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Title:Comparison of echocardiography and computed tomography for characterization of cardiac clots in cats with heart disease
Author(s):Vititoe, Kyle Patrick
Advisor(s):Fries, Ryan
Contributor(s):Joslyn, Steve; O'Brien, Mauria; McMichael, Maureen
Department / Program:Vet Clinical Medicine
Discipline:VMS-Veterinary Clinical Medcne
Degree Granting Institution:University of Illinois at Urbana-Champaign
Computed tomographic angiography (CTA)
Filling defect
Abstract:Arterial thromboembolism (ATE) is a devastating and life-threatening condition in cats most commonly secondary to heart disease. Echocardiography is the reference standard to evaluate for presence of a clot or its precursor known as spontaneous echocardiographic contrast (SEC or “smoke”) within the left atrium and left auricle. In humans, trans-esophageal echocardiography (TEE) is the gold standard, however computed tomographic angiography (CTA) is becoming more widely used to assess detection of left atrial thrombi precluding the use of sedation. The purpose of this prospective study is threefold. The first objective is to compare echocardiography and CTA (also dynamic versus continuous phase) in their abilities to identify and characterize cardiac clots from smoke in awake cats. Our second objective is to maximize prognostic indicators and comorbidities (e.g. congestive heart failure, heart chamber enlargement, clots, pulmonary pathology) provided on an emergency basis or when a cardiologist (or echocardiography) is unavailable. Our third objective is to ensure this protocol is safe in cats with heart disease and congestive heart failure. Cats with smoke or clot were recruited and an echocardiogram and CTA (continuous phase and dynamic) were performed within 24 hours. A total of 14 cats were included (7 with clots and 7 with smoke) based on original echocardiographic images. All but one (6/7, 85.7%) of the clots were identified on CTA by at least one reviewer as filling defects within the left auricle (n=6) and right heart (n=1). The highest sensitivity for detection was 71.4% (in continuous phase) and highest specificity was 85.7% (dynamic study). The intra-class correlation coefficient (ICC) showed moderate agreement for both (0.58 for continuous, 0.64 dynamic). Smaller clots, or ones with incomplete filling of the left auricle, were more likely missed by reviewers on CTA. Echocardiography had low specificity (67%) and poor inter-observer agreement (ICC of .38) with multiple false positives, but had 100% sensitivity – based on original echocardiographic diagnosis. CT provided multiple prognostic indicators and comorbidities: severe diffuse idiopathic pulmonary fibrosis (n=1), asthma (n=1), cardiac enlargement (n=14), left atrial enlargement (n=13), congestive heart failure (5 with pulmonary edema and 8 with pleural effusion), and an aortic thromboembolism. Findings from this study suggest CTA is safe, can identify cardiac clots, provide important prognostic indicators (in patients with heart disease and congestive heart failure), and may be used on an emergency basis or when echocardiography is unavailable.
Issue Date:2017-04-13
Rights Information:Copyright 2017 Kyle Vititoe
Date Available in IDEALS:2017-08-10
Date Deposited:2017-05

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