Transthoracic echocardiography (TTE) was found to have a fair sensitivity and good specificity compared with delayed enhancement cardiac magnetic resonance (DE-CMR) for the identification of left ventricle (LV) thrombi, and computed tomography (CT) was found to have greater accuracy than transesophageal echocardiography (TEE) for detecting left atrial appendage (LAA) thrombosis, according to the results of a systematic review and meta-analysis published in Clinical Research in Cardiology.

A total of 6 studies in which TTE and CMR were compared for their ability to identify LV thrombosis were analyzed, and 10 studies in which CT and TEE were compared for the detection of LAA thrombosis were examined. Specificity and sensitivity values for the accuracy of diagnostic performance for each method were pooled across studies.

In the first meta-analysis which compared TTE vs DE-CMR, the pooled sensitivity was 62% (95% CI, 37–81%) and the pooled specificity was 97% (95% CI, 94–99%). The pooled diagnostic odds ratio (DOR) was 60 (95% CI, 13–277), and the pooled LR + value was 24% (95% CI, 9–65%) and LR− value was 39% (95% CI, 12–74%). The area under the curve (AUC) of 0.96 indicated a high diagnostic accuracy.

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For the second meta-analysis comparing the diagnostic accuracy of CT vs TEE, the sensitivity values were between 29% and100%, and specificity ranged from 73% to 100%. Overall, the pooled sensitivity and specificity values were 97% (95% CI, 77–100%) and 94% (95% CI, 87–98%), respectively. The pooled DOR was 500 (95% CI, 52–4810), and the pooled LR + and LR− values were 17% (95% CI, 7–40%) and 3% (95% CI, 0–28%), respectively. The AUC of 0.99 indicated high accuracy of CT vs TEE.

A limitation of the meta-analyses was that it wasn’t powered or designed to identify best management of patients with cardiac thrombosis, including the need for additional follow-up imaging.

“TTE is a fair alternative to DE-CMR for the identification of LV thrombi, limited by a suboptimal sensitivity, while CT has a good accuracy compared to TEE for the detection of LAA thrombosis,” concluded the study authors.


Aimo A, Kollia E, Ntritsos G, et al. Echocardiography versus computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta-analysis. Published online September 13, 2020. Clin Res Cardiol. doi:10.1007/s00392-020-01741-7