Selective coronary angiography versus two-dimensional echocardiography for diagnosis of left atrial thrombi.

Coronary angiographic findings indicative for left atrial thrombi (neovascularization in the region of the left atrium) were compared with echocardiographic ones. Of 214 patients who had mitral surgery, the authors had all the available data for 161 (31 of whom had left atrial thrombi). The presence of a neovascularization had a sensitivity of 61%, a specificity of 100%, predictive accuracy of 100%, and predictive value of 92%, while echocardiography had a sensitivity of 52%, specificity of 96%, predictive accuracy of 76%, and predictive value of 89%. There was no difference in the sensitivity of both methods for the detection of thrombi located in the left atrium as a whole cavity (p less than 0.05). However, coronary angiography was superior to echocardiography in the diagnosis of thrombi located in the left atrial appendage (p less than 0.05). The diagnosis of left thrombi could be improved by using both methods (specificity 77%, predictive value 95%). Thus, selective coronary angiography is a useful diagnostic method, in addition to echocardiography, in the diagnosis of left atrial thrombi.