title: Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography.
abstract: The detection of embolic sources in patients with atrial fibrillation (AF) is important to guide anticoagulant therapy. Two-dimensional transesophageal echocardiography (TEE) is the gold standard to study left atrial appendage (LAA) anatomy and morphology, despite some false-positive diagnosis. We hypothesized that real time 3D TEE (RT3DTEE) is superior to 2DTEE in detecting and/or excluding LAA thrombi. We studied 93 patients with non-valvular AF (60 males, age = 67.1 ± 14.2 years) referred for electric cardioversion with transthoracic, 2DTEE and RT3DTEE. Before cardioversion, TTE allowed a confident measurement of emptying velocity of LAA (LAAeV) only in 59/93 patients (63%). On the contrary a good quality TEE LAAeV was obtained in all patients with 49/93 (53%) dysfunctional LAA (LAAeV < 40 cm/s). A subgroup of 5 patients (7.2% of the 69 effective cardioversion) presented a persistent dysfunction after cardioversion (with LAAeV values of <40 cm/s on the TEE post-CV). TEE allowed to observe a bilobed shape in 45 patients (48.4%) and three lobes in 22 patients (23.7%). In addition, besides to several additional findings, 2DTEE managed to detect thrombi with certainty in 8/93 patients (8.6%). In other 5 cases with diagnostic doubts for thrombi with 2DTEE (5/93 patients: 5.4%), the addition of the RT3DTEE mode allowed to discriminate with certainty the presence of just pectinate muscles in 4 patients RT3DTEE in patients with AF at risk of embolism is feasible, accurate and showed an additional diagnostic capability in the differential diagnosis of selected cases with suspected LAA thrombi.
authors.affiliation: Cardiology Department, Hospital Policlinico of Bari, Piazza G. Cesare, 70124, Bari, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Dentamaro
authors.affiliation: Cardiology Department, Hospital Policlinico of Bari, Piazza G. Cesare, 70124, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Vestito
authors.affiliation: Cardiology Department, Hospital Policlinico of Bari, Piazza G. Cesare, 70124, Bari, Italy.
authors.forename: Ennio
authors.initials: E
authors.lastname: Michelotto
authors.affiliation: Cardiology Department, Hospital Policlinico of Bari, Piazza G. Cesare, 70124, Bari, Italy.
authors.forename: Delia
authors.initials: D
authors.lastname: De Santis
authors.affiliation: Cardiology Department, Hospital Policlinico of Bari, Piazza G. Cesare, 70124, Bari, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Ostuni
authors.affiliation: Department of Medical Sciences "M Aresu", University of Cagliari, Cagliari, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Cadeddu
authors.affiliation: Cardiology Department, Hospital Policlinico of Bari, Piazza G. Cesare, 70124, Bari, Italy. colonna@tiscali.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Colonna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016279:Atrial Function, Left; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: 3D Echocardiography; Atrial appendage; Atrial fibrillation; Cardioversion; Transesophageal echocardiography