Evaluation Of Left Atrial Appendage Function Value By Transesophageal Echocardiography Quantitative Techniques In Patients With Atrial Fibrillation

Objective:1 ? To evaluate the function of left atrial appendage(LAA)in patient with atrial fibrillation using omni-directional M-mode echocardiograph(OME)?quantitative tissue velocity Imaging(QTVI)technique ? real-time three dimensional transesophageal echocardiograph technology and other quantitative techniques.2 ? Comparing characteristics and correlation of the echocardiography technology assessment left atrial appendage function in patients with atrial fibrillation.3?The predictive value of the echocardiography technology for left atrial appendage spontaneous echocontrast(SEC)and thrombus in patients with atrial fibrillation.Methods:1 ? object : 87 cases atrial fibrillation patients were divided into 2 groups,anticoagulant drugs are not to regular used prior to admission,paroxysmal atrial fibrillation groups 51 cases and persistent atrial fibrillation group 36 cases,13 case of normal group?Meanwhile atrial fibrillation patients also were divided into two groups based on the absence or presence of SEC in the LAA,SEC 16 cases,without SEC 71 cases.2?equipment:Omni-directional M-mode echocardiograph work station,GE Vivid-E9 dimension,Color ultrasound imaging system(M5-D probe ?6VT three dimensional transesophageal probe)with Echo PAC work station.3 ? measurement : Using OME and quantitative tissue velocity Imaging(QTVI)technique to measure peak systolic velocity of lateral wall,septal wall and the apical tip of LAA;Using real-time three dimensional transesophageal echocardiograph to measure three dimensionl ejection fraction 3D-EF,3DEDV,and use fractional area change by two dimensional imaging(2DFAC),peak emptying velocity(PEV)parameter by Pulsed wave Doppler to evaluate the function of LAA.Analysis of the correlation of the echocardiography techniques in assessment characteristics of left atrial appendage function.Comparing the predictive value of the echocardiography technology for left atrial appendage spontaneous echocontrast(SEC)and thrombus in patients with atrial fibrillation.Result:1?Compared with the controls group,2D-FAC,3D-EF?PEV,peak systolic velocity of lateral wall,septal wall and the apical tip were significantly lower in patients with AF,even more significantly lower in the persistent atrial fibrillation group(P < 0.01).2?Compared to patients without spontaneous echo contrast(SEC),patients with SEC have significantly lower 2D-FAC,3D-EF?PEV,peak systolic velocity of lateral wall,septal wall and the apical tip,LAD?3DEDV enlargement patients with SEC(P < 0.01).Correlation analysis indicated that there was a good correlation between OME and TVI?3DEF?2DFAC?PEV of technical measurements,The correlation coefficient r=0.94?r=0.83? r=0.84? r=0.86 respectively(P < 0.01)?3DEF and 2DFAC?PEV has good correlation,The correlation coefficient r=0.90?r=0.85 respectively(P < 0.01),3DEDV and LAD have good correlation,The correlation coefficient r=0.76(P < 0.01).3?OME?TVI?3DEF?2DFAC?PEV of techniques measurements were founded to be an independent predictor of SEC,The best cutoff value(4.2 cm/s?4.6cm/s?46%?26 %?34cm/s)resepectively.Conclusion:1?The echocardiographic technique can evaluate dysfunction of LAA in patients with atrial fibrillation,omni-directional M-mode echocardiograph can quantitatively assess velocity of left atrial appendage wall in patients with atrial fibrillation,real-time three-dimensional transesophageal echocardiography technology can dynamically observe the contraction of the left atrial appendage movement and volume change,and the relationship adjacent to surrounding structure.2?The combination of technology can more comprehensive evaluation function of the left atrial appendage.LAA function gradually impaired in atrial fibrillationand accelerate to thrombus formation.3?Transesophageal echocardiographic predictors of SEC can to guide the clinical early anticoagulation,prevent thrombosis.Assessment of LAA anatomy and function plays an important role in the diagnostic work-up and management of many clinical conditions.