title: Improved Doppler echocardiographic assessment of the left atrial appendage by peripheral vein injection of sonicated albumin microbubbles.
abstract: We evaluated the usefulness of peripherally injected sonicated albumin microbubbles in transesophageal echo-Doppler cardiographic assessment of the left atrial appendage in 19 patients (age 61 +/- 19 [range 21 to 86] years; 12 [63%] women). Multiplane transesophageal echocardiography was performed before and after intravenous injection of sonicated albumin, and the left atrial appendage image and Doppler flow signal quality were assessed by a grading system of 0 to 3+ (0 = poor, 1 + = adequate, 2+ = good, and 3+ = excellent). Microbubbles appeared in the left atrium in 15 (79%) of 19 patients and completely opacified the left atrial appendage in 7 (37%) of 19 patients. Left atrial appendage maximal and minimal areas by planimetry were similar before and after contrast injection, although image quality improved in 13 (68%) of 19 patients (echocardiographic grade 1.8 +/- 0.6 vs 2.6 +/- 0.5, p< 0.001). Similarly, left atrial appendage peak emptying and peak filling Doppler flow velocities did not change before and after contrast injection, although Doppler flow signal quality improved in 12 (63%) of 19 patients (Doppler grade 1.6 +/- 0.5 vs 2.1 +/- 0.8, p < 0.05). Overall, contrast injection improved left atrial appendage echocardiographic or Doppler quality in 16 (84%) of 19 patients. Thus peripheral vein injection of sonicated albumin microbubbles can improve the assessment of left atrial appendage structure and function by transesophageal echocardiography.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Yao
authors.forename: A
authors.initials: A
authors.lastname: Ilercil
authors.forename: J S
authors.initials: JS
authors.lastname: Meisner
authors.forename: J A
authors.initials: JA
authors.lastname: Strom
authors.forename: J
authors.initials: J
authors.lastname: Shirani
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D016279:Atrial Function, Left / Q000502:physiology*; D001783:Blood Flow Velocity / Q000502:physiology; D003287:Contrast Media / Q000008:administration & dosage*; D015150:Echocardiography, Doppler / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
chemical_list: D000418:Albumins; C060687:Albunex; D003287:Contrast Media