Diagnostic value of contrast-enhanced cardiac CT for left atrial appendage thrombus in patients with atrial fibrillation
WANG Longtao
LIU Shuo
ZHANG Tao
ZHANG Xu
LIU Wencong
Abstract：Objective To explore the diagnostic value of contrast-enhanced cardiac CT for detecting left atrial appendage(LAA)thrombus in patients with atrial fibrillation(AF).Methods All of 116 patients with AF were prospectively selected.All patients received contrast-enhanced cardiac CT and transesophageal echocardiography(TEE).Based on the TEE findings,the patients were divided into the LAA thrombus group(45 cases)and the LAA non-thrombus group(71 cases).Using TEE as the gold standard,the diagnostic performance of contrast-enhanced cardiac CT for LAA thrombus was assessed.The Kappa test was used to analyze the agreement between CT and TEE diagnosis.The Chi-square test was applied to compare the accuracy of first-and second-phase CT scans,and the t test was used to compare the structural and volumetric indexes of left atrium and LAA between the two groups.Multivariate Logistic regression analysis was applied to analyze the independent risk factors for LAA thrombus.Results For diagnosing LAA thrombus in AF patients,the first-phase enhanced CT showed a sensitivity of 91.11％and a specificity of 88.73％,with excellent diagnostic consistency(κ=0.786);the second-phase scan showed a sensitivity of 95.56％and a specificity of 92.96％,with excellent diagnostic consistency(K=0.874).Compared with the non-thrombus group,patients in the thrombus group had significantly larger maximum left atrial volume(LAVmax),minimum left atrial volume(LAVmin),maximum and minimum left atrial anteroposterior diameters(LADmax,LADmin),LAA volume(LAAV),and LAA orifice dimensions(long diameter,short diameter,and vertical diameter)(all P＜0.05),whereas LAA ejection fraction(LAA-EF)was significantly lower(P＜0.05).Multivariate Logistic regression analysis showed that increased LAAV and long orifice diameter were independent risk factors for LAA thrombus in AF patients(both P＜0.05),while increased LAA-EF was a protective factor(P＜0.05).Conclusion Contrast-enhanced cardiac CT examination have high diagnostic value for detecting LAA thrombus in AF patients.Structural and functional parameters of the atrium and LAA can provide additional insights into cardiac pump function assessment.
Keywords：Atrial fibrillationLeft atrial appendage thrombusTomographyX-ray computedTransesophageal echocardiography
Publication Date：2025-09-15
Online Publishing Date：2025-10-13(First online date of this platform, not the publication date of the document)
Pages：5( 516-520 )