Abstract
Purpose The left atrial appendage (LAA) is responsible for thrombus formation in patients with atrial fibrillation. The evaluation of both LAA function and morphology is crucial for the patient characterization and the preprocedural planning of LAA closure intervention. Despite the availability of 3D imaging modalities, the current standard image analysis is based on manual delineation of the LAA contours on 2D views. Methods In this study, a comprehensive approach based on a full 3D analysis of the tomographic dataset by surface extraction and processing (3D-S) is presented. The proposed method allows extracting functional and morphologic information in the entire cardiac cycle by minimalizing manual user interaction. The proposed methodology has been validated on ten computer tomography datasets. Results The proposed 3D-S method was feasible in all cases. Reproducibility was improved with respect to the reference 2D manual procedure (2D-S) (coefficient of variation 2.9 vs. 4.1% for diastolic ostium area; 3.8 vs. 6.1% for systolic ostium area; 2.4 vs. 5.3% for diastolic LAA volume; 2.7 vs. 5.9% for systolic LAA volume; and 7.7 vs. 17.1% for LAA ejection fraction). No significant differences were found between 2D-S and 3D-S measurements. Conclusions In this study, we introduced a fully 3D approach for LAA characterization, allowing the simultaneous assessment of LAA function and geometry. The proposed approach could be used to improve the patient selection and the best sizing of the device for LAA closure and to allow a patient-specific 3D printing.
Highlights
Giorgia Vivoli,1 Emanuele Gasparotti,1 Marco Rezzaghi,2 Elisa Cerone,2 Massimiliano Mariani,2 Luigi Landini,1,3 Sergio Berti,2 Vincenzo Positano,1 and Simona Celi 1
Purpose. e left atrial appendage (LAA) is responsible for thrombus formation in patients with atrial fibrillation. e evaluation of both LAA function and morphology is crucial for the patient characterization and the preprocedural planning of LAA closure intervention
Current imaging protocols for assessment of LAA anatomy and functionality involve the use of multiple detectors computed tomography (MDCT), cardiac magnetic resonance (CMR), and transoesophageal (TEE) or intracardiac (ICE) echocardiography [1, 6, 7]. e use of volumetric techniques, such as MDCT, CMR, and 3D Ultrasound, allows obtaining additional qualitative and quantitative information not otherwise available [7]
Summary
E evaluation of both LAA function and morphology is crucial for the patient characterization and the preprocedural planning of LAA closure intervention. E proposed method allows extracting functional and morphologic information in the entire cardiac cycle by minimalizing manual user interaction. E proposed approach could be used to improve the patient selection and the best sizing of the device for LAA closure and to allow a patient-specific 3D printing. Accurate evaluation of the LAA morphology could be useful in the preprocedural planning, allowing the selection of the most appropriate device size [4, 5]. Current imaging protocols for assessment of LAA anatomy and functionality involve the use of multiple detectors computed tomography (MDCT), cardiac magnetic resonance (CMR), and transoesophageal (TEE) or intracardiac (ICE) echocardiography [1, 6, 7]. Due to the complex anatomy of LAA, the standard procedure previously described could be affected by high inter- and intraobserver variability and could require high processing time
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