Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Am Soc Echocardiogr. 2009 Oct;22(10):1165-72. doi: 10.1016/j.echo.2009.05.028. Epub 2009 Jul 31.
The aim of this study was to determine the ability to identify thrombus within the left atrial appendage (LAA) in the setting of atrial fibrillation (AF) using transthoracic echocardiography (TTE). In AF, the structure and function of the LAA has historically been evaluated using transesophageal echocardiography (TEE). The role of TTE remains undefined.
The Comprehensive Left Atrial Appendage Optimization of Thrombus (CLOTS) multicenter study enrolled 118 patients (85 men; mean age, 67 +/- 13 years) with AF of >2 days in duration undergoing clinically indicated TEE. On TEE, the LAA was evaluated for mild spontaneous echo contrast (SEC), severe SEC, sludge, or thrombus. Doppler Tissue imaging (DTI) peak S-wave and E-wave velocities of the LAA walls (anterior, posterior, and apical) were acquired on TTE. Transthoracic echocardiographic harmonic imaging (with and without intravenous contrast) was examined to determine its ability to identify LAA SEC, sludge, or thrombus.
Among the 118 patients, TEE identified 6 (5%) with LAA sludge and 2 (2%) with LAA thrombi. Both LAA thrombi were identified on TTE using harmonic imaging with contrast. Anterior, posterior, and apical LAA wall DTI velocities on TTE varied significantly among the 3 groups examined (no SEC, mild SEC, severe SEC, sludge or thrombus). An apical E velocity < or = 9.7 cm/s on TTE best identified the group of patients with severe SEC, sludge, or thrombus. An anterior S velocity < or = 5.2 cm/s on TTE best identified the group of patients with sludge or thrombus.
The CLOTS multicenter pilot trial determined that TTE is useful in the detection of thrombus using harmonic imaging combined with intravenous contrast (Optison; GE Healthcare, Milwaukee, WI). Additionally, LAA wall DTI velocities on TTE are useful in determining the severity of LAA SEC and detecting sludge or thrombus.
本研究旨在通过经胸超声心动图（TTE）确定在房颤（AF）背景下左心耳（LAA）内血栓的识别能力。在 AF 中，LAA 的结构和功能一直使用经食管超声心动图（TEE）进行评估。TTE 的作用仍未确定。
CLOTS 多中心研究纳入 118 例（85 例男性；平均年龄 67 +/- 13 岁），AF 持续时间>2 天，临床指征 TEE。在 TEE 上，LAA 评估轻度自发性回声对比（SEC）、重度 SEC、淤泥或血栓。TTE 采集 LAA 壁（前壁、后壁和顶部）的多普勒组织成像（DTI）峰值 S 波和 E 波速度。检查经胸超声心动图谐波成像（有和无静脉内对比）以确定其识别 LAA SEC、淤泥或血栓的能力。
在 118 例患者中，TEE 发现 6 例（5%）LAA 淤泥和 2 例（2%）LAA 血栓。TTE 上使用谐波成像和对比剂均能识别出 LAA 血栓。TTE 上的 LAA 壁 DTI 速度在前壁、后壁和顶部在 3 个检查组之间差异显著（无 SEC、轻度 SEC、重度 SEC、淤泥或血栓）。TTE 上的 E 速度<或=9.7 cm/s 可最佳识别 SEC 严重程度、淤泥或血栓的患者组。TTE 上前 S 速度<或=5.2 cm/s 可最佳识别出有淤泥或血栓的患者组。
CLOTS 多中心试验确定 TTE 结合谐波成像和静脉内对比（Optison；GE Healthcare，Milwaukee，WI）在血栓检测方面是有用的。此外，TTE 上的 LAA 壁 DTI 速度可用于确定 LAA SEC 的严重程度和检测淤泥或血栓。
