Takahashi Tomonori, Kusunose Kenya, Hayashi Shuji, Zheng Robert, Yamaguchi Natsumi, Morita Sae, Hirata Yukina, Nishio Susumu, Saijo Yoshihito, Ise Takayuki, Yamaguchi Koji, Yagi Shusuke, Yamada Hirotsugu, Soeki Takeshi, Wakatsuki Tetsuzo, Sata Masataka
Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, Japan.
Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
Int J Cardiovasc Imaging. 2023 Mar;39(3):511-518. doi: 10.1007/s10554-022-02749-y. Epub 2022 Nov 10.
In patients with sludge or severe spontaneous echo contrast (SEC) in the left atrial appendage (LAA), cases with isoproterenol loading transesophageal echocardiography (ISP-TEE) have been reported to identify the presence of thrombus in the LAA. This study aimed to assess the validity and hemodynamic changes of ISP-TEE in the LAA. We prospectively enrolled patients with atrial fibrillation (AF) who underwent ISP-TEE. The degree of sludge/SEC was categorized as being either absent (grade 0), mild SEC (grade 1), moderate SEC (grade 2), severe SEC or sludge (grade 3). The hemodynamic evaluation was performed by measuring LAA flow velocity, LAA tissue Doppler imaging (LAA-TDI) velocity, and pulmonary vein systolic forward flow velocity (PVS). In total, 35 patients (mean age 71 ± 7 years; 71% male) underwent ISP-TEE. Among 35 patients, 30 patients had grade 3 or 2 SEC, 5 patients had grade 1 SEC. After ISP loading, 23 patients (66% of all patients) showed improved sludge/SEC and one patient was diagnosed with thrombus in the LAA. There were 25 patients with grade 1 SEC, or no SEC (classified as Group1), 10 patients had residual sludge or grade 2 to 3 SEC (classified as Group2) after ISP administration. LAA flow, LAA-TDI, and PVS velocities were significantly higher in group 1 than in group 2 after ISP administration. There was no complication during the examination and after 24 h and 3 months. ISP infusion may be a potential tool to recognize LAA thrombus under the sludge/SEC during TEE in AF.
在左心耳（LAA）存在淤滞或严重自发显影（SEC）的患者中，已有异丙肾上腺素负荷经食管超声心动图（ISP-TEE）病例报告用于识别LAA中血栓的存在。本研究旨在评估ISP-TEE在LAA中的有效性和血流动力学变化。我们前瞻性纳入了接受ISP-TEE的房颤（AF）患者。淤滞/SEC程度分为无（0级）、轻度SEC（1级）、中度SEC（2级）、重度SEC或淤滞（3级）。通过测量LAA流速、LAA组织多普勒成像（LAA-TDI）流速和肺静脉收缩期正向流速（PVS）进行血流动力学评估。共有35例患者（平均年龄71±7岁；71%为男性）接受了ISP-TEE。35例患者中，30例有3级或2级SEC，5例有1级SEC。异丙肾上腺素负荷后，23例患者（占所有患者的66%）淤滞/SEC情况改善，1例患者被诊断为LAA血栓。异丙肾上腺素给药后，有25例患者为1级SEC或无SEC（归类为第1组），10例患者仍有淤滞或2至3级SEC（归类为第2组）。异丙肾上腺素给药后，第1组的LAA流速、LAA-TDI流速和PVS流速显著高于第2组。检查期间以及24小时和3个月后均无并发症发生。在AF患者的TEE检查中，异丙肾上腺素输注可能是识别淤滞/SEC情况下LAA血栓的潜在工具。
