Contrast-enhanced tissue Doppler imaging of the left atrial appendage is a new quantitative measure of spontaneous echocardiographic contrast in atrial fibrillation

Donal, Erwan; Sallach, John A.; Murray, R.Daniel; Drinko, Jeanne K.; Jasper, Susan E.; Thomas, James D.; Klein, Allan L.

doi:10.1016/j.euje.2006.10.001

Cited by 14 publications

(14 citation statements)

References 33 publications

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“…58 In cases where spontaneous echo contrast may render the identification of thrombi difficult, tissue Doppler imaging with or without echocardiographic contrast injection may improve thrombus detection. 59 Beyond detection of thrombus, TEE provides assessment of LAA structure. 3D TEE has been shown to be superior to 2D TEE for delineation of LAA geometry, which has obvious implications for LAA closure device implantation.…”

Section: La Appendagementioning

confidence: 99%

Atrial Fibrillation Pathophysiology and Prognosis

Siontis

Gersh

2015

Circ: Cardiovascular Imaging

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Section: La Appendagementioning

confidence: 99%

Atrial Fibrillation Pathophysiology and Prognosis

Siontis

Gersh

2015

Circ: Cardiovascular Imaging

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“…It has been deemed to be "our most lethal attachment" taking into account the morbidity and mortality of cardiogenic embolism [49]. Low blood flow velocities within the LAA [57] are associated with the occurence of spontaneous echo contrast (SEC) [22,78,96] and a procoagulatory milieu [7] which is strongly associated with LAA thrombus formation and systemical embolism [51,108]. Therefore, LAA flow velocities and SEC density have been considered as surrogate parameters for stroke risk stratification and may help in case of doubt to decide in favor or against warfarin [37].…”

Section: The Concept Of Laa Closure For Prophylaxis Of Thromboembolismentioning

confidence: 99%

Treatment strategies for prevention of cardioembolic stroke in atrial fibrillation

Park

Leithäuser

Rittger

et al. 2010

Clinical Hemorheology and Microcirculation

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Stroke is the third leading cause of mortality and is one of the leading cause of disability in the world today. Although underused, anticoagulation with warfarin is still the treatment of choice for prevention of stroke in patients with AF, though hemorrhage is clearly increased in the anticoagulated patient. The substantial difficulties associated with warfarin use give reasons for the continuing challenge of decision making about antithrombotic therapy. They have led to a search for alternative approaches of stroke prophylaxis resulting in a strategy of mechanically sealing the left atrial appendage (LAA) and excluding it from the systemic circulation. A couple of years ago a percutaneous transcatheter transseptal approach to LAA occlusion has become feasible. Since then, valuable technical knowledge and a proof of concept emerged from clinical trials using three different systems. However, also the intervention bears a risk. Thus, identifying those patients who gain the most from either therapy is crucial which, in the first line, means to calculate the risk of stroke or bleeding. Unfortunately, patients with some defined comorbidities are at risk of both, cerebral embolism or hemorrhage. Whether this target group may benefit from LAA occlusion is a matter of this discussion.

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“…Further improvement of B-mode image quality of 3D-TOE will be available in the near future. The combination of tissue doppler imaging and use of contrast agents may help to better characterize thrombogenic structures within the LAA 58). Also, with respect to LAA imaging, few studies using MRI and spiral CT scan have been reported on detection of thrombus and SEC 38)39)143-146).…”

Section: Cardiac Imaging For Thrombus Detectionmentioning

confidence: 99%

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Leithäuser

Park

2009

Korean Circ J

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Atrial fibrillation is the most common cardiac arrhythmias, and a major cause of morbidity and mortality due to cardioembolic stroke. The left atrial appendage is the major site of thrombus formation in non-valvular atrial fibrillation. Loss of atrial systole in atrial fibrillation and increased relative risk of associated stroke point strongly toward a role for stasis of blood in left atrial thrombosis, although thrombus formation is multifactorial, and much more than blood flow irregularities are implicated. Oral anticoagulation with vitamin-K-antagonists is currently the most effective prophylaxis for stroke in atrial fibrillation. Unfortunately, this treatment is often contraindicated, particularly in the elderly, in whom risk of stroke is high. Moreover, given the risk of major bleeding, there is reason to be skeptical of the net benefit when warfarin is used in those patients. This work reviews the pathophysiology of cardioembolic stroke and critically spotlights the current status of preventive anticoagulation therapy. Various techniques to exclude the left atrial appendage from circulation were discussed as a considerable alternative for stroke prophylaxis.

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Contrast-enhanced tissue Doppler imaging of the left atrial appendage is a new quantitative measure of spontaneous echocardiographic contrast in atrial fibrillation

Abstract: Contrast-enhanced TDI is an original new tool that provides a quantification of the mean velocity of LAA-SEC that might improve our decision making in patients with atrial fibrillation.

Cited by 14 publications

References 33 publications

Atrial Fibrillation Pathophysiology and Prognosis

Atrial Fibrillation Pathophysiology and Prognosis

Treatment strategies for prevention of cardioembolic stroke in atrial fibrillation

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

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