Analysis of real-time three dimensional transesophageal echocardiography in the assessment of left atrial appendage function in patients with atrial fibrillation

Abstract

The aim of the study was to examine changes in left atrial appendage volume (LAA-V) in patients with non-valvular atrial fibrillation (AF) using real-time three-dimensional transesophageal echocardiography (RT3D-TEE) and evaluate the prediction value on the high risk of thrombosis of LAA. Using RT3D-TEE we measured: i) LAA peak empty velocity (LAA-PEV), ii) LAA-V including LAA end-diastolic volume (LAA-EDV) and end-systolic volume (LAA-ESV). We also calculated LAA ejection fraction (LAA-EF). RT3D-TEE was applied in 20 control cases and 74 patients with non-valvular AF. According to the presence of thrombosis, 74 patients were divided into the no thrombosis group (NTH group, n=52) and thrombosis group (TH group, n=22). Our results showed that there were significant differences in LAA-V and LAA-EF values in different groups (P<0.05). LAA-EDV moderately correlated with LAA-PEV (r=−0.531, P<0.001) while LAA-ESV demonstrated a strong correlation with LAA-PEV (r=−0.741, P<0.001). LAA-EF also showed a strong correlation with LAA-PEV (r=0.693, P<0.001). Through receiver operating characteristic (ROC) curves, the cut-off values of LAA-EDV and LAA-ESV in thrombosis of LAA were 18.45 and 9.69 ml, respectively. RT3D-TEE effectively evaluated the LAA-V, LAA-PEV and LAA-EF parameters, and proved to be valuable in the process of evaluation of thrombosis of LAA.

Impact of Atrial Fibrillation on Left Atrium Haemodynamics: A Computational Fluid Dynamics Study

“…These values suggest an atrial remodeling caused by the AF pathology; hinting at the possibility of a persistent AF. As reported in Table 2, the in-silico values we compute are in accordance with the clinical measurements, for both LAEF [70,72,71], and LAAEF [49], making the whole displacement procedure significant and reliable.…”

“…Similarly to what done in [40,41,42,43,44,45,46,47,48], we use a parametric displacement combined with patient-specific geometry to fill the lack of information on the chamber displacement. Starting from the analytical formulation in [40], we modify the displacement to catch a more realistic movement of LAA and matching the variations of volume with the physiological or pathological values of the Left Atrial Appendage Ejection Fraction (LAAEF) [49]. We generate a displacement which embodies medical constraints to get a more physiological movement for the chamber and the LAA.…”

Impact of left atrial wall motion assumptions in fluid simulations on proposed predictors of thrombus formation

“…In instances where patient-specific data are unavailable, the parameter k can be calibrated based on clinical measurements of LAA contraction. 54 The space-dependent functions f LA x ð Þ and f LAA x ð Þ were defined as:…”

Finding low CHA2DS2-VASc scores unreliable? Why not give morphological and hemodynamic methods a try?

“…38). An LAA end-systolic volume and an end-diastolic volume larger than 18.45 and 9.49 mL were believed to be critical values (47). There was a significant increase in thrombus events in patients with LAA volumes larger than 8.6 cm 3 (45).…”

“…Its predictive value is considerable, having an AUC of 0.735, with a sensitivity of 75.7% and a specificity of 74.9%, and the cutoff point was more than 23.45 mm ( 38 ). An LAA end-systolic volume and an end-diastolic volume larger than 18.45 and 9.49 mL were believed to be critical values ( 47 ). There was a significant increase in thrombus events in patients with LAA volumes larger than 8.6 cm 3 ( 45 ).…”