Assessment Of Left Atrial Appendage Volume And Function Using Real-time Three-dimensional Transesophageal Echocardiography In Patients With Nonvalvular Atrial Fibrillation

Objective:Using real-time three-dimensional transesophageal echocardiography (RT-3D TEE) to evaluate the volume and function of left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation.Methods:Eighty-seven patients studied by RT-3D TEE were divided into four groups: normal sinus rhythm group (SR), paroxysmal atrial fibrillation groups with sinus rhythm and with fibrillation (PaAf-S,PaAf-F), persistent atrial fibrillation group (PeAf). RT-3D TEE 3D-ZOOM images of 5 to 8 cardiac cycle were obtained firstly, then analyzed offline with Qlab analysis system. The data including the end- diastolic volume and end-systolic volume of LAA(EDV,ESV), the maximal area and diameter of orifice of LAA(Amax, Dmax), and the minimal area and diameter of the orifice (Amin, Dmin), were calculated respectively with Simpson's biplane mode and manual describe except the maximal emptying velocity (Vep), then, the ejection fraction(EF) of LAA, change rate of area and diameter of orifice (A%,D%) were derived. LSD of One-way ANOVA was used to analysis the same parameters among these groups, and Pearson correlation coefficient between EF with the other parameters in the fibrillation group were obtained respectively.Results:â‘ The change rate of spontaneous echo contrast (SEC) and thrombi of LAA were increasing with duration of atrial fibrillation.â‘¡In patients with atrial fibrillation, the enlargement of EDV of the LAA occurred firstly, then ESV, A% and D% diminished, the parameters of volume and contraction declined lastly in patients with persistent atrial fibrillation.â‘¢The correlation analysis indicated that there was significantly negative correlation between LAA-EF and ESV, and there were lower negative correlation among LAA-EF and EDV,Amax and the patients ages. Otherwise, LAA-EF correlated positively with A%, D%, and had medium positive correlation with Vep. There was no correlation between LAA-EF and Dmax.Conclusion:LAA could be visualized clearly by RT- 3D TEE. Quantitative study of the volume and function of LAA, the area and diameter of orifice, and the relationship between the characteristics of LAA and the duration of atrial fibrillation, may offer important information for the evaluation of atrial fibrillation and the choose of treatment protocol.