[Transesophageal echocardiography study with dynamic spontaneous contrast of the left atrial appendage, its relationship with the anatomy and thrombus formation].
OBJECTIVE
Transesophageal two-dimensional echocardiographic study of anatomical characteristics of the left atrial appendage and its relation to spontaneous dynamic echocardiographic contrast.


METHODS
Outpatients undergoing a prospective two-dimensional transesophageal echocardiographic study.


METHODS
Consecutive outpatients studied at the Echocardiographic Laboratory of Gregorio Marañon General Hospital, Madrid.


METHODS
In each patient at the level of the left atrial appendage we calculated the following transesophageal echocardiographic parameters: end-systolic and end-diastolic maximal longitudinal and transversal diameters, total systolic and diastolic areas, percentage of systolic fractional shortening, presence of left atrial appendage thrombus and spontaneous dynamic echo-contrast.


RESULTS
Left atrial appendage spontaneous dynamic contrast was observed in 48% of the total population. In the group of patients with left atrial spontaneous echo-contrast we observed larger longitudinal systolic (44 +/- 14 mm vs 28 +/- 13 mm, p = 0.01) and diastolic (52 +/- 16 mm vs 38 +/- 12 mm, p = 0.005) diameters, larger transversal systolic (25 +/- 10 mm vs 19 +/- 6 mm, p = 0.03) and diastolic (28 +/- 8 mm vs 25 +/- 9 mm, p = NS) diameters and also larger systolic (601 +/- 204 mm2 vs 337 +/- 110 mm2, p < 0.0001) and diastolic (715 +/- 230 mm2 vs 507 +/- 184 mm2, p = 0.001) areas, compared to the group without this dynamic echocardiographic phenomena. Left atrial appendage percentage of fractional shortening was considerably reduced in patients with spontaneous dynamic echo-contrast (15 +/- 14% vs 39 +/- 18%, p = 0.001) and related to local thrombus formation (13% vs 1%, p < 0.001).


CONCLUSIONS
Left atrial spontaneous dynamic echo-contrast is more common in patients with enlarged left atrial appendage systo-diastolic diameters and areas. In this group of patients the presence of left atrial spontaneous echo-contrast is related to a significant reduction in left atrial appendage contractile function and thrombus formation. Parameter analysis of left atrial appendage anatomy by two-dimensional transesophageal echocardiography may have clinical relevance in the assessment of patients with high risk for left atria thromboembolic phenomena.
Laboratório de Ecocardiografia, Hospital Gregorio Marañon, Madrid, Espanha.
M A
MA
Garcia-Fernandes
J E
JE
Azevedo
D
D
SanRoman
E
E
Torrecilla
R
R
Esturau
J M
JM
Hernandez
J L
JL
Delcan
D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D004947:Esophagus; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D011446:Prospective Studies; D013599:Systole; D013927:Thrombosis / Q000000981:diagnostic imaging*
Estudo ecocardiográfico transesofágico do contraste espontâneo dinâmico no apêndice auricular esquerdo, sua relação com a anatomia e formação de trombos.