Evaluation of the Left Atrial Appendage With Real-Time 3-Dimensional Transesophageal Echocardiography
Open Access
- 1 September 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Imaging
- Vol. 4 (5), 514-523
- https://doi.org/10.1161/circimaging.111.963892
Abstract
Precise knowledge of left atrial appendage (LAA) orifice size is crucial for correct sizing of LAA closure devices. The aim of the present study was to determine the performance of real-time 3D transesophageal echocardiography (RT3DTEE) for LAA orifice size assessment, compared with 2D transesophageal echocardiography (2DTEE), and to investigate the impact of atrial fibrillation (AF) on LAA orifice size. One hundred thirty-seven patients (38 control subjects, 31 with paroxysmal AF, 38 with persistent AF and 30 with permanent AF) underwent 2DTEE and RT3DTEE. Both techniques were used to measure LAA orifice area. Clinically-indicated 64-slice computed tomography (CT) was used as reference technique in 46 patients. Two-dimensional TEE underestimated LAA orifice area, compared with RT3DTEE (1.99±0.94 cm 2 versus 3.05±1.27 cm 2 ; P r =0.92; 95% confidence interval, 0.85 to 0.95, versus r =0.72; 95% confidence interval, 0.54 to 0.83, respectively). At Bland–Altman analysis, RT3DTEE and 2DTEE underestimated LAA orifice area, compared with CT. However, RT3DTEE showed smaller bias (0.07 cm 2 versus 0.72 cm 2 ) and narrower limits of agreement (−0.71 to 0.85 cm 2 versus −0.58 to 2.02 cm 2 ) with CT, compared with 2DTEE. Among AF patients, a progressive increase in RT3DTEE-derived LAA orifice area was observed with increasing frequency of AF ( P P <0.001 for both) were independently associated with RT3DTEE-derived LAA orifice area. RT3DTEE is more accurate than 2DTEE for the assessment of LAA orifice size. A progressive increase in LAA orifice area is observed with increasing frequency of AF.Keywords
This publication has 30 references indexed in Scilit:
- Left Atrial Appendage Dimensions Predict the Risk of Stroke/TIA in Patients With Atrial FibrillationJournal of Cardiovascular Electrophysiology, 2011
- Left Atrial Appendage Studied by Computed Tomography to Help Planning for Appendage Closure Device PlacementJournal of Cardiovascular Electrophysiology, 2010
- Left Atrial Strain and Strain Rate in Patients With Paroxysmal and Persistent Atrial FibrillationCirculation: Cardiovascular Imaging, 2010
- Left atrial appendage exclusion: State‐of‐the‐artCatheterization and Cardiovascular Interventions, 2010
- Occluding the left atrial appendage: anatomical considerationsHeart, 2008
- Left Atrial Appendage Exclusion for Stroke Prevention in Patients With Nonrheumatic Atrial FibrillationStroke, 2007
- ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial FibrillationCirculation, 2006
- Left Atrial Appendage Occlusion Study (LAAOS): Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for strokeAmerican Heart Journal, 2005
- Multiplane Transesophageal Echocardiography: Image Orientation, Examination Technique, Anatomic Correlations, and Clinical ApplicationsMayo Clinic Proceedings, 1993
- Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method.Circulation, 1977