The role of Flexi Slice imaging by real time 3D transesophageal echocardiography in measurement of left atrial appendage in patients with atrial fibrillation

Abstract

Objective To measure left atrial appendage (LAA) in patients with atrial fibrillation using Flexi Slice imaging by real time 3D transesophageal echocardiography(TEE), and compare with common multiplane TEE. Methods Forty-six patients with atrial fibrillation were performed 2D and real time 3D TEE. Zero degree, 45°, 90° and 135° plane were acquired by 2D TEE and Flexi Slice remolding. Maximum and minimum values of ostium of left atrial appendage were acquired in the short axis view of LAA by Flexi Slice remolding. Results Compared with 2D TEE, values acquire by Flexi Slice in measurement of LAA ostium showed no significant difference(P>0.05). The depth measurement by Flexi Slicein 45° and 90° plane showed significant difference with 2D TEE(P-values were successively 0.045, 0.002), and in 0 and 135° plane showed no difference. All values measured by 2D TEE and Flexi Slices showed significant correlation. Bland-Altman plot showed that 94.29% of plots were among limits of agreement, which was (–2.5 mm, 2.9 mm). The maximum values of LAA ostium values ranged from 30° to 160°, among which 87%(40/46 cases) distributed between 90° and 150°, and minimum values ranged from 0° to 160°, among which 85%(39/46 cases) distributed between 0° and 60°. Conclusions Measurement of LAA can be well achieved by Flexi Slice imaging, which showed significant advantage compared with 2D TEE. Key words: Echocardiography, real-time three-dimensional; Echocardiography, transesophageal; Atrial fibrillation; Atrial appendage