Diagnostic accuracy of two-dimensional echocardiography for detection of left atrial thrombus in patients with mitral stenosis.

Two-dimensional echocardiograms of 56 patients with mitral stenosis, who subsequently underwent operation, were analyzed to evaluate the accuracy for the detection of left atrial thrombi. From left parasternal, apical, and subcostal cardiac windows, multiple planes (including standard planes and their derived scanning planes) were assessed for the presence or absence of mass echoes in the left atrium. The results showed 63% sensitivity, 95% specificity, 87% positive predictive value, 84% negative predictive value, and 83% overall diagnostic accuracy. Most of the false-negative cases had their thrombi confined to the left atrial appendage. We conclude that in patients with mitral stenosis, two-dimensional echocardiography is promising for the diagnosis of left atrial thrombi, particularly when they locate or extend to the main left atrial cavity (not confined to atrial appendage).