TY - BOOK AU - Asch, Federico M AU - Bering, Patrick AU - Chang, Ian AU - Fazlalizadeh, Hooman AU - Kenigsberg, Benjamin AU - Kumar, Preetham AU - Medvedofsky, Diego AU - Meltzer, Seth AU - Phatak, Prajakta M AU - Rogers, Toby AU - Satler, Lowell F AU - Shah, Manish H AU - Weissman, Gaby TI - Three-Dimensional Echocardiographic Left Atrial Appendage Volumetric Analysis SN - 0894-7317 PY - 2021/// KW - *Atrial Appendage KW - *Atrial Fibrillation KW - *Echocardiography, Three-Dimensional KW - Atrial Appendage/dg [Diagnostic Imaging] KW - Atrial Fibrillation/dg [Diagnostic Imaging] KW - Echocardiography KW - Echocardiography, Transesophageal KW - Humans KW - Reproducibility of Results KW - MedStar Heart & Vascular Institute KW - MedStar Washington Hospital Center KW - Cardiovascular Disease Fellowship KW - Journal Article N2 - BACKGROUND: Left atrial appendage (LAA) echocardiographic assessment is difficult because of the complex shape and relatively small size of the LAA. Three-dimensional (3D) echocardiographic imaging can overcome the limitations of two-dimensional imaging. Pulsed-wave Doppler is the only currently standard LAA functional parameter. The aim of this study was to test a new approach for 3D echocardiographic volumetric analysis to obtain LAA ejection fraction (EF), its size and shape; CONCLUSIONS: A novel 3D echocardiographic approach can determine the geometry, size, and function of the LAA. A new parameter, LAA EF, provides functional quantitation. Copyright (c) 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved; METHODS: Transesophageal two-dimensional and 3D LAA images were prospectively obtained in 159 consecutive patients. LAA volumes were measured from 3D echocardiographic images using available software. Pulsed-wave Doppler was considered the reference value for LAA function and was used for comparison with LAA EF. Comparison with cardiac computed tomography was performed in a subgroup of 32 patients. Comparisons included linear regression and Bland-Altman analyses. Repeated measurements were performed to assess measurement variability; RESULTS: Nine patients were excluded because of suboptimal image quality (94% feasibility). Three-dimensional LAA calculated EF was in good agreement with LAA pulsed-wave measurements. Three-dimensional morphologic evaluation showed that 43% of the patients had "chicken wing," 33% "cactus," 19% "windsock," and 5% cauliflower shapes. At the time of data acquisition, patients with atrial fibrillation had nonsignificantly larger LAA end-systolic and end-diastolic volumes, leading to lower calculated EFs. Three-dimensional echocardiographic LAA end-systolic volumes were in good agreement with cardiac computed tomography (r = 0.75), with small biases (mean, -2.5 +/- 3.9 ml). Reproducibility was better for larger LAA volumes UR - https://dx.doi.org/10.1016/j.echo.2021.03.008 ER -