# Diagnostic Accuracy of Left Atrial/Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

## TL;DR

This study compares various diagnostic methods for detecting blood clots in the left atrium of patients with atrial fibrillation and finds that dual-source CT is the most accurate.

## Contribution

The study introduces a network meta-analysis to compare the diagnostic accuracy of multiple imaging techniques for LA/LAA thrombus detection.

## Key findings

- Dual-source CT (DSCT) had the highest sensitivity and specificity for detecting LA/LAA thrombus.
- 3D-CMRI and 3-minute delayed CCT showed better performance than TEE and could potentially replace it.
- DSCT also had the best negative likelihood ratio and overall diagnostic accuracy.

## Abstract

This paper aimed to appraise the diagnostic precision of
assorted methodologies to identify left atrial/left atrial appendage (LA/LAA)
thrombus through a network meta-assessment.

Methodologically,
we conducted a comprehensive literature search across multiple databases.
Utilizing the risk of bias tool from the Cochrane Collaboration, methodological
quality of included studies was critically assessed and potential publication
bias was examined via funnel plots. The subsequent data analysis was executed
using Stata software, with the most efficacious diagnostic modalities being determined based on cumulative ranking curve (SUCRA) values.

We scrutinized a sum
of 18 papers, comprising 4102 subjects and utilizing 10 different diagnostic
techniques. The hierarchical results derived from the network meta-analysis
indicated that in regards to sensitivity, the dual-source cardiac computed
tomography (DSCT) was superior (with a SUCRA value of 71.7%), it was succeeded
by 3-minute delayed cardiac computed tomography (CCT) (scoring 66.8%), which
surpassed the transesophageal echocardiography (TEE) (holding a SUCRA value of
57.5%). In terms of specificity, DSCT was the best (SUCRA value of 84.3%),
followed by three dimensional (3D) cardiac magnetic resonance imaging (3D-CMRI) (SUCRA value of
78.0%), which was better than TEE (SUCRA value of 66.6%). In terms of positive
likelihood ratio (PLR), 6-minute delayed CCT (SUCRA value of 85.6%) was superior
to 3-minute delayed CCT (SUCRA value of 80.1%), both of which were superior to
TEE (SUCRA value of 69.1%). DSCT (SUCRA value of 89.3%) had the best negative
likelihood ratio (NLR), while DSCT (SUCRA value of 79.9%) had the highest
accuracy.

This study demonstrated that DSCT outperformed
TEE in sensitivity, specificity, NLR, and accuracy in identifying thrombus of
LA/LAA among patients suffering from atrial fibrillation. Our conclusion is that
DSCT is the best in diagnosing LA/LAA. In addition, 3D-CMRI and 3-minute delayed
CCT are expected to replace TEE.