COMPARISON OF TRANSTHORACIC AND TRANS-ESOPHAGEAL ECHOCARDIOGRAPHY IN THE DETECTION OF CARDIAC EMBOLI IN AFIB PATIENTS

H PASHA; U SUBHAN; M SALIM

doi:10.54112/bcsrj.v2024i1.791

Authors

H PASHA Department of Emergency, Shifa International Hospital, Islamabad. Pakistan
U SUBHAN Department of Emergency, Shifa International Hospital, Islamabad. Pakistan
M SALIM Department of Emergency, Shifa International Hospital, Islamabad. Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.791

Keywords:

Atrial Fibrillation, Cardiac Emboli, Echocardiography, Thromboembolism, Transesophageal Echocardiography, Transthoracic Echocardiography

Abstract

Atrial fibrillation (AFib) predisposes patients to an increased risk of thromboembolic events, including stroke, due to the formation of cardiac emboli. Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) are commonly used to detect cardiac emboli in AFib patients, but their comparative effectiveness remains unclear. Objective: This study aimed to compare the diagnostic accuracy of TTE and TEE in detecting cardiac emboli in AFib patients. Methods: A prospective observational study was conducted at the Shifa International Hospital in Islamabad, Pakistan, from January 2022 to January 2023. The study included 100 adult patients diagnosed with AFib, undergoing evaluation for suspected cardiac emboli. Both TTE and TEE examinations were performed as part of routine clinical care. Diagnostic accuracy parameters were calculated for both modalities using standard formulas, and comparative analyses were conducted using appropriate statistical tests. SPSS version 25 was used, and a P value less than 0.05 is considered statistically significant. Results: The study included 100 patients with atrial fibrillation (AFib), of which 55 were male, and 45 were female. The mean age of the patients was 65 years (standard deviation [SD] ± 7 years). Transoesophageal echocardiography (TEE) demonstrated a higher sensitivity in detecting cardiac emboli than transthoracic echocardiography (TTE). TEE identified a significantly higher number of emboli than TTE (48 vs. 40, p < 0.05). TEE was also associated with a lower risk of complications than TTE (0 vs. 2 cases, p < 0.05). Conclusion: In evaluating cardiac emboli in AFib patients, transoesophageal echocardiography (TEE) showed superior diagnostic accuracy and a lower complication risk than transthoracic echocardiography (TTE). Therefore, TEE may be considered the preferred imaging modality for this patient population.

Downloads

Download data is not yet available.

References

Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. International Journal of Stroke. 2021;16(2):217-21.

Essa H, Hill AM, Lip GY. Atrial fibrillation and stroke. Cardiac Electrophysiology Clinics. 2021;13(1):243-55.

Ferguson C, Inglis SC, Newton PJ, Middleton S, Macdonald PS, Davidson PM. Atrial fibrillation: stroke prevention in focus. Australian Critical Care. 2014;27(2):92-8.

Topcuoglu MA, Liu L, Kim D-E, Gurol ME. Updates on prevention of cardioembolic strokes. Journal of Stroke. 2018;20(2):180.

Al Rawahi M, Samuel M, Galatas C, Joza J, Lima PY, Barbosa R, et al. Incidence and predictors of intracardiac thrombus on pre-electrophysiological procedure transesophageal echocardiography. CJC open. 2019;1(5):231-7.

Khurshid S, Chen W, Singer DE, Atlas SJ, Ashburner JM, Choi JG, et al. Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model. Journal of the American Heart Association. 2021;10(18):e020330.

Thong EHE, Kong WK, Poh K-K, Wong R, Chai P, Sia C-H. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. Journal of Cardiovascular Development and Disease. 2023;11(1):13.

Quintana RA, Dong T, Vajapey R, Reyaldeen R, Kwon DH, Harb S, et al. Preprocedural Multimodality imaging in atrial fibrillation. Circulation: Cardiovascular Imaging. 2022;15(10):e014386.

Yang G, Ye Q, Xia J. Unbox the black-box for the medical explainable AI via multi-modal and multi-centre data fusion: A mini-review, two showcases and beyond. Information Fusion. 2022;77:29-52.

Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, et al. Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism. Journal of the American Society of Echocardiography. 2016;29(1):1-42.

Du X, Wang Y. The diagnostic efficacy of cardiac CTA combined with D-dimer assay for the detection of left atrial thrombus in patients with atrial fibrillation. The American journal of emergency medicine. 2019;37(10):1922-6.

Khenkina N, Aimo A, Fabiani I, Masci PG, Sagris D, Williams SE, et al. Magnetic resonance imaging for diagnostic workup of embolic stroke of undetermined source: A systematic review. International Journal of Stroke. 2023:17474930231189946.

Pathan F, Hecht H, Narula J, Marwick TH. Roles of transesophageal echocardiography and cardiac computed tomography for evaluation of left atrial thrombus and associated pathology: a review and critical analysis. JACC: Cardiovascular Imaging. 2018;11(4):616-27.

Lurie A, Wang J, Hinnegan KJ, McIntyre WF, Belley-Côté EP, Amit G, et al. Prevalence of left atrial thrombus in anticoagulated patients with atrial fibrillation. Journal of the American College of Cardiology. 2021;77(23):2875-86.

Dentamaro I, Vestito D, Michelotto E, De Santis D, Ostuni V, Cadeddu C, et al. Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography. The International Journal of Cardiovascular Imaging. 2017;33:491-8.

Yu S, Zhang H, Li H. Cardiac computed tomography versus transesophageal echocardiography for the detection of left atrial appendage thrombus: a systemic review and meta‐analysis. Journal of the American Heart Association. 2021;10(23):e022505.

Jain V, Wang TKM, Bansal A, Farwati M, Gad M, Montane B, et al. Diagnostic performance of cardiac computed tomography versus transesophageal echocardiography in infective endocarditis: a contemporary comparative meta-analysis. Journal of cardiovascular computed tomography. 2021;15(4):313-21.