Abstract
BackgroundThe presence of impaired left atrial appendage (LAA) function identifies patients who are prone to thrombus formation in the LAA and therefore being at high risk for subsequent cardioembolic stroke. LAA function is typically assessed by measurements of LAA emptying velocities using transesophageal echocardiography (TEE) in clinical routine. This study aimed at evaluating the feasibility of assessing LAA emptying by velocity encoded (VENC) cardiovascular magnetic resonance (CMR).MethodsThis study included 30 patients with sinus rhythm (n = 18) or atrial fibrillation (n = 12). VENC-CMR velocity measurements were performed perpendicular to the orifice of the LAA. Peak velocities were measured of passive diastolic LAA emptying (e-wave) in all patients. Peak velocities of active, late-diastolic LAA emptying (a-wave) were assessed in patients with sinus rhythm. Correlation and agreement was analyzed between VENC-CMR and TEE measurements of e- and a-wave peak velocities.ResultsA significant correlation and good agreement was found between VENC-CMR and TEE measurements of maximal e-wave velocities (r = 0.61, P < 0.001; mean difference 0 ± 10 cm/s). The a-wave was detectable by VENC-CMR in all patients with sinus rhythm. Correlation was also significant for measurements of peak a-wave velocities between VENC-CMR and TEE (r = 0.71, P < 0.001). There was no significant correlation of LAA emptying velocities with clinical characteristics and only a modest negative correlation of passive LAA emptying with LA function.ConclusionsThe assessment of active and passive LAA emptying by VENC-CMR is feasible. Further evaluation is required of potential future clinical applications such as risk stratification for cardioembolic stroke.
Highlights
The presence of impaired left atrial appendage (LAA) function identifies patients who are prone to thrombus formation in the LAA and being at high risk for subsequent cardioembolic stroke
Correlation was significant for measurements of peak a-wave velocities between velocity encoded (VENC)-cardiovascular magnetic resonance (CMR) and transesophageal echocardiography (TEE) (r = 0.71, P < 0.001, Figure 4B)
There was no significant correlation of LAA emptying velocities with clinical characteristics and only a modest negative correlation of passive LAA emptying with LA function
Summary
The presence of impaired left atrial appendage (LAA) function identifies patients who are prone to thrombus formation in the LAA and being at high risk for subsequent cardioembolic stroke. LAA function is typically assessed by measurements of LAA emptying velocities using transesophageal echocardiography (TEE) in clinical routine. This study aimed at evaluating the feasibility of assessing LAA emptying by velocity encoded (VENC) cardiovascular magnetic resonance (CMR). The left atrial appendage (LAA) is the major source of thrombotic material in patients with cardioembolic stroke [1]. Velocity-encoded (VENC) CMR serves as the reference method for the quantification of intracardiac flow, indicating a potential use for measurements of LAA flow as a component of a comprehensive CMR protocol in patients at risk for stroke [14]. This study compared measurements of LAA emptying velocities between VENC-CMR and TEE
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