Three-Dimensional Echocardiographic Left Atrial Appendage Volumetric Analysis.

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Citation: Journal of the American Society of Echocardiography. 34(9):987-995, 2021 09.PMID: 33775733Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Cardiovascular Disease FellowshipForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Atrial Appendage | *Atrial Fibrillation | *Echocardiography, Three-Dimensional | Atrial Appendage/dg [Diagnostic Imaging] | Atrial Fibrillation/dg [Diagnostic Imaging] | Echocardiography | Echocardiography, Transesophageal | Humans | Reproducibility of ResultsYear: 2021ISSN:
  • 0894-7317
Name of journal: Journal of the American Society of Echocardiography : official publication of the American Society of EchocardiographyAbstract: 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.All authors: Asch FM, Bering P, Chang I, Fazlalizadeh H, Kenigsberg B, Kumar P, Lang RM, Medvedofsky D, Meltzer SN, Phatak PM, Rogers T, Satler LF, Shah MH, Weissman GOriginally published: Journal of the American Society of Echocardiography. 2021 Mar 26Fiscal year: FY2021Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33775733 Available 33775733

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.

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