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Mechanical concordance between left atrium and left atrial appendage in nonvalvular atrial fibrillation: can it be exploited to avoid transesophageal echocardiography prior to electrical cardioversion during Covid-19 pandemic?
Sonaglioni, Andrea; Lombardo, Michele; Nicolosi, Gian Luigi; Gensini, Gian Franco; Ambrosio, Giuseppe.
  • Sonaglioni A; Department of Cardiology, Ospedale San Giuseppe MultiMedica, IRCCS, Via San Vittore 12, 20123, Milan, Italy. sonaglioniandrea@gmail.com.
  • Lombardo M; Department of Cardiology, Ospedale San Giuseppe MultiMedica, IRCCS, Via San Vittore 12, 20123, Milan, Italy.
  • Nicolosi GL; Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy.
  • Gensini GF; Department of Cardiology, Ospedale San Giuseppe MultiMedica, IRCCS, Via San Vittore 12, 20123, Milan, Italy.
  • Ambrosio G; Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy.
Int J Cardiovasc Imaging ; 38(2): 351-362, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1427312
ABSTRACT
Transesophageal echocardiography (TEE) is the gold standard for assessing left atrial appendage (LAA) mechanic and thrombosis (LAAT); however, TEE is a high-risk procedure for viral transmission during coronavirus disease 2019 (COVID-19) pandemic. We investigated whether deformation indices of left atrium (LA) at transthoracic echocardiography (TTE) correlate with those of LAA assessed by TEE in nonvalvular atrial fibrillation (NVAF) patients undergoing electrical cardioversion (ECV). Consecutive patients with NVAF of ≥ 48 h or unknown duration, who underwent TEE and TTE at our Institution before ECV were retrospectively investigated. Standard echo-Doppler and LA and LAA myocardial strain and strain rate parameters were analyzed. A total of 115 NVAF patients (71.3 ± 8.1 yr/o, 59.1% men) were included LAAT was diagnosed in 25 (21.7%) patients. Compared to patients without LAAT, those with LAAT had significantly higher CHA2DS2-VASc Risk score (4.5 ± 1.4 vs. 3.5 ± 1.1, p < 0.001), and lower ejection fraction (46.0 ± 14.8 vs. 57.6 ± 8.6%, p < 0.001). In LAAT patients, global strain of LA (8.7 ± 2.6 vs. 16.3 ± 4.5%, p < 0.001) and LAA (7.0 ± 1.7 vs. 11.7 ± 2.0%, p < 0.001) was significantly reduced compared to non-LAAT patients. A close relationship between left atrial strain reservoir (LASr) and LAA-global strain was demonstrated (r = 0.81). By univariable analysis, CHA2DS2-VASc Risk Score (OR 2.01, 95%CI 1.34-3.00), NT-proBNP (OR 1.36, 95%CI 1.19-1.54), ejection fraction (OR 0.92, 95%CI 0.88-0.96), E/e' ratio (OR 2.07, 95%CI 1.51-2.85), and LASr (OR 0.39, 95%CI 0.25-0.62) were strongly associated with LAAT presence at TEE. By multivariable analysis, only LASr (OR 0.40, 95%CI 0.24-0.70) retained statistical significance. ROC curve analysis revealed that an LASr cut-off value ≤ 9.3% had 98.9% sensibility and 100% specificity to identify LAAT by TEE (AUC = 0.98). In patients with NVAF of ≥ 48 h or unknown duration, scheduled to undergo ECV, LA deformation assessment by TTE might substitute invasive measurement of LAA function by TEE, simplifying diagnostic approach and possibly contributing to reduce COVID-19 infection diffusion.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Atrial Fibrillation / Atrial Appendage / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male Language: English Journal: Int J Cardiovasc Imaging Journal subject: Diagnostic Imaging Year: 2022 Document Type: Article Affiliation country: S10554-021-02414-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Atrial Fibrillation / Atrial Appendage / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male Language: English Journal: Int J Cardiovasc Imaging Journal subject: Diagnostic Imaging Year: 2022 Document Type: Article Affiliation country: S10554-021-02414-w