Le enviamos información de este estudio que enfatiza la importancia de investigar Trombos en la orejuela de la aurícula izquierda, como causa de ACV isquémico realizado en la Universidad Yonsei, Corea del Sur.
Se estima que entre un 20-40% de ACV isquémicos son de origen cardiaco y el sitio de localización del trombo es la “orejuela de aurícula izquierda”.
La Eco Cardiografía Transesofágica se ha considerado como el método de diagnóstico ideal, tiene una sensitividad del 100% y una especificidad del 90%. Desafortunadamente, no está disponible en todos los hospitales y requiere un experto cardiólogo.
En la práctica diaria se utiliza un método más fácil y accesible, consiste en una Angiotomografía cardiaca con Tomógrafo de 64 cortes disponible en todos los Hospitales Grandes y Centros de Diagnóstico en Guatemala.
El examen se realiza en 10-20 segundos, tiene una sensitividad del 100%, especificidad del 95% y una precisión diagnóstica del 96%.
En todo paciente con ACV isquémico se debe investigar bifurcaciones carotideas por Ultrasonido Doppler y un probable Trombo en orejuela auricular izquierda por Tomografía Helicoidal, especialmente en pacientes con arritmias (fibrilación auricular).
La Eco Cardiografía Transesofágica se ha considerado como el método de diagnóstico ideal, tiene una sensitividad del 100% y una especificidad del 90%. Desafortunadamente, no está disponible en todos los hospitales y requiere un experto cardiólogo.
En la práctica diaria se utiliza un método más fácil y accesible, consiste en una Angiotomografía cardiaca con Tomógrafo de 64 cortes disponible en todos los Hospitales Grandes y Centros de Diagnóstico en Guatemala.
El examen se realiza en 10-20 segundos, tiene una sensitividad del 100%, especificidad del 95% y una precisión diagnóstica del 96%.
En todo paciente con ACV isquémico se debe investigar bifurcaciones carotideas por Ultrasonido Doppler y un probable Trombo en orejuela auricular izquierda por Tomografía Helicoidal, especialmente en pacientes con arritmias (fibrilación auricular).
Muy atentamente, equipo TecniScan Científico.
Artículo de Referencia
Thrombus in the Left Atrial Appendage in Stroke Patients: Detection with Cardiac CT Angiography—A Preliminary Report
Radiology Select, Oct 2008, Vol. 249:81-87
Purpose: To assess the diagnostic performance of 64-section cardiac computed tomographic (CT) angiography for detection of left atrial appendage (LAA) thrombi in stroke patients by using transesophageal echocardiography (TEE) as the reference standard.
Materials and Methods: This study was approved by the institutional review board. Records were reviewed from 101 consecutive patients who had experienced a recent stroke (onset within the previous 1 month) from a suspected cardioembolic source and who had undergone both 64-section cardiac CT angiography and TEE within 1 week. The numbers of thrombi in the LAA detected with cardiac CT angiography and with TEE were recorded, and the agreement between thrombus detection with CT and with TEE was assessed by using κ statistics.
Results: Eight thrombi in the LAA were detected with TEE, and 12 were detected with cardiac CT angiography. With TEE used as the reference standard, the overall sensitivity, specificity, and accuracy of 64-section cardiac CT angiography for detecting thrombi were 100% (95% confidence interval [CI]): 63%, 100%), 95% (95% CI: 90%, 99%), and 96% (95% CI: 92%, 100%), respectively. The concordance between LAA thrombus detection with 64-section cardiac CT angiography and with TEE was high: 89 patients with no thrombus at CT or TEE; eight patients with thrombus at both CT and TEE; and four patients with thrombus at CT but not at TEE (overall κ = 0.779 [95% CI: 0.571, 0.987]).
Conclusion: Sixty-four–section cardiac CT angiography is a noninvasive and sensitive modality for detecting thrombi in the LAA of stroke patients. Although TEE is currently considered the reference standard modality for detecting LAA thrombi, 64-section cardiac CT angiography has the potential to become a useful modality for detection of intracardiac thrombus. © RSNA, 2008
Thrombus in the Left Atrial Appendage in Stroke Patients: Detection with Cardiac CT Angiography—A Preliminary Report
Radiology Select, Oct 2008, Vol. 249:81-87
Purpose: To assess the diagnostic performance of 64-section cardiac computed tomographic (CT) angiography for detection of left atrial appendage (LAA) thrombi in stroke patients by using transesophageal echocardiography (TEE) as the reference standard.
Materials and Methods: This study was approved by the institutional review board. Records were reviewed from 101 consecutive patients who had experienced a recent stroke (onset within the previous 1 month) from a suspected cardioembolic source and who had undergone both 64-section cardiac CT angiography and TEE within 1 week. The numbers of thrombi in the LAA detected with cardiac CT angiography and with TEE were recorded, and the agreement between thrombus detection with CT and with TEE was assessed by using κ statistics.
Results: Eight thrombi in the LAA were detected with TEE, and 12 were detected with cardiac CT angiography. With TEE used as the reference standard, the overall sensitivity, specificity, and accuracy of 64-section cardiac CT angiography for detecting thrombi were 100% (95% confidence interval [CI]): 63%, 100%), 95% (95% CI: 90%, 99%), and 96% (95% CI: 92%, 100%), respectively. The concordance between LAA thrombus detection with 64-section cardiac CT angiography and with TEE was high: 89 patients with no thrombus at CT or TEE; eight patients with thrombus at both CT and TEE; and four patients with thrombus at CT but not at TEE (overall κ = 0.779 [95% CI: 0.571, 0.987]).
Conclusion: Sixty-four–section cardiac CT angiography is a noninvasive and sensitive modality for detecting thrombi in the LAA of stroke patients. Although TEE is currently considered the reference standard modality for detecting LAA thrombi, 64-section cardiac CT angiography has the potential to become a useful modality for detection of intracardiac thrombus. © RSNA, 2008
Comité Editorial: Grupo de Radiológicos TecniScan.
Solicite el artículo completo a nuestro correo electrónico, especificando el nombre del boletín: tecniscancientifico@tecniscan.com