The Value Of Transesophageal Echocardiography And Computer Tomography Angiography In Selection Of The Size Of Left Atrial Appendage Closurer Comparing With Left Atrial Appendage Angiography

Objective: There have been less data about different images to determine the occluder size selection before and during the procedure of left atrial appendage closure(LAAC).The purpose of this study is to discuss the value of transesophageal echocardiography(TEE)and computer tomography angiography(CTA)in selection of the occluder size of LAAC comparing with LAA angiography(LAA-A).Methods: The patients with nonvalvular AF undergoing LAAC who also had the results of TEE,CTA and LAA-A before and during the procedure were included from January 2020 to December 2021 in the General Hospital of Northern Theater Command,and the Watchman or LAmbre devices were used in these patients.The gold standard for assessing LAA size is the LAA-A during the procedure.The intraclass correlation coefficient(ICC)analysis and Pearson analysis were utilized to examine the consistency of CTA,TEE,and LAA-A in measuring LAA size.Results: 1.This study included a total of 215 patients with nonvalvular AF.All patients had LAA-A,TEE,and CTA results.2.There were 165 patients in the Watchman device group,and the diameters of LAA landing zone measured by TEE and CTA were correlated with that measured by LAA-A(r values were 0.862 and 0.956,respectively;P <0.001).However,the diameters of LAA depth zone measured by TEE and CTA were not correlated with that measured by LAA-A(r values were 0.377 and 0.427,respectively;P <0.001).The diameters of LAA landing zone measured by TEE and CTA were consistent with that measured by LAA-A(ICC values were 0.862 and 0.955,respectively;P<0.001).However,the diameters of LAA depth zone measured by TEE and CTA were not consistent with that measured by LAA-A(ICC values were 0.363 and 0.377,respectively;P<0.001).3.When the eccentric index(EI)was >0.2,the average diameter showed the least absolute error in LAA size measurement,and all other parameters showed significant difference from it(all P <0.001).The maximum and minimal diameters of the landing zone estimated by CTA were weakly compatible with LAA-A(ICC values were 0.414 and 0.317,both P <0.001),as were the diameters of the landing zone determined from the perimeter and area(ICC values were 0.394 and 0.509,both P <0.001).The average diameter of landing zone is consistent with that measured with LAA-A,and the ICC value was 0.762,P <0.001.When the EI was ≤0.2,there was a significant error between the average diameter and the perimeter-derived diameter(P = 0.03),while the other parameters showed no difference(all P >0.05).The perimeter-derived diameter and the area-derived diameters of landing zone were weak correlation with that measured with LAA-A,and the ICC values were 0.552 and 0.612,both P <0.001.The diameters of the LAA landing zone measured by the maximal diameter,the minimal diameter and the average diameter were consistent with that measured with LAA-A,and the ICC value were 0.765,0.852 and 0.88,all P <0.001).4.There were 50 patients in the LAmbre device group,and the diameters of LAA orifice measured by TEE and CTA were correlated with that measured by LAA-A(the r values were 0.831 and 0.966,respectively;P <0.001),and the diameters of the landing zone measured by TEE and CTA were also correlated with that measured by LAA-A(the r values were 0.825 and 0.937,respectively;P <0.001).The diameters of LAA orifice measured by TEE and CTA were consistent with that measured by LAA-A(the ICC values were 0.801 and 0.965,respectively;P <0.001),and the diameters of the landing zone measured by TEE and CTA were also consistent with that measured by LAA-A(the ICC values were 0.792 and 0.934,respectively;P <0.001).Conclusion: 1.In the watchman group,the diameter of the LAA landing zone measured by CTA and TEE are consistent with that determined by LAA-A.This information can be used to help choose the occluder size during LAAC.However,the measurements of the available depth are not consistent with that of LAA-A,so it is not recommended to guide the selection of LAA occluder size.2.When the EI was >0.2,The average diameter of the landing zone was the most accurate one for LAA size among the five parameters.The maximal diameter,the minimal diameter and the average diameter of the landing zone were more accurate for five parameters when the EI was≤0.2.3.In the LAmbre group,the diameters of the ostia and landing zone measured by CTA and TEE are consistent and correlated with those measured by LAA-A,which have high credibility and important value.They can direct the selection of LAA occluder size.