Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Circ Cardiovasc Imaging. 2011 Sep;4(5):514-23. doi: 10.1161/CIRCIMAGING.111.963892. Epub 2011 Jul 7.
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.
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.
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.
准确了解左心耳（LAA）口的大小对于正确选择 LAA 封堵装置至关重要。本研究旨在比较实时 3 维经食管超声心动图（RT3DTEE）与 2 维经食管超声心动图（2DTEE）在评估 LAA 口大小方面的性能，并探讨房颤（AF）对 LAA 口大小的影响。
137 例患者（38 例对照组，31 例阵发性 AF，38 例持续性 AF，30 例永久性 AF）接受了 2DTEE 和 RT3DTEE 检查。两种技术均用于测量 LAA 口面积。46 例患者采用临床提示的 64 排 CT（CT）作为参考技术。与 RT3DTEE 相比，二维 TEE 低估了 LAA 口面积（1.99±0.94 cm2 与 3.05±1.27 cm2；P<0.001）。与 2DTEE 相比，RT3DTEE 与 CT 评估 LAA 口面积的相关性更高（r=0.92；95%置信区间，0.85 至 0.95，r=0.72；95%置信区间，0.54 至 0.83）。在 Bland-Altman 分析中，与 CT 相比，RT3DTEE 和 2DTEE 均低估了 LAA 口面积。然而，与 2DTEE 相比，RT3DTEE 显示出较小的偏差（0.07 cm2）和较窄的一致性区间（-0.71 至 0.85 cm2 与-0.58 至 2.02 cm2）。在 AF 患者中，随着 AF 频率的增加，RT3DTEE 测量的 LAA 口面积逐渐增加（P<0.001）。多变量分析显示，AF 和左心房容积指数（两者均 P<0.001）与 RT3DTEE 测量的 LAA 口面积独立相关。
RT3DTEE 比 2DTEE 更准确地评估 LAA 口大小。随着 AF 频率的增加，LAA 口面积逐渐增加。
