1st Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Curie-Sk lodowskiej 9, 41-800 Zabrze, Poland.
Cardiol J. 2019;26(6):687-695. doi: 10.5603/CJ.a2018.0019. Epub 2018 Mar 7.
Real-time three-dimensional transesophageal echocardiography (RT3D TEE) enables better visualization of the left atrial appendage (LAA) and may be superior to real-time two-dimensional transesophageal echocardiography (RT2D TEE) for LAA occlusion (LAAO). The aim of this study was to assess inter- and intra-observer variability of RT2D TEE and RT3D TEE measurements of LAA, and to assess the accordance of RT2D TEE and RT3D TEE with appropriate occluder selection.
Transesophageal echocardiography was performed in 40 patients during LAAO. RT2D TEE and RT3D TEE measurements of the ostium and landing zone were performed independently by two echocardiographers. The appropriate choice of occluder was confirmed with fluoroscopic criteria. After the procedures, RT2D TEE and RT3D TEE evaluation were repeated separately by the same echocardiographers.
The mean ostium diameters by RT2D TEE obtained by the two observers were 23.6 ± 4.2 vs. 24.8 ± 5.2 (p = 0.04), and the mean landing zone diameters were 17.7 ± 4.4 vs. 19.4 ± 3.9 (p < 0.01). In the case of RT3D TEE, the ostium diameters were 29.6 ± 5.3 vs. 29.4 ± 6.4 (p = not significant [NS]) and the landing zone diameters were 21.4 ± 3.8 vs. 21.6 ± 3.9 (p = NS). Intra-observer differences were absent in the case of RT3D TEE. The comparison of RT2D TEE vs. RT3D TEE analyses performed by the same echocardiographer revealed significant differences in the ostium and landing zone measurements (both p < 0.01). Agreement between the suggested device size was better for RT3D TEE (weighted kappa was 0.62 vs. 0.28, respectively).
The results obtained with RT3D TEE showed significantly larger dimensions of the ostium and the landing zone. RT3D TEE showed lesser inter- and intra-observer variability and better agreement with the implanted device.
实时三维经食管超声心动图（RT3D TEE）可更好地显示左心耳（LAA），并且在 LAA 闭塞（LAAO）方面可能优于实时二维经食管超声心动图（RT2D TEE）。本研究旨在评估 RT2D TEE 和 RT3D TEE 测量 LAA 的观察者内和观察者间变异性，并评估 RT2D TEE 和 RT3D TEE 与合适封堵器选择的一致性。
在 40 例 LAAO 期间进行经食管超声心动图检查。由两名超声心动图医师独立进行 RT2D TEE 和 RT3D TEE 的口部和着陆区测量。通过荧光透视标准确认合适的封堵器选择。手术完成后，由同一名超声心动图医师分别重复 RT2D TEE 和 RT3D TEE 评估。
两名观察者通过 RT2D TEE 获得的平均口部直径分别为 23.6 ± 4.2 与 24.8 ± 5.2（p = 0.04），平均着陆区直径分别为 17.7 ± 4.4 与 19.4 ± 3.9（p < 0.01）。在 RT3D TEE 的情况下，口部直径分别为 29.6 ± 5.3 与 29.4 ± 6.4（p = 无显著差异[NS]），着陆区直径分别为 21.4 ± 3.8 与 21.6 ± 3.9（p = NS）。在 RT3D TEE 的情况下，观察者内差异不存在。同一名超声心动图医师对 RT2D TEE 与 RT3D TEE 分析的比较显示，口部和着陆区测量存在显著差异（均 p < 0.01）。与建议的设备尺寸之间的一致性在 RT3D TEE 中更好（加权kappa 分别为 0.62 与 0.28）。
RT3D TEE 获得的结果显示口部和着陆区的尺寸明显更大。RT3D TEE 显示出较小的观察者内和观察者间变异性，并且与植入的设备具有更好的一致性。
