%0 Journal Article
%T Contrast enhanced transesophageal echocardiography in patients with atrial fibrillation referred to electrical cardioversion improves atrial thrombus detection and may reduce associated thromboembolic events
%A Philip H Jung
%A Marisa Mueller
%A Christoph Schuhmann
%A Madeleine Eickhoff
%A Philip Schneider
%A Gueler Seemueller
%A Raphael Dutton
%A Johannes Rieber
%A Stefan K£¿£¿b
%A Hae-Young Sohn
%J Cardiovascular Ultrasound
%D 2013
%I BioMed Central
%R 10.1186/1476-7120-11-1
%X Of 180 patients with AF (51 females, 65.2¡À13 years) who were referred to CV, 90 were examined with native imaging and contrast enhancement within the same examination (group 1), and 90 were examined with native TEE alone and served as control (group 2). Cineloops of the multiplane examination of the LA and LA appendage (LAA) were stored digitally before and, in group 1, after intravenous bolus application of a transpulmonary contrast agent. Images of group 1 were assessed offline and the diagnosis of LA thrombi was made semi-quantitatively: 1= thrombus present; 2=inconclusive result; 3=no thrombus. The presence of spontaneous echocontrast (SEC) was registered and flow velocity in the LA appendage (LAA-flow) was measured. All patients in whom CV was performed were followed up for 1 year or until relapse of AF. CV related adverse events were defined as any thromboembolic event within 1 week after CV.No serious adverse events occurred during TEE and contrast enhanced imaging. In group 1 atrial thrombi were diagnosed in 14 (15.6%) during native and in 10 (11.1%) patients during contrast enhanced imaging (p<0.001). Of the 10 patients with thrombi in the contrast TEE group, 7 revealed a decreased LAA-flow (¡Ü0,3m/s) and 8 showed moderate or marked SEC. Uncertain results were significantly more common during native imaging than with contrast enhanced TEE (16 vs. 5 patients, p<0.01). Thrombi could definitely be excluded in 60 (66.7%) during conventional and in 75 patients (83.3%) during contrast enhanced TEE (p<0.01). CV was performed subsequently after exclusion of thrombi and at the discretion of the investigator. In group 1, 74 patients (82.2%) were cardioverted and no patient suffered a CV related complication (p=0.084). In group 2, 76 patients (84.4%) underwent CV, of whom 3 suffered a thromboembolic complication after CV (2 strokes, 1 peripheral embolism).In patients with AF planned for CV contrast enhancement renders TEE images more interpretable, facilitates the excl
%K Atrial fibrillation
%K Atrial thrombus
%K Contrast echocardiography
%K Transesophageal echocardiography
%K Cardioversion
%K Thromboembolic events
%U http://www.cardiovascularultrasound.com/content/11/1/1