Abstract
Introduction: Cardioembolic events are accompanied by left atrial appendage (LAA) in patients suffering from atrial fibrillation (AF); therefore, the LAA closure is implemented as a preventive strategy. The detection of LAA morphologies and function is a paramount step before establishing the LAA closure. Herein, we sought to determine the morphologic features of the LAA in an Iranian population using echocardiographic evaluation. Methods: Seventy-two near-normal heart patients were investigated by conducting a cross-sectional study. All patients were examined using the 2-dimensional and 3-dimensional transesophageal echocardiography (2D- and 3D-TEE) method. The anatomical features and functions of LAA were examined. All images were stored and analyzed offline. Results: The patients’ mean age was 39 ± 15.5 year and 33 (45.8%) were female. The most frequent shape of LAA was wind sock . More LAA lobes was observed in patients with AF compared to those with NSR. In comparison with AF group, the NSR had higher LAA flow velocity (P < 0.01). The paroxysmal AF had greater LAA flow velocity and LAA ejection fraction in comparison with the chronic AF (39 ± 19 vs. 75 ± 22, P < 0.01; and 49±4 vs. 72±14, P < 0.003; respectively). The paroxysmal AF had smaller systolic LAA orifice area in comparison with the chronic AF (P < 0.02). Conclusion: The morphologic features of LAA in Iranian population were within the range of other studies and LAA length and orifice diameters in 2D- and 3D-TEE were consistent. In addition, AF influenced the morphologies and functions of LAA compared to sinus rhythm.
Highlights
Cardioembolic events are accompanied by left atrial appendage (LAA) in patients suffering from atrial fibrillation (AF); the LAA closure is implemented as a preventive strategy
All data are presented as number (%) or mean ± SD AF, atrial fibrillation; BSA, body surface area; TTE, trans thoracic echocardiography; LAA, left atrial appendage
When comparing chronic AF and paroxysmal AF, the LAA flow velocity and the LAA ejection fraction were lower in chronic AF compared with paroxysmal AF (39 ± 19 versus 75 ± 22, P < 0.01; and 49 ± 4 versus 72 ± 14, P < 0.003; respectively)
Summary
Cardioembolic events are accompanied by left atrial appendage (LAA) in patients suffering from atrial fibrillation (AF); the LAA closure is implemented as a preventive strategy. Conclusion: The morphologic features of LAA in Iranian population were within the range of other studies and LAA length and orifice diameters in 2D- and 3D-TEE were consistent. One must be aware of the complexity and the variability of shape, size, and number of lobes to avoid misinterpretation and the exact evaluation of LAA closure device.[4,5,6,7] Given the temporary experiences with the implementation of LAA closure devices in Iran, we sought to determine the morphologic features of the LAA in Iranian population using echocardiographic evaluation, 2-dimensional transthoracic and transesophageal echocardiography (2D-TTE and 2D-TEE) as well as 3-dimensional TEE (3D-TEE) techniques, to compare it with the morphologies of other populations and provide an invaluable tool for proper closure device implementation
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