Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography
Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography
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DOI：
10.1007/s10554-016-1026-6
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发表时间：
2017-04-01
影响因子：
2.1
通讯作者：
Colonna, Paolo
中科院分区：
文献类型：
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作者：
Dentamaro, Ilaria;Vestito, Domenico;Colonna, Paolo
心房颤动（AF）患者栓塞源的检测对于指导抗凝治疗具有重要意义。二维经食管超声心动图（TEE）是研究左心耳（LAA）解剖和形态的金标准，尽管存在一些假阳性诊断。我们假设真实的3D TEE（RT 3DTEE）在检测和/或排除LAA血栓方面优于2DTEE（上级）。我们研究了93例非瓣膜性房颤患者（60例男性，年龄= 67.1 ± 14.2岁），这些患者采用经胸、2DTEE和RT 3DTEE进行了电复律。在心脏复律前，TTE仅在59/93例患者（63%）中能够可靠地测量左心耳排空速度（LAAeV）。与此相反，在49/93例（53%）LAA功能障碍（LAAeV < 40 cm/s）的所有患者中获得了质量良好的TEE LAAeV。一个由5名患者组成的亚组（69例有效心脏复律的7.2%）在心脏复律后出现持续性功能障碍（CV后TEE上的LAAeV值< 40 cm/s）。TEE可观察到45例患者（48.4%）的双叶形状和22例患者（23.7%）的三叶形状。此外，除了几个额外的结果，2DTEE设法在8/93例患者（8.6%）中确定性地检测到血栓。在其他5例2DTEE血栓诊断可疑的病例中（5/93例患者：5.4%），增加RT 3DTEE模式可以确定性地区分4例患者中仅存在梳状肌。在有栓塞风险的AF患者中，RT 3DTEE是可行的、准确的，并在疑似LAA血栓的选定病例的鉴别诊断中显示出额外的诊断能力。
The detection of embolic sources in patients with atrial fibrillation (AF) is important to guide anticoagulant therapy. Two-dimensional transesophageal echocardiography (TEE) is the gold standard to study left atrial appendage (LAA) anatomy and morphology, despite some false-positive diagnosis. We hypothesized that real time 3D TEE (RT3DTEE) is superior to 2DTEE in detecting and/or excluding LAA thrombi. We studied 93 patients with non-valvular AF (60 males, age = 67.1 +/- 14.2 years) referred for electric cardioversion with transthoracic, 2DTEE and RT3DTEE. Before cardioversion, TTE allowed a confident measurement of emptying velocity of LAA (LAAeV) only in 59/93 patients (63%). On the contrary a good quality TEE LAAeV was obtained in all patients with 49/93 (53%) dysfunctional LAA (LAAeV < 40 cm/s). A subgroup of 5 patients (7.2% of the 69 effective cardioversion) presented a persistent dysfunction after cardioversion (with LAAeV values of < 40 cm/s on the TEE post-CV). TEE allowed to observe a bilobed shape in 45 patients (48.4%) and three lobes in 22 patients (23.7%). In addition, besides to several additional findings, 2DTEE managed to detect thrombi with certainty in 8/93 patients (8.6%). In other 5 cases with diagnostic doubts for thrombi with 2DTEE (5/93 patients: 5.4%), the addition of the RT3DTEE mode allowed to discriminate with certainty the presence of just pectinate muscles in 4 patients RT3DTEE in patients with AF at risk of embolism is feasible, accurate and showed an additional diagnostic capability in the differential diagnosis of selected cases with suspected LAA thrombi.