Evaluation of left atrial appendage structure and function in patients with atrial fibrillation by real-time three-dimensional transesophageal echocardiography and speckle tracking imaging / 中华超声影像学杂志

ABSTRACT

Objective:To evaluate the left atrial appendage (LAA) structure and function in patients with atrial fibrillation (AF) by real-time three-dimensional transesophageal echocardiography (RT-3DTEE) and speckle tracking imaging (STI).Methods:One-hundred and one patients examined by RT-3DTEE in the First Central Hospital of Baoding from January 2018 to August 2020 were selected and divided into non-atrial fibrillation group (non-AF group) and atrial fibrillation group (AF group), and further divided the AF group into three subgroups non-spontaneous echo contrast subgroup (non-SEC subgroup), spontaneous echo contrast subgroup (SEC subgroup) and thrombosis subgroup (TH subgroup). The structural and functional parameters of the LAA were compared among all the groups. Logistic regression analysis and ROC curve analysis were used to screen the risk factors of thrombosis.Results:①Compared with the non-AF group, end-diastolic volume of LAA (LAA-EDV) and end-systolic volume of LAA (LAA-ESV) were significantly increased in AF group, emptying velocity of LAA (LAA-EV), filling velocity of LAA (LAA-FV), emptying fraction of LAA (LAA-EF), strain of LAA (LAA-S), left ventricular systolic velocity of pulmonary vein (VS) and left ventricular diastolic velocity of pulmonary vein (VD) were significantly decreased in AF group (all P<0.05). Comparison between subgroups in AF group, long diameter of LAA opening (LAA-D1) and short diameter of LAA opening (LAA-D2) in TH group were significantly larger than other groups, open areas of LAA (LAA-OA) in SEC group and TH group were significantly larger than non-SEC, and left ventricular systolic early velocity of pulmonary vein (VR), VS and VD were significantly smaller than non-SEC( P<0.05). The differences of LAA-EV, LAA-FV, LAA-EF and LAA-S among the subgroups were statistically significant (all P<0.05). ②Logistic regression analysis found that LAA-EV, LAA-FV, LAA-EF and LAA-S were independent factors of LAA thrombosis in patients with AF ( P<0.05). ③ROC curve analysis found that the cut-off values of LAA-EV, LAA-FV, LAA-EF and LAA-S for predicting LAA thrombosis in patients with AF were 30.95 cm/s, 29.60 cm/s, 30.84% and 10.95, respectively. Conclusions:By combining RT-3DTEE with STI to analyze the structure and function of LAA with multiple parameters, and observe whether the LAA has SEC and thrombosis, it can more effective and accurate information for AF progressim and guide clinicians to formulate the further treatment plan.