Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany.
Open Heart. 2021 Mar;8(1). doi: 10.1136/openhrt-2020-001403.
Interventional closure of the left atrial appendage closure (LAAC) has been established as an alternative treatment in patients with atrial fibrillation (AF) and an increased risk of stroke. So far it is unknown whether the use of ultrasound contrast agent (UCA) would influence the correct sizing of the LAA and thereby have an impact on device selection during interventional LAAC.
Between January 2017 and April 2018, 223 transoesophageal echocardiography (TOE) examinations were prospectively performed in adult patients with non-valvular AF (Impact of the use of ultrasound contrast agent on the detection of thrombi in the left atrial appendage during transesophageal echocardiography (CONDOR) study). LAA was examined both with and without the use of UCA. The following measurements were taken at 0, 45, 90 and 135: diameter of LAA ostium, maximal depth of the LAA, maximal available depth of the LAA orthogonal to the ostial plane and area of the LAA.
The use of UCA had no relevant influence on the size determination of the LAA. Additionally, Bland-Altman blots demonstrate a high degree of correlation between the measurements with and without UCA with no evidence for a systematic effect arising from the use of UCA. When comparing the measurements of two independent investigators, the use of UCA rather leads to a higher variability than to an improved precision.
Despite the fact that the use of UCA during TOE leads to an improved rule out of thrombi, our study shows that there is no advantageous effect of UCA on the size determination of the LAA and should therefore not be used for this purpose.
经皮左心耳封堵术（LAAC）已被确立为伴有房颤（AF）和中风高风险患者的一种替代治疗方法。到目前为止，尚不清楚使用超声对比剂（UCA）是否会影响左心耳（LAA）的正确测量，从而对介入性 LAAC 期间的器械选择产生影响。
在 2017 年 1 月至 2018 年 4 月期间，前瞻性地对 223 例非瓣膜性 AF 成年患者进行了经食管超声心动图（TOE）检查（超声对比剂对经食管超声心动图检测左心耳血栓的影响（CONDOR）研究）。分别在使用和不使用 UCA 的情况下检查 LAA。在 0、45、90 和 135 时进行以下测量：LAA 口直径、LAA 最大深度、与口平面正交的 LAA 最大可用深度和 LAA 面积。
UCA 的使用对 LAA 的大小确定没有明显影响。此外，Bland-Altman 图表明，使用 UCA 和不使用 UCA 的测量之间具有高度相关性，没有证据表明 UCA 的使用会产生系统影响。当比较两名独立研究人员的测量值时，UCA 的使用导致更高的变异性，而不是更高的精度。
尽管在 TOE 中使用 UCA 可改善血栓的排除，但我们的研究表明，UCA 对 LAA 的大小确定没有有利影响，因此不应将其用于此目的。
