title: Characteristics of Anatomy and Function of the Left Atrial Appendage and Their Relationships in Patients with Cardioembolic Stroke: A 3-Dimensional Transesophageal Echocardiography Study.
abstract: BACKGROUND
  Increasing attention is being paid to the left atrial appendage (LAA) in the context of risk stratification in cardioembolic stroke (CES) and the requirement for meticulous planning of percutaneous closure device implantation. However, detailed systematic assessment of the LAA remains limited.
  
  
  METHODS
  This study evaluated the anatomy and function of LAA using 3-dimensional transesophageal echocardiography (3D-TEE) on 194 consecutive patients older than 50 years old hospitalized exclusively for CES. Patients were stratified into 3 groups on the basis of cardiac rhythm: (1) chronic atrial fibrillation (AF), n = 53; (2) paroxysmal AF, n = 26; and (3) no detected AF, n = 115.
  
  
  RESULTS
  Significant differences between the groups were observed for anatomical (orifice area [OA], depth, diastolic volume) and functional parameters (ejection fraction [EF], flow velocity [FV]), as measured by 3D-TEE. The anatomical parameters were consistently the greatest, and functional parameters were the poorest, in the group with chronic AF. There were significant inverse correlations between them (r = -.33, P = .0003 for depth and EF; r = -.27, P = .0020 for depth and FV; r = -.22, P = .016 for OA and EF; and r = -.38, P < .0001 for OA and FV).
  
  
  CONCLUSIONS
  LAA morphology and function were strongly affected by cardiac rhythm disturbances. Patients with chronic AF had the greatest LAA dimensions, areas, and volumes as well as the lowest LAA functions. An inverse correlation was observed between LAA size and function.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan. Electronic address: ymorino@iwate-med.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Morino
authors.affiliation: Division of Cardiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kumagai
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Hozawa
authors.affiliation: Division of Cardiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Division of Neurology and Gerontology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Terayama
authors.affiliation: Division of Cardiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tashiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging; D016279:Atrial Function, Left / Q000502:physiology*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D015898:Tomography Scanners, X-Ray Computed
keywords: Left atrial appendage; atrial fibrillation; embolic stroke; transesophageal echocardiography