Yu Yi, Zhang Rui, Chen Yu-Han, Wang Ting, Tang Xiao-Li, Gong Chang-Qi, Shao Yun, Wang Zheng, Wang Yue-Peng, Li Yi-Gang
Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China.
Front Cardiovasc Med. 2023 Jan 26;10:1018877. doi: 10.3389/fcvm.2023.1018877. eCollection 2023.
This study aims to evaluate the diagnostic value of real-time four-dimensional transesophageal echocardiography (RT4D-TEE) for implant-related thrombus (IRT).
We collected 1,125 patients with atrial fibrillation from May 2019 to February 2022 in our hospital. All patients accepted transesophageal echocardiography (TEE) examination to exclude any thrombi before the LAAC procedure.
There were 760 patients with LAAC, 66 patients with CIED, and 299 patients without any implantations. A total of 40 patients with an established diagnosis of IRT were further analyzed. The accurate detection rate of IRT by RT4D-TEE was 4.8% (40/826), which was higher than 3.8% (31/826) by 2D-TEE ( = 0.004). No IRT was found on TEE in the rest of the 786 patients. These 40 patients were divided into LAAC ( = 23) and CIED ( = 17) groups according to the results of RT4D-TEE. In the LAAC group, IRT distributed on different parts of the LAA occluder surface, 91.3% (21/23) with clumps of thrombi, and 8.7% (2/23) with a thin layer of thrombi covering the surface of the occluder. In the CIED group, thrombi were seen attached to the leads in the right atrium and right ventricle. The thrombi were beaded in 17.6% (3/17), corded in 17.6% (3/17), and clotted in the remaining 64.7% (11/17) of cases. After adjusting the anticoagulant dosage and following up for 6 months, 20% (8/40) of cases were successfully resolved, 67.5% (27/40) became smaller, and 12.5% (5/40) showed no changes.
The accurate detection rate of IRT by RT4D-TEE was significantly higher than that by 2D-TEE. 2D-TEE has limitations, but RT4D-TEE can be used as an effective complementary method. Imaging and some clinical features differ significantly between IRT on occluder and IRT on CIED lead.
本研究旨在评估实时四维经食管超声心动图（RT4D-TEE）对植入相关血栓（IRT）的诊断价值。
我们收集了2019年5月至2022年2月在我院的1125例房颤患者。所有患者在左心耳封堵术（LAAC）前均接受经食管超声心动图（TEE）检查以排除任何血栓。
有760例LAAC患者，66例心脏植入电子设备（CIED）患者，299例未进行任何植入的患者。对总共40例确诊为IRT的患者进行了进一步分析。RT4D-TEE对IRT的准确检测率为4.8%（40/826），高于二维TEE（2D-TEE）的3.8%（31/826）（P = 0.004）。其余786例患者的TEE检查未发现IRT。根据RT4D-TEE结果，这40例患者分为LAAC组（n = 23）和CIED组（n = 17）。在LAAC组中，IRT分布在左心耳封堵器表面的不同部位，91.3%（21/23）为血栓团块，8.7%（2/23）为覆盖封堵器表面的薄层血栓。在CIED组中，血栓附着于右心房和右心室的导线。血栓呈串珠状的占17.6%（3/17），呈条索状的占17.6%（3/17），其余64.7%（11/17）为凝块。调整抗凝剂量并随访6个月后，20%（8/40）的病例成功缓解，67.
