
Meharry Medical College, Nashville, TN, USA.
A
A
Seelochan
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
James E
0000-0003-0287-3967
JE
Siegler
Department of Neurology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Maria
M
Chavez-Keatts
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
Jonathan
J
Tiu
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
Denise
D
Pineda
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
Alexander
0000-0002-2971-036X
A
George
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA.
Amir
0000-0002-5044-8781
A
Shaban
Department of Cardiology, Tulane University Medical Center, New Orleans, LA, USA.
Nidal
N
Abi Rafeh
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
Laurie
0000-0002-7569-7215
L
Schluter
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
Sheryl
0000-0003-3168-3521
S
Martin-Schild
Tulane Stroke Research Program, Tulane University Medical Center, New Orleans, LA, USA.
Ramy
0000-0003-0895-9091
R
El Khoury
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006332:Cardiomegaly / Q000150:complications / Q000000981:diagnostic imaging*; D003710:Demography; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D012372:ROC Curve; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging*