Evaluation of the Left Atrial Appendage With Real-Time 3-Dimensional Transesophageal Echocardiography Implications for Catheter-Based Left Atrial Appendage Closure
Evaluation of the Left Atrial Appendage With Real-Time 3-Dimensional Transesophageal Echocardiography Implications for Catheter-Based Left Atrial Appendage Closure
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DOI：
10.1161/circimaging.111.963892
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发表时间：
2011-09-01
影响因子：
7.5
通讯作者：
Auricchio, Angelo
中科院分区：
文献类型：
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作者：
Nucifora, Gaetano;Faletra, Francesco F.;Auricchio, Angelo
背景-准确了解左心耳（LAA）开口尺寸对于LAA封堵器的正确尺寸至关重要。本研究的目的是确定实时3D经食管超声心动图（RT 3DTEE）与2D经食管超声心动图（2DTEE）评估LAA开口尺寸的性能，并研究房颤（AF）对LAA开口尺寸的影响。38例对照组（阵发性房颤31例，持续性房颤38例，永久性房颤30例）进行了二维经食管超声心动图和实时三维经食管超声心动图检查。两种技术均用于测量LAA瓣口面积。46例患者使用临床适用的64层计算机断层扫描（CT）作为参考技术。与RT 3DTEE相比，二维TEE低估了左心耳瓣口面积（1.99 +/- 0.94 cm（2）vs 3.05 +/- 1.27 cm（2）; P < 0.001）。与2DTEE相比，RT 3DTEE在评估LAA瓣口面积方面显示出与CT更高的相关性（分别为r=0.92; 95%置信区间，0.85 - 0.95 vs. r=0.72; 95%置信区间，0.54 - 0.83）。在Bland-Altman分析中，与CT相比，RT 3DTEE和2DTEE低估了LAA开口面积。然而，与2DTEE相比，RT 3DTEE显示与CT的偏倚更小（0.07 cm（2）vs 0.72 cm（2））和一致性范围更窄（-0.71至0.85 cm（2）vs-0.58至2.02 cm（2））。在AF患者中，随着AF频率的增加，观察到RT 3DTEE得出的LAA瓣口面积逐渐增加（P < 0.001）。在多变量分析中，AF和左心房容积指数（两者P < 0.001）与RT 3DTEE推导的LAA口面积独立相关。结论RT 3DTEE比2DTEE更准确地评估LAA口尺寸。随着房颤频率的增加，观察到左心耳瓣口面积逐渐增加。2011;4：514-523）。
Background-Precise knowledge of left atrial appendage (LAA) orifice size is crucial for correct sizing of LAA closure devices. The aim of the present study was to determine the performance of real-time 3D transesophageal echocardiography (RT3DTEE) for LAA orifice size assessment, compared with 2D transesophageal echocardiography (2DTEE), and to investigate the impact of atrial fibrillation (AF) on LAA orifice size.Methods and Results-One hundred thirty-seven patients (38 control subjects, 31 with paroxysmal AF, 38 with persistent AF and 30 with permanent AF) underwent 2DTEE and RT3DTEE. Both techniques were used to measure LAA orifice area. Clinically-indicated 64-slice computed tomography (CT) was used as reference technique in 46 patients. Two-dimensional TEE underestimated LAA orifice area, compared with RT3DTEE (1.99 +/- 0.94 cm(2) versus 3.05 +/- 1.27 cm(2); P < 0.001). RT3DTEE showed higher correlation with CT for the assessment of LAA orifice area, compared with 2DTEE (r=0.92; 95% confidence interval, 0.85 to 0.95, versus r=0.72; 95% confidence interval, 0.54 to 0.83, respectively). At Bland-Altman analysis, RT3DTEE and 2DTEE underestimated LAA orifice area, compared with CT. However, RT3DTEE showed smaller bias (0.07 cm(2) versus 0.72 cm(2)) and narrower limits of agreement (-0.71 to 0.85 cm(2) versus -0.58 to 2.02 cm(2)) with CT, compared with 2DTEE. Among AF patients, a progressive increase in RT3DTEE-derived LAA orifice area was observed with increasing frequency of AF (P < 0.001). At multivariate analysis, AF and left atrial volume index (P < 0.001 for both) were independently associated with RT3DTEE-derived LAA orifice area.Conclusions-RT3DTEE is more accurate than 2DTEE for the assessment of LAA orifice size. A progressive increase in LAA orifice area is observed with increasing frequency of AF. (Circ Cardiovasc Imaging. 2011;4:514-523.)